International Journal of Public Health

Background School stress and psychosomatic complaints are linked and increase in high-income countries, with differences between countries. Evidence of how these parameters develop in Italy, particularly through combined parental and self-reported perspectives across age and gender, is limited. Methods A population-based online survey investigated school stress and psychosomatic complaints in children and adolescents aged 6-19 years, analyzing proxy- and self-reported data based on standardized validated instruments. Data was stratified by gender and age for children (6-10), early adolescents (11-14), and late adolescents (15-19). Results For early and late adolescents, the gender gap was evident, with higher levels of stress and health complaints in late adolescent girls. In this group, 56% of the girls self-reported rather/high school stress, and 43% of the boys. Parents perceived school stress and psychosomatic problems of their children as less severe than adolescents themselves. Parents stated a higher effect of parental help with school problems, and a lower effect of physical activity and digital media use on their childrens psychosomatic problems. Physical activity was related to fewer psychosomatic complaints, especially in girls. Conclusions This study identified late adolescent girls as vulnerable group, underscoring the critical need for gender-specific early prevention strategies starting in childhood, particularly for families with lower socioeconomic status. Parental perspectives may underestimate adolescents stress levels and psychosomatic well-being. In early adolescence, less digital media use may prevent psychosomatic problems, in late adolescence, physical activity may be a preventive method. Further longitudinal investigations should put a special focus on self- and proxy-reported perspectives.

Abstract Background: Schools are widely recognised as key settings for promoting childrens health behaviours. However, many schools struggle with the implementation and especially sustainment of health promotion programmes e.g. due to limited resources. Strengthening schools capacity for health promotion has therefore been identified as a central strategy for achieving better implementation and ultimately behaviour change outcomes among children. The fit4future Kids programme was developed as a large-scale, multi-component initiative in Germany that aims to promote childrens physical activity, nutrition, mental health, and responsible digital media use while simultaneously supporting schools in building structures for sustainable health promotion. Methods: This paper describes the intervention and evaluation protocol of the nationwide fit4future Kids programme implemented in several cohorts of German primary schools from Sept. 2022 to Sept. 2027. The intervention is based on the Health Promoting Schools framework and integrates established implementation and behaviour change frameworks, including the Consolidated Framework for Implementation Research, the COM-B model, and Behaviour Change Techniques. The programme combines curricular materials, environmental components, and structured implementation support to facilitate the integration of health promotion into everyday school practice. The evaluation follows a mixed-methods design involving multiple stakeholder groups, including school staff, parents, and children. Quantitative and qualitative data are collected to assess implementation processes, contextual factors, and programme outcomes. The large and diverse sample of 1,153 participating primary schools allows for the exploration of different implementation trajectories and the investigation of potential equity-related effects. Discussion: By combining evidence-based health promotion strategies with implementation science approaches, fit4future Kids provides a large-scale real-world example of how schools can be supported in implementing sustainable health promotion. The evaluation is expected to generate important insights into the implementation and potential effectiveness of multi-component school-based interventions and to inform future initiatives aiming to strengthen health-promoting school environments.

Introduction Education is a core social determinant of health for children and adolescents. Unfortunately, academic achievement, health, and wellbeing of adolescents have decreased in many developed countries in the past decade. The purpose of the Wellbeing and Education linkages in school-aged children (WELL-ED) study is to examine associations of school absences and academic achievement with use of school-based and community-based health and social welfare services. In addition, we will assess user experiences and multi-sector services pathways of school-aged children for a better understanding of how the service system could respond to the needs of children. Methods and analysis WELL-ED is a large population-based study that combines register data on school absences and educational support from municipalities with register data on healthcare and social service use collected from wellbeing services counties in Finland. The study cohort includes all children who attended mandatory education in public schools in Southern Finland in school year 2023-2024. A smaller cohort of adolescents in school year 8 was invited to complete a user experience survey. The primary outcomes of this study are related to equity of service use. Ethics and dissemination The Regional Committee on Medical Research Ethics of the Helsinki and Uusimaa Hospital District (2803/2024) has approved the WELL-ED study protocol. For the survey, adolescents in year 8 and parents of adolescents younger than 15 provided informed consent. Results will be published in peer-reviewed journals, summaries will be sent to participating municipalities and wellbeing services counties and press releases will be written on key findings.

Background: Medical and doctoral students in health sciences represent a strategic public health lever as future professionals who will have a lasting influence on healthcare practices and the overall quality of health systems. Impaired quality of life and mental health issues among these students, coupled with scarce prevention programmes, led us to develop PROMESS-Group, an innovative multimodal programme designed to promote healthier lifestyle habits among university students. Methods: We will conduct a 2-arm randomised, controlled, superiority monocentric trial to assess the effect of this programme on medical and doctoral students compared to a control group. The intervention will consist of six sessions covering stress, sleep and physical activity domains. Each session will include group and individual meetings led by trained peer experts, focusing on needs assessment, self-care education, and personalised goals setting. Students' quality of life, academic self-efficacy, and broader health outcomes will be assessed using validated questionnaires and objective tools at baseline, during, and post-intervention. Data will be analysed according to the intention-to-treat principle and presented in accordance with CONSORT guidelines. Ethical approval was obtained from the institutional review board (IRB2025021802). All procedures will be performed in adherence to the Helsinki Declaration. Discussion: This study will enable the generation of high-quality evidence to evaluate the programme's effects on students' quality of life and related psychosocial outcomes, and may inform evidence-based health promotion strategies in university settings. Trial registration: ClinicalTrials.gov: NCT07030751 (https://clinicaltrials.gov/study/NCT07030751?locStr=Lyon,%20France&country=FR&state=Auvergne-Rh%C3%B4ne-Alpes&city=Lyon&cond=promess%20group&rank=1), 06.12.2025 - retrospectively registered. This protocol study follows the SPIRIT guidelines (Appendix 1). Keywords: Doctoral student, health behaviour, medical student, quality of life, physical activity, sleep, stress

Background: Many mental health problems originate in childhood, highlighting the need for early preventive approaches. Preventive services to promote children's mental health are offered in the health, education, and social sectors (H-E-S) but are often not used by certain at-risk groups or early enough. To identify children at-risk and provide needs-oriented support, professionals from all sectors must be well trained, collaborate closely to refer to specialized services for specific mental health problems or risk factors, and understand the regional psychosocial support system and its services. A comprehensive approach to preventing mental health problems requires structured planning and a systematic overview of all institutions and services in the region and their collaboration. This study aims to map the preventive mental health and psychosocial support service system and the collaboration between institutions across three sectors (H-E-S) in two exemplary city districts. The study is integrated into a whole-district approach to child mental health promotion that is being implemented in one of the researched city districts, and its results will inform further activities there. Methods: We use a mixed-methods approach, combining qualitative interviews with a quantitative survey to map psychosocial services for children aged 4 to 10 and their families across the H-E-S sectors in two socioeconomically disadvantaged city districts in East and West Germany. All institutions that potentially offer psychosocial services for children and families will be approached to recruit professionals (e.g., schools, practices, counseling centers). To understand the regional psychosocial support system, we will analyze existing services and their characteristics (e.g., target groups, intervention types) descriptively. Social network analysis will be applied to gain an in-depth understanding of collaboration between institutions, to identify potential gaps in services and pathways, and to inform an intervention aimed at improving interinstitutional and intersectoral collaboration. Discussion: To our knowledge, this is the first study to comprehensively analyze regional preventive psychosocial support systems for children and families across sectors at the community level. Previous mappings of psychosocial services have focused on a single sector (e.g., health) or specific diagnoses only. The psychosocial preventive landscape spanning the H-E-S sectors involves complex financing structures and referral logics. Understanding the characteristics of the existing support landscape requires a systematic and comprehensive approach. Our study advances service mapping and operationalization methods in public health research. Additionally, the findings will inform recommendations for improving comprehensive prevention approaches in the selected city districts.

Background: Physical activity is a well-established modifiable risk factor for depression and anxiety. However, whether vigorous intermittent lifestyle physical activity (VILPA), defined as short, sporadic bouts embedded in daily life, confers mental health benefits remains unclear. We aimed to examine the associations of accelerometer-measured VILPA with risks of incident depression and anxiety among non-exercising adults. Methods: This prospective cohort study included 19,962 non-exercising adults (mean age 62.3 years) from the UK Biobank, free of depression and anxiety at baseline (2013-2015), with 7-day wrist-worn accelerometry data. Cox proportional hazards models and restricted cubic splines were used to examine associations between average daily duration of VILPA bouts lasting up to 1 or 2 minutes and these outcomes. Findings: Over an average follow-up of 7.8 years, 469 participants developed depression and 536 developed anxiety. Approximately 94.6% of participants engaged in VILPA bouts lasting up to 1 minute. Daily VILPA duration exhibited L-shaped associations with both depression and anxiety. Compared with participants who accumulated no VILPA, the whole-sample median daily VILPA duration for bouts lasting up to 1 minute, 4.1 minutes, was associated with a hazard ratio of 0.70 (95% confidence interval [CI]: 0.56-0.88) for depression and 0.79 (95% CI: 0.64-0.97) for anxiety. Findings were similar for VILPA bouts lasting up to 2 minutes. Interpretation: Among non-exercisers, even small amounts of VILPA were associated with substantially lower risks of depression and anxiety, highlighting the potential of high-intensity incidental physical activity as a feasible strategy for preventing depression and anxiety, particularly among individuals unable or unwilling to engage in structured exercise.

Background Smartphone ownership among UK adolescents is near universal. Teachers report phones increasingly being involved in classroom disruption, and misuse during school hours is among the more common serious behavioural issues in secondary schools. Evidence on whether restrictive policies improve behaviour, attainment, or wellbeing remains limited. Objectives The primary objective is to assess the impact of a lockable smartphone pouch on educational attainment and behaviour. Secondary objectives are to assess impacts on general functioning, psychological wellbeing, and school level indicators such as exclusions, and to examine whether effects differ for pupils who may be most at risk. Methods We will conduct a mixed methods cohort study in secondary schools across Northern Ireland and England during the 2025 to 2026 academic year. The quantitative component uses a serial cross sectional design. Students will complete an online questionnaire at 0, 4 weeks, and 8 weeks, covering homework completion, classroom disruption, participation in PE and extracurricular activities, peer interaction during break, and patterns of smartphone use. Measures include the Strengths and Difficulties Questionnaire (SDQ), the Revised Child Anxiety and Depression Scale (RCADS), the short form of the Smartphone Addiction Scale (SAS SV), and the Bergen Social Media Addiction Scale (BSMAS). Each participating school will also supply half termly aggregate data on exclusions, detentions, CAMHS referrals, counsellor visits, and parent visits between September 2023 and May 2026. Assuming 90% power, a two-sided type 1 error of 0.05, an intracluster correlation of 0.02, and 25% loss to follow up, we aim to recruit a minimum of 3,200 students from six or more schools to detect a small effect (Cohen's d = 0.2) on SDQ hyperactivity score. Continuous outcomes will be analysed with linear regression and binary outcomes with logistic regression. Prespecified subgroup analyses cover SEN or neurodivergent status, area level deprivation, and which phone policy is in place at each school. Qualitative analyses comprise focus groups with students and staff at each participating school and semi-structured interviews with school leads. Transcripts will be coded both inductively and deductively and analysed thematically with Braun and Clarke's six phase approach. Ethics and Dissemination The study has been approved by the King's College London Research Ethics Committee. A Data Protection Impact Assessment has been agreed with the Northern Ireland Department of Education. Findings will be published in peer reviewed journals and shared with participating schools, parents, and policy makers to inform smartphone policy in schools.

During the COVID-19 pandemic, limited testing capacity and reporting delays complicated epidemic surveillance and decision-making in Mexico. We calibrated \textit{covidestim}, a Bayesian nowcasting model, to estimate the total SARS-CoV-2 infections from reported cases and deaths using Mexican surveillance data. Disease-progression distribution priors were calibrated using Mexico City records and validated through comparisons with national seroprevalence surveys, hospitalization data, and annual reported severe-case rates across all states. Using the reconstructed estimates of active infections, we implemented an event-based risk framework that quantifies the probability of encountering at least one infectious individual in gatherings of different sizes. This probability was subsequently translated into a four-level epidemiological traffic-light indicator and computed at both state and municipality levels. The resulting estimates revealed substantial spatial heterogeneity that is obscured by state-level aggregation, particularly in states with marked differences between urban and rural municipalities. To evaluate consistency with public-health indicators, we compared the proposed risk classification with the official Mexican epidemiological traffic-light system, considering interpretable gathering sizes relevant to public-health decision making. Weekly reports derived from this framework were delivered to policymakers in the State of Queretaro in Mexico, as an anticipation tool for school reopening and public-space management. This demonstrates that this Bayesian reconstruction of infections combined with event-based risk metrics can provide an interpretable and generalizable municipality-level complement to routine surveillance systems, particularly in regions with limited testing capacity and heterogeneous local transmission dynamics.

Given the growing crisis in youth mental health, there is a critical need to rebuild and sustain healthy social environments. Cooperative experiences (e.g., sports, clubs) may promote mental health but we lack rigorously tested measures to drive research and evaluation. This study sought to develop a measure of cooperative experiences and test associations with health. We developed and revised a measure of cooperative experiences based on interdisciplinary literature and 20 cognitive interviews. We recruited youth aged 13-25 years (N = 262) through youth-serving organizations and snowball sampling to complete an investigator-administered (n = 50) or self-administered (n = 212) survey assessing cooperative experiences (48 items), mental and physical health, and demographics. We assessed item characteristics, dimensionality, reliability, and construct validity. Multivariable linear regressions were used to estimate the association between the total score and self-reported health. Participants were 57% female, 69% Latino, 55% high school students, and 25% college students. The measure was reduced to 35 items (alpha = 0.90) with six subscales: sense of a unified group (7 items, alpha = 0.83), goal alignment (3 items, alpha = 0.80), inclusion and shared purpose (10 items, alpha = 0.88), social exclusion (2 items, alpha = 0.91), positive interdependence (7 items, alpha = 0.77), and negative interdependence (6 items, alpha = 0.87). A higher total score was associated with better self-reported mental health (beta = 0.25 standard deviation change in health score for each standard deviation change in cooperation scale, 95% CI [0.108, 0.394], p = 0.001) and self-reported general health (beta = 0.25, 95% CI [0.107, 0.395], p = 0.001). The study provides preliminary support for the reliability and validity of a new measure of exposure to cooperative experiences among youth. The measure holds promise as a tool to examine the relationship between social environments and health outcomes in real-world settings.

Background Physical inactivity and sedentary behaviour are major contributors to non-communicable diseases (NCDs) and are unevenly distributed across populations, disproportionately affecting migrants and ethnic minority groups. Somali communities in the UK experience multiple structural and socio-economic disadvantages; however, evidence on physical activity and associated inequities remains limited. This study examined physical activity, sedentary behaviour, and related barriers and facilitators among Somali residents in Sheffield, United Kingdom. Methods A cross-sectional mixed-methods study was conducted among Somali adults (n = 238). Quantitative data were collected using the International Physical Activity Questionnaire Short Form (IPAQ-SF) and analysed using descriptive statistics and ordinal logistic regression. Qualitative data were obtained from two focus group discussions (n = 14) and analysed using inductive thematic analysis to explore socio-cultural, environmental, and structural determinants of physical activity. Results No statistically significant predictors of physical activity were identified in the adjusted analysis; however, consistent trends indicated lower activity levels among older adults and those in employment. Qualitative findings revealed multiple, intersecting barriers rooted in structural inequities, including migration-related lifestyle changes, reduced incidental activity, sedentary occupations, limited health literacy, language barriers, financial constraints, and gendered responsibilities. Cultural norms and environmental conditions further shaped behaviour. Facilitators included community-based, culturally tailored interventions, peer support, gender-sensitive programmes, and adaptation of traditional practices. Conclusion Somali residents in Sheffield face overlapping structural and socio-cultural barriers to physical activity that are not fully captured by quantitative measures alone. Equity-oriented, culturally competent, and community-led interventions addressing both systemic and behavioural determinants are essential to improve access to physical activity and reduce health inequalities and NCD risk.

Introduction: Socioeconomic deprivation is often associated with poorer health outcomes, but some studies suggest the opposite for Lyme disease. Here we test two hypotheses to explain this: differences in (i) local landcover of high risk habitats such as woodlands (landscape hypothesis) and (ii) outdoor recreation in such habitats (behaviour hypothesis). Methods: We analysed reported Lyme disease incidence data for 824 data zones in the city of Glasgow, UK, against deprivation rank (based on indicators relating to income, employment, health, education, crime and housing). We then tested how these relate to woodland cover and indices of urban greenspace usage (per capita and per ha of greenspace). Additionally, we measured Lyme disease hazard (density of infected ticks) in 32 greenspaces and tested relationships with deprivation, woodland and greenspace usage. Results: More advantaged data zones (data zones with low deprivation rank) had higher Lyme disease incidence. These areas had more woodland and woodland cover was positively correlated with both Lyme disease incidence and hazard. Deprivation did not correlate with greenspace usage, nor did greenspace usage correlate with Lyme disease incidence. Intensely used greenspaces had lower infected tick densities, consistent with a human disturbance effect on wildlife that carry ticks. Conclusions: Differences in woodland cover, but not outdoor recreation behaviour, can help explain our finding of higher Lyme disease incidence in more advantaged areas. However, to further test the behaviour hypothesis, we need more detailed data on outdoor recreation activity per capita both locally and in rural areas, as well data on mitigation behaviours.

Background Migraine prevalence is higher among individuals with attention deficit hyperactivity disorder (ADHD). However, most research has focused on single-disease studies. This study used Global Burden of Disease (GBD) data to analyze co-occurrence patterns and related risk factors. Methods This study extracted the incidence and age-standardized incidence rate (ASIR) of migraine and ADHD among individuals across 204 countries and territories in GBD 2021, as well as exposure values for risk factors. To explore the co-occurrence patterns of migraine and ADHD and their spatial heterogeneity in global distribution, the incidence of both diseases was classified into quartiles, and countries and territories were categorized into three regional types: consistent regions, migraine-dominant regions, and ADHD-dominant regions. Global groupings by economy and risk factors were analyzed separately for co-occurrence patterns, and disease burden projections were made for 2050. Results In 2021, countries and regions were categorized into three distinct groups based on disease prevalence patterns: the majority exhibited an ADHD-dominant profile, predominantly found in high-SDI regions; a consistent pattern, where both diseases occurred at comparable levels, was primarily observed across South Africa and the Middle East, while a migraine-dominant pattern was identified in North Africa. Co-occurrence patterns were generally less prevalent in areas with lower socioeconomic development. Across all three patterns, high temperature exposure, iron deficiency, and metabolic risks emerged as the primary contributing factors. Looking ahead to 2050, the global burden of migraine was projected to stabilize, whereas the prevalence of ADHD was expected to experience a slight yet consistent increase. Conclusion This study systematically identifies the co-occurrence patterns of ADHD and migraine, along with their socioeconomic and environmental drivers, offering evidence-based insights for early prevention and targeted intervention in disease populations globally. Keywords GBD, migraine, ADHD, incidence, disease burden

Background Physical activity (PA) is essential for childrens physical, cognitive, and psychosocial development; however, many children do not meet recommended PA levels, particularly in low- and middle-income settings. Parents play a critical role in shaping childrens PA behaviours, yet limited empirical evidence exists regarding parental perceptions of PA participation, satisfaction, barriers, and improvement strategies within the Nigerian context. Methods A qualitative study was conducted in Enugu City, Nigeria, using in-depth semi-structured interviews with 20 parents of children enrolled in nursery, primary, and secondary schools. Participants were recruited purposively from community settings. Interviews were audio-recorded, transcribed verbatim, and analysed using reflexive thematic analysis following Braun and Clarkes framework. Reporting adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results Five themes were identified: (1) parents perceptions of childrens PA participation as context-dependent and variable; (2) satisfaction with PA opportunities existing along a continuum from high satisfaction to dissatisfaction; (3) perceived enablers, including accessible spaces, social support, parental involvement, and safety; (4) perceived barriers, notably time constraints, academic prioritisation, limited facilities, safety concerns, and parental availability; and (5) strategies for improvement, emphasising school-based reforms, parental engagement, community collaboration, and policy-level support. Conclusions Parental satisfaction with childrens PA opportunities was mixed and frequently conditional, with many participants expressing dissatisfaction related to academic prioritisation, limited time for physical education, and inadequate recreational facilities. The findings suggest that improving both satisfaction and participation may require strengthened school-based physical activity provision, greater parental engagement, and enhanced community infrastructure to support balanced child development.

Objective: Cross-sectional studies indicate associations between self-reported social media use and adolescent wellbeing outcomes. We aimed to evaluate longitudinal associations of objectively measured smartphone and social media use with psychosocial wellbeing. Design: Observational study with one year of follow-up Setting: High schools in Finland from 2022 to 2023 Population: 259 adolescent girls (mean age 16.3 years at baseline) Main outcome measures: screenshots depicting smartphone and social media use, Bergen Social Media Addiction Scale (BSMAS), Generalized Anxiety Disorder-7 questionnaire, Body Appreciation Scale 2 (BAS-2) and visual analogue scales (VAS) of mood, tiredness, and loneliness Results: Across one year of follow-up, anxiety, body appreciation, and mood improved, but possible social media addiction increased from 15% to 17%. Social media addiction at baseline was associated with increased anxiety (r=0.29, p<0.001), lower body appreciation (r=-0.15, p=0.022), and more loneliness (r=0.20, p=0.001) at follow-up. Anxiety at baseline was associated with social media addiction at follow-up (r=0.19, p=0.005). The highest quartile of TikTok users reported more social media addiction (BSMAS 19 [IQR 16-21] vs. 17 [IQR 14-20]; p=0.009) and lower body appreciation (BAS-2 32 [IQR 28-38] vs. 35 [IQR 29-40]; p=0.003) than did others. The highest quartile of Snapchat users reported more social media addiction (BSMAS 19 [IQR 15-21] vs. 17 [IQR 14-20]; p=0.007) and tiredness (VAS 21 [IQR 13-32] vs. 26 [IQR 15-35]; p=0.049) than did others. Conclusions: Consistent with cross-sectional studies, social media addiction was associated with poorer psychosocial outcomes across follow-up. Policies to protect adolescents from social media addiction are urgently needed.

Introduction Air pollution is the largest environmental risk to human health. Children are disproportionately affected by air pollution and their exposure is amplified during physical activity. Observed concentrations of nitrogen dioxide in 1 in 4 London school playground exceeds the European limit, but the health impacts of air pollution exposure in London school playgrounds remain unexplored. Our study aims to assess and compare the acute changes in lung function and airway inflammation of primary school-aged children exercising in school playgrounds. Methods and analysis 330 children aged 8 to 11 years from ten London schools will be recruited to complete 90 minutes of physical activity and 90 minutes of rest in their school playground in a randomised crossover design. Pre-, post-, and 24-hour post-exposure oscillometry measurements will be performed with airway resistance at 5 Hz (R5) the primary physiological outcome. Nasal lavage samples will be collected pre-exposure and 24-hour post-exposure for analysis of inflammatory, oxidative, and vascular biomarkers, with IL-6 as the primary biological outcome. Mixed-effects regression models will examine associations between estimated pollutant exposures, exercise and physiological responses.

Introduction Access to quality early childhood development (ECD) services remains limited for families working in economic settings in many low-and middle-income countries. This study examined the associations between participation in integrated ECD centres of integrated ECD centres located in market and cross-border communities in Rwanda and childcare access, child nutrition, caregiving practices, and developmental outcomes. Methods A repeated cross-sectional pre-post evaluation without a comparison group was conducted between 2023 and 2025 across eight markets and cross-border ECD centres in Rwanda. Quantitative data were analyzed with logistic regression models adjusted for socio-demographic characteristics, while qualitative data were analysed thematically. University of Rwanda College of Medicine and Health Sciences Institution review board approved the study (No.366/CMHS IRB/2023). Results The proportion of children aged 6-23 months who achieved minimum meal frequency increased from 26.6% to 57% (AOR=2.35; 95% CI: 1.01-5.49), and those meeting minimum acceptable diet increased from 15.4% to 51.4% (AOR=4.51; 95% CI: 1.77-11.45). Stunting declined from 32.6% to 15.7% (AOR=0.45; 95% CI: 0.32-0.63) and underweight from 9.3% to 4.3% (AOR=0.55; 95% CI: 0.32-0.97). The proportion of children aged 24-59 months who were developmentally on track increased from 77.9% to 93.8% (AOR=3.85; 95% CI: 2.23-6.65). Households reported higher income at endline, and the centres generated strong demand for childcare services. However, reports of scolding and physical punishment increased between surveys. Conclusions Integrated ECD centres in market and cross-border settings were associated with improved child feeding practices, nutritional status, and developmental outcomes among children from vulnerable working families in Rwanda. Place-based childcare models may represent a promising strategy for expanding access to integrated ECD services while supporting womens economic participation in economic settings.

Background and Objectives: Arts and cultural engagement may contribute to well-being in later life. However, evidence from longitudinal studies from Asia, including Japan, remains limited. This study examined the association of arts and cultural engagement with subsequent multidimensional well-being among older adults in Japan, one of the fastest-aging countries. Research Design and Methods: This longitudinal study used panel data from 354 individuals aged 60 and older (mean age 74.0 years; 78.6% women) who completed self-administered questionnaires by mail between 2022 and 2024. The PERMA-Profiler was used to assess five multifaceted aspects of psychological well-being: positive emotion, engagement, relationships, meaning, and accomplishment. Frequencies of arts and cultural engagement at baseline were measured for active (e.g., activities by individuals and participation in groups, such as music and painting) and receptive (e.g., visiting museums, galleries, and theaters) forms. Results: Multivariable linear regression analysis, adjusted for the covariates including baseline PERMA scores, showed that higher frequencies of active engagement were positively associated with higher PERMA scores for all domains. Higher frequencies of receptive engagement were associated with the domains of positive emotion, meaning, and accomplishment, but not clearly associated with engagement and relationships. Restricted cubic spline analyses suggested clearer positive frequency-response patterns for active engagement than for receptive engagement. Discussion and Implications: Arts and cultural engagement, both active and receptive forms, was associated with subsequent multiple aspects of well-being in later life. These findings suggest the importance of ensuring access to arts and cultural opportunities for older adults to create, participate, and connect.

Lower cognitive ability measured in childhood or late adolescence has been consistently associated with higher mortality risk across adulthood. However, this evidence largely relies on single assessments, leaving it unclear to what extent mortality risk reflects cognitive differences established early in life versus developmental divergence during adolescence - a period of substantial neurocognitive plasticity. Using two nationally representative Swedish cohorts comprising 9,412 males born in 1948 and 1953, we linked cognitive ability assessed in primary school at age 13 years and military conscription at age 18 years to all-cause and cause-specific mortality recorded in nationwide registers through 2025. We decomposed late-adolescent cognitive ability into childhood cognitive level and adolescent cognitive change and evaluated their independent associations with mortality. Childhood cognitive level (HR = 0.81; 95% CI, 0.78-0.85) and adolescent cognitive change (HR = 0.84; 95% CI, 0.79-0.89) independently predicted lower mortality risk, also after adjustment for parental education. Childhood cognitive level and adolescent cognitive change showed partially distinct cause-specific patterns. Childhood cognitive level was most strongly associated with mortality from intrinsic causes, whereas adolescent cognitive change showed relatively stronger associations with external causes, particularly accidental deaths. Although adolescent cognitive change was associated with psychosocial factors including education and psychiatric diagnosis at conscription, its association with mortality persisted after adjustment for these factors. These findings suggest that cognitive development during adolescence carries independent prognostic information regarding long-term survival beyond cognitive level established by late childhood, highlighting adolescence as a consequential period for lifelong health.

Evidence from many countries shows that later life cognitive health is shaped by childhood poverty. However, whether it is associated with neurodegenerative biomarkers measured in population settings remains unclear. Methods We conducted a pooled analysis of 5,473 adults aged [&ge;]50 years from Denmark, Sweden and Germany participating in Wave 6 (2015) of the Survey of Health, Ageing and Retirement in Europe. Neurodegenerative biomarkers (neurofilament light chain, glial fibrillary acidic protein and phosphorylated tau) were assayed from dried blood spots. Childhood poverty was constructed as a latent variable from retrospective life histories. Weighted Poisson regression models estimated associations adjusting for age, sex, education, marital status and wealth in later life. Marginal predictions along age and across country were derived. Results Childhood poverty was strongly associated with higher NfL concentrations ({beta}=1.66, p<0.001), but not with GFAP or p-tau217. Predicted values indicated substantially elevated NfL among the childhood poor (10.3 pg/mL vs 2.0 pg/mL for the non-poor). Age profiles showed widening disparities: the childhood poor in midlife exhibited higher NfL levels than the oldest old who grew up not poor. No consistent differences were observed for GFAP or p-tau217. Findings were robust and similar across all three countries with different histories and health systems. Conclusions Childhood poverty is associated with markedly elevated levels of NfL in later life, suggesting long-term neuroaxonal injury consistent with life course shaping of brain health. Moreover, the evidence implies substantial acceleration of neurobiological ageing. These findings emphasise the importance of early-life interventions for brain health in ageing populations.

Background: The traditional wealth index, based on principal component analysis (PCA), used in the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS), suffers from urban bias, distorting estimates of health inequality. We compared the traditional index (PEAR1) with an alternative two-component polychoric PCA index (POLY2) using annual expenditure from 12 LSMS surveys as the gold standard to determine which provides more accurate SEP measures for equitable policy targeting. Methods: We compared the traditional wealth index (PEAR1) with a two-component polychoric PCA approach (POLY2) using 12 LSMS (Living Standards Measurement Study) surveys (2015-2022) from 12 African countries. Annual household consumption expenditure was the gold standard. We assessed agreement using weighted Cohen's kappa and validated against education (proportion of households with secondary or higher education) using the concentration index (CIX) and slope index of inequality (SII). Results: The POLY2 index showed higher agreement with expenditure quintiles (average national weighted kappa = 43.3%) than the PEAR1 index (35.1%), with notable improvements in urban (43.5% vs. 27.5%) and rural (35.3% vs. 22.4%) areas. POLY2 also attenuated extreme household distributions observed in PEAR1. Education validation showed that POLY2 produced intermediate inequality gradients between the flatter expenditure-based gradient and the steeper PEAR1-based gradient. Conclusion: The POLY2 wealth index is superior to the traditional index, reducing urban-rural bias and providing more accurate socioeconomic classifications. Its adoption in large-scale surveys such as DHS and MICS is recommended to improve equitable monitoring of health inequalities in low- and middle-income countries.