BMC Public Health

Background YouTube highlights packages are a major and growing route to football consumption, particularly among children and young people, but brand exposure within them has not been quantified. We measured unhealthy commodity brand exposure in English Premier League (EPL) and FIFA World Cup (WC) highlights. Methods We coded brand appearances lasting two or more seconds in 10 Sky Sports EPL highlights (final 10 games of the 2025/26 season) and 19 official FIFA 2026 WC highlights, recording commodity category, placement, and match moment, alongside pre-roll YouTube adverts. Data were collected between 4 June and 27 July 2026. Five highlights were double-coded (Cohen's kappa 0.85). Results Overall brand density was similar across competitions (13.1 vs 13.9 references per minute), but composition differed markedly. Unhealthy commodity branding occupied 38.0% of EPL screen time versus 18.7% at the WC, a difference driven almost entirely by gambling (32.6% vs 1.5%). Gambling appeared in every EPL package, mainly on pitchside boards and LED screens (50.4%), with front-of-shirt accounting for 27.1%. WC exposure was more evenly spread across HFSS food (13%), alcohol (4%) and trading/crypto/prediction markets (3.7%), and appeared almost exclusively pitchside. Gambling brands accounted for ten of twelve pre-roll EPL adverts (123 of 153 seconds); no gambling adverts preceded WC highlights. Conclusions Gambling dominates unhealthy commodity exposure in EPL highlights, both in-video and in pre-roll advertising. Because most appearances occur away from the front of shirt, the voluntary front-of-shirt sponsorship withdrawal will leave the majority of this exposure intact. The WC comparison shows that tighter central control of the advertising environment produces lower and more diffuse exposure, and that governments and governing bodies with such control could restrict unhealthy categories altogether.

This study aimed to examine factors associated with behavioural difficulties among school-aged children (aged 7 -11) using self-reported survey data linked with education data from a national cohort study of over 50,000 children (the HAPPEN national cohort) in Wales, UK between 2014 and 2024. Data include self-reported health and wellbeing linked to additional learning needs (ALN) status collected from education data in Wales. Measures included self-reported time spent on screens, frequency of sugary snack, fizzy drink and takeaway food consumption, physical activity levels, sleep duration and behavioural difficulties (as measured by the Me and My Feelings Survey). Associations were analysed using descriptive trends, K-means cluster analysis and multivariate regression modelling. Findings showed a rise in behavioural difficulties during and post Covid, which are now improving in Wales. Cluster analysis identified that children with poor sleep and high takeaway and fizzy drinks dietary habits had the highest levels of behavioural difficulties, a trend that remained significant after adjusting for all potential confounders. Physical activity associated with reduced behavioural difficulty, with 5-6 days of activity associated with the lowest difficulty scores. These findings suggest that behavioural difficulty is driven by health behaviours especially sleep and diet rather than single factors. The results highlight the need for integrated public health approaches that address dietary quality and sleep hygiene rather than focusing on single factors in isolation. Promoting more balanced daily activity patterns, promoting good sleep routines, improving food environments and building movement into the school day may have important benefits for childrens behaviour.

Despite having received increasing attention over the past decade, little is known about the factors that can increase or decrease symptoms of problematic gaming (PG) in individuals with different video gaming (VG) habits (e.g., occasional use gamers vs heavy use gamers). Here, we apply a specification curve analysis to assess the impact of changes in two key risk factors, gaming consumption and impulsivity, as well as one protective factor, family environment, on changes in PG symptoms over 2 years in a large sample of Singaporean adolescents between 2007 and 2009. By considering individual differences in baseline video game habits, we show that changes in VG consumption influenced changes in PG in adolescents who reported not usually playing games at study inception (i.e., occasional use gamers), whereas changes in impulsivity influenced PG symptoms in those who reported being the most heavy use gamers at study inception. These findings highlight the importance of designing preventive measures that differ as a function of current video game habits. Possible measures may involve introducing gaming progressively (e.g., through setting age-appropriate limits or structured scaffolding with parents) to improve symptoms of tolerance and preoccupation in occasional use gamers while promoting self-control early in development before gaming can become a problematic habit.

Background Type 2 diabetes (T2D) disproportionately affects socioeconomically disadvantaged communities. Evidence on the feasibility and effectiveness of prevention and self-management strategies in complex contexts remains limited. Objective To report effectiveness outcomes from a feasibility trial comparing the SMART2D intervention with routine primary care for T2D prevention and control in two neighbourhoods in Stockholm. Methods A cluster-randomized feasibility trial with hybrid type 1 design was conducted in two neighbourhoods among individuals at high risk of T2D (n=84) or with diagnosed T2D (n=58), allocated to an integrated care arm (n=70; personal coaching and community outreach) or facility-only arm (n=72; routine care). Primary outcomes were glycaemic control (participants with T2D) and HbA1c reduction (participants at high risk of T2D); secondary outcomes were retention to care and diabetes incidence (participants at high risk of T2D). Analysis used intention-to-treat principles: difference-in-differences with mixed-effects models for HbA1c reduction, and modified Poisson regression (IRR, 95% CI) for other outcomes. Results Among participants with T2D, glycaemic control (adjusted IRR=0.92, 95% CI=0.89-0.95) and retention to care (adjusted IRR=0.91, 95% CI=0.91-0.92) were significantly lower in the integrated care arm. Among participants at high risk of T2D, integrated care showed a marginally significant, greater HbA1c reduction (adjusted 2.02, 0.20-3.84) and significantly higher retention to care (adjusted IRR=1.22, 1.15-1.29), plus fewer incident diabetes cases (0 vs. 2 in facility-only). Conclusions Integrated care (personal coaching, community outreach) benefited HbA1c reduction and retention among participants at high risk of T2D, whereas facility-only care improved glycaemic control and retention among participants with T2D.

Background: The retail food environment is a widely used exposure in behavioural-nutrition and obesity research, on the premise that nearby food retailers shape diet and obesity risk. Over the past quarter-century, grocery stores have declined across rural and small-town America while limited-assortment discount ("dollar") stores have proliferated. Standard food-environment indices classify retailers as healthy or less-healthy but typically exclude dollar stores, now the fastest-growing food-retail format. As a result, a single classification decision may alter how the food environment is measured and the conclusions drawn from it. We develop a dollar-aware index, quantify how counting dollar stores changes the measured exposure, and derive a longitudinal trajectory typology. Methods: Using establishment-level data from Data Axle for all 878 Mississippi census tracts (1997-2024), we classified food retailers into five mutually exclusive categories using a previously validated approach and calculated the modified Retail Food Environment Index (mRFEI) in both its standard and dollar-aware forms, with the latter counting dollar stores as less-healthy outlets. We fitted Nagin-style group-based trajectory models to the tract-level dollar-aware index, related class membership to the Social Vulnerability Index (SVI) and urbanicity with multinomial regression, and characterised spatial clustering (Getis-Ord Gi*, join-counts) and grocery access. Results: Grocery stores fell from 1,616 to 716 while dollar stores rose from 315 to 1,005, intersecting in 2018. Counting dollar stores lowered the index by a margin that widened over time, and a growing number of tracts had only dollar-store retail, undefined under the standard index. Six trajectory classes emerged: stable adequate (5.6% of tracts), steady decline (13.1%), early collapse (11.1%), late collapse (6.7%), persistently constrained (34.1%) and chronic desert (29.3%); only the stable-adequate class (5.2% of children) stayed adequate throughout. Constrained and steady-decline membership rose steeply with vulnerability (RRR 11.7 and 9.9); chronic desert was urban (RRR 5.2, a food-swamp pattern); collapse classes had no cross-sectional social signature. Conclusions: In the US state with the highest adult obesity prevalence, a single retailer-classification decision substantially changes the measured food environment. The dollar-aware index and trajectory typology offer a transferable, time-varying exposure for behavioural-nutrition and obesity research and establish a foundation for future childhood-obesity studies.

Preventive health is a crucial health systems component for managing disease burden and achieving health promotion policy goals. However, effective prevention relies on the modification of relevant risks, often requiring systemic health behaviour change. Australia's National Preventive Health Strategy (NPHS) prioritises seven focus areas: tobacco and nicotine, healthy diet, physical activity, cancer screening, immunisation, alcohol and other drugs, and mental health. The readiness of community members in Australia to address health behaviours relating to these areas has not been fully examined. In response, six focus groups were conducted with 27 adults from the Australian general population to explore their perspectives and experiences of preventive health information and behaviours relating to the seven NPHS focus areas. Themes and sub-themes were identified using an applied descriptive framework. Participants described motivations, barriers and experiences surrounding preventive health through the themes of 'Making informed health choices', 'Facilitating behaviour change and the role of support systems' and 'Spreading the preventive health word'. Sub-themes detailed processes of prioritisation, risk-benefit assessment, critical appraisal, sociocultural influence and support-seeking to understand and personalise preventive health information, implement behavioural change, and share information with others. The focus areas participants engaged with most strongly were healthy eating and physical activity, while cancer screening was discussed less often. These findings indicate high preventive health engagement in the Australian community, alongside challenges navigating and adapting relevant information to personal needs. These insights can support policymakers, healthcare providers and others to effectively enact the NPHS through more targeted preventive health information and care delivery.

Background: Over half of UK adults eat food prepared out-of-home (OOH) weekly and the poor nutritional profile of OOH food contributes to ill health. Nutri-Score is a form of interpretative labelling which assigns food products a value of A (healthiest) to E (least healthy) based on nutritional quality, and inclusion on menus could be a public health policy option to reduce obesity. This is the first real-world Randomised Control Trial to test the effectiveness of Nutri-Score alongside calorie labelling on food menus in UK OOH settings. Methods: Adult participants (N=672), majority White (80%) female (63%), with a mean age of 47(SD18) years, were recruited from the local community to visit OOH food businesses to order, consume, and pay for meals. Data collection days were randomised to be control (calorie labelling) or Nutri-Score (calorie labelling with Nutri-Score). Linear mixed models assessed impacts of labelling condition on perceived effectiveness of menu labelling and nutritional quality of food orders. Findings: Scores for perceived effectiveness of labelling were significantly greater in the Nutri-Score condition compared to control (B = 0.21, p=0.010; 95% CI 0.05, 0.37) and food orders were significantly better nutritional quality, indicated by lower Nutrient Profiling Model scores in the Nutri-Score vs. control condition (B = -0.89, p=0.003; 95% CI -1.48, -0.31). Interpretation: Compared to providing calorie labelling alone, inclusion of Nutri-Score could be an effective policy approach to improve nutritional quality of diet and reduce diet-related disease.

Atopic dermatitis (AD) is a chronic inflammatory skin condition with a multidimensional burden. This study aimed to estimate the socioeconomic burden of the pediatric and adult population with AD in Argentina and explore the health system's response to their needs. We employed a mixed-methods approach, combining a cross-sectional cost-of-illness analysis with a qualitative component to comprehensively assess the social and economic impact of atopic dermatitis in Argentina. We collected data from a survey, focus group and in-depth interviews conducted in Argentina between May 2023 and September 2023. We recruited adult patients and caregivers of children with AD below 18 years of age. We used multivariable ordinal regression to assess associations between sociodemographic and clinical characteristics and burden associated with AD. 1471 subjects participated in the pediatric analysis, and 1412 in the adult analysis. The average annual per capita cost was USD 2639 for adults with AD and USD 8682 for children with AD. Costs increased significantly with disease severity in both groups and were strongly associated with patients' quality of life. Patients and caregivers highlighted the poor response of the health system in terms of adequate and timely access, as well as comprehensive care of the disease. Patients and caregivers suffer from a significant economic burden and quality of life impact associated with AD, which requires urgent attention and comprehensive support from the healthcare system to improve their lives.

Background. Metabolic syndrome is a cluster of cardiometabolic risk factors that may increase the risk of cardiovascular disease and type 2 diabetes, and African studies report a higher prevalence in women than in men. Prevention may depend, in part, on whether women recognise the condition and its modifiable risk factors. Relatively little appears to be known about this among women using primary-level health facilities in fast-growing peri-urban areas of Ghana. Objective. To assess knowledge of metabolic syndrome, describe lifestyle risk behaviours, self-reported cardiometabolic conditions and preventive practices, and examine selected lifestyle correlates of self-reported diabetes and hypertension among women attending Kasoa Polyclinic, Ghana. Methods. A descriptive cross-sectional survey was conducted in June and July 2024 among 174 women aged 18-45 years recruited by convenience sampling. A structured, interviewer-assisted questionnaire covered knowledge, lifestyle behaviours, self-reported diagnoses and preventive practices. Data were summarised as frequencies and percentages, and associations were examined with Pearson's chi-square test. Results. Only 37 women (21.3%) described metabolic syndrome as a condition that raises the risk of heart disease and type 2 diabetes, 40 (23.0%) identified central (apple-shaped) fat as the high-risk pattern and 31 (17.8%) knew that dietary recommendations exist. Most reported no weekly physical activity (116; 66.7%), daily sugary drinks (109; 62.6%), daily processed or fast food (100; 57.5%), high stress (103; 59.2%), and less than six hours' sleep (94; 54.0%). Self-reported diagnoses were hypertension in 60 (34.5%) and type 2 diabetes in 49 (28.2%). Fifty-nine (33.9%) had never received advice on prevention and 105 (60.3%) did not monitor their weight or waist. Self-reported diabetes was associated with short sleep (36.2% among those sleeping under six hours; p = 0.035) and with stress level (p = 0.028), being most frequent among women reporting low stress. Self-reported hypertension was more common with high stress (42.7%; p = 0.022) and with some physical activity (p = 0.005). Conclusion. Women attending this polyclinic appeared to have limited understanding of metabolic syndrome and a high burden of modifiable risk behaviours. Routine counselling on diet, activity, sleep, and weight monitoring at the polyclinic may be warranted. The bivariate, self-reported associations should be interpreted cautiously.

Background: Quantifying behavioral drivers of protective action during infectious disease outbreaks remains challenging. App-based experimental epidemic games (epigames) provide a framework for studying these decisions in naturalistic settings, but correspondence between in-game measures and real-life beliefs or behaviors requires evaluation. We examined whether an activity-based opportunity cost influenced voluntary quarantine decisions within an epigame and whether real-life health beliefs transferred into the game and predicted observed choices. Methods: We conducted a two-week randomized controlled trial from May 4 to May 17, 2026, at VinUniversity (VinUni) in Hanoi, Vietnam. Participants using the Epigames app installed in their smartphone were randomized to a low-barrier group, earning 1 point per qualifying contact with other participant when remaining active, or a high-barrier group, earning 2 points per contact. Of 439 enrolled participants, 283 were successfully randomized to one of the two groups, made at least one valid daily quarantine decision, and their data was used in the analysis. Real-life (S1) and in-game (S2) beliefs measured susceptibility, severity, quarantine self-efficacy, and perceived benefits. Belief correspondence was assessed using Holm-adjusted Spearman correlations and prospective cumulative-logit models. Quarantine choices were analyzed using participant-day binomial generalized estimating equations (GEE) and participant-level quasi-binomial models. Results: Participants made 1,823 valid daily decisions and chose quarantine on 458 participant-days (25.1%). Quarantine rates were 30.1% in the low-barrier group and 20.2% in the high-barrier group. The high barrier was associated with 41% lower population-averaged odds of quarantine (GEE odds ratio [OR] 0.59, 95% confidence interval [CI] 0.40-0.86, = 0.0059); the quasibinomial estimate was identical (OR 0.59, 95% CI 0.40-0.86, = 0.0055). Among 251 participants with matched S1-S2 data, all four corresponding beliefs were positively associated (Spearman's = 0.259-0.418; all Holm-adjusted < 0.001). Prospective ordinal models confirmed positive matched-domain associations (ORs 1.39-2.18 per one-point S1 increase). Beliefs showed little robust association with quarantine behavior, and neither S1 nor S2 beliefs jointly modified the randomized effect. Self-efficacy, network degree, and the preregistered gender main effect were also unsupported. Conclusion: A higher activity-based opportunity cost reduced voluntary quarantine within the VinUni epigame, while participants carried relative differences in stated health beliefs from real-life to in-game framing. These beliefs did not reliably predict observed quarantine choices within the game framing. Epigames can support controlled study of incentives and belief correspondence in naturalistic settings such as college campuses, but behavioral validity or real-world generalizability requires further work.

Background There is evidence that non-problematic videogaming, particularly action and first-person shooter gaming, is associated with enhanced cognition in some areas such as attention and spatial cognition. However, many studies to date have been cross-sectional, making it difficult to determine how videogaming influences cognitive development during adolescence. Objectives To investigate whether videogaming habits in early adolescence, including gaming genre, are associated with cognitive development in the prospective Study of Cognition, Adolescents and Mobile Phones (SCAMP). Methods Data on videogaming habits, demographics and cognitive abilities (executive functioning, visual attention, mental rotation and sustained attention) was collected at two timepoints, when participants were age 11-12 (baseline, N= 6590) and 13-15 (follow-up, N= 4976). Multi-level linear regression, adjusted for demographics and baseline cognition, was used to evaluate whether baseline videogaming (hours per week and specific genres) predicted cognitive abilities cross-sectionally and at follow-up. Interaction terms and stratified analyses were used to examine potential gender differences. Results Overall videogaming duration at baseline was not associated with subsequent cognitive development, however playing some specific genres was associated with improved mental rotation (first-person shooter and strategy games) and sustained and visual attention (platform games), and some genres (first-person shooter and roleplayer games) were associated with worse sustained attention. Further, effects were modified by gender, with stratified analyses suggesting detrimental effects of overall gaming on sustained attention in boys, and improvements in visual attention in girls. Conclusions Overall videogaming duration was not consistently associated with cognitive development during early adolescence. However, associations varied according to participant gender and gaming genre, supporting the hypothesis that videogaming should not be considered a homogeneous activity. These findings highlight the importance of distinguishing between specific gaming experiences and broader screen-time exposure when evaluating potential impacts on adolescent cognitive development and informing public health recommendations.

School reopening during an Ebola outbreak is often framed as a binary question of whether schools are safe. For Ebola, however, the immediate operational question is where an infected school-age child may reach the school system before recognition and isolation, and whether local systems can detect and respond rapidly. We developed an exploratory, scenario-based health-zone framework for the September 2026 rentree during the ongoing Bundibugyo virus disease outbreak in eastern Democratic Republic of the Congo. The primary estimand was scenario-based expected introduction pressure, expressed on an expected-count scale, for infected school-age children reaching school in each health zone during a one-week window. The framework combined recent reported transmission, estimated school-age exposure and attendance, a surveillance/interception probability, and directed mobility-based importation. Case-fatality patterns were analysed separately and did not determine introduction pressure. A 10,000-draw probabilistic sensitivity analysis examined uncertainty in the school-age case share, attendance, pre-isolation school-entry probability and mobility scaling. Geographic components were retrospectively evaluated at eight non-overlapping weekly origins from 1 June to 20 July 2026, using subsequent reported seven-day health-zone activity and first reported cases in previously unaffected zones as outcomes. Seven-day local epidemic pressure discriminated health zones with subsequent reported activity with pooled ROC-AUC 0.848; the 14-day local measure increased this to 0.885. Adding directed mobility increased ROC-AUC to 0.952. In the base scenario, the six-province combined scenario-based expected introduction pressure was 10.97; the probabilistic sensitivity median was 11.17, with a 2.5-97.5% sensitivity range of 5.56-20.97. Bunia, Rwampara and Nizi had the highest base introduction pressures, followed by Katwa and Nia Nia. Among 24 previously unaffected health zones that subsequently reported a first confirmed case, 13 (54.2%) were in the top 10 and 18 (75.0%) in the top 20 mobility-ranked zones; random selection would have been expected to capture approximately 2.05 and 4.10 events, respectively. In a separate six-origin exploratory nested-specification sensitivity, surveillance/access modifiers did not improve geographic discrimination over local epidemic pressure alone, whereas mobility did. The dominant structural uncertainty remained the probability that an infected child reaches school before being identified. The framework supports targeted geographic prioritisation and minimum school-health readiness, but its probabilities are model-implied scenario probabilities rather than calibrated forecasts or evidence for a single national open/close decision.

Introduction Vaccination against human papillomavirus (HPV) is the most effective strategy for preventing cervical cancer. We evaluated HPV Vaccine Integrated Service Implementation (HPV-VISION), a program aimed at integrating HPV vaccination with adolescent health (AH) services and the Expanded Program on Immunization (EPI) to improve vaccine uptake among girls aged 9 to 14 years in rural Ethiopia. Methods This mixed-methods implementation study was implemented in four woredas testing two models of integrating HPV vaccination into routine health services: integration with EPI and with an AH service package. We used program monitoring data; exit interviews, in-depth interviews, and focus group discussions with adolescent girls and caregivers; key informant interviews; and costing data. We analyzed effectiveness using negative binomial generalized estimating equation models with facility-level monthly HPV vaccinations as the primary outcome. We analyzed exit interview data descriptively across models. We analyzed qualitative data thematically and conducted a costing analysis. Results The HPV-VISION program delivered 25,821 HPV vaccinations from March to August 2025. Adjusting for baseline differences, facilities in the AH model delivered, on average, 34% fewer HPV vaccinations per month compared to those in the EPI model (adjusted IRR: 0.66; 95% CI: 0.51-0.87). Nearly all girls said they would be happy to receive services again at the place they were interviewed (EPI: 94%, AH: 98%). Experience of care was positive overall with individual measures varying across models. The incremental delivery cost (excluding vaccine cost) per vaccinated girl was USD $7.54 in the EPI model and USD $14.28 in the AH model. Conclusion We recommend that HPV vaccine delivery incorporates integration with AH services and routine vaccination to most efficiently reach underserved girls. An optimal mix of integration with the EPI program and AH services should be based on regional HPV vaccination indicators, other AH needs, population demographics, and costs of the models.

Background: Childhood experiences contribute to health and wellbeing across the life course, yet research from low- and middle-income countries has largely focused on a few outcomes rather than broader patterns of adult wellbeing, behaviors, and social and financial circumstances. Methods: In this cross-sectional analysis, we used a nationally representative sample of adults in India (N = 12,765; aged [&ge;] 18 years) from the Global Flourishing Study (GFS) Wave 1 (2023) to examine associations between eight retrospectively reported childhood experience items, 45 adult outcomes, and two composite flourishing indices. Survey-weighted linear, logistic, and proportional-odds models adjusted for age, gender, education, and residential setting, with Bonferroni correction were used to assess associations and effect modification by gender. Findings: Although the breadth and strength of associations differed across childhood experiences, less favorable childhood experiences were generally associated with poorer wellbeing and flourishing, greater odds of adverse health outcomes, and reduced access to resources and safety in adult life. However, outcomes related to prosocial behaviors showed a different pattern: childhood abuse (physical or sexual) was associated with greater odds of volunteering (OR 1.31, 95% confidence interval or CI [1.13,1.51]), feeling like an outsider in one's family with greater odds of donating (OR 1.80, 95% CI [1.52,2.13]), volunteering (OR 1.53, 95% CI [1.28,1.82]), and helping a stranger (OR 1.49, 95% CI [1.27,1.74]). Associations were broadly similar between females and males, with little evidence of gender differences. Interpretation: Associations of childhood adversity with poorer health and increased prosocial behavior in adult life may reflect unmeasured social, cultural, or dispositional factors and heterogeneous life-course responses. Nevertheless, these findings support strengthening child-protection, financial assistance programs, and mental health services in India.

Background: Adolescent and youth substance use is an important public health concern in rapidly urbanizing low- and middle-income countries; however, evidence on how social networks and community substance-use environments jointly shape recent use remains limited, particularly in African megacities. Methods: We conducted a cross-sectional, community-based, convergent mixed-methods study of adolescents and young adults aged 12-24 years in the Yaba Local Council Development Area, Lagos, Nigeria. Quantitative data were collected using a structured questionnaire adapted from established, international survey instruments. The primary outcome was self-reported substance use within the past 30 days. Key exposures included a Social Exposure Score incorporating substance use among friends and family members, membership in a substance-using peer group, and perceived easy community availability of substances. Multivariable logistic regression was used to examine factors associated with past-30-day substance use, followed by an interaction model to assess whether perceived availability modified the association between social exposure and recent use. Open-ended responses on community approaches to reducing substance use were thematically analyzed and integrated with quantitative findings through a joint display. Results: Among 285 participants (mean age 18.9 years; 52.6% male), 66 (23.2%) reported past-30-day substance use and 84 (29.5%) reported lifetime polysubstance use. A Higher Social Exposure Score was associated with increased odds of past-30-day substance use (adjusted odds ratio [aOR]=2.18; 95% CI: 1.59-2.99; p<0.001), while perceived easy community availability was independently associated with recent use (aOR=3.22; 95% CI: 1.42-7.30; p=0.005). The interaction between social exposure and perceived availability was statistically significant (aOR=1.51; 95% CI: 1.01-2.27; p=0.047), indicating that the association between social exposure and recent use varied according to perceived availability. The marginal effect of a one-unit increase in the Social Exposure Score on the predicted probability of past-30-day use was +0.08 when easy availability was not reported and +0.18 when it was reported. Among lifetime substance users, past-30-day use was more common among polysubstance users than single substance users (50.0% vs. 22.0%; chi-square[1]=16.51; p<0.001). Qualitative findings identified supply side law enforcement (43.5%), population awareness campaigns (24.6%), regulatory and legislative control (16.1%), enhanced parental supervision (14.7%), and economic and youth empowerment (13.3%) as prominent community-proposed solutions. Integrated analysis demonstrated complementarity between the quantitatively identified social and environmental correlates and community-proposed intervention priorities. Conclusions: In this urban Nigerian setting, past-30-day substance use was independently associated with social exposure and perceived community availability, with evidence that the association between social exposure and recent use varied according to perceived availability. The findings support multilevel prevention approaches that address environmental access alongside peer, family, community, and broader socioeconomic influences.

Problematic Internet Use (PIU)--marked by compulsive or maladaptive online behavior--is an emerging public health issue among adolescents and is associated with psychological distress, social difficulties, and academic problems. In Finnmark County, Norways northernmost and ethnically diverse region, limited research has examined the underlying mechanisms of PIU among Sami and non-Sami youth, despite increasing levels of digital engagement. This study protocol outlines a population-based cross-sectional survey investigating the associations between social norms (descriptive and injunctive), ethnic identity, and ethnicity-based discrimination in relation to PIU among Sami and non-Sami adolescents in Finnmark. Guided by Social Norm Theory and Ethnic Identity Theory, the study aims to examine risk and resilience factors associated with adolescents digital behavior in a geographically sparsely populated, multiethnic region. A population-based, cross-sectional school survey will include all upper secondary school students in Finnmark County (N {approx} 2,230). A culturally adapted, bilingual questionnaire (Northern Sami - Norwegian) will measure problematic internet use, perceived social norms in family, peer, and school contexts, ethnic identity, ethnicity-based discrimination, positive internet use, and key covariates. Ethnicity will be classified based on indicators of Sami language use and self-identification. Data will be prepared using prespecified quality procedures and analyzed with partial least squares structural equation modeling (PLS-SEM) to examine associations between social norms, ethnic identity, ethnicity-based discrimination, and internet use outcomes, including mediation and moderation. Group differences between Sami and non-Sami adolescents will be assessed using PLS Multi-Group Analysis. The findings may inform the development of culturally appropriate approaches to screening, prevention, and early intervention, and are relevant for mental health services, school-based programs, and public health strategies targeting Indigenous youth in rural and semi-rural regions.

Introduction: Cash transfer programs could reduce diabetes risk by decreasing chronic stress and increasing food security, physical activity, and preventive care, but there is an evidence gap on the relationship between cash transfer access and diabetes and prediabetes incidence. Methods: We used data from the Health and Ageing in Africa: Longitudinal Studies in South Africa (HAALSA) Indepth cohort of Black South Africans ages 40+ (N=5059). We fit log binomial models to estimate the relationship between household cash transfer eligibility (HCT) and cumulative incidence of diabetes and prediabetes between 2014/15 and 2021/22. We performed quantile regression to estimate change in continuous glucose values across the glucose distribution with additional HCT. Results: No association was observed between HCT and diabetes risk. Each additional unit of HCT was associated with reduced prediabetes risk [aCIR (95% CI): 0.94 (0.90, 0.98); p=0.007]. The largest reduction in glucose values associated with additional HCT was at the highest end of the glucose distribution. Discussion: Our observations suggest household cash transfer access reduces risk of prediabetes but not diabetes. However, household cash transfer access was associated with the largest decrease in glucose for the most severely glucose-impaired, implying the potential for HCT to reduce risk of hyperglycemic complications.

Long COVID (LC) impacts quality of life, daily functioning, and healthcare utilization. Understanding the onset and duration of symptoms, characteristics of those at higher risk, and the barriers and facilitators for healthcare access and therapeutics are key to addressing this growing disease burden. In 2024 the Arizona CoVHORT, an ongoing 6-year longitudinal study, distributed a cross-sectional LC survey to gain additional in-depth information. Of 1,543 participants, 700 reported LC symptoms lasting 2-49 months. Following their first infection, LC+ participants had a 21% higher risk for a second infection and were 3.2 times more likely to report LC symptoms after that second infection compared to LC- participants. Significant factors associated with LC included female sex (OR=2.3), Hispanic ethnicity (OR=1.5), BMI>34.5 (OR= 1.7) and >2 infections (OR=3.2), while vaccination prior to first infection decreased the odds of reporting LC by 51% (R=0.49). Qualitative analyses detailed significant barriers to care and encounters with providers who lacked knowledge to test for or treat LC symptoms. With an estimated 400 million people impacted globally by LC, it is critical to gain in-depth information from patients to improve both access and quality of care, improve messaging, and target mitigation strategies to decrease the burden over time.

The analysis uses a global 2010-2023 panel comprising 3,038 economy-years across 217 economies. It explicitly separates between-economy and within-economy estimands and tests the longitudinal interpretation using an identical-sample temporal analysis with cluster-aware coefficient contrasts, a formal isometric log-ratio sensitivity analysis, independent fixed-effects replication, and wild-cluster-bootstrap inference. The central finding is deliberately calibrated: cross-economy agreement cannot validate national sugar availability for longitudinal obesity surveillance. The study identifies temporal and construct instability without claiming that sugar is protective or that the mechanisms producing the instability have been identified. The manuscript aligns well with PLOS ONEs emphasis on technically sound, transparent and reproducible research of broad relevance. All data required to reproduce the findings, complete metadata, executable code, full-precision results, diagnostic outputs and a completed STROBE checklist are provided as S1-S5. Figures are provided separately as compliant 350-dpi TIFF files. The study used only publicly available, aggregated economy-year statistics and involved no individual participants, identifiable information or biological specimens; institutional ethics review and consent were therefore not required. This is original work; it is not under consideration elsewhere, and the sole author has approved the submission and accepts responsibility for its content. Funding and competing-interest declarations will be entered accurately in the submission portal. An Academic Editor with expertise in nutritional epidemiology, global health metrics, longitudinal panel methods, or food-system surveillance would be well placed to assess the work.

Introduction: Small-quantity lipid-based nutrient supplementation (SQ-LNS) is an intervention that provides supplemental nutrition to young children and has significant impacts on mortality, nutrition, and developmental outcomes. The World Health Organization recommends the use of SQ-LNS in certain targeted contexts, but evidence on the cost-effectiveness of SQ-LNS targeting approaches is limited. Methods: We utilized an individual-based simulation model to estimate the cost-effectiveness of SQ-LNS within first-level administrative divisions in Ethiopia, Nigeria, and Pakistan. We estimated the cost-effectiveness of subnational targeting strategies including threshold- and priority-based targeting algorithms with several indicators across child mortality, nutrition, and complementary feeding measures. Results: Subnational targeting according to wasting, stunting, and anemia thresholds was on average more cost-effective than untargeted strategies for all locations. Incremental cost-effectiveness ratios for these targeted and untargeted strategies respectively were $363 (95% uncertainty interval, UI: 243, 666) per disability-adjusted life year (DALY) averted and $458 (95% UI: 291, 863) in Ethiopia, $135 (95% UI: 74.2, 305) and $227 (95% UI: 124, 513) in Nigeria, and $474 (95% UI: 329, 718) and $544 (95% UI: 366, 878) to in Pakistan. Priority-based targeting using a composite ranking measure across mortality, wasting, and stunting burdens offered the greatest cost-effectiveness of any strategy assessed, achieving 7.0% (UI: 4.4, 12) and 4.6% (UI: 1.4, 7.3) more DALYs averted for the same cost as the threshold-based targeting approach in Nigeria and Ethiopia and equal impact in Pakistan. Conclusions: Subnational targeting of SQ-LNS can significantly improve cost-effectiveness relative to untargeted scale-up strategies. Several targeting strategies and indicators may be used to improve cost-effectiveness, with highest performance seen with a priority-based algorithm using a composite ranking measure across child mortality, wasting, and stunting burdens. Subnational targeting according to such measures should be considered in the implementation of SQ-LNS programs in accordance with existing guidelines.