Journal of Epidemiology and Community Health

Background: The two-child benefit cap, implemented in April 2017, restricted Universal Credit and Child Tax Credit to the first two children in households with three or more children. We evaluate the impact of the two-child benefit cap on parental mental, general, and financial health, as well as investigate how this may differ in particular sociodemographic and economic subgroups based on sex, ethnicity and income. Methods: Data was obtained from parents (youngest child aged 5 or under) in the UK Household Longitudinal Survey from 2009 to 2023. Outcomes included parental mental health (psychological distress and life satisfaction), general health (health-related quality of life (HRQoL), self-rated health and health satisfaction), and financial health (current financial situation and financial outlook). We used complementary policy evaluation methods with different strengths and assumptions to triangulate evidence and strengthen inference: interrupted time series (ITS), difference-in-differences (DiD) and controlled time series analysis (CITS). Subgroup analyses were stratified by sex, ethnicity, and income. Findings: Across methods, findings consistently indicate that the policy worsened life satisfaction, self-rated health, health satisfaction, and financial health for parents of 3+ children. Findings were less consistent across methods for psychological distress and HRQoL. For instance, for psychological distress ITS and CITS indicate adverse impacts of the policy; however, one DiD model did not support this conclusion due to greater average worsening in the control group between the pre- and post-periods. Subgroup analyses indicate greater mental health and general health impacts in lower income, male and ethnic minority parents; while financial health was negatively impacted in all subgroups examined. Conclusions: Using repeated cross-sectional panel data and triangulating across causal inference methods, we conclude that the two-child benefit cap in the UK had a measurable adverse impact on most health outcomes examined, with worse outcomes for male, lower income and ethnic minority parents.

Background Childhood socioeconomic position (SEP) is a key determinant of later life health. Understanding the extent to which adult SEP mediates this association into early old age is important for explaining how health inequalities are propagated across generations and how they might be addressed in later life. To our knowledge, no prospective study has examined whether childhood SEP remains associated with health at the threshold of older age and the extent to which any such association is mediated by adult SEP. Methods We used data from the 1958 British Birth Cohort, a prospective study that has followed participants since birth, drawing on earlier data collected at birth and ages 33 and 55 years and newly collected data from the age 62 sweep. Using interventional causal mediation analyses, we assessed whether adult occupational class, education, housing tenure, and income mediate associations between childhood social class (manual vs non manual) and health at age 62 (self rated health, C reactive protein [CRP], cholesterol ratio, Glycated hemoglobin [HbA1c], and N terminal pro B type natriuretic peptide [NT proBNP]). Findings Associations between childhood SEP and self rated health, CRP, cholesterol ratio, and HbA1c persisted after accounting for adult SEP. Mediation was outcome specific and differed by sex. Among men, occupational class mediated 39% of the association with self rated health (indirect effect RR 0.90, 95% CI 0.86,0.95) and education mediated 27% (0.93, 0.90,0.96). Among women, education mediated 10% (0.95, 0.91,0.98) and housing tenure mediated 6% (0.97, 0.94,0.99). Indirect effects for CRP were smaller, and mediation was minimal for cholesterol ratio, HbA1c, and NT proBNP Interpretation Population level improvements in adult SEP could reduce, but are unlikely to eliminate, later life health inequalities associated with childhood SEP. Reducing these inequalities will require policies that address disadvantage in early life and improve adult financial and employment conditions. Funding UK Economic and Social Research Council

This study investigated the wellbeing of UK police officers transitioning out of service, examining retirees, early leavers, and those within 12 months of retirement (N = 370). Using the Job Demands-Resources model, the research identifies a wellbeing paradox: leavers demonstrate high resilience and subjective wellbeing alongside significantly elevated psychological distress compared to general population norms. Findings reveal that recently retired ([≤]5 years) and soon-to-retire groups are particularly vulnerable, reporting lower quality of life and higher distress than long-term retirees. Perceived organisational support and resilience emerged as critical buffers against the psychological burden of a policing career. However, participants identified significant unmet needs for career, financial, and mental health guidance during the transition. The study highlights that the anticipatory retirement period is an acute window of vulnerability, suggesting that proactive, targeted organisational interventions are essential to mitigate the lasting psychological burden of policing and ensure successful civilian transitions.

Background: Whole-population linked administrative data platforms provide an opportunity to generate evidence on early life multidimensional disadvantage to inform resourcing and service provision to families with complex needs. Methods: We used individual-level de-identified data from nine administrative data sources included in the Better Evidence Better Outcomes Linked Data (BEBOLD) platform. The population included all children born in South Australia between 2004-2011 (n=143,083), and their parents. We described the prevalence and distribution of multiple disadvantages affecting children from the 12 months before birth to age 5. Eleven domains of parental disadvantage were created: economic, education, access to services, mental health, substance misuse, smoking during pregnancy, domestic and family violence, health, child protection contact, justice system contact, and death. We investigated the concordance of our measure with an area-level socioeconomic measure used in government reporting. Results: One in two children (48%) were exposed to at least one disadvantage domain, and one in seven (14%) were exposed to three or more domains before age five. Economic disadvantage was most prevalent, affecting one in four (27%) children, of which 75% were exposed to additional forms of disadvantage. Substance misuse, domestic and family violence, and justice system contact were the least likely domains to occur in isolation. Only 54.4% who experienced five or more disadvantage domains were classified in the area-level socioeconomic measure's 'most disadvantaged' quintile. Conclusion: Early life exposure to parental disadvantage can be highly multidimensional. Measurement across different systems is important for informing coordinated service provision for families with complex needs.

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.

Background Education outcomes predict life chances. However, poverty, ill-health and disability are barriers to achievement. We examined determinants of academic attainment of children with and without major congenital anomalies in state-funded mainstream schools at ages 11 and 16 (key stages [KS] 2 and 4). Methods and Findings Routinely collected electronic records for children born in Wales 01/01/1998-31/12/2007 until 31/12/2019 were linked in the Secure Anonymised Information Linkage (SAIL) Databank. Education outcomes were explored using logistic regression, adjusting for: anomalies, maternal and child deprivation, prescribing, hospitalisation, gestation length, childs sex, and special education needs (SEN) provision. Children with anomalies were less likely to achieve academic standards: however, attainment was more closely associated with affluence. At age 11, 81.87% (7167/8754) with and 93.80% (232,450/247,814) without anomalies passed (odds ratio [OR] 0.30, 95% confidence intervals [CI] 0.28-0.32). At age 16, 46.76% (2070/4427) with and 56.10% (69,732/124,300) without anomalies achieved 5 General Certificates of Secondary Education (GCSEs) at grades C-A* including English/Welsh, Maths and Science (EWMS) (OR 0.69, 0.65-0.73). Discrepancies narrowed in adjusted analyses, particularly when SEN provision was accounted: aOR 0.72 (0.66-0.78) at KS2, and aOR 0.93, (0.87-1.00) for 5 GCSEs C-A* with EWMS. These GCSEs were achieved by 29.65% (307/1034) children with anomalies and 38.42% (10,875/28,305) of unaffected children in the most deprived quintile{dagger}: in the most affluent quintile, figures were 67.57% (547/810) and 74.98% (16,978/22,644). Children with anomalies, receiving maximum SEN support, eligible for Free School Meals (FSM) were the least successful: 5/192 (2.6%) passed 5 GCSEs C-A* with EWMS, as did 37/354 (10.4%) ineligible for FSM. The strongest associations with these GCSEs were SEN statements (aOR 0.07, 0.06-0.07), FSM eligibility (aOR 0.39, 0.37-0.41), and epilepsy (aOR 0.60, 0.45-0.80). However, data were unavailable for 15-18% of children, mainly those educated outside mainstream schools, and some co-morbidities. Generalisation of findings to other countries rests with readers. Conclusions Many children with anomalies from affluent households succeeded. The children left behind lived with poverty and ill-health from congenital anomalies and/or epilepsy. SEN provision mitigated the impact of disadvantage, but poor children with anomalies were unlikely to succeed. {dagger}taking maternal Welsh Index of Multiple Deprivation (WIMD) 2014 at birth.

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.

The end-of-career stage of the police lifecycle represents a profound shift in identity and psychological stability, yet it remains historically neglected in research. This mixed-methods study investigated perspectives of UK police leavers and those approaching retirement (N = 325) regarding desired improvements to organisational support. Content analysis identified four themes: Holistic support and long-term welfare, Institutional culture and professional worth, Navigating the structural transition, and Individual and systemic perspectives. Findings suggest that the psychological contract between the officer and the organisation is often breached at the exit point, shifting from a relational bond to a transactional disposal. Middle-ranking officers and early leavers report the highest levels of institutional abandonment. To address these gaps, this paper makes recommendations for developing effective transitions. By implementing post-service welfare, and adopting structured resettlement models, police organisations can fulfil their duty of care and mend the psychological contract for those who have served.

BackgroundFirst Nations children are over-represented in child protection systems in Australia and other colonised countries. Here, we apply a prevention and equity lens to the use of child protection data, to inform early opportunities to support Aboriginal children and families at risk of escalating child protection contact, from pregnancy to adolescence. MethodsWe followed 15 whole-population cohorts (born 2006-2020) of Aboriginal (n=119,716) and non-Aboriginal (n=1,456,698) children in New South Wales (NSW), Australia, to December 2021, using birth and child protection datasets linked for the NSW Child E-Cohort. In each Aboriginal and non-Aboriginal cohort (2006-2020), we calculated the cumulative incidence (risk) of first-time child protection contacts from the prenatal period up to age 15 years: child concern reports, screened in reports, investigations, child protection-defined substantiations, and OOHC placements. Risk differences and relative risks were also calculated. FindingsBy birth, 10-15% of Aboriginal children born 2006-2020 had a first report to child protection, with 48-54% by age 5y (2006-2016 births), and 74% by age 15y (2006 births), with similar risks of screened-in reports (e.g. 68% by age 15y). The risk of first-time substantiation was 1-5% of Aboriginal children by birth, 17-20% by 5y, and 32% by 15y, with higher risks in more contemporary cohorts. By age 1y, 3-4% of Aboriginal children born 2006-2020 had a first OOHC placement, with 7-9% by 5y, and 14% by 15y. The risk differences between Aboriginal and non-Aboriginal children were 23 and 3 percentage points for reports and OOHC by age 1y (2020 births), respectively, increasing as children age. InterpretationDespite extensive inquiries, calls for prevention and Closing the Gap targets, our study shows the lifetime risk of child protection involvement for Aboriginal families has not improved and inequities persist. These findings support the call for Aboriginal-led approaches and greater investment in early supports for First Nations children and families. Research in ContextEvidence before this study We searched PubMed and Medline for studies on the lifetime risk of child protection contacts among First Nations child populations, published January 2005 to May 2025. Thirteen studies reported various child protection contacts, from the perinatal period through childhood, among birth or synthetic cohorts of First Nations children, born between 1990 and 2018, created from population data sources in jurisdictions in Australia (n=5), the United States(US) (n=6), and Aotearoa/New Zealand (NZ) (n=2) (Table E1). O_TBL View this table: org.highwire.dtl.DTLVardef@1a0d510org.highwire.dtl.DTLVardef@4198eorg.highwire.dtl.DTLVardef@129da77org.highwire.dtl.DTLVardef@c5e234org.highwire.dtl.DTLVardef@18600d7_HPS_FORMAT_FIGEXP M_TBL O_FLOATNOTable E1.C_FLOATNO O_TABLECAPTIONSystematic Review Results: Details of 13 studies on the lifetime risk of child protection contacts among First Nations child populations, published January 2005 to May 2025. C_TABLECAPTION C_TBL The most recently published study included First Nations children born 2000 to 2013 in Western Australia, which quantified the risk of reports, investigations, substantiations and removals into OOHC, from age 1 to 16 years. By age 1, 12% were reported and 3% were removed into OOHC. By age 16, 52% were reported, and 14% were removed into OOHC. Prior studies of birth or synthetic cohorts of First Nations children born 1990-2018, in the USA, NZ, and South Australia showed similar results. By age 5 years, 16% to 54% for reports, 20% for investigations, 7% to 11% for substantiations and 8% for removals into OOHC. Among the five studies with cohorts followed to 18 years, 42% were reported, 28% to 50% were investigated, 9% to 27% were substantiated, 7% to 16% were removed into OOHC and 0.8% to 3.8% had termination of parental rights. Added value of this study This is the largest and most contemporary study to quantify the lifetime risk of child protection contact among whole-populations of First Nations children internationally. Among 15 consecutive whole-population cohorts of First Nations children in New South Wales (NSW), Australia, born 2006 to 2020, we reported--for the first time--the full spectrum of child protection contacts, from the prenatal period. By birth, 16% were reported to child protection, 14% were investigated and 5% were substantiated in the most contemporary cohort born 2020. By age 1 year, 2.8% were removed into OOHC. In the oldest cohort born 2006, 74% were reported and 14.4% removed into OOHC by age 15 years. We also reveal the magnitude of the inequity in child protection contacts between First Nations and non-Indigenous children across the lifecourse. For example, among 2006 births, the risk of first-time reports to child protection for Aboriginal and non-Aboriginal children, respectively, was 10.5% versus 1.5% by birth (risk difference (RD), 9 percentage points; risk ratio (RR), 7.0), 53% vs 16% by age five (RD, 38pp; RR, 3.4) and 74% vs 33% by age 15 (RD, 41pp; RR 2.2). Implications of all the available evidence This study unequivocally shows that the lifetime risk of child protection involvement in the lives of First Nations families has not reduced in more contemporary whole-population cohorts and that inequities persist. This is consistent with evidence from prior studies internationally. It is critical that First Nations-led responses and investment in early family supports must be at the centre of system reform to realise the long-called-for shift toward prevention and to re-dress the pervasive inequities experienced by First Nations children and families in colonised countries such as Australia.

Background Meat processing plants in Alberta, Canada experienced among North America's largest COVID-19 outbreaks. We examined health impacts among workers by occupational hierarchy and equity-relevant characteristics. Methods This exploratory sequential mixed-methods study was guided by community-based participatory research and the PROGRESS-Plus framework. Multilingual qualitative interviews and surveys using validated instruments were conducted among meat plant workers who experienced outbreaks. Interviews were analysed using inductive-deductive thematic analysis. Multivariable logistic regression and linear regression estimated associations between occupational group, racialization, facility, and self-reported COVID-19 diagnosis, physical and mental health, and mean Everyday Discrimination Scale score. We integrated findings using joint displays. Findings Qualitative and integrated analysis of thirty-six interviews described occupational hierarchy shaping unequal protection, limited communication, constrained agency, and psychosocial harms, amplified by income insecurity and family separation. Among 187 survey respondents, compared with general labour, skilled labour (aOR 0.38; 95% CI 0.15-0.89) and management (aOR 0.13; 95% CI 0.01-0.75) had lower odds of reported COVID-19 diagnosis. Compared with Black workers, other racialized workers had lower odds of reporting fair or poor mental (aOR 0.24; 95% CI 0.09-0.58) and physical health (aOR 0.20; 95% CI 0.06-0.54). Compared with workers from the primary facility, others reported lower mean everyday discrimination scores ({beta} = -0.54; 95% CI -0.96 to -0.12). Interpretation COVID-19 harms followed workplace social hierarchies. Pandemic preparedness should combine infection-control measures with paid sick leave and income protection, multilingual communication, enforceable anti-discrimination standards, and independent reporting mechanisms. Funding Canadian Institutes for Health Research (CIHR Application no. 469206). Keywords COVID-19, immigrant workers, migrants, essential workers, health equity, occupational health, PROGRESS Plus

BackgroundExposure to trauma is associated with poor mental health, but little is known about how trauma profiles differ between ex-servicewomen and civilian women. Differences in trauma exposure may arise before, during, and after military service. ObjectiveTo characterise trauma profiles in ex-servicewomen and civilian women in the UK using separate latent class analyses, and to examine associations between trauma class membership and mental health outcomes within each group. MethodsData were drawn from the UK Biobank and stratified by serving status. Ex-servicewomen (n = 446) were compared with civilian women (n = 54,068). Within each group, sixteen lifetime traumatic experiences were assessed, and latent class analysis was applied to identify trauma profiles. Multinomial logistic regression examined associations between class membership and sociodemographic characteristics, and logistic regression assessed associations between trauma classes and mental health difficulties. ResultsFive trauma classes were identified for both ex-servicewomen and civilian women. Ex-servicewomen were less likely than civilians to belong to the low-trauma class (33.0% vs 62.8%) and reported higher exposure to childhood trauma and intimate partner violence. Among civilians, all trauma classes were associated with elevated odds of depression, anxiety, self-injurious thoughts and behaviours (SITB), as well as reduced meaning in life. Among ex-servicewomen, associations were less consistent; only severe cumulative trauma was linked to all adverse mental health outcomes, while other classes showed no differences in anxiety compared to ex-servicewomen with low trauma exposures. ConclusionTrauma profiles and their mental health correlates differ between ex-servicewomen and civilian women. These differences may reflect early life vulnerabilities, military experiences, and post-service exposures. Although ex-servicewomen reported higher levels of trauma, the associations between trauma classes and mental health were less pronounced than among civilians. HighlightsO_LIEx-servicewomen showed substantially higher prevalence of trauma exposure compared to civilian women, with the greatest differences in childhood adverse events and intimate partner violence C_LIO_LISeparate latent class analyses identified five distinct trauma profiles in both groups, with ex-servicewomen considerably less likely to belong to the low-trauma class than civilian women (33.0% vs 62.8%). C_LIO_LIThe association between trauma exposure and mental health outcomes was less consistent among ex-servicewomen than civilian women, suggesting that military service may involve resilience factors that moderate the trauma-mental health relationship. C_LI

Background Health inequalities between occupational or social class groups are pervasive and persistent. Healthcare professionals have better health outcomes compared to the general population. Whether this is a result of healthcare education, favourable socio-demographic characteristics among professionals or other effects is not certain and the extent to which single healthcare occupational groups exhibit inequalities is unknown. We have described self-rated health and quantified geographic health inequalities among a single occupational group of Registered Nurses compared to the general population. Methods We analysed nationally representative samples from the 2011 UK Censuses across England, Wales and Scotland in the Office for National Statistics Longitudinal Study and Scottish Longitudinal Study. Self-rated health and socio-demographic characteristics for the study population are described. Inequalities in health by area deprivation among Registered Nurses and the General Population are quantified. Logistic regression analysis was used to assess the association between Nurse status and self-rated health, adjusting for socio-demographic variables. Results Among economically active, working age adults (n = 478,802), we identified 9,180 Registered Nurses resident in England, Wales and Scotland. 59% of Registered Nurses reported very good self-rated health, with only 1% reporting poor or very poor health. A smaller proportion of Registered Nurses reported less than good health than the General Population at every level of area deprivation and had smaller absolute (4.1 percentage points vs. 9.1) and relative (RR: 1.5 vs. 2.0) inequalities between residents in the most and least deprived areas. Registered Nurses have an increased likelihood of reporting good or better health compared to the general population (Scotland OR: 1.3, 95% CI: 1.2 - 1.5, England & Wales OR: 1.4, 95% CI: 1.3 - 1.5) after adjusting for socio-demographic factors. Discussion Registered Nurses report better health compared to the general population and have smaller inequalities in health by area deprivation. However, unfair and avoidable geographical differences in health are present even in this socioeconomically privileged professional group. After adjusting for socioeconomic and demographic factors, the positive association between being a Registered Nurse and having good self-rated health remained.

Objectives We aimed to describe the characteristics of children and young people referred to social prescribing across the UK and understand what social prescribing looks like for these young people. Additionally, we aimed to explore whether access to and experiences of social prescribing vary with age and have changed from 2017 to 2025. Overall, we aimed to identify whether social prescribing reduces or exacerbates health inequalities among children and young people, and whether this has changed over time. Design Analysis of social prescribing electronic health records Setting Social prescribing hubs and services across the UK that use Access Elemental (a cloud-based social prescribing platform) Participants 52,585 individuals referred to social prescribing in 2017-2025 aged 4-25 years (mean=20.04, SD=4.71), of whom 57% were female, 39% male, <2% were in other gender groups, and 3% did not disclose their gender Primary and secondary outcome measures We summarised the characteristics of young people and described the care pathway received. We then used regression models to test whether these factors differed by age and over time. Results Most individuals were aged 18 and over, 91% lived in urban areas and 58% lived in the top three most deprived deciles of the UK. Most were referred by GPs or other allied health workers (79%) and mental health was the leading reason for referral (44%). The typical pathway included 4.64 social prescribing contacts (SD=7.70) totalling 66 minutes (SD=108), with 34% receiving an onward referral to community support. The average age of those referred to social prescribing increased over time. Conclusions Our findings indicate that social prescribing currently has limited reach for those under 18 and this disparity may be increasing. It was promising that children and young people referred to social prescribing were more likely to live in deprived areas. However, given current findings, more work is needed to increase the reach of social prescribing for children and young people across the UK.

BackgroundSurgery is a widely used treatment option but the impact of surgery on long-term disease across socioeconomic groups is unknown. MethodsLongitudinal population study using linked primary and secondary care data describing adults ([&ge;]18 years) in England recorded in the Clinical Practice Research Datalink (CPRD) between 1st January 2012 and 31st December 2021. Socioeconomic deprivation was defined using the Index of Multiple Deprivation (IMD). The exposure was surgery and primary outcome was long-term disease. Data are presented as n (%), median (IQR), and adjusted hazards ratios (HR) with 95% confidence intervals. FindingsOf 18,329,659 people, 8,951,145 (48{middle dot}8%) underwent surgery. 78{middle dot}6% of index surgeries were elective (n=7,032,475), 21{middle dot}4% were emergency (n=1,918,670). Amongst surgical patients, 4,741,188 (52{middle dot}0%) were women, 3,540,136 (39{middle dot}6%) from the most deprived deciles (IMD 1-4) and 994,595 (11{middle dot}1%) from a minority ethnic group. Age-standardised rates of surgery were higher in deprived individuals (comparative rate ratio IMD 1 vs. IMD 10 elective: 1{middle dot}11 (95% CI 1{middle dot}11-1{middle dot}11), emergency: 1{middle dot}54 (1{middle dot}54-1{middle dot}54)). Age at first surgery was 42 (27-60) years for elective and 42 (25-65) years for emergency surgery overall, but lower for people from IMD 1-4 (elective: 39 (26-57) years, emergency: 38 (24-60) years). Rates of long-term disease increased following both elective (baseline 19{middle dot}6%, three years 24{middle dot}5%) and emergency surgery (baseline 10{middle dot}3%, three years 12{middle dot}3%). Risk of new long-term disease following surgery increased with increasing levels of deprivation (IMD 1 vs. IMD 10 elective: HR 1{middle dot}46 (1{middle dot}45-1{middle dot}48), emergency: HR 1{middle dot}46 (1{middle dot}44-1{middle dot}48)). InterpretationSurgical treatment is strongly associated with the onset of long-term disease and factors which limit healthy life expectancy. Surgery occurs at a younger age among socioeconomically deprived groups and may be linked to health inequalities. Similar but more complex patterns of inequality were seen in minority ethnic groups. FundingBarts Charity and UK Academy of Medical Sciences. Research in ContextO_ST_ABSEvidence before this studyC_ST_ABSThe impact of surgery on long-term health outcomes beyond mortality and surgical complications such as persistent pain is unknown. People from deprived socioeconomic and minority ethnic groups experience increased risks of postoperative complications, readmissions, and death. We searched PubMed, for English language publications in adults aged over 19 years, over the last 10 years to 10th February 2026 using the following search terms: (surg* OR operat*) AND (long-term outcome OR chronic disease OR comorbidit* OR co-morbidit* OR multimorbidit* OR multi-morbidity*) AND (ethnic* OR race OR racial OR socio* OR depriv* OR ineq* OR disparit*). We identified 7,979 reports. To our knowledge, no previous studies have examined the development of long-term disease following surgery or differences in long-term outcomes following surgery between different socioeconomic and ethnic groups. Added value of this studyThis large national cohort study is to our knowledge the first to examine the relationship between surgery and onset of long-term disease. We included over 18{middle dot}3 million individuals, of whom 48{middle dot}8% underwent a surgical procedure during the study period. 5% of elective surgical patients and 2% of emergency surgical patients developed new long-term disease within three years of surgery. Accounting for differences in age, people from the most deprived decile experienced 11% higher rates of elective and 54% higher rates of emergency surgery compared to the least deprived. People in the most deprived decile underwent their first surgery nearly ten years earlier than those in the least deprived decile with a 46% higher risk of developing new long-term disease within three years of surgery. Although age standardised rates of surgery were lower, people from minority ethnic backgrounds underwent surgery for the first time up to sixteen years earlier that those from white backgrounds and had similarly had higher risk of developing new long-term disease at three years. Implications of all the available evidenceSurgical treatments are associated with onset of long-term disease. This unexpected consequence should be considered when managing patients expectations when planning surgery with them. There are important inequalities in rates of both elective and emergency surgery, and the age this first occurs, between different socioeconomic and ethnic groups. Those from socioeconomically deprived backgrounds and minority ethnic groups undergo surgery at a younger age and are also at greater risk of developing long-term disease and hence reduced healthy life expectancy. One explanation for this may be differences in lifestyle and disease prevention behaviour. Surgery is therefore an important marker for inequalities in healthy life expectancy. The perioperative period is a key opportunity to better manage long-term health to reduce further inequalities. The patterns of these relationships are complex, and a more detailed understanding is needed to ensure that surgery can be better utilised as an opportunity to improve societal health.

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.

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.

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.

Background: The ECAIL trial, launched in 2017, targets hard-to-reach families and evaluates a multicomponent childhood obesity prevention intervention. At a maternity hospital in Lille, France, healthcare providers screened pregnant women experiencing social vulnerability, and dietitians delivered a home-based intervention until age 2. The COVID-19 pandemic led to a six-month suspension in 2020. This study compared eligibility and participation before the pandemic and after resumption, and examined how the pandemic and subsequent cost-of-living crisis shaped implementation and reach. Methods: We analyzed 5,744 eligibility questionnaires distributed at the maternity ward. Inclusion criteria included [&ge;]1 indicator of social vulnerability (e.g., socioeconomic disadvantage, precarious housing, or social isolation). To capture implementation experiences, a psychosocial researcher conducted a focus group with six dietitians delivering the intervention; it was recorded, transcribed, and analyzed thematically focusing on reach, acceptability, and adaptation. Results: Eligibility increased from 29.7% (n=955) prepandemic to 33.6% (n=849) after resumption, while the distribution of vulnerability criteriaremainedsimilar across periods:78.3% received social/medical benefits; employment was not the main source of household income for 58.7%; 24.4% experienced financial hardship; 14.7% reported social isolation; 6.0% lived in precarious housing; and 19.0% had three or more vulnerabilities. Participation among eligible women remained stable (24.6%; n=443). Qualitative findings indicated dietitians satisfaction and participants enthusiasm for the resumption of home visits, particularly in addressing social isolation. After resumption, the introduction of a pre-visit COVID-19 questionnaire reduced missed appointments. Converging qualitative and quantitative findings indicated sustained, and in some cases strengthened, provider engagement despite pandemic-related strain on hospital services. Conclusions: This study shows that a complex intervention can maintain reach and acceptability through adaptive implementation under major contextual disruptions.The rapid resumption of home-based services emerged as a robust strategy for engaging and retaining socially disadvantaged families, highlighting the importance of flexible, context-sensitive approaches during social and economic crises.

BackgroundThe public health grant is used by upper-tier and unitary local authorities in England to fund public health services. Public health grant allocations have declined by 26% per person since 2015/16, with cuts being made without any adjustment based on population needs, resulting in absolute cuts often being greater for more deprived local authorities. This study seeks to investigate how these cuts have affected spending decisions across different areas of public health and how changes in spend relate to population health needs. MethodsIn this longitudinal ecological study, data on local government revenue expenditure and financing to 146 upper-tier local authorities in England were extracted from the Ministry of Housing, Communities, and Local Government for the years 2017/18, 2018/19 2019/20 and 2022/23. Demand for each function of the public health grant was proxied using a publicly available indicator of need. Descriptive analyses explored changes to grant expenditure over time by function and IMD quintile. A compositional regression model was developed to account for the relatedness of spend data. The significance of associations between indicators of need and spend on functions of the grant was tested using MANOVA, producing Pillais Trace statistics as an indication of the effect size of each explanatory variable relative to others. FindingsPublic health grant spending reductions were widespread. More deprived local authorities often experienced deeper absolute cuts against a backdrop of greater need, with spend being protected across all IMD quintiles in only three areas: childrens 0 to 5 non-prescribed functions, health protection, and public mental health. In the multivariate regression, there was limited relationship between indicators of health need and patterns of grant spend between public health categories. InterpretationThere is no clear relationship between potential indicators of need and expenditure of the public health grant in different reporting categories. Instead, spending decisions are being driven by other factors that may include historic spend, wider local priorities and financial pressures. These findings suggest a review of the public health grant formula to support local authority public health teams to more strategically apportion spend based on population health need. O_LIWhat is already known on this topic O_LILocal authority public health teams in England receive a ring-fenced grant from central government which was originally based on an allocation formula that has not been updated since 2012/13. C_LIO_LIThe grant has been cut substantially over the past decade, often with larger absolute cuts for more deprived local authorities. C_LIO_LINo previous study has investigated how public health teams allocate a diminishing grant across competing areas of public health need and how this may vary by deprivation. C_LI C_LIO_LIWhat this study adds O_LIThis study found limited evidence that indicators of health need have driven public health grant allocation in related spend categories, nor any differences by deprivation. Our analysis is the first to explore multiple indicators of need and to employ compositional regression to account for corelations between categories of grant spend. C_LI C_LIO_LIHow this study might affect research, practice and policy O_LIThis study supports a review of the public health grant funding formula to better distribute the public health grant according to local population health need. C_LI C_LI

This study investigated retirement adjustment in retired police officers in the UK (N = 289), examining how time since leaving the service moderates the relationship between perceived organisational support and retirement adjustment while accounting for resilience. Results indicated a developmental trend: organisational support remains stable initially but becomes increasingly influential in later life. Using Johnson-Neyman analysis, a threshold of 32.07 years was identified, after which the association reaches statistical significance. These findings suggest an organisational legacy effect; for the older generation, the retrospective perception of being valued by the service acts as a durable psychological resource. This study offers a novel conceptualisation of long-term organisational influence by identifying a temporally delayed legacy effect that extends beyond existing models of retirement adjustment. The study advocate for lifelong wellbeing strategies that extend, recognising that the organisational relationship continues to shape adjustment outcomes decades after the conclusion of active duty.