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.

Key points1) Women get to spend more healthy years on retirement, but no clear occupational class gradient could be seen. 2) Retiring early to statutory retirement is associated with more healthy years on retirement. 3) Policies aiming to change the retirement age should consider the equitability and effects on the health of the retirees. ObjectivesLonger lifespans lead to longer time on retirement, despite the efforts to raise the retirement age. Therefore, it is important to study how the retirement years can be spent without diseases. This study examined socioeconomic and sociodemographic differences in healthy years spent on retirement. MethodsWe followed a cohort of retired Finnish municipal employees (N=4231, average follow-up 15.4 years) on national administrative registers for major chronic diseases: cancer, coronary heart disease, cerebrovascular disease, diabetes, asthma or chronic obstructive pulmonary disease, dementia, mental disorders, and alcohol-related disorders. Median healthy years on retirement and age at first occurrence of illness (ICD-10 and ATC-based) in each combination of sex, occupational class, and age of retirement were predicted using Royston-Parmar models. Prevalence rates for each diagnostic group were calculated. ResultsMost healthy years on retirement were spent by women having worked in semi-professional jobs who retired at age 60-62 (median predicted healthy years 11.6, 95% CI 10.4-12.7). The least healthy years on retirement were spent by men having worked in routine non-manual jobs who retired after age 62 (median predicted healthy years 6.5, 95% CI 4.4-9.5). Diabetes was slightly more common among lower occupational class women, and dementia among manual working women having retired at age 60-62. DiscussionHealthy years on retirement are not enjoyed equally by women and men and those who retire early or later. Policies aiming to increase the retirement age should consider the effects of these gaps on retirees and the equitability of those effects.

Abstract Background: Insufficient physical activity, excessive sedentary time, and suboptimal sleep are linked to premature mortality and chronic disease and may contribute to social inequalities in health, but most evidence is self-reported. Device-measured, nationally representative data capturing the full 24-hour movement spectrum remain scarce, particularly among older adults. This study examined social, economic, and environmental disparities in 24-hour movement behaviours in the 2021-23 English Longitudinal Study of Ageing (ELSA) accelerometry sub-study. Methods: A subset of 5,382 ELSA participants (71.9%) was invited to wear an Axivity AX3 wrist accelerometer for eight days, with 4,354 (80.9%) agreeing. Raw data were processed using machine learning to derive step count, sleep duration, moderate-to-vigorous and light physical activity, sedentary time, and time in bed. Cross-sectional associations with sex, age, education, marital status, wealth, and urbanicity were examined using linear regression. Findings: Data from 3,648 participants (mean age 68.5 {+/-} 9.3 years; 44.3% men) were included in wear time analyses (median 6.6 days, IQR 6.0-6.9), with 3,161 (86.7%) having sufficient wear time for movement behaviour analyses. Older, unmarried, or lower education/wealth participants were less active, more sedentary, and slept less. Rural participants were more active than urban participants. Women accumulated fewer steps and less moderate-to-vigorous physical activity and sedentary time, but more light activity and longer sleep than men. Interpretation: Social, economic, and environmental disparities exist across the full 24-hour movement spectrum, highlighting population groups for targeted interventions. Follow-up data will clarify how 24-hour movement behaviours influence healthy ageing and contribute to social inequalities in health.

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.

BackgroundMenarche is a critical developmental milestone, with earlier onset associated with adverse long-term health consequences. Despite a reported global decline in age at menarche over the last century, this trend and its determinants remain insufficiently studied in Spain. ObjectiveTo assess secular trends in age at menarche and its determinants in the Valencian Community, Spain. MethodsThis population-based study included 417,260 participants born between 1931 and 2008. First, secular trends in age at menarche were assessed using time-series models across 5-year birth cohorts for the overall population. Then, participants were categorized as either women (born 1931-1985) or girls (born 1990-2008), and Bayesian linear regression models were fitted for each group, adjusting for birth cohort and continent of birth in all models, and additionally for educational level in women and body mass index (BMI) in girls. ResultsMean age at menarche decreased by 1.9 years, from 13.1 to 11.1, between the 1931-1935 and 2006-2008 birth cohorts, with a steeper decline after 1975. Compared to Europeans, women born in South/Central America ({beta}[95% CI]: 0.33[0.30, 0.36] years) and Africa (0.52[0.45, 0.58] years) experienced later menarche, while girls from South/Central America experienced earlier onset (-0.18[-0.28, -0.09] years). In girls, lower BMI was associated with later menarche (0.96[0.74, 1.18] years) and higher BMI with earlier onset (-0.53[-0.57, -0.48] years). ConclusionThere was a marked decline in age at menarche in the Valencian Community, with no evidence of leveling off. Key determinants included continent of birth (with cohort-specific effects) and BMI.

BackgroundForeign bodies (FBs) can cause obstruction, infection, or injury, yet comprehensive global assessments remain limited. This study evaluated the burden of FBs from 1990-2021, projected trends to 2050, and identified high-risk populations. MethodsUsing Global Burden of Disease 2021 data, we estimated age-standardized incidence ratio (ASIR), death ratio (ASDR), and disability-adjusted life years (DALYs) by age, sex, and region. Temporal trends were assessed with estimated annual percentage change (EAPC) and Joinpoint regression; projections applied Bayesian age-period-cohort models; decomposition quantified the effects of aging, population, and epidemiological change. ResultsFrom 1990-2021, global ASIR declined from 660.75 to 561.16 per 100,000 (EAPC: -0.84), ASDR from 2.11 to 1.41 (-1.47), and DALYs from 145.14 to 77.87 (- 2.13). Males had consistently higher burden (2021: 725.96 versus 394.11 per 100,000 in females). Children under 5 and adults over 80 bore the highest risks, with intraocular FBs dominating incidence and pulmonary aspiration/airway FBs driving mortality. Western Europe had the highest ASIR, Andean Latin America the highest ASDR. Since 2019, the onset of the COVID-19 pandemic, intraocular FBs incidence has surged in East Asia, mainly China. Projections suggest ASIR will continue to rise through 2050, while ASDR and DALYs continue to decline, driven by global population growth (187.27%) and aging (46.82%) but offset by epidemiological improvements (-134.09%). ConclusionsDespite long-term declines, FB incidence is rebounding, with marked disparities across sex, age, and region. Targeted interventions, including workplace safety, pediatric and geriatric care, and region-specific policies, are needed to mitigate risks and reduce inequalities.

Loneliness--the perceived discrepancy between desired and actual social connection--is a common and aversive psychological state associated with a range of adverse health outcomes. Several theoretical models suggest that these associations may operate partly through health behaviors. In this preregistered study, we used data from the All of Us Research Program to evaluate associations of loneliness and functional rurality (FR), a study-specific contextual index of reduced neighborhood accessibility, with Fitbit-derived physical activity and sleep outcomes. Final samples included 16,912 participants for physical activity analyses and 13,937 for sleep analyses. In adjusted models, higher FR was associated with greater loneliness ({beta} = 0.061, 95% CI [0.045, 0.077], p = 9.63 x 10-14). FR and loneliness were independently associated with fewer daily steps and lower moderate-to-vigorous physical activity. Loneliness was also associated with shorter sleep duration, greater sleep duration variability, higher odds of short sleep, and higher odds of low sleep efficiency. FR was not associated with sleep duration or sleep duration variability but showed a small positive association with mean sleep efficiency and lower odds of low sleep efficiency. Interaction analyses provided little evidence that FR modified the associations of loneliness with most outcomes, although the FR x loneliness interaction was significant for sleep duration variability, indicating that loneliness was more strongly associated with irregular sleep duration in higher-FR contexts. Sensitivity analyses using stricter valid-day thresholds, winsorization, quartile-based exposure coding, and a backward 30-day window yielded directionally similar findings. These results suggest that FR and loneliness are independently associated with lower physical activity, whereas loneliness shows a more consistent relationship with adverse sleep patterns.

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.

BackgroundEvidence on the long-term impact of urban green and blue spaces (UGBS) interventions remains limited. This study is a 15-year evaluation of an urban greenway development in Belfast (United Kingdom), assessing the potential effects of this UGBS intervention on physical activity (PA), mental wellbeing and co-benefits. MethodsUsing quasi-experimental design, a repeated cross-sectional survey was conducted in 2010 (baseline), 2017 (post-opening) and 2023 (long-term follow-up) with about 1,200 adults participated each wave. Outcomes included PA, mental wellbeing, general health, quality of life, social capital and environmental perception. Multilevel mixed-effect regressions were performed to examine within-group changes at long-term follow-up. Difference-in-differences analysis investigated the between-group changes that might be attributed to the greenway. Additional comparative analyses included distance-decay analysis and comparison with population trends in Northern Ireland. ResultsAt six years after completion, the greenway intervention appears to buffer a decline in duration of PA - mainly from moderate-intensity activity (decline lower by 118.6 min/week, 95%CI: 3.9-232.2) but with no significant impact on the proportion of the population meeting the recommended PA level. The intervention is associated with a smaller decline in self-rated health (4.98 units; 95%CI: 0.62-9.34) relative to control group. Intervention association with mental wellbeing was positive but not significant (p=0.30). The greenway also showed positive effects on social capital and environmental perceptions, with impacts most evident in improving safety and trust in the local area. ConclusionThis study provides evidence to support the public health impact of UGBS and its long-term health and social benefits.

BackgroundHigher levels of sedentary behaviour, such as leisure screen time (LST), and lower levels of physical activity are associated with diseases across multiple body systems which contribute to a large global health burden. Whether these associations are causal is unclear. The primary aim of this study is to investigate the causal effects of higher LST (given greater power) and, secondarily, lower moderate-to-vigorous intensity physical activity (MVPA), on a wide range of diseases in a hypothesis-free approach. MethodsA two-sample Mendelian randomisation phenome-wide association study was conducted for the main analyses. Genetic single nucleotide polymorphisms (SNPs) were first selected as exposure genetic instruments for LST (hours of television watched per day; 117 SNPs) and MVPA (higher vs. lower; 18 SNPs) based on the genome-wide significant threshold (p < 5x10-8) from the largest relevant genome-wide association study (GWAS). For disease outcomes, we used summary results from FinnGen GWAS, including 1,719 diseases defined by hospital discharge International Classification of Diseases (ICD) codes in 453,733 European participants. For the main analyses, we used the inverse-variance weighting method with a Bonferroni corrected p-value of p [&le;] 3.47x10-4. Sensitivity analyses included Steiger filtering, MR-Egger and weighted median analyses, and data from UK Biobank were used to explore replication. FindingsGenetically predicted higher LST was associated with increased risk of 87 (5.1% of the 1,719) diseases. Most of these diseases were in musculoskeletal and connective tissue (n=37), genitourinary (n=12) and respiratory (n=8) systems. Genetic liability to lower MVPA was associated with six diseases: three in musculoskeletal and connective tissue and genitourinary systems (with greater risk of these diseases also identified with higher LST), and three in respiratory and genitourinary systems. Sensitivity analyses largely supported the main analyses. Results replicated in UK Biobank, where data available. ConclusionsHigher levels of sedentary behaviour, and lower levels of physical activity, causally increase the risk of diseases across multiple body systems, making them promising targets for reducing multimorbidity.

HighlightsO_LIHealth inequalities have widened over 15 years, favouring high-income groups C_LIO_LIInequality in physical activity & mental health widened the most pre-intervention C_LIO_LIPost-intervention, inequalities persisted but stayed relatively unchanged. C_LIO_LILong-term illness and unemployment were key drivers of inequality C_LIO_LIThe greenway may have slowed down the inequality widening but the impact is limited C_LI BackgroundEvidence concerning health inequalities following urban green and blue space UGBS) interventions is limited. This study examined the changes in health inequalities after a major urban regeneration project, the Connswater Community Greenway (CCG), in Belfast, UK. MethodCross-sectional household surveys were conducted in 2010/11 (baseline), 2017/18 (immediately after completion), and 2023/24 (long-term follow-up) with a sample of approximately 1,000 adults each wave. Using concentration indices (CI), income-related health inequalities for three outcomes (physical activity, mental wellbeing and quality of life) were measured. A regression-based decomposition of concentration index examined the contribution of sociodemographic factors to the observed inequalities underpinning each outcome over time. ResultsAcross three waves, there was widening of inequalities over the 15-year period across all three health outcomes, with those from high-income groups reported higher levels of physical activity (CI=0.33, SE=0.026), better mental wellbeing (CI=0.03, SE=0.003), and better quality of life (CI=0.09, SE=0.008). The widening inequalities mainly occurred during the construction phase of CCG (2010-2017) and remained stable post-intervention (2017-2023). Decomposition analysis revealed that the pro-poor concentration of long-term illness and unemployment was the key driver that together explained approximately 51%-76% of the inequalities. ConclusionThe CCG was limited in reducing health inequalities which were mainly driven by long-term illness and unemployment - factors beyond the direct scope of the UGBS intervention - resulting in low-income groups likely to fall further behind the wealthier groups. The widening of inequality is consistent with findings from other public interventions that did not have a primary equity focus.

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.

BackgroundImplementing proven vehicle safety standards recommended by the UN World Forum for Harmonization of Vehicle Regulations is among the most cost-effective strategies to reduce road traffic deaths. In 2022, Mexico approved updated vehicle safety standards, including side pole testing, electronic stability control, seatbelts, airbags, side structures, and anchorage child restraint systems. However, pedestrian protection and advanced driver-assistance technologies, such as autonomous emergency braking systems (AEBS), were excluded. These exclusions are critical, given that more than half of road traffic deaths involve vulnerable road users. Local evidence on the expected benefits of implementing comprehensive vehicle safety standards is needed to guide policy decision-making. ObjectiveTo estimate the potential public health impact of increasing the availability of recommended vehicle safety technologies in Mexico. MethodsWe conducted a comparative risk assessment analysis to estimate the impact of improving vehicle safety standards on road traffic deaths, injuries, and disability-adjusted life years. Counterfactual analyses were defined using traffic statistics for 2019 as baseline, relative risk estimates associated with each safety technology, and technology penetration within Mexicos vehicle fleet. Three scenarios were modeled: (1) full implementation of Mexicos 2022 standards; (2) addition of crashworthiness, AEBS, and motorcycle ABS/ESC; and (3) inclusion of expanded AEBS crash configurations, lane departure warning (LDW), and lane keeping assistance (LKA) systems. ResultsScenario 1 reduced deaths by 18%, injuries by 16%, and DALYs by 18%, with the greatest benefits for car occupants. Scenario 2 reduced deaths by 29%, injuries by 27%, and DALYs by 30%, benefiting motorcyclists and pedestrians the most. Scenario 3 reduced deaths, injuries, and DALYs by 41%, 38%, and 41%, respectively, benefiting car occupants and motorcyclists. ConclusionsCurrent vehicle safety standards in Mexico are expected to reduce deaths, injuries, and disabilities, yet existing guidelines focus largely on protecting car occupants. Mexico should strive to update and strengthen its current legislation by adding technologies that protect vulnerable road users, such as pedestrians and cyclists, and to focus on technologies for motorcycle users to further reduce the burden of road traffic injuries.

Abstract Background: Previous physical activity simulation studies only account for the effects of cardiovascular diseases, diabetes, dementia, and some cancers, which neglects many of its costs and benefits. We estimate the health and economic impacts of increased physical activity in Australia, including those on mental health, increased injury rate, and conditions mediated by other risk factors, commencing 2021, over 20 years. Methods: We used a Proportional Multistate Lifetable Model specified with disease rate and risk factor forecasts, and causal associations, derived from the Global Burden of Disease study and other sources. Findings: If all Australians shifted to the maximum physical activity level of 4200+ MET-min/week, there would be: 653,000 (230,000 - 1,210,000) or 0.16% more HALYs lived; 9,720 (7,400 to 12,700) or 1.33% fewer deaths before age 75; increased working age income of AUD$16.8 billion ($12.8 - $22.2 billion); and decreased health expenditure of $748 million (-$4.46 billion - $6.98 billion) or 0.02%. Net health gains diminish for each additional 600 MET-min/week increase in physical activity, and above 4,200 MET-min/week the health costs from injuries outweigh the reduction in health costs from avoided disease. Because of injuries, increasing physical activity in the lowest activity group to meet the physical activity guidelines reduces health expenditure more ($1.86 billion; 896 million - 3.13 billion) than shifting to maximum activity levels. Interpretation: Increasing physical activity levels in Australia would improve population health (even allowing for injuries due to participation), reduce health spending, and increase income. Funding: Australian Sports Commission. TB is funded by NHMRC Investigator Grant (2023) #2026992

Period Life Expectancy (PLE) is a measure of longevity valued for its sensitivity to short and long-term changes. However, it refers to a hypothetical cohort, not to a real population, thereby undervaluing longevity under declining mortality conditions. Other measures such as the Average Cohort Life Expectancy (ACLE) only partially overcome this limitation, still underestimating population longevity. This article introduces a new indicator, the Population Life Expectancy (PoLE), defined as the mean age at death of active cohorts in the studied population. Using a log-linear Poisson model with age-period interaction to project mortality of non-extinct cohorts, we estimated PoLE in Switzerland and Norway over 1876-2024, and compared it to PLE, Cohort Life Expectancy (CLE), and ACLE. PoLE clearly exceeded PLE, increasing from 63.3 to 89.7 for Swiss men (PLE from 37.7 to 82.4), and from 65.4 to 91.3 for Swiss women (PLE from 41.4 to 85.9), revealing a gain of about +50% over 150 years, rather than +100% suggested by PLE. Comparable results were obtained in Norway. PoLE was also higher than CLE until the mid-20th century, when the relation reversed, indicating that life expectancy is now higher for newborns than for those already alive, a tangible sign of human progress.

BackgroundOutdoor play and limited screen time are critical for preschoolers physical health and socio-emotional development, yet little is known about how caregiver nativity and acculturation shape these behaviors. MethodsWe analyzed the 2022-2023 National Survey of Childrens Health data for 10,157 U.S. children 3-5 years old. Generalized linear models estimated associations between caregiver nativity and length of U.S. residence and childrens outdoor play and weekday screen time, adjusting for child, caregiver, and household covariates. Models tested interactions with race/ethnicity. ResultsOverall, caregiver length of U.S. residence was not associated with childrens outdoor play. However, screen time differed - children whose caregivers arrived Pre-1997 had lower odds of screen time frequency, whereas those whose caregivers arrived between 1997-2005 had higher odds compared with children of U.S.-born caregivers. Associations for weekday outdoor play and screentime varied significantly by child race/ethnicity. ConclusionsCaregiver length of U.S. residence appears more strongly related to preschoolers screen time than outdoor play, with notable differences across racial/ethnic groups. Culturally tailored strategies may be needed to reduce early childhood screen exposure and support healthy movement behaviors among immigrant families.

BackgroundCommercial motorcycle riders are among the most vulnerable road users in low- and middle-income countries and contribute substantially to the burden of road traffic injuries. The use of personal protective equipment (PPE), including helmets and protective clothing, reduces injury severity; however, uptake remains suboptimal. This study evaluated the effectiveness of a theory-driven health education intervention in improving knowledge, attitudes, and use of PPE among commercial motorcycle riders in Cameroon. MethodsA quasi-experimental, non-randomized controlled before-and-after study was conducted in Limbe (intervention) and Tiko (control) Health Districts between August 4, 2024, and April 6, 2025. Participants were recruited from a cohort of commercial motorcycle riders and followed over an eight-month intervention period. The intervention, guided by the Health Belief Model and developed using the Intervention Mapping framework, combined face-to-face sensitization sessions with mobile phone-based educational messaging adapted to participants literacy levels and communication preferences. Data were collected at baseline and endline using structured questionnaires and direct observation checklists. Intervention effects were estimated using difference-in-differences analysis with generalized estimating equations, adjusting for socio-demographic factors. ResultsA total of 313 riders were enrolled at baseline (183 intervention, 130 control), with 249 retained at endline (149 intervention, 100 control). The intervention was associated with significant improvements in PPE knowledge ({beta} = 2.91; 95% CI: 2.14-3.68; p < 0.001) and attitudes ({beta} = 5.76; 95% CI: 4.32-7.21; p < 0.001) compared with the control group. No statistically significant effect was observed for PPE practice scores ({beta} = 0.21; 95% CI: -0.09-0.52; p = 0.171). Among individual PPE items, helmet use increased significantly in the intervention group relative to the control group (AOR = 2.38; 95% CI: 1.19-9.45; p = 0.036), while no significant effects were observed for gloves, trousers, eyeglasses, or closed-toe shoes. ConclusionThe theory-driven health education intervention significantly improved knowledge and attitudes toward PPE and increased helmet use among commercial motorcycle riders but did not lead to broader improvements in the uptake of other protective equipment. These findings highlight the need for complementary structural and policy interventions to address persistent barriers to PPE use in similar low-resource settings. Trial registrationClinicalTrials.gov Identifier: NCT07087444 (registered July 28, 2025, retrospectively)