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 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.

Young people are increasingly remaining in the parental home for longer - a trend associated with poorer mental health. There is little evidence on this transition for young people with disability. We used three waves of the Australian Census Longitudinal Dataset, a 5% sample of linked Census records. Two analyses compared transitions between 2011-2016 and 2016-2021 among people 15-34y living with parents at baseline with complete data on disability and housing. The proportion of people no longer living with parents at follow-up was calculated, comparing people with and without disability, along with absolute and relative inequalities. Young people with disability were half as likely to leave the parental home as their peers without disability. Inequalities were greatest for people 25-29y (relative difference 0.41 (95%CI 0.36-0.45), living outside major cities (0.48, 0.44-0.52), or with higher income (0.53 (0.47-0.59). Patterns were consistent over time. Targeted supports are needed to enable independent living. Points of interestO_LIWe found that less people with disability leave the parental home than people without disability C_LIO_LIWe also found the gap between people with and without disability was biggest outside major cities. C_LIO_LIThis may mean people with disability in rural, regional and remote areas find it more difficult to move out of home C_LIO_LIBetter housing and income supports are needed to help young people with disability live in the way they choose C_LI

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.

BackgroundSexual minority (SM) individuals have worse mental health than heterosexual peers. However, there is no total population-based and national-level evidence on differences in risk of self-harm and suicide by sexual orientation. This study provides the first national population-based estimates in England and Wales. MethodsUsing 2021 Census data linked with hospital records and death registrations, we analysed sexual orientation (SO) differences in: (i) at least one hospital inpatient admission/emergency attendance for intentional self-harm, and (ii) death by suicide. We calculated age-standardised rates per 100,000 people by SO between March 2021 and December 2023, and stratified by sociodemographic, geographical, socioeconomic and health-related variables. We calculated rate ratios for lesbian/gay/bisexual/other SO (LGB+) groups compared with heterosexuals to estimate sexual identity disparities. FindingsOur study population included 28.7 million people (mean age 48.1 years, 53.7% female, 84.2% White) aged [≥]16 years who self-reported their SO in Census 2021 and linked to an NHS number. LGB+ individuals had 2.52 (95% CI 2.48-2.56) times higher risk for self-harm and 2.17 (95% CI 1.98-2.37) times higher risk for suicide than heterosexual people. Relative risk of self-harm was highest for LGB+ females, younger adults, and Black individuals. Relative risk of suicide was highest for LGB+ females, older adults, and Black individuals. InterpretationThis study demonstrates stark inequalities in risk of self-harm and suicide by sexual orientation, consistent across multiple sociodemographic factors. These findings are important for informing government prevention programs and further mental health research. FundingThere was no external funding for this study. Research in contextO_ST_ABSEvidence before the studyC_ST_ABSThe substantial evidence on higher risk for self-harm and suicide in sexual minority groups in the UK (and wider Europe) is impacted by regional samples, younger populations, or surveys limited by smaller numbers precluding analyses by key sociodemographic factors (like sex, ethnic group, socioeconomic indicators, faith, housing situations and geographical indicators) or combining all sexual minority groups together. To date, no study has used total population-based data to examine sexual orientation inequalities in self-harm and suicide and in relation to a range of sociodemographic factors. Added value of this studyTo our knowledge, this is the first study in the UK to provide national population-based estimates of intentional self-harm and suicide by sexual orientation, including intersectional analyses across age, sex, ethnic group, and socioeconomic position. This study used a unique linkage between the census, hospital inpatient data, emergency care records and death registrations from across England and Wales, with a study population of 28.7 million people aged [≥]16 years who self-reported their sexual orientation in Census 2021 and linked to a National Health Service (NHS) number. Implications of all the available evidenceThis research provides national population-level evidence of substantial increased risk for self-harm and suicide among sexual minority individuals, compared with heterosexual individuals. This study also identified key groups of individuals at an increased risk of self-harm and suicide. These findings are important for informing government prevention programs and further research supporting the mental health of sexual minority groups.

BackgroundHome disciplinary practices shape childrens health and development. Yet, comprehensive, up-to-date global evidence on their levels, trends, and socioeconomic and regional inequalities remains limited. This study provides the first global prevalence estimates of both violent and non-violent forms of discipline, examining regional disparities, variations by child and family characteristics, and changes over time. MethodsWe drew from 176 nationally-representative Multiple Indicator Cluster Surveys and Demographic and Health Surveys, collected between 2005 and 2023 across 83 low- and middle-income and 5 high-income countries (N= 1,544,000 1-14y-olds). We estimated weighted prevalence estimates for all types of discipline (exclusively or only non-violent, physical and severe physical punishment, emotional violence, exclusively or only physical punishment, exclusively or only emotional violence, both physical and emotional violence). Disparities by child age, sex, residence, maternal education, household wealth, and world regions were computed. We also assessed changes over time for countries with multiple surveys. ResultsOnly 19.1% of children experienced exclusively non-violent discipline; 55.0% and 12.7% physical and severe physical punishment; and 64.0% emotional violence. Violent discipline was highest among 6-9y-olds, in Sub-Saharan Africa, and in poorer households. Sex differences were more limited. Use of only non-violent discipline slightly increased in 26 countries, while physical and emotional violence decreased in 33 and 31 countries, respectively. Yet, in some countries, violent discipline increased over time. ConclusionsDespite policy efforts to increase its use, exclusive non-violent discipline remains low, and violent methods are widespread. Targeted and context-specific interventions for specific age groups and poorer households curb violence exposure at home.

BackgroundConcern about long-term health effects of repetitive head impacts in football has increased, but it remains unclear whether position-specific exposure patterns were associated with differential long-term all-cause mortality among elite players across the 20th century. MethodsWe conducted two retrospective cohort studies of elite male professional football players. The World Cup cohort included all players on the team rosters from FIFA World Cup tournaments (1930-1990), and the UEFA European Cup cohort included all players who appeared in annual quarterfinal, semifinal, or final matches (1956-1991). Vital status was ascertained through archival linkage. Playing position was harmonized into six categories. Age was the time scale. Cox proportional hazards models were stratified by birth cohort and adjusted for origin region; interaction models were used to estimate region-specific marginal hazard ratios. FindingsThe World Cup cohort included 4,223 players (2,330 deaths), and the European Cup cohort included 2,710 players (1,126 deaths). In the World Cup cohort, goalkeepers had lower mortality than midfielders (hazard ratio [HR] 0.73, 95% CI 0.63-0.84), whereas center-forwards had higher mortality (HR 1.27, 95% CI 1.08-1.50); mortality among center-backs was elevated but not statistically significant (HR 1.13, 95% CI 0.98-1.31). In the European Cup cohort, center-backs (HR 1.28, 95% CI 1.07-1.55) and other defenders (HR 1.20, 95% CI 1.02-1.42) had higher mortality than midfielders. Region-stratified marginal estimates indicated that elevated risks for central playing roles were greatest in Northwestern Europe and Central/Eastern Europe. InterpretationAmong footballers active during the 20th century, long-term all-cause mortality differed by playing position and varied by region, with higher risks concentrated in central attacking and defensive roles. These patterns were most pronounced in regions where aerial contests historically predominated, suggesting that long-term health risks associated with professional football participation vary by role-specific exposure profiles.

ObjectiveExplore self-reported racial discrimination in healthcare. MethodsRepresentative population sample, Switzerland, repeated cross-sectional data 2016 to 2024 (N=15,525). ResultsContrary to expectation, respondents from the migration-related population (foreign citizens, foreign born, migration background, first/second generation) report less racial discrimination than members of the majority population. Over time, we see an increase in the non migration-related population reporting (racial) discrimination in healthcare, while the share for the migration-related population is constant. The validity of the instrument is demonstrated with reported discrimination at work and in housing and the results are reliable across specifications and statistical controls. ConclusionWe speculate that in some cases, reported racial discrimination may express unmet expectations in healthcare more generally.

BackgroundCommunity safety is a key determinant of mental well-being, yet racially and ethnically minoritised communities in the UK often face higher exposure to violence alongside barriers to formal protection and support. In these contexts, informal support networks may play a critical role in shaping how safety is experienced and how distress is managed. Although such networks are widely recognised as protective for mental well-being, there is limited qualitative research examining how they operate in relation to community safety in settings shaped by structural inequality. This study explores how informal support networks influence experiences of community safety and mental well-being among racially and ethnically minoritised groups in South East London. MethodsThis qualitative study draws on semi-structured interviews (n = 31) with racially and ethnically minoritised participants aged 16+ living or working in Lambeth and Southwark [South East London]. Using a co-produced qualitative design, community consultations informed the development of interview topics. Interviews explored informal support networks, experiences of community safety and their intersections with mental well-being. Audio-recorded interviews were transcribed verbatim and analysed using inductive thematic analysis. ResultsFour themes were identified: (1) experiences of community safety and their mental health impacts; (2) gendered experiences of safety and responsibility; (3) formal support and its barriers; and (4) community and peer-led initiatives as a response to institutional distrust. ConclusionInformal support networks are central to everyday safety and emotional well-being, yet they cannot substitute for adequately resourced, culturally informed public provisions. Strengthening public infrastructure must involve meaningful collaboration with trusted community networks and address the intersectional needs of racially and ethnically minoritised groups.

IntroductionImproving the number of children who achieve a good level of development (GLD) on the Early Years Foundation Stage Profile (EYFSP) at the end of their first school year (aged five), and reducing the equity gap in this outcome was made a national priority in England in 2025. Children in England also receive a developmental assessment - the Ages and Stages Questionnaire-3 (ASQ-3) aged two. No study to date has explored the association between the ASQ-3 and EYFSP assessments. The aim of this study is to explore whether a GLD on the ASQ-3 is predictive of a GLD on the EYFSP using a longitudinal sample of children. MethodsLongitudinal pseudonymised data from the Connected Bradford dataset was used to undertake multiple regression analyses. ResultsFrom September 2013 to May 2025, 47,046 children had an ASQ-3 record, of whom 6,021 (13%) had a linked EYFSP record. Boys and children living in the lowest quintiles of the Index of Multiple Deprivation were less likely to achieve a GLD on both the ASQ-3 and the EYFSP. Children from South Asian ethnic groups were least likely to achieve a GLD on the ASQ-3, whilst White Other children were least likely to achieve a GLD on the EYFSP. Achieving a GLD on the ASQ-3 was predictive of a GLD on the EYFSP, with children who achieved a GLD on the ASQ-3 having more than three-times the odds of achieving a GLD on the EYFSP (OR 3.18, 95% CI 2.70 to 3.75). ConclusionThis study highlights the potential value of using the ASQ-3 results to intervene early and support more children to become school ready. These findings also show that many children have fallen behind by the age of two, thus emphasising the importance of intervening from the earliest possible moment to reduce inequities in child development. Key MessagesO_ST_ABSWhat is already known on this topicC_ST_ABSO_LIIn England, approximately 3 in 10 children do not reach a Good Level of Development (GLD) on the Early Years Foundation Stage Profile (EYFSP) which is undertaken at the end of the Reception year of school. Reaching a GLD is associated with later educational attainment. C_LI What this study addsO_LIThis study is the first to use longitudinal data to explore whether achieving a GLD on the developmental assessment undertaken at age 2 - the Ages and Stages Questionnaire 3 (ASQ-3), can predict the GLD on the EYFSP at school. C_LIO_LIThis study found that children who did not achieve a GLD on the ASQ-3 had three times the odds of not achieving a GLD on the EYFSP. Boys, those living in areas of high deprivation, and those from White Other backgrounds were also less likely. C_LI How this study might affect research, practice or policyO_LIThis study highlights the potential value of using the ASQ-3 results to intervene early and support more children to become school ready. These findings also show that many children have fallen behind by the age of two, thus emphasising the importance of intervening from the earliest possible moment to reduce inequities in child development. C_LI

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

BackgroundOut-of-hospital cardiac arrest (OHCA) survival depends on timely bystander cardiopulmonary resuscitation (CPR) and quick defibrillation via automated external defibrillator (AED). However, access to CPR education and willingness to intervene are not equitably distributed. Within the Muslim community, intersecting religious identity, language, immigration-related concerns, and other social determinants of health may affect CPR/AED education, bystander response, and ultimately OHCA outcomes, underscoring the need for culturally responsive, faith-based training models. MethodsA survey based cross sectional study was conducted to evaluate the perceived barriers to emergency response and lay rescuer cardiopulmonary resuscitation (CPR). Individuals aged 13 years and older were recruited between January and June 2025 through convenience sampling at free, non-certification public CPR/AED classes, where participants self-reported demographic characteristics and barriers to calling 9-1-1 or initiating CPR. Analyses compared Muslim and non-Muslim participants using Fisher exact tests and multivariable logistic regression models adjusted for demographic and socioeconomic factors, with results reported as odds ratios (OR) and 95% confidence intervals (CI). ResultsOf the 651 surveys collected, 33% of participants identified as Muslim, and 46% reported no prior CPR/AED training, with a higher proportion among Muslim respondents (57% vs 41%). Religion was significantly associated with some perceived barriers, with Muslim participants more likely to report law enforcement as a barrier to calling 9-1-1 (OR: 0.53 for non-Muslims vs Muslims, p=0.04) and less likely to report "no problem" starting CPR (OR: 0.91, p=0.04). Race and gender also influenced barriers, with non-white and female participants more likely to report immigration status, language, cost, and concern for violence as barriers to initiating CPR or calling 9-1-1. ConclusionMuslim participants were more confident in performing CPR, but reported less confidence in calling 9-1-1, revealing gaps in emergency response readiness. This emphasizes the importance of culturally adapted CPR/AED training that addresses specific barriers within faith-based communities and to strengthen all links of the chain of survival.

Since the cessation of real-time monitoring of COVID-19 hospitalizations in early 2024, the burden of and vaccine effectiveness (VE) against severe COVID-19 in the Netherlands was largely unknown. Recently, hospitalization data from 2024 were made available for the purpose of monitoring and evaluating the COVID-19 vaccination campaigns. These data were linked to the population registry, vaccination registry and healthcare use data (for classification into medical risk groups). We analyzed the number and incidence of COVID-19 hospitalizations in 2023 and 2024 by age and medical risk group. VE against hospitalisation of the autumn booster of 2023 (by time since vaccination, 25 September 2023 to 16 September 2024) and of the autumn booster of 2024 (16 September to 31 December 2024) were estimated by medical risk group among persons aged 60 years and older using Cox proportional hazards models with calendar time as underlying time scale and vaccination status as time-varying exposure. Models were adjusted for age, sex, region and household socio-economic status. From around age 60 onward, intermediate and high medical risk groups had a markedly higher incidence than younger age groups, increasing with age. Persons in the low medical risk group had a low incidence up to the age of 80. In 2024, incidence was lower than in 2023. For both autumn booster rounds, estimated VE against hospitalisation was moderate at 55-67% in the first 3 months post-vaccination. In the high medical risk group, 2023 VE decreased fast and was no longer significant at 6 months post-vaccination. For both years, estimates of the number of averted hospitalizations and number needed to vaccinate to prevent one hospitalization indicated that significant health benefit can be achieved by vaccinating the intermediate and high medical risk groups aged 60 years and older. Efforts to increase the moderate vaccine uptake among risk groups could potentially prevent a considerable disease- and healthcare burden. Highlights- In 2023 and 2024, incidence of COVID-19 hospitalization was highest among medical risk groups aged 60 years and older, despite vaccination campaigns. - Estimated VE against hospitalisation of the 2023 and 2024 autumn booster campaigns was moderate (55-67%) in the first year-quarter post-vaccination among persons aged 60 years and older. - Estimated VE of the 2023 autumn booster decreased over the year, and faster among persons with a medical risk condition. Data availability precluded estimates of 2024 VE beyond the first 3 months since the start of the campaign. - Despite lower and waning VE, the estimated number needed to vaccinate to prevent one COVID-19 hospitalization was much lower among intermediate and high medical risk groups compared with the low medical risk group.

Childhood adversities are common and linked to increased risk of premature mortality, including deaths from accidents in early adulthood. We examined associations between childhood adversity and specific types of lethal accidents using nationwide register data from 1,282,636 individuals in the DANish LIFE course (DANLIFE) cohort born between Jan 1, 1980, and Dec 31, 2001, who did not die or emigrate before age 16. Individuals were classified into five trajectory groups based on annual exposure to 12 adversities across three dimensions from ages 0-15. Accident mortality was categorised into traffic, narcotic and hallucinogenic, other poisoning, and other accidents. Individuals were followed through Dec 31, 2022. Relative and absolute risks were estimated using Cox proportional hazards and Aalen additive hazard models. Compared with the low-adversity group, individuals in one of the childhood adversity groups experienced 4.4 to 33.8 additional accident deaths per 100,000 person-years. The largest relative (HR=13.4 95% CI [9.9-18.6]) and absolute (HD=12.9 95%CI [10.0-15.8]) differences were identified for the high versus low adversity group. High childhood adversity is strongly associated with preventable accident mortality in early adulthood, underscoring the need for structural and social interventions to reduce adversity exposure and related excess mortality.

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.

IntroductionObesity and related health conditions are unevenly distributed across neighborhoods, often co-occuring with multiple health challenges and socioeconomic disadvantages. Using an ecosyndemic framework, which integrates ecological and social dimensions that contribute to the clustering of health problems, this study examines how adverse obesity-related health outcomes spatially cluster in relation to obesogenic environments and socioeconomic position (SEP) across Dutch neighborhoods. MethodsNationwide neighborhood-level data on health outcomes, obesogenic environmental exposures (food environment, walkability, drivability, bikeability, sports facilities), and SEP were combined for all inhabited Dutch administrative neighborhoods in 2016 (N=12,420). Cluster analysis was used to identify distinct neighborhood profiles and descriptive statistics to characterize each cluster, with spatial patterns visualized using an interactive heatmap and principal component plots. ResultsFive neighborhood clusters were identified. The Ecosyndemic cluster (N=1,070 neighborhoods) exhibited the highest burden of obesity (17% [IQR 16;19), chronic diseases (36% [IQR 33;38%) and risk of anxiety/depression (55% [IQR 51;58]), unhealthy food environments and low SEP. In contrast, the Privileged cluster (N=6,425) had more favorable health outcomes and living conditions, including lower obesity prevalence (12% [IQR 11;14]). The Psychosocial Vulnerability cluster (N=991) was notable for elevated risk of anxiety/depression (47% [IQR 43;51]) combined with relatively low obesity (11% [IQR 8;12]). The Syndemic cluster (N=1,836; obesity 15% [IQR 14;17]) and Towards Privileged cluster (N=2,098; obesity 12% [IQR 10;13]) represented intermediate profiles. ConclusionObesity and related health issues frequently cluster with unfavorable environment and SEP at the neighborhood level. The ecosyndemic framework offers a novel approach for identifying high-risk areas and supports targeted, social and place-based interventions.