Pub Date : 2025-08-14DOI: 10.1016/s2468-2667(25)00200-2
Aug 9th marked the International Day of the World's Indigenous Peoples—a moment to reflect on the profound inequalities affecting Indigenous Peoples worldwide. Representing 476 million people across more than 90 countries, Indigenous Peoples today are arguably among the most disadvantaged and vulnerable groups of people. With worse health outcomes than non-Indigenous populations and a substantially lower life expectancy, Indigenous Peoples suffer considerable health inequalities—shaped by historical injustices, persistent structural, economic, and cultural barriers, and inequitable health systems. A series of papers published this month in The Lancet Public Health and The Lancet Regional Health–Western Pacific shed light on cancer inequalities affecting Indigenous Peoples and offer valuable insights for policy makers.
{"title":"Tackling health inequalities in Indigenous Peoples","authors":"","doi":"10.1016/s2468-2667(25)00200-2","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00200-2","url":null,"abstract":"Aug 9th marked the International Day of the World's Indigenous Peoples—a moment to reflect on the profound inequalities affecting Indigenous Peoples worldwide. Representing 476 million people across more than 90 countries, Indigenous Peoples today are arguably among the most disadvantaged and vulnerable groups of people. With worse health outcomes than non-Indigenous populations and a substantially lower life expectancy, Indigenous Peoples suffer considerable health inequalities—shaped by historical injustices, persistent structural, economic, and cultural barriers, and inequitable health systems. A series of papers published this month in <em>The Lancet Public Health</em> and <em>The Lancet Regional Health–Western Pacific</em> shed light on cancer inequalities affecting Indigenous Peoples and offer valuable insights for policy makers.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"70 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144851307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-08DOI: 10.1016/s2468-2667(25)00172-0
Aime Powell, Lorraine Anderson, Julia M L Brotherton, Tamara Butler, James P Codde, Paul A Cohen, Catherine Engelke, David Hawkes, James Killen, Yee Leung, Marion Saville, Megan A Smith, Katrina Spilsbury, Nerida Steel, Kay Walley, Lisa J Whop, Jared Watts
Background
Aboriginal and Torres Strait Islander women can face substantial cancer screening barriers in remote areas. To support WHO cervical cancer elimination targets, we evaluated a novel screening approach integrating self-collection, point-of-care human papillomavirus (HPV) testing, and same-day specialist assessment for Aboriginal and Torres Strait Islander women in remote Western Australia.
Methods
We developed a screening approach using point-of-care HPV testing on self-collected samples with same-day results and immediate specialist assessment. This implementation study was delivered to six remote Kimberley Aboriginal communities and assessed clinical outcomes and participant satisfaction. The approach was implemented as part of routine outreach gynaecology care between Sept 1 and Dec 31, 2022, with follow-up for cervical test results continuing up to March 31, 2023. Women aged 25–74 years were eligible for this study if they identified as an Aboriginal and/or Torres Strait Islander, were asymptomatic, were due or overdue for cervical screening (or had not had a previous HPV screening test), and were residing in a remote community. The primary objective of this study was to assess whether a point-of-care testing and same-day follow-up approach increased participation in cervical screening among under-screened and never-screened Aboriginal and Torres Strait Islander women in remote Western Australia.
Findings
Of the 844 women identified as eligible, 303 (36%) were directly invited to participate. Within 4 months, 108 women participated in the intervention, a 36% response rate. Among participants, 22 (21%) of 108 tested positive for oncogenic HPV, with 21 (95%) of these completing the same-day colposcopic assessment. No high-grade cervical abnormalities were detected. Participants reported high satisfaction with self-collection rapid results and same-day specialist access, with 107 (99%) indicating a willingness to recommend the approach to others.
Interpretation
We showed the feasibility of integrating portable, same-day cervical screening and follow-up care into remote health-care settings, achieved through successful community engagement and advocacy. These findings offer valuable insights for policy makers and opportunities to increase women's participation in screening programmes, particularly in geographically remote areas.
Funding
Department of Health's Indigenous Australians' Health Programme Emerging Priorities Grant, Australian Gynaecological Cancer Foundation's Cindy Sullivan Fellowship, Mary Jane Foundation, and National Health and Medical Research Council.
{"title":"Cervical screening approach of self-collection, point-of-care HPV testing, and same-day colposcopy among Aboriginal and Torres Strait Islander women in remote Western Australia (the PREVENT Project): an implementation study","authors":"Aime Powell, Lorraine Anderson, Julia M L Brotherton, Tamara Butler, James P Codde, Paul A Cohen, Catherine Engelke, David Hawkes, James Killen, Yee Leung, Marion Saville, Megan A Smith, Katrina Spilsbury, Nerida Steel, Kay Walley, Lisa J Whop, Jared Watts","doi":"10.1016/s2468-2667(25)00172-0","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00172-0","url":null,"abstract":"<h3>Background</h3>Aboriginal and Torres Strait Islander women can face substantial cancer screening barriers in remote areas. To support WHO cervical cancer elimination targets, we evaluated a novel screening approach integrating self-collection, point-of-care human papillomavirus (HPV) testing, and same-day specialist assessment for Aboriginal and Torres Strait Islander women in remote Western Australia.<h3>Methods</h3>We developed a screening approach using point-of-care HPV testing on self-collected samples with same-day results and immediate specialist assessment. This implementation study was delivered to six remote Kimberley Aboriginal communities and assessed clinical outcomes and participant satisfaction. The approach was implemented as part of routine outreach gynaecology care between Sept 1 and Dec 31, 2022, with follow-up for cervical test results continuing up to March 31, 2023. Women aged 25–74 years were eligible for this study if they identified as an Aboriginal and/or Torres Strait Islander, were asymptomatic, were due or overdue for cervical screening (or had not had a previous HPV screening test), and were residing in a remote community. The primary objective of this study was to assess whether a point-of-care testing and same-day follow-up approach increased participation in cervical screening among under-screened and never-screened Aboriginal and Torres Strait Islander women in remote Western Australia.<h3>Findings</h3>Of the 844 women identified as eligible, 303 (36%) were directly invited to participate. Within 4 months, 108 women participated in the intervention, a 36% response rate. Among participants, 22 (21%) of 108 tested positive for oncogenic HPV, with 21 (95%) of these completing the same-day colposcopic assessment. No high-grade cervical abnormalities were detected. Participants reported high satisfaction with self-collection rapid results and same-day specialist access, with 107 (99%) indicating a willingness to recommend the approach to others.<h3>Interpretation</h3>We showed the feasibility of integrating portable, same-day cervical screening and follow-up care into remote health-care settings, achieved through successful community engagement and advocacy. These findings offer valuable insights for policy makers and opportunities to increase women's participation in screening programmes, particularly in geographically remote areas.<h3>Funding</h3>Department of Health's Indigenous Australians' Health Programme Emerging Priorities Grant, Australian Gynaecological Cancer Foundation's Cindy Sullivan Fellowship, Mary Jane Foundation, and National Health and Medical Research Council.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"33 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144802806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-28DOI: 10.1016/s2468-2667(25)00176-8
No Abstract
没有抽象的
{"title":"Correction to Lancet Public Health 2025; 10: e588–98","authors":"","doi":"10.1016/s2468-2667(25)00176-8","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00176-8","url":null,"abstract":"No Abstract","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"5 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-28DOI: 10.1016/s2468-2667(25)00148-3
Michiyo Iwami, Oumnia Bouaddi, Mohammad S Razai, Rania Mansour, Beatriz Morais, Nafeesa Mat Ali, Alison F Crawshaw, Sainabou Bojang, Farah Seedat, Anna Deal, Sophie Webb, Jessica Carter, Nathaniel Aspray, Nuria Sanchez Clemente, Juan Arroyo-Laguna, Sanjeev Krishna, Yolanda Augustin, Henry M Staines, Sally Hargreaves
<h3>Background</h3>WHO's Cervical Cancer Elimination Initiative has set a target for 90% of girls to be fully vaccinated against human papillomavirus (HPV) by the age of 15 years by 2030, to substantially reduce deaths from cervical and other HPV-related cancers. However, progress has been slow, with only 27% global vaccine coverage in 2023. Migrants are an under-immunised group globally for many vaccine-preventable diseases, with data showing that they experience a high burden of HPV infection and widespread HPV under-immunisation. We aimed to identify drivers of HPV vaccine uptake in migrants, as well as assess uptake and explore recommended approaches, strategies, and best practices to promote uptake in migrant communities.<h3>Methods</h3>In this systematic review and meta-analysis, we searched seven databases and several grey literature sources for information published in any language between Jan 1, 2006, and Dec 4, 2024, on the drivers of HPV vaccine uptake among migrants globally. Defining migrants as foreign-born nationals, we included qualitative and quantitative cross-sectional studies, cohort studies, and randomised controlled trials focused on first-generation and second-generation migrants and excluded studies of internal migrants. Outcomes were frequency and percentage of HPV vaccine uptake; factors positively or negatively influencing uptake; and recommended approaches, strategies, and best practices to promote uptake as reported by study authors or participants. We conducted a hybrid thematic analysis using the WHO Behavioural and Social Drivers of Vaccination model to map drivers of uptake, and a random-effects meta-analysis to calculate pooled estimates of uptake. Risk of bias was assessed using Joanna Briggs Institute checklists. This study is registered with PROSPERO, CRD42022347513.<h3>Findings</h3>Of 3562 records returned by the search, 117 studies were included in the analysis, involving 5 638 838 participants across 16 countries and one territory, of whom 933 189 were first-generation and second-generation migrants. The pooled estimates of HPV vaccine uptake were 23·0% (95% CI 10·0–44·0; <em>I</em><sup>2</sup>=99·3%; n=7614) among female migrants, 21·0% (5·0–58·0; <em>I</em><sup>2</sup>=99·3%; n=2764) among male migrants, and 17·0% (8·0–33·0; <em>I</em><sup>2</sup>=98·0%; n=3583) among male and female migrants combined. 79 (68%) studies were considered at low risk of bias, 32 (27%) were considered at moderate risk, and six (5%) were considered at high risk. Factors negatively influencing vaccine uptake included concerns about vaccine safety, cultural beliefs, uncertainty and low levels of knowledge about HPV vaccines or infection, exposure to negative information, and lack of recommendations from health-care providers. Practical barriers to uptake included little information on services, language barriers, logistical challenges, and the high cost of the vaccine. Enablers mainly included positive perceptions and trust in th
{"title":"Drivers of human papillomavirus vaccine uptake in migrant populations and interventions to improve coverage: a systematic review and meta-analysis","authors":"Michiyo Iwami, Oumnia Bouaddi, Mohammad S Razai, Rania Mansour, Beatriz Morais, Nafeesa Mat Ali, Alison F Crawshaw, Sainabou Bojang, Farah Seedat, Anna Deal, Sophie Webb, Jessica Carter, Nathaniel Aspray, Nuria Sanchez Clemente, Juan Arroyo-Laguna, Sanjeev Krishna, Yolanda Augustin, Henry M Staines, Sally Hargreaves","doi":"10.1016/s2468-2667(25)00148-3","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00148-3","url":null,"abstract":"<h3>Background</h3>WHO's Cervical Cancer Elimination Initiative has set a target for 90% of girls to be fully vaccinated against human papillomavirus (HPV) by the age of 15 years by 2030, to substantially reduce deaths from cervical and other HPV-related cancers. However, progress has been slow, with only 27% global vaccine coverage in 2023. Migrants are an under-immunised group globally for many vaccine-preventable diseases, with data showing that they experience a high burden of HPV infection and widespread HPV under-immunisation. We aimed to identify drivers of HPV vaccine uptake in migrants, as well as assess uptake and explore recommended approaches, strategies, and best practices to promote uptake in migrant communities.<h3>Methods</h3>In this systematic review and meta-analysis, we searched seven databases and several grey literature sources for information published in any language between Jan 1, 2006, and Dec 4, 2024, on the drivers of HPV vaccine uptake among migrants globally. Defining migrants as foreign-born nationals, we included qualitative and quantitative cross-sectional studies, cohort studies, and randomised controlled trials focused on first-generation and second-generation migrants and excluded studies of internal migrants. Outcomes were frequency and percentage of HPV vaccine uptake; factors positively or negatively influencing uptake; and recommended approaches, strategies, and best practices to promote uptake as reported by study authors or participants. We conducted a hybrid thematic analysis using the WHO Behavioural and Social Drivers of Vaccination model to map drivers of uptake, and a random-effects meta-analysis to calculate pooled estimates of uptake. Risk of bias was assessed using Joanna Briggs Institute checklists. This study is registered with PROSPERO, CRD42022347513.<h3>Findings</h3>Of 3562 records returned by the search, 117 studies were included in the analysis, involving 5 638 838 participants across 16 countries and one territory, of whom 933 189 were first-generation and second-generation migrants. The pooled estimates of HPV vaccine uptake were 23·0% (95% CI 10·0–44·0; <em>I</em><sup>2</sup>=99·3%; n=7614) among female migrants, 21·0% (5·0–58·0; <em>I</em><sup>2</sup>=99·3%; n=2764) among male migrants, and 17·0% (8·0–33·0; <em>I</em><sup>2</sup>=98·0%; n=3583) among male and female migrants combined. 79 (68%) studies were considered at low risk of bias, 32 (27%) were considered at moderate risk, and six (5%) were considered at high risk. Factors negatively influencing vaccine uptake included concerns about vaccine safety, cultural beliefs, uncertainty and low levels of knowledge about HPV vaccines or infection, exposure to negative information, and lack of recommendations from health-care providers. Practical barriers to uptake included little information on services, language barriers, logistical challenges, and the high cost of the vaccine. Enablers mainly included positive perceptions and trust in th","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"14 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-28DOI: 10.1016/s2468-2667(25)00139-2
Bernardo Meza-Torres, Gavin Jamie, Rashmi Wimalaratna, Robert Williams, Rachel Byford, Anna Forbes, William Elson, William Hinton, Jose M Ordóñez-Mena, Marinos Pericleous, Michael Feher, Martin Whyte, Mark Joy, Simon de Lusignan
Background
International guidelines recommend the administration of two doses of pre-exposure hepatitis A vaccination for people with chronic liver disease to prevent severe complications. We aimed to describe hepatitis A vaccination coverage and mortality in adults with chronic liver disease in England.
Methods
We did a retrospective cohort study using routinely collected medical record data from the Oxford-Royal College of General Practitioners Research and Surveillance Centre (RSC) primary care sentinel network. We included people aged 18 years or older who were diagnosed with chronic liver disease between Jan 1, 2012, and Dec 31, 2022. The primary outcome of interest was hepatitis A vaccination. Hepatitis A vaccination coverage was calculated using the number of vaccinated people with chronic liver disease as the numerator and the chronic liver disease population in the RSC dataset as the denominator. We compared individual characteristics by vaccination status using descriptive statistics. We used a multistate survival model to estimate the transition probabilities between four states: (1) diagnosis of chronic liver disease; (2) first hepatitis A vaccination; (3) second hepatitis A vaccination; and (4) death.
Findings
664 571 individuals aged 18 years or older with chronic liver disease were identified from the RSC sentinel network population, of whom 625 079 individuals were included in our analysis. Of 625 079 individuals with chronic liver disease, 13 875 (2·2%) had received a first hepatitis A vaccination, 3007 (0·4%) had received a second dose, 732 (5·3%) of 13 875 vaccinated individuals died, and 101 065 (16·5%) of 611 204 individuals without vaccination died during the study period. Adjusting for death as a competing risk, vaccination was more likely among younger age quintiles (hazard ratio 5·46 [95% CI 5·13–5·81]), non-smokers (1·59 [1·54–1·65]), residents of urban areas (1·28 [1·21–1·35]), individuals with higher socioeconomic status (1·06 [1·03–1·10]), and individuals with a diagnosis of metabolic dysfunction-associated steatotic liver disease (MASLD; 1·71 [1·64–1·78]). Individuals with a history of harmful alcohol use (0·36 [0·32–0·39]), type 1 diabetes (0·46 [0·36–0·57]), chronic kidney disease (0·63 [0·57–0·70]), or mental disorders (0·66 [0·64–0·69]) were less likely to be vaccinated. The lowest risk of mortality was in people with chronic liver disease of infectious or autoimmune aetiology and in people with MASLD.
Interpretation
Hepatitis A vaccine uptake among people with chronic liver disease in England is low, with disparities by age, location (urban vs rural), and socioeconomic status. Steps should be taken to reduce the inequalities in vaccine administration.
{"title":"Hepatitis A vaccination coverage in adults with chronic liver disease in primary care in England: a retrospective cohort study","authors":"Bernardo Meza-Torres, Gavin Jamie, Rashmi Wimalaratna, Robert Williams, Rachel Byford, Anna Forbes, William Elson, William Hinton, Jose M Ordóñez-Mena, Marinos Pericleous, Michael Feher, Martin Whyte, Mark Joy, Simon de Lusignan","doi":"10.1016/s2468-2667(25)00139-2","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00139-2","url":null,"abstract":"<h3>Background</h3>International guidelines recommend the administration of two doses of pre-exposure hepatitis A vaccination for people with chronic liver disease to prevent severe complications. We aimed to describe hepatitis A vaccination coverage and mortality in adults with chronic liver disease in England.<h3>Methods</h3>We did a retrospective cohort study using routinely collected medical record data from the Oxford-Royal College of General Practitioners Research and Surveillance Centre (RSC) primary care sentinel network. We included people aged 18 years or older who were diagnosed with chronic liver disease between Jan 1, 2012, and Dec 31, 2022. The primary outcome of interest was hepatitis A vaccination. Hepatitis A vaccination coverage was calculated using the number of vaccinated people with chronic liver disease as the numerator and the chronic liver disease population in the RSC dataset as the denominator. We compared individual characteristics by vaccination status using descriptive statistics. We used a multistate survival model to estimate the transition probabilities between four states: (1) diagnosis of chronic liver disease; (2) first hepatitis A vaccination; (3) second hepatitis A vaccination; and (4) death.<h3>Findings</h3>664 571 individuals aged 18 years or older with chronic liver disease were identified from the RSC sentinel network population, of whom 625 079 individuals were included in our analysis. Of 625 079 individuals with chronic liver disease, 13 875 (2·2%) had received a first hepatitis A vaccination, 3007 (0·4%) had received a second dose, 732 (5·3%) of 13 875 vaccinated individuals died, and 101 065 (16·5%) of 611 204 individuals without vaccination died during the study period. Adjusting for death as a competing risk, vaccination was more likely among younger age quintiles (hazard ratio 5·46 [95% CI 5·13–5·81]), non-smokers (1·59 [1·54–1·65]), residents of urban areas (1·28 [1·21–1·35]), individuals with higher socioeconomic status (1·06 [1·03–1·10]), and individuals with a diagnosis of metabolic dysfunction-associated steatotic liver disease (MASLD; 1·71 [1·64–1·78]). Individuals with a history of harmful alcohol use (0·36 [0·32–0·39]), type 1 diabetes (0·46 [0·36–0·57]), chronic kidney disease (0·63 [0·57–0·70]), or mental disorders (0·66 [0·64–0·69]) were less likely to be vaccinated. The lowest risk of mortality was in people with chronic liver disease of infectious or autoimmune aetiology and in people with MASLD.<h3>Interpretation</h3>Hepatitis A vaccine uptake among people with chronic liver disease in England is low, with disparities by age, location (urban <em>vs</em> rural), and socioeconomic status. Steps should be taken to reduce the inequalities in vaccine administration.<h3>Funding</h3>GlaxoSmithKline's Investigator Sponsored Studies Program.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"131 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-28DOI: 10.1016/s2468-2667(25)00177-x
No Abstract
没有抽象的
{"title":"Correction to Lancet Public Health 2025; 10: e189–202","authors":"","doi":"10.1016/s2468-2667(25)00177-x","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00177-x","url":null,"abstract":"No Abstract","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"93 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-28DOI: 10.1016/s2468-2667(25)00145-8
Lauren A Gardner, Nicola C Newton, Amy-Leigh Rowe, Siobhan O’Dean, Maree Teesson, Leanne Hides, Nyanda McBride, Matthew Sunderland, Becky Freeman, Lyra Egan, Annabelle Hawkins, Rhiannon Ellem, Amra Catakovic, Elise Caradmone, Chloe Alcorn, Kathleen Blackburn, Jazlyn East, Louise Thornton, Lexine Stapinski, Louise Birrell, Emily Stockings
Background
E-cigarette use among adolescents is a global public health concern. The efficacy of scalable prevention approaches is yet to be established. We aimed to evaluate the efficacy of a school-based eHealth intervention (OurFutures Vaping) to prevent e-cigarette use among adolescents.
Methods
A two-arm cluster randomised controlled trial was conducted among year 7 and 8 students (12–14 years) in 40 secondary schools across three Australian states: New South Wales, Western Australia, and Queensland. Schools were randomly assigned (1:1) to OurFutures Vaping (a four-lesson, web-based skills and education programme) or an active control group (usual health education) by a biostatistician using the Blockrand function in R, stratified by state and school gender composition. All year 7 and 8 students who attended participating schools, were fluent in English, and provided consent were eligible to participate. Teachers, students, and researchers were not masked to allocation. The primary outcome was past 12-month e-cigarette use, assessed at the 12-month follow-up. Intention-to-treat analyses were conducted using generalised mixed effects regression, with random effects accounting for participants clustered within schools. The trial was prospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12623000022662).
Findings
Between January and October, 2023, we recruited 49 schools (7653 students). Nine schools withdrew before baseline (three control; six intervention). A total of 40 schools with 5157 eligible students (2329 [46·0%] girls and 2600 [51·3%] boys; mean age 13·30 years [SD 0·60]) completed the baseline survey in the intervention (20 schools, 2449 students) and control (20 schools, 2708 students) groups. Compared with the control group, participants who received the intervention had reduced odds of past 12-month e-cigarette use (odds ratio 0·35 [95% CI 0·18–0·66], p=0·0013) 1 year after receiving the intervention, indicating a 65% reduction in the odds of use among students who received the intervention compared with the control. No adverse events were reported.
Interpretation
The OurFutures Vaping programme offers an efficacious demand-reduction approach to prevent e-cigarette use among adolescents.
Funding
The Medical Research Future Fund and the Australian National Health and Medical Research Council.
青少年使用电子烟是一个全球性的公共卫生问题。可扩展的预防方法的效力尚未确定。我们的目的是评估以学校为基础的电子健康干预（我们的未来电子烟）在防止青少年使用电子烟方面的有效性。方法对澳大利亚新南威尔士州、西澳大利亚州和昆士兰州40所中学的7年级和8年级学生（12-14岁）进行了两组随机对照试验。生物统计学家使用R中的Blockrand函数，按州和学校性别构成分层，将学校随机（1:1）分配到OurFutures Vaping（一个四课的网络技能和教育项目）或积极对照组（通常的健康教育）。所有7年级和8年级的学生在参与的学校，英语流利，并提供同意有资格参加。教师、学生和研究人员没有被掩盖。主要结果是过去12个月的电子烟使用情况，在12个月的随访中进行评估。意向治疗分析使用广义混合效应回归进行，随机效应考虑了聚集在学校内的参与者。该试验已在澳大利亚和新西兰临床试验注册中心（ACTRN12623000022662）前瞻性注册。在2023年1月至10月期间，我们招募了49所学校（7653名学生）。9所学校在基线前退出(3所作为对照；6干预)。共有40所学校，符合条件的学生5157人，其中女生2329人（46.0%），男生2600人（51.3%）；在干预组（20所学校，2449名学生）和对照组（20所学校，2708名学生）中，平均年龄13.30岁[SD 0.60]完成基线调查。与对照组相比，接受干预的参与者在接受干预一年后，过去12个月使用电子烟的几率降低（优势比为0.35 [95% CI 0.18 - 0.66], p= 0.0013），表明接受干预的学生与对照组相比，使用电子烟的几率降低了65%。无不良事件报告。“我们的未来”电子烟项目提供了一种有效的减少需求的方法，以防止青少年使用电子烟。资助医学研究未来基金和澳大利亚国家卫生和医学研究委员会。
{"title":"The OurFutures Vaping eHealth intervention to prevent e-cigarette use among adolescent students in Australia: a cluster randomised controlled trial","authors":"Lauren A Gardner, Nicola C Newton, Amy-Leigh Rowe, Siobhan O’Dean, Maree Teesson, Leanne Hides, Nyanda McBride, Matthew Sunderland, Becky Freeman, Lyra Egan, Annabelle Hawkins, Rhiannon Ellem, Amra Catakovic, Elise Caradmone, Chloe Alcorn, Kathleen Blackburn, Jazlyn East, Louise Thornton, Lexine Stapinski, Louise Birrell, Emily Stockings","doi":"10.1016/s2468-2667(25)00145-8","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00145-8","url":null,"abstract":"<h3>Background</h3>E-cigarette use among adolescents is a global public health concern. The efficacy of scalable prevention approaches is yet to be established. We aimed to evaluate the efficacy of a school-based eHealth intervention (OurFutures Vaping) to prevent e-cigarette use among adolescents.<h3>Methods</h3>A two-arm cluster randomised controlled trial was conducted among year 7 and 8 students (12–14 years) in 40 secondary schools across three Australian states: New South Wales, Western Australia, and Queensland. Schools were randomly assigned (1:1) to OurFutures Vaping (a four-lesson, web-based skills and education programme) or an active control group (usual health education) by a biostatistician using the Blockrand function in R, stratified by state and school gender composition. All year 7 and 8 students who attended participating schools, were fluent in English, and provided consent were eligible to participate. Teachers, students, and researchers were not masked to allocation. The primary outcome was past 12-month e-cigarette use, assessed at the 12-month follow-up. Intention-to-treat analyses were conducted using generalised mixed effects regression, with random effects accounting for participants clustered within schools. The trial was prospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12623000022662).<h3>Findings</h3>Between January and October, 2023, we recruited 49 schools (7653 students). Nine schools withdrew before baseline (three control; six intervention). A total of 40 schools with 5157 eligible students (2329 [46·0%] girls and 2600 [51·3%] boys; mean age 13·30 years [SD 0·60]) completed the baseline survey in the intervention (20 schools, 2449 students) and control (20 schools, 2708 students) groups. Compared with the control group, participants who received the intervention had reduced odds of past 12-month e-cigarette use (odds ratio 0·35 [95% CI 0·18–0·66], p=0·0013) 1 year after receiving the intervention, indicating a 65% reduction in the odds of use among students who received the intervention compared with the control. No adverse events were reported.<h3>Interpretation</h3>The OurFutures Vaping programme offers an efficacious demand-reduction approach to prevent e-cigarette use among adolescents.<h3>Funding</h3>The Medical Research Future Fund and the Australian National Health and Medical Research Council.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"69 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-28DOI: 10.1016/s2468-2667(25)00168-9
Elisa Pineda
High dietary salt intake is a major contributor to elevated blood pressure and cardiovascular disease globally.1 Although the link between excessive sodium intake and health risks is well established, implementing effective policies to reduce population-level salt consumption remains a crucial public health challenge. In the UK and many other countries, much of the salt consumed originates from processed and out-of-home foods, for which regulatory oversight is often weaker than it is for packaged products.2, 3 Addressing sodium content in this sector is a pressing need.4
{"title":"Strengthening salt reduction strategies in the out-of-home food sector: warning labels and beyond","authors":"Elisa Pineda","doi":"10.1016/s2468-2667(25)00168-9","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00168-9","url":null,"abstract":"High dietary salt intake is a major contributor to elevated blood pressure and cardiovascular disease globally.<span><span><sup>1</sup></span></span> Although the link between excessive sodium intake and health risks is well established, implementing effective policies to reduce population-level salt consumption remains a crucial public health challenge. In the UK and many other countries, much of the salt consumed originates from processed and out-of-home foods, for which regulatory oversight is often weaker than it is for packaged products.<span><span>2</span></span>, <span><span>3</span></span> Addressing sodium content in this sector is a pressing need.<span><span><sup>4</sup></span></span>","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"13 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-28DOI: 10.1016/s2468-2667(25)00149-5
Sema Mandal, David Leeman, Mary E Ramsay
Most sporadic cases of hepatitis A diagnosed in England are associated with travel to endemic countries. Occasional outbreaks result from person-to-person transmission following initial importations2 or contaminated food.3, 4 Since hepatitis A incidence in the UK is low, hepatitis A immunisation is only recommended for people at high risk of exposure (including travellers to endemic countries, people who inject drugs, and men who have sex with men) and for those at increased risk of complications, such as people with chronic liver disease,5 in whom infection might lead to acute fulminant hepatitis and potentially death.6
{"title":"Hepatitis A targeted vaccination in England: a system challenge","authors":"Sema Mandal, David Leeman, Mary E Ramsay","doi":"10.1016/s2468-2667(25)00149-5","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00149-5","url":null,"abstract":"Most sporadic cases of hepatitis A diagnosed in England are associated with travel to endemic countries. Occasional outbreaks result from person-to-person transmission following initial importations<span><span><sup>2</sup></span></span> or contaminated food.<span><span>3</span></span>, <span><span>4</span></span> Since hepatitis A incidence in the UK is low, hepatitis A immunisation is only recommended for people at high risk of exposure (including travellers to endemic countries, people who inject drugs, and men who have sex with men) and for those at increased risk of complications, such as people with chronic liver disease,<span><span><sup>5</sup></span></span> in whom infection might lead to acute fulminant hepatitis and potentially death.<span><span><sup>6</sup></span></span>","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"15 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-28DOI: 10.1016/s2468-2667(25)00143-4
Rebecca Evans, Jane Brealey, Natasha Clarke, Jennifer Falbe, Amy Finlay, Andrew Jones, Paula Thorp, Beth Witham, Rozemarijn Witkam, Eric Robinson
Background
High salt intake increases the risk of cardiovascular disease. The salt content of many commonly consumed foods in the out-of-home food sector (eg, restaurants) is excessive, but there are few policy options to address this problem. In this study, we evaluated an emerging policy approach—high salt warning labels on packaged food and resturant menus—for which, to date, there is little supporting evidence from randomised controlled trials.
Methods
These randomised controlled trials (one online study and one trial conducted in a real-world setting) were conducted in the UK. For study 1, an online study, participants (stratified by age, sex, and education to be representative of the UK adult population) were eligible if they were a current UK resident, aged 18 years or older, fluent in English, purchased supermarket sandwiches and savoury snacks, and ate out at or ordered from restaurants at least monthly. Exclusion criteria included being pregnant or breastfeeding or having major dietary restrictions. Participants were randomly assigned (1:1:1:1:1) to one of four different salt warning label conditions or to a control condition (QR code). Participants assigned to each group completed three packaged food scenarios and three restaurant ordering scenarios, all online, followed by questionnaires about the labelling and their food choices. The primary outcome was the perceived message effectiveness of salt warning labels. In study 2, the inclusion criteria were similar, except that participants who ate an out-of-home meal at least once a month were recruited. Exclusion criteria were severe dietary allergies and veganism. As in study 1, participants were stratified by age, sex, and education. Participants were randomly assigned (block randomisation with block size ~50) to receive menus with or without salt warning labels, from which they purchased and consumed lunchtime meals in a real-world restaurant. Participants then completed questionnaires. Primary outcomes were perceived message effectiveness and salt awareness. In both studies, perceived message effectiveness was measured with adapted versions of the University of North Carolina Perceived Message Effectiveness Scale. Participants in both studies were paid and masked to the study aims. Study 2 is registered with ClinicalTrials.gov (NCT06458270) and is complete.
Findings
In study 1, 2549 participants were randomly assigned to one of four salt warning label groups (red triangle, n=512; black triangle, n=512; red octagon, n=509;
背景：高盐摄入量会增加患心血管疾病的风险。在户外食品部门（例如，餐馆）中，许多经常食用的食品的含盐量过高，但解决这一问题的政策选择很少。在这项研究中，我们评估了一种新兴的政策方法——在包装食品和餐馆菜单上贴上高盐警告标签——迄今为止，几乎没有来自随机对照试验的支持证据。这些随机对照试验（一项在线研究和一项在现实环境中进行的试验）在英国进行。研究1是一项在线研究，参与者（按年龄、性别和教育程度分层，代表英国成年人口）符合条件，前提是他们目前是英国居民，年龄在18岁或以上，英语流利，购买超市三明治和美味小吃，至少每月在餐馆吃饭或点餐。排除标准包括怀孕或哺乳或有重大饮食限制。参与者被随机分配（1:1:1:1:1）到四种不同的盐警告标签条件之一或控制条件（QR码）。被分配到每一组的参与者完成了三个包装食品场景和三个餐厅点餐场景，所有这些都是在线的，然后是关于标签和食物选择的问卷调查。主要结果是盐警告标签的感知信息有效性。在研究2中，纳入标准相似，除了每月至少吃一次户外餐的参与者被招募。排除标准是严重的饮食过敏和素食主义。与研究1一样，参与者按年龄、性别和教育程度分层。参与者被随机分配（分组随机，分组大小约为50），收到有或没有盐警告标签的菜单，他们在现实世界的餐馆购买和食用午餐。然后参与者完成问卷调查。主要结果是感知信息有效性和盐意识。在这两项研究中，感知信息有效性是用北卡罗来纳大学感知信息有效性量表的改编版本来测量的。两项研究的参与者都得到了报酬，并对研究目标进行了隐瞒。研究2已在ClinicalTrials.gov （NCT06458270）注册完成。在研究中，1249名参与者被随机分配到四个盐警告标签组(红色三角形，n=512；黑色三角形，n=512；红色八边形，n=509；和黑色八角形（n= 510）或对照组（n=506），数据收集时间为2024年2月20日至2024年4月2日。158名参与者被排除在分析之外，最终的分析样本为2391人（1205名[50%]女性，1181名[49%]男性，5名[1%]不愿透露）。所有盐警告标签在阻止盐摄入方面被认为比对照组更有效，平均感知信息有效性差异为1.23 (95% CI 1.12 - 1.34；p < 0.0001)和1.22 (95% CI 1.11 - 1.33；P < 0.0001)用于菜单场景。在研究2中，465名符合条件的参与者被随机分配到高盐食品旁边有红色三角盐警告标签的菜单（n=240）或餐馆的标准菜单(对照组；n=225)，数据收集于2024年6月5日至2024年9月14日之间。11名参与者的全部数据被排除在分析之外，最终的分析样本为454人（女性246人[54%]，男性203人[45%]，缺失5人[1%]）。标签菜单在感知信息有效性方面被评为比对照菜单更有效，平均差异为1.00 (95% CI 0.79 - 1.18；术;0·0001)。被分配到标签菜单条件下的参与者在点餐时比被分配到标准菜单条件下的参与者更有可能考虑饭菜的含盐量(优势比19.50,95% CI 8.24 - 46.16；术;0·0001)。餐馆菜单上的盐警告标签是一项有希望的政策选择，以阻止户外食品部门的高盐摄入量。需要进一步的实际研究来优化潜在的减少实际盐摄入量的政策。资助国家健康和护理研究所牛津健康生物医学研究中心和欧洲研究委员会。
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