International Journal of Public Health

IntroductionClimate change is expected to alter daily patterns of sleep, sedentary behaviour and physical activity, yet empirically grounded projections across the full 24-hour movement spectrum are lacking. This study estimated how projected future warming may alter 24-hour movement behaviour patterns in adults. MethodsA Monte Carlo simulation framework estimated temperature-dependent distributions of daily movement behaviour duration using data from 368 adults in the Annual Rhythms in Adults (ARIA) study in Adelaide, Australia. A total of 85,182 valid person-days were linked to daily temperature data to determine empirical temperature-behaviour relationships. The resulting distributions were used to simulate behaviour under five Intergovernmental Panel on Climate Change warming scenarios (+1.5{degrees}C to +4.4{degrees}C above pre-industrial levels) across a full calendar year relative to current-climate conditions (+0.99{degrees}C above pre-industrial levels). ResultsSimulations projected small but consistent behavioural shifts with warming. Annual median increased for MVPA (+49min to +4h 22min per person) and LPA (+3h to +13h 1min per person), while sleep declined (-5h 29min to -23h 19min per person). Physical activity gains were concentrated in cooler months, whereas sleep losses persisted year-round. Changes in sedentary behaviour were minimal and inconsistent. DiscussionRising temperatures may modestly increase year-long physical activity but reduce sleep duration, in a temperate-zone Mediterranean climate geography producing meaningful cumulative health implications. However, these might be confounded by the effect of other meteorological changes such as rainfall and humidity, which warrant further investigation.

Objectives: Longer 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. Methods: We 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. Results: Most 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. Discussion: Healthy 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.

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.

BackgroundAlthough health mediation is widely studied in the U.S. through community health worker programs, evidence on their effectiveness in promoting cancer screening in Europe is limited. Since 2022, the "13 en Sante" program has implemented a multicomponent health mediation intervention -- combining educational activities, outreach strategies, and navigation support -- in socioeconomically disadvantaged neighbourhoods of Marseille, France. This study evaluates the effectiveness of this program in promoting breast, colorectal, and cervical cancer screening. MethodsA controlled before-after design based on two cross-sectional surveys was conducted in 2022 and 2024 in intervention or control neighbourhoods. Individuals aged 18-74 were randomly selected and interviewed via door-to-door questionnaires. Weighting was applied to account for stratified sampling and to align age and sex distributions with census data. Weighted logistic regression models were fitted for each cancer screening to estimate the interventions effects on uptake and awareness at both individual and population levels. FindingsOverall, 4,523 individuals were included across the two cross-sectional surveys. The program successfully reached individuals facing cumulative socioeconomic barriers to healthcare access. No significant population-level effect was observed. At the individual level, declared exposure to health mediation was associated with significantly higher uptakes of breast and colorectal cancer screenings (breast: 54% vs. 74%, OR=2.3 [1.1-4.5]; colorectal: 30% vs. 50%, OR=2.8 [1.3-5.8]). In addition, colorectal cancer screening awareness was significantly higher among exposed participants (83% vs. 93%, OR=8.1 [2.1-31]). InterpretationThis study provides the first evidence that a multicomponent health mediation intervention could effectively promote breast and colorectal cancer screening in disadvantaged French neighbourhoods. The study highlights screening-specific mechanisms of action that should be considered to further optimize intervention effectiveness. FundingThe survey was funded by the Regional Health Agency of Provence-Alpes-Cote dAzur and Sante publique France.

BackgroundFood systems--particularly livestock production--account for substantial greenhouse gas (GHG) emissions, while unhealthy diets, characterized by excessive animal-based and insufficient plant-based food consumption, are a major risk factor for all-cause mortality in Europe. Implementing climate mitigation policies related to the GHG emissions of the food system could therefore bring important health co-benefits. MethodsWe developed a health impact assessment model based on a life table approach and evaluated the mortality impact of transitions in food consumption through four contrasting scenarios leading to net-zero GHG emissions for France in 2050. These involved varying dietary shifts, all moving toward more plant-based foods. For each scenario, we modeled the evolution of the diet, as well as the impacts on all-cause mortality by applying the most recent and robust dose-response relationships derived from meta-analyses for 13 food groups. FindingsThe different trajectories of dietary shifts translated into a health impact ranging from 19% [uncertainty interval, UI: 17%-21%] to 24% [UI: 21%-26%] of all-cause mortality prevented in 2050 in the French population. Variation in intakes of nuts, red meat, processed meat, whole grains and legumes bring most of the health benefits. Whatever the parameters chosen in the sensitivity analyses, the results remained robust, with about 100,000-200,000 deaths that could be prevented yearly by 2050 in France. InterpretationThe present study highlights the considerable potential health benefits that trajectories toward net-zero emissions can bring, especially through shifts toward sustainable diets. These results reinforce the strong convergence of environmental and human health issues in the agri-food sector. FundingFrench High Council for the Future of Health Insurance (HCAAM) and the National Agency for Ecological Transition (Ademe). Research in contextO_ST_ABSEvidence before this studyC_ST_ABSFood systems are a significant contributor to climate change and in parallel, dietary risks are one of the leading causes of all-cause mortality globally, notably in high-income countries such as France. A recent systematic review by Moutet et al. revealed that only two studies evaluating health co-benefits through dietary shifts in net-zero GHG emissions scenarios were published to date. This suggests a convergence and a possible win-win situation between climate change and human health challenges regarding food production and consumption. In order to face the climate crises, governments around the world, and particularly those of the countries historically the largest contributors to climate change, must cut their greenhouse gas emissions to achieve net-zero emission by 2050. Dietary shifts would be a major driver to pursue this objective and could bring important health benefits to the population conducting these changes. For instance, Hamilton et al. showed that dietary changes in line with the Paris Agreements could result in 188 deaths prevented per 100,000 persons in 2040 in Germany and 141 in the UK. Added value of this studyOf the two previously published studies, only one assumed a gradual implementation of changes in diets, combined with a time lag in health effects. We also made these assumptions and considered the gradual change in consumption of thirteen food groups for which recent meta-analyses provided all-cause mortality dose-response relationships with a high level of quality. This study is also among the first to combine nutritional and environmental optimization, through four scenarios; all of which are expected to lead to net-zero emission by 2050 via very contrasting climate change mitigation trajectories. Nevertheless, all of them require a dietary shift toward more plant-based foods. We conducted a health impact assessment for France and showed that achieving net-zero emission by 2050 while considering nutrition references set by national guidelines would provide health co-benefits. Depending on the scenarios, health gains could range from 19% to 24 % of all-cause mortality prevented in the adult French population in 2050, compared to a scenario assuming that we would maintain the current observed dietary habits in the future. Implications of all the available evidenceThis study adds to the available evidence that taking action to mitigate climate change is an opportunity to strongly improve public health. Engaging populations in a shift toward a healthier and more sustainable diet could bring major human health and environmental benefits.

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.

Background Higher 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. Methods A 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 < 5*10-8) 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;] 3.47*10-4. Sensitivity analyses included Steiger filtering, MR-Egger and weighted median analyses, and data from UK Biobank were used to explore replication. Findings Genetically 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. Conclusions Higher 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.

BackgroundIn Colombia, internal violence, displacement, COVID-19, suicide, and climate crises threaten the survival of younger adults, many of whom are parents. Such premature mortality increases orphanhood risks. Evidence-based psychosocial support for surviving caregivers has potential to mitigate adverse impacts of orphanhood for bereaved children in crisis settings. Here, we adapted the Hope Group program from war-affected Ukraine to post-COVID-19 Colombia Parenting with Hope, and evaluated the effectiveness of psychosocial and parenting support delivered via home visits on improvements in caregiver mental health, violence against children, parenting practices, and child behavioral issues. MethodsParticipants (n=220) included surviving caregivers co-residing with children experiencing death of a parent or caregiver in the previous 12-36 months. Next-of-kin caregivers were identified through vital statistics data, death certificate annexes, radio/social media, schools, COVID-19 laboratories, and referrals. We used pre-post and quasi-experimental approaches to evaluate the effectiveness of Parenting with Hope. For both analysis types, we constructed Bayesian models to estimate mean change and percent change following completion of the 8-session program. ResultsBoth pre-post and quasi-experimental findings showed significant improvements across all mental health, violence prevention, parenting, and child outcomes. Pre-post results showed caregiver depression/anxiety ratings decreased by 91.2% (95% posterior credible interval (CrI) - 93.7, -87.6), and hopefulness increased by 43.8% (95% CrI 34.5, 54.8) and self-care, by 139.5% (95% CrI 107.5, 178.1). Each component measure of parenting practises (nonviolent discipline, positive parenting, parental monitoring, and parental involvement) improved significantly. By endline, violence against children had decreased by 63.9% (95% CrI -71.1, -54.4), and child externalizing and internalizing behaviors, by 74.4% (95% CrI, -78.0%, -70.3%). Pre-post and quasi-experimental findings showed equivalence. ConclusionThis study generalizes evidence for effectiveness of Parenting with Hope in crisis settings to surviving Colombian caregivers, on improved mental health, parenting practices, and reduced violence against children and child behavioral issues. Article Summary Parenting with Hope for families in crisis settings significantly improved mental health and parenting strategies in post-COVID-19 Colombia, generalizing effectiveness previously measured in war-affected Ukraine. Whats Known on This SubjectCaregiver death harms children long-term. Colombia experiences both community violence affecting caregivers and substantial COVID-19-related parental death burden. A Ukrainian program improved caregiver mental health, parenting, and reduced child violence, offering a model for Colombias prevention efforts. What This Study AddsWe report pre-post evidence of the Parenting with Hopes effectiveness in Colombian families experiencing bereavement. Adapted from Ukraine Hope Groups, the intervention shows consistent benefits and is a promising, transferable and scalable strategy to prevent violence against children in communities globally.

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.

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)

Background Diverse epigenetic clocks are known to capture health risks associated with increased adiposity, but their estimates have never been combined to represent a holistic estimate of biological age acceleration (BAA). There is also a gap in research using epigenetic clocks to study adiposity in lower-middle income Asian countries. Methods and Findings Data from 1,745 participants (21.7{+/-}0.3 years old, 45% female) of the Cebu (Philippines) Longitudinal Health and Nutrition Survey were analyzed. BAA was calculated using PCHorvath 2, PCHannum, PCPhenoAge, PCGrimAge, PCDNAmTL, and DunedinPACE. After ascertaining suitability for factor analysis (Kaiser-Meyer-Olkin 0.81), factor analysis was used to create PCFactorAge. Analogously, FactorAge was created using Horvath, Hannum, PhenoAge, GrimAge, DNAmTL, and DunedinPACE. BMI, waist circumference (WC), and waist-to-height ratio (WHtR) were used to represent adiposity. Linear regression was used to test the association of each adiposity measure with each BAA measure. BMI, WC, and WHtR were positively associated with both BAA combinations: 5 kg/m2 higher BMI corresponded to 0.097 (p=0.015) standard deviation (SD) increase in FactorAge and 0.099 (p=0.004) SD increase in PCFactorAge; 10 cm increase in WC--with 0.091 (p=0.005) SD increase in FactorAge and 0.094 (p<0.001) SD increase in PCFactorAge; 0.1 increase in WHtR--with 0.164 (p=0.001) SD increase in FactorAge and 0.163 (p<0.001) SD increase in PCFactorAge. Additionally, WHtR was associated with meaningful increases in PhenoAge, PCPhenoAge, PCHorvath 2, PCHannum, PCGrimAge, and DunedinPACE. WC was positively associated with PCHorvath 2, PCHannum, PCPhenoAge, and DunedinPACE. BMI was positively associated with PCHannum, PCPhenoAge, and DunedinPACE. Conclusions Our study presents a novel approach to creating a BAA estimate using multiple epigenetic clocks and shows that adiposity measures predict this factor in a young Filipino cohort.

BackgroundDrowning remains a major global public health challenge. This study examined whether the timing and trajectories of urbanisation--beyond the current built environment--are associated with subnational drowning mortality. MethodsWe linked satellite-derived measures of built-environment change (GHSL), population crowding (WorldPop), surface water exposure (JRC Global Surface Water), and infrastructure proxies (VIIRS/DMSP nighttime lights) to GBD 2021 drowning mortality estimates across 203 ADM1 regions in 12 countries (2006-2021; 3,248 region-year observations). Temporal predictors captured recent expansion, development "newness" ([&le;]10-year built share), acceleration/volatility, and a crowdingxgrowth interaction. We screened predictors using LASSO (10-fold cross-validation) and fitted mixed-effects models with region random intercepts. Distributed-lag models tested temporal precedence and development age, and income-stratified models assessed heterogeneity. ResultsAdding temporal predictors improved fit beyond contemporaneous built-environment measures ({Delta}AIC=177; {Delta}BIC=147). In adjusted models, crowdingxgrowth was strongly positively associated with drowning mortality, and a higher share of recent development was associated with higher mortality. Lag models showed a development age gradient: older built environment was most protective. Associations differed by income group, with several key coefficients reversing sign across strata. DiscussionDrowning mortality appears shaped by development histories as well as present-day conditions, with risk concentrated in rapidly changing, dense settings and the newest built environments. Cross-context heterogeneity suggests mechanisms and prevention priorities are unlikely to be uniform. ConclusionsDevelopment timing and trajectories help explain subnational drowning mortality beyond current built form alone. Prevention and planning should prioritise transition-period safety strategies in newly developing and rapidly densifying areas.

Sleep is essential for childrens health and development, yet sleep problems are common worldwide. Comfort items such as soft toys or blankets are widely used to promote independent sleep, but their effects have not been evaluated in a randomised controlled trial (RCT). The REST trial emerged from a child-led citizen-science study (The Kids Trial) where children co-created and designed the trial. Therefore, this paper had two aims, to assess whether sleeping with a comfort item affected childrens sleep; and to assess the feasibility of conducting an online, child-led citizen-science RCT. The REST (Randomised Evaluation of Sleeping with a Toy or comfort item) trial was an online two-arm, parallel-group, superiority RCT. Children, aged 7 to 12 years, were randomised (1:1) to either sleep with a self-chosen comfort item ( Try-it-Out group) or refrain from using one ("Wait-and-See" group) for one week. The primary outcome was sleep-related impairment (SRI; PROMIS Pediatric Short Form v1.0 SRI 4a). The secondary outcome was overall sleep quality (Single Item Sleep Quality Scale, SQS). Analyses followed an intention-to-treat principle using mixed-effects models adjusted for baseline measures. A total of 139 children from 11 countries were randomised (mean age: 9.8 years; 45% female); 101 children (73%) completed post-test measures at one week. The adjusted mean difference (Intervention minus Control) in SRI T-scores was -0.53 (95% CI: -3.40 to 2.34; p = 0.714), equivalent to approximately -0.05 SD on a scale where 10 points = 1 SD. This indicated a trivial effect, well below the minimal important difference (MID) of 3 points. The adjusted mean difference in SQS was 0.28 (95% CI: 0.01 to 0.55; p = 0.040), suggesting a small and uncertain difference in favour of the intervention group. However, this result was not supported in subsequent sensitivity or exploratory subgroup analyses. No adverse events were reported. Sleeping with a comfort item for one week did not influence sleep-related impairment. A small statistically significant difference in perceived sleep quality was observed in the primary analysis, but was not sustained in the per-protocol analysis. Together, these findings suggest that any benefit of comfort items for sleep is small and uncertain. The trial demonstrated that children can meaningfully engage in online, citizen-science research, supporting the feasibility of child-led RCTs. Trial registrationISRCTN13756306 (registered 10 January 2025)

BackgroundHelmet use is a proven safety measure that reduces the risk of head injury among cyclists and e-scooter riders. Despite legal requirements for pedal bikes and e-bikes in Australia, compliance varies, particularly among users of electric vehicles. The growing popularity of e-bikes and e-scooters in urban areas presents new public health challenges, yet observational data on helmet use, behavioural determinants, and the effectiveness of safety interventions remain limited. AimPhases 1 and 2 aim to assess helmet use among e-bike, pedal bike, and e-scooter riders in Canberra, and evaluate the impact of health-benefit and legal-penalty signage on compliance. MethodsThis study employs a multi-phase, quasi-experimental observational design across three urban bike paths in Canberra. Phase 1 (Baseline): Helmet use will be recorded via discreet video surveillance, capturing vehicle type, estimated age group, gender presentation, and weather conditions. Phase 2 (Intervention): Two sites will receive signage emphasising either safety benefits or legal penalties, while a third site serves as a control; post-intervention observations will assess changes in helmet compliance. Expected ResultsBaseline helmet use is expected to be higher among pedal bike riders than e-bike and e-scooter riders. Signage interventions are anticipated to increase compliance, with potential variation by message type, vehicle type, and rider demographics. Trial RegistrationAustralian and New Zealand Clinical Trials Registry (ANZCTR) [ACTRN12626000245392]

Socioeconomic inequalities in health and well-being are a major public health concern, particularly in ageing populations. Education is a key determinant shaping multiple aspects of health outcomes. We used cross-sectional data from wave 9 of the German sample (n=4,148) of the Survey of Health, Ageing and Retirement in Europe (SHARE) to test whether formal education is associated with well-being in later adulthood, with health literacy, self-rated health, and preventive health behaviours as possible mediators. Our results showed that education was positively associated with greater well-being, but only via indirect pathways. Specifically, self-rated health, health literacy, and fruit and vegetable consumption mediated the relationship between education and well-being accounting for 54.7, 24.7, and 12.6 percent of the total effect, respectively. In addition, there were significant positive correlations between education and health literacy, as well as high-intensity physical activity, daily fruit and vegetable consumption, more preventive health check-ups, and less smoking. In contrast, alcohol consumption was more common among those with higher levels of education. All health behaviours and health literacy were correlated directly or indirectly (i.e., mediated by health) with well-being. These findings highlight the importance of examining indirect pathways linking education to well-being in later life. Interventions aimed at improving health literacy and promoting healthy behaviours may help reduce educational inequalities in quality of life among older adults.

BackgroundHelmet use is a proven safety measure that reduces the risk of head injury among cyclists and e-scooter riders. Despite legal requirements for pedal bikes and e-bikes in Australia, compliance varies, particularly among users of electric vehicles. The growing popularity of e-bikes and e-scooters in urban areas presents new public health challenges, yet observational data on helmet use, behavioural determinants, and the effectiveness of safety interventions remain limited. AimPhase 3 of the Helmet Use in Canberra study aims to characterise head injury presentations associated with cycling and e-scooter use and examine their association with helmet use and injury severity. MethodsDe-identified emergency department records from The Canberra Hospital will be retro-spectively analysed for presentations involving cycling or e-scooter-related head injuries during the study period. Extracted variables will include age, sex, vehicle type, documented helmet use, injury diagnosis, severity indicators, and date/time of presentation. Descriptive statistics will summarise injury patterns, while regression analyses will evaluate associations between helmet use and injury severity, controlling for demographic and contextual factors. Sensitivity analyses will address missing helmet data and subgroup differences by vehicle type, age, and gender. Expected ResultsIt is hypothesised that lower helmet use will correlate with higher rates and greater severity of head injury presentations. Findings will provide a population-level perspective on helmet effectiveness, inform local injury prevention strategies, and guide public safety interventions. Trial RegistrationAustralian and New Zealand Clinical Trials Registry (ANZCTR) [ACTRN12626000245392]

Aims: Youth loneliness is a prevalent global health concern with lifelong health ramifications. Schools, as children's primary peer environments, are promising settings for loneliness interventions. However, school-based interventions are highly heterogeneous and no review to date has evaluated their effect on loneliness specifically. Methods: A systematic review was conducted to identify studies of school-based interventions measuring loneliness as an outcome in children and young people aged up to 18. Meta-analyses were conducted using a random-effects model to pool effect sizes and examine the significance of intervention characteristics and study design. Reported implementation factors were extracted and narratively synthesised. Results: Thirty-eight studies were included in meta-analysis, of which 19 were randomized controlled trials, ten were non-randomized controlled, and nine were single group studies. A small-to-moderate effect estimate was found, Hedges' g = -0.42 [95% CI: -0.71, -0.13], p = .006, and sub-group analyses indicated that differences in study design and quality did not result in significantly different effect estimates. Psychological interventions, followed by social and emotional skills training, produced significantly higher effects estimates compared with other intervention types. Conclusions: Findings indicate that school-based interventions are effective in reducing youth loneliness. However, study heterogeneity, reporting inconsistencies, and a wide prediction interval indicates this finding should be interpreted with caution. Future research may benefit from improved measurement and reporting of implementation factors, particularly dosage and fidelity.