Journal of Public Health

Background: Workplace discrimination and violence against health workers including sexual harassment is a societal problem worldwide. We aimed to assess the frequency, predictive factors, and effects of sexual harassment using a nationwide survey of physicians working in Switzerland. Materials and Methods: We conducted a self-administered questionnaire survey of physicians working in Swiss healthcare institutions. The questionnaire assessed experiences of sexual harassment at work, including frequency, types, and sources of harassment. It also asked about the impact of sexual harassment, whether incidents were reported, and what actions were taken following a report. Results: Among the 1837 physicians that participated in the survey, 575 (31.3%) had experienced sexual harassment at least once during their career. Among those reporting sexual harassment, 39.1% of women and 13.2% of men had experienced harassment at least once in their job. Women reported more verbal harassment, while men reported more physical harassment. Women were also more likely to face both forms combined. The main sources of harassment were colleagues of the same profession (46.7%), patients (42.3%), and superiors (41.0%). The most frequently reported impacts included stress (60.1%), emotional exhaustion (34.7%), reduced motivation at work (30%), and considering leaving the job (7.5%). Gender-men was associated with a lower likelihood of experiencing harassment 0.24 (0.18 to 0.31), whereas working in the German-speaking region was associated with a slightly higher likelihood of having experienced sexual harassment at least once (OR 1.35, 95% CI:1.02-1.81). Conclusions: Sexual harassment is common among physicians in Swiss healthcare institutions. It adversely affects the mental health and career trajectories of both men and women yet remains widely underreported due to fears of reprisals and inaction. Institutions should effectively intervene to ensure that reported incidents result in appropriate actions, and that those who report them receive adequate protection from reprisals.

Objectives To investigate the association between time spent in NHS Type 1 emergency departments (EDs, consultant led 24 hour services with full resuscitation facilities) and risk of leaving employment and hospitalisation after leaving the department alive up to two years after attendance. Methods We conducted a retrospective cohort study using linked administrative data from the NHS Emergency Care Dataset, Hospital Episode Statistics, Census 2021, and mortality records. ED length of stay was categorised from under 2 hours to 12 hours or more. Cox proportional hazards models were fitted to estimate the association between ED length of stay and subsequently leaving employment or being hospitalised over a two year follow-up period, adjusting for demographic, socioeconomic, and clinical characteristics. Results Our study population comprised 3,347,008 individuals aged 25 to 64 who attended a Type 1 ED in England between April 2021 and March 2023. For leaving employment, adjusted hazard ratios (aHRs) increased from 1.04 (95% CI 1.03 to 1.06) for stays of 2 to <4 hours to 1.21 (1.17 to 1.24) for 12 hours or more, compared with stays under 2 hours. A similar but more pronounced gradient was observed for post-discharge hospitalisation, with aHRs rising from 1.06 (1.04 to 1.07) at 2 to <4 hours to 1.95 (1.91 to 1.99) for stays of 12 hours or more. Conclusions Prolonged time spent in the ED is associated with poorer outcomes among working-age employees, including reduced labour market participation and increased hospital use. These findings suggest that long ED stays may have wider and longer-term implications beyond immediate clinical outcomes, including potentially for national labour markets and economic growth.

This paper examines the impact of Cancer Care Ontario's regionalization of lung cancer surgery on blood transfusion use for thoracic surgery at The Ottawa Hospital. Using aggregate data scraped from the paper ''Changing trends in blood transfusion: an analysis of 244,013 hospitalizations'' by Shehata et al. (2014) we estimated the effect regionalization on the log mean number of blood transfusions among thoracic surgeons (who treat lung cancer), utilizing other surgical specialties as controls. We found that the average number of blood transfusions increased significantly among thoracic surgeons following the opening of a new cancer care centre at the hospital in December 2009, while control specialties showed no parallel change. Contextualizing these results in a modified ''population level'' treatment threshold model, it is argued that the main driver of this increase in blood transfusions among thoracic surgeons was due to the influx of less skilled thoracic surgeons to The Ottawa Hospital, and the closing of thoracic surgery units at smaller hospitals which was part of the broader regionalization process.

Background: Disaster medicine has been a formal curricular recommendation in German health professions education since 2006, and comparable recommendations exist internationally. Evidence on implementation is confined almost entirely to human medicine, rests on faculty self-reports or small student samples, and measures delivery rather than retention. Whether curricular exposure is associated with willingness to serve has not been adequately examined in interprofessional samples. Objective: We aimed to characterize disaster medicine education across 7 health professions in Germany, distinguishing delivery from retention, to identify profession-specific gaps and training priorities, and to examine how educational and experiential factors relate to willingness to serve. Methods: We conducted an anonymous nationwide online cross-sectional survey of students and trainees across 7 health professions in Germany between July 9 and August 25, 2026, recruited through institutional distribution lists. The interprofessionally developed instrument comprised 48 items. We assessed delivery and retention of 12 disaster medicine topics (4-point scale), self-rated confidence in 22 clinical and nursing skills (6-point scale), desired content, formats, motivators and barriers, and formal and spontaneous willingness. For all rating scales, higher values denote the more favorable level. We derived a delivery-retention gap and a want-deficit index, examined the dimensional structure of the competence battery, tested for differential item functioning by prior civil protection engagement, and modeled willingness with a cumulative link model. Results: Of 8133 respondents (completion rate 87.5%), 33.1% had never been taught disaster medicine and 25.0% only in passing; 22.1% had comprehensive teaching including practical exercises. Across the 12 topics, the proportion able to retrieve content confidently never exceeded 23.9%; the delivery-retention gap reached 47.3 percentage points. More than half (54.6%) had never taken part in a practical exercise. Competence formed more than 1 dimension: 18 acute-technical items loaded 0.54-0.86 on the first factor, 4 relational and nursing items 0.14-0.28. Prior civil protection engagement was associated with higher confidence on every acute-technical item (Cliff delta 0.26-0.55) and lower confidence on all 4 relational items (-0.22 to -0.09). Willingness was high and homogeneous across groups (78.7% formal, 84.1% spontaneous), whereas competence varied by about 2 scale points. Adjusted, active civil protection engagement (odds ratio 2.49, 95% CI 2.12-2.94) and practical exercise experience (odds ratio 1.78, 95% CI 1.54-2.05) were the strongest predictors; curricular exposure contributed weakly (odds ratio 1.06 per SD, 95% CI 0.99-1.14). Conclusions: Two decades after the curricular recommendation, disaster medicine is largely absent from health professions education in Germany, and what is delivered is not retained. Willingness is nevertheless high and largely decoupled from competence, so qualification and recruitment require separate instruments. Curricula should be prioritized by the coincidence of demand and deficit rather than by coverage, built for retention, and should treat relational and nursing competence as a distinct learning objective.

Background: Social vulnerability is associated with adverse health outcomes, but existing social vulnerability indices often rely on cohort-based and self-reported data, potentially limiting their population-level applicability. Therefore, this study aimed to develop an SVI from routinely collected electronic health records (EHRs) using natural language processing (NLP) and examine its association with mortality and healthcare utilization. Method: EHR data from 193,629 individuals aged 35 to102 from the Wellbeing Services County of Central Finland between years 2010 and 2023 were used in this study. A 6 item SVI (total score 0 to 6) was developed from free-text clinical notes using deep-learning-based NLP. SVI scores were calculated at baseline and annually for individuals. Associations between baseline SVI and all cause mortality and healthcare utilization were assessed over 12-year follow-up using Cox and count models. Results: The mean baseline SVI among all participants was 0.35 (range 0 to 6). Women had higher SVI (0.39) than men (0.32, p<0.001). SVI increased with age. One unit increase in SVI was associated with a higher risk of mortality (Hazard Ratio (HR) 1.23; 95% Confidence Interval (CI) (1.21 to 1.24), a higher odds of using healthcare services (Odds Ratio (OR) = 1.20; 95% CI): 1.19 to 1.21) and a greater healthcare service use (Incidence Rate Ratio (IRR) = 1.07; 95% CI: 1.06 to 1.07). Discussion: An index capturing multiple domains of social vulnerability can be derived from EHRs using NLP. Higher SVI was associated with increased mortality and healthcare utilization. These findings support the potential of EHR data for assessing social vulnerability and related health risks.

Introduction In July 2025, WHO launched the 3 by 35 Initiative calling on countries to increase real prices of tobacco, alcohol, and sugary drinks by at least 50% by 2035 to secure an additional $ 1 trillion in public revenue. While the effectiveness of excise taxes and prices in reducing tobacco use is well-documented, the feasibility of this call to action has not been evaluated empirically across the world. Methods Trend changes in countries nominal and inflation-adjusted retail prices were investigated using the most-sold brand of cigarettes over windows ranging from 2 to 16 years over the period 2008-2024, derived from nine editions of the World Health Organization Report on the Global Tobacco Epidemic. Statistical models of the association of cigarette excise taxes and prices from the panel of 195 countries were estimated. The frequencies of cigarette prices rising by at least 20% and 50% over preceding periods was estimated, and the length of time countries would need to reach these targets based on past trends were predicted. Results Over one- fifth of nominal cigarettes prices (and up to 40% in WHOs African region) were sticky across successive periods, even in countries with high overall consumer price inflation. Between 2008 and 2024, inflation-adjusted international dollar cigarette prices rose at a least squares annual trend growth rate of 2.9% (95% UI 2.8-3.0%) Excise tax increases strongly predict price increases. One-third of countries saw real prices at least 50% higher than 10 years prior. Conclusion Many of the instances of real price increases of 50% or more over 10-year periods occurred without countries implementing a conscious strategy to raise taxes. It is feasible to achieve and even surpass WHOs 3 by 35 call to action for tobacco if countries strategize and accelerate tobacco tax increases.

Adolescent suicidal ideation is a critical public health issue, yet empirical evidence on its prevalence and associated factors among adolescents in northern Bangladesh remains limited. This study estimated the 12-month prevalence of suicidal ideation and examined its associated factors among school-going adolescents in Nilphamari District, Bangladesh. A cross-sectional survey was conducted between May and June 2026 among 365 adolescents aged 13-19 years across eight secondary schools and colleges. Self-administered questionnaires assessed suicidal ideation alongside validated tools for depression (PHQ-9), anxiety (GAD-7), and perceived social support (MSPSS). Factors associated with suicidal ideation were examined using multivariable logistic regression. The 12-month prevalence of suicidal ideation was 30.7% (112/365; 95% CI 26.0%-35.7%). In the primary multivariable model, moderate depression (AOR = 6.05, 95% CI 1.03-35.38; p = 0.046) and moderately severe depression (AOR = 6.86, 95% CI 1.05-44.62; p = 0.044) were associated with higher odds of suicidal ideation compared to minimal depression. However, this association was not statistically significant in a sensitivity analysis using the PHQ-8 score after excluding Item 9 (AOR = 1.06, 95% CI: 0.96-1.17; p = 0.228). Loneliness "often" showed the strongest association with suicidal ideation (AOR = 10.59, 95% CI: 2.53-44.35; p = 0.001). Suicidal ideation was also associated with truancy of 6-9 days (AOR 4.44, 95% CI 1.24-15.90; p = 0.022), truancy of [&ge;]10 days (AOR 3.77, 95% CI 1.34-10.59; p = 0.012), intentional self-harm (AOR = 2.51, 95% CI: 1.17-5.41; p = 0.018), and physical harm exposure (AOR = 2.63, 95% CI: 1.24-5.57; p = 0.012). Maternal secondary education was associated with lower odds of suicidal ideation (AOR = 0.34, 95% CI: 0.12-0.99; p = 0.048). Suicidal ideation was common among school-going adolescents in northern Bangladesh, affecting nearly one in three participants. Early school-based identification and support for adolescents experiencing mental-health and psychosocial difficulties, together with family engagement and strengthened suicide-prevention services, are warranted.

Background: Long-term mortality data among Brazilian police officers and firefighters are scarce. This study investigated the leading causes of death in Brazilian male military police officers and firefighters over three decades, comparing their mortality and mean age at death with those of the male population. Methods: We retrospectively analyzed death records of male military police officers and firefighters from Espirito Santo (ES), Brazil, from 1988 to 2019. Mortality was analyzed across three decades and the standardized mortality ratios (SMRs) for the three leading causes were calculated using the male populations of ES and Brazil as references. Results: Overall, 2,198 deaths were identified, with a mean age at death of 59 {+/-} 18.5 years, compared with 60.5 {+/-} 23.9 years among men in ES and 63.4 {+/-} 23.7 years among Brazilian men. Mean age at death was 36 {+/-} 9 years among active-duty and 68 {+/-} 13 years among inactive personnel. Across the study population, the leading causes of death were circulatory system diseases (32%), external causes (26%) and neoplasms (15%). Circulatory disease mortality was higher in the second and third decades compared with both reference populations, whereas external-cause mortality shifted from higher, in the first two decades, to lower than expected in the last decade. Neoplasm mortality was higher relative to Brazil only in the last decade. Conclusion: Mortality patterns differed by cause and over time. The younger mean age at death among active-duty personnel, together with cause-specific excess mortality, highlights the importance of long-term occupational health surveillance and preventive strategies.

Introduction Within the Tobacco and Vapes Act 2026, the UK Government is considering restricting retail displays of vaping and other nicotine products to discourage youth uptake. We explored how adult nicotine users and adolescents responded to conventional and restricted displays. Methods Two UK-wide cross-sectional online surveys were conducted April-June 2026, with current and former adult nicotine users (n=2,851), and adolescents (11-17 years; n=2,123). Participants rated images of vape and nicotine pouch point-of-sale (POS) displays (two conventional, two restricted) across 10 items. Other measures included demographics, smoking/vaping/nicotine pouch use, vaping susceptibility, and product choice. Results Ratings of two conventional POS images were consistently favourable. Two restricted POS images were almost exclusively rated unfavourably. GEE analyses, controlling for demographics and behaviour, indicated that a display with standardised white packs (versus a conventional display) consistently had lower odds of favourable ratings (adults range:0.13-0.31; adolescents range:0.11-0.32). A fully covered display had even lower odds of favourable ratings on all items (adults range:0.06-0.19; adolescents range:0.05-0.10). Presented with hypothetical restricted displays, most adults using nicotine remained consistent with their product choice. Favourable ratings of conventional displays were positively associated with adolescents' vaping susceptibility. Those favourably rating a large, branded display were more likely to be susceptible than those giving unfavourable/neutral ratings (AOR=2.73, 95%CI [2.16-3.45] p<0.001). No association was found between favourable ratings of restricted displays and susceptibility. Conclusion Restricting POS displays could reduce positive messaging around vaping and adolescent susceptibility. The potential impact of restrictions on adult users' perceptions of harm and accessibility should be considered.

PURPOSE: Women with metastatic breast cancer (MBC) are at risk of developing financial toxicity due to prolonged treatment. Resilience has been identified as a key protective factor associated with better quality of life among cancer populations. However, it is unknown if resilience is associated with financial toxicity. We sought to examine the relationship between resilience and financial toxicity among women with MBC and explore whether socioeconomic factors moderate this association. PATIENTS AND METHODS: Our sample included 209 women with MBC who completed self-reported questionnaires of the Resilience Scale Specific to Cancer (RS-SC) and the Comprehensive Score for Financial Toxicity (COST). Participants (n=2) with missing data were excluded from analysis. We conducted multiple linear regression to examine the association of resilience with financial toxicity. Interaction terms were used to test moderating effects of age (18-39, 40-64 and > =65 years), race, education, health insurance, household income and employment status. RESULTS: Of the sample, 56.5% were aged 40-64 years, 76.6% were White, and 79.9% had a college or master degree or above. Women reported moderately high resilience with mean RS-SC score of 34.49 (SD = 6.67), and moderate financial toxicity (mean COST score =21.01 [SD = 10.51]). Adjusting for covariates, higher resilience was linked to better financial well-being (b = 0.37, SE= 0.11, 95% CI [0.14, 0.59], P < 0.01). Age, education and health insurance moderated this relationship, with resilience more strongly associated with better financial well-being among those aged 40-64 years, with college/master degree or above and private insurance. Race, household income, and employment status did not moderate the association between resilience and financial toxicity. CONCLUSION: Women with MBC who reported higher resilience are more likely to experience better financial well-being, but the strength of this association varied by socioeconomic factors. Further research is needed to confirm these findings. Our results have important implications for incorporating resilience into financial toxicity interventions and tailoring such interventions based on individual socioeconomic characteristics.

Background/Aims This work aimed to estimate the annual tertiary healthcare and societal costs associated with paediatric congenital heart disease (CHD) in the United Kingdom using real-world data from a Level 1 cardiac surgical centre in the National Health Service (NHS). Methods A prevalence-based cost-of-illness analysis was conducted using patient-level inpatient and outpatient activity data from Evelina London Children's Hospital between 1 June 2023 and 31 May 2024. Costs were estimated from NHS and societal perspectives and extrapolated to national level using National Congenital Heart Disease Audit (NCHDA) procedural activity data. Healthcare costs included tertiary centre care costs. Societal costs included parental productivity losses and impacts on lifetime earnings for children. Deterministic sensitivity analysis explored parameter uncertainty. Results Approximately 9.6% of UK paediatric CHD procedures were undertaken at Evelina London Children's Hospital at a cost of {pound}15.0 million per annum, corresponding to a national estimate of {pound}156.4 million. Single-ventricle procedures accounted for 4.8% of inpatient activity but 19.4% of inpatient costs. Sensitivity analysis produced national healthcare cost estimates ranging from {pound}125.1 million to {pound}187.7 million. National productivity losses associated with parental absence from work were estimated at {pound}82.4 million annually. Individuals with CHD were estimated to experience a mean reduction in lifetime earnings of {pound}81,509. Conclusion Paediatric CHD imposes a substantial economic cost on the UK healthcare system and wider society. This study provides the first real-world national estimate of the economic impact of paediatric CHD in the UK and may inform future service planning, research investment, and innovation adoption strategies.

Background Owing to a growing body of evidence, clinical guidelines now recommend exercise for stroke survivors. However, many stroke survivors are physically inactive and may need more support to engage with exercise in the community. There are between 600-800 exercise referral schemes in the United Kingdom, but engagement from stroke survivors is very low. This study aimed to evaluate the accessibility of exercise referral schemes in England to stroke survivors. Methods A cross-sectional, online survey was conducted throughout England. All 317 local authorities in England were invited to participate. Geospatial mapping was used to visualise the accessibility of exercise referral schemes across England. Data on scheme design and delivery parameters were analysed descriptively. Results Data were collected from 147 local authorities. Exercise referral schemes were offered in 134 local authorities, of which, stroke survivors were able to access 128. However, stroke-specific schemes were available in only 17 local authorities. Significant variations in exercise referral scheme design and delivery were identified across the country. Only two consistencies were found between schemes: the involvement of fitness instructors, and the lack of transport provision. The capacity of exercise referral schemes did not correlate with the general population, stroke population, or stroke prevalence within a local authority. Conclusions Exercise referral schemes are widely available across England, and the majority are open to stroke survivors. However, stroke-specific services are very limited and there is substantial variation in scheme eligibility, capacity, costs, and referral pathways. These inconsistencies, paired with the lack of transport provision, may explain the low uptake of exercise referral schemes within the stroke population.

Chronic pain and insomnia are common, each has serious consequences and they often coexist [1-5]. This novel study employed a phenomenological method to explore adults lived experiences of the core and meaning of comorbid insomnia and pain, here conceptualized as COMIP. The empirical data is based on 22 semi-structured interviews with adults with COMIP. Each interview was analysed, developing themes and analytical frameworks for all participants, which were then compared to construct one main analytical framework. The consolidated criteria for reporting qualitative research were used [6]. The essence of COMIP was: A vicious cycle of insomnia and pain driven by four intertwined primary factors with cross effects, which reduced sleep quality and quality of life. Four main themes emerged: Firstly, insomnia with hyperarousal like racing thoughts, and difficulties with finding comfortable sleeping positions due to pain, disturbed sleep and decreased sleep quality. Secondly, daytime symptoms like reduced energy, with reduced daytime function and reduced quality of life. Thirdly, 24-hour hyperarousal, stress and distressing experiences such as suffering. Finally, contextual factors like treatment reduced and/or increased COMIP. The main contribution of this research is three-fold; mapping of the experiences of living with COMIP, the conceptualization of COMIP, and introduction of novel concepts. Our findings indicate that, when evaluating patients with COMIP, there is value in exploring the four COMIP factors. Although, it varies between individuals which factor/s is central to their COMIP experience, we emphasize that COMIP is distressing, and patients are likely to need emotional support and validation. Keywords: COMIP, sleep, phenomenology, disability, rehabilitation, ICF.

Across the UK, older adults in deprived areas like Barnsley are spending more of their lives in poor health. Alongside increased loneliness, this creates barriers to leading active healthy lives that can lead to decreases in the quality of life of residents and increased pressure on healthcare services. To address these issues, Barnsley Council brought together over 80 providers of physical activity classes for adults aged 50 and over as part of a joined up partnership called the Barnsley Older People Physical Activity Alliance (BOPPAA). The evaluation will explore how effectively the joined up partnership (BOPPAA) works in helping older adults lead active health lives by collecting information on involvement in the classes, and speaking to residents and organisations to get their thoughts and opinions. The findings will be used to help understand how BOPPAA can be improved to better meet the needs of the local population.

Childhood experiences are important antecedents of adult flourishing, yet gender patterns in these experiences are under-studied in large global samples using a common survey instrument and population-based study design. From the Global Flourishing Study Wave 1 data (2022-2024), we analyzed responses from 203,430 adults (51% female, 49% male) in nationally representative samples from 21 nations on eight childhood-related items: experiencing physical or sexual abuse, feeling like an outsider in the family, feeling loved by one's mother or father, quality of relationship with one's mother or father, health growing up, and perceived family financial situation. Greater negative experiences were noted in more affluent nations (as measured by gross domestic product (GDP) per capita), with negative experiences generally reported more often among females than males, again especially in more affluent nations. Gender differences were more pronounced when it came to relationships with mothers compared to fathers. Perceptions regarding health and family finance while growing up did not show appreciable gender differences and had weaker correlations with other items.

We analyse the effect of waiting time for elective musculoskeletal treatment on labour market outcomes in England using hospital records for working-age adults who received treatment between April 2015 and March 2023 to Census, tax and benefit records. To address clinical prioritisation and unobserved severity, we leveraged provider-level waiting time as an instrument for individual waiting time and estimated two-stage least squares models adjusted for baseline labour market outcomes, demographic and socioeconomic characteristics, and provider, referral-time and procedure fixed effects. We find that longer waits reduce annual employee earnings, with effects persisting for up to five years. For an additional four weeks of waiting, the largest estimated annual losses range from {pound}301 for osteoarthritis to {pound}487 for other joint disorders. There was no evidence of effects on employment status or benefit receipt, suggesting that delays primarily operate through reduced productivity or hours worked among those who remain employed. Reducing waiting times may not only improve health outcomes but help patients maintain earnings and support economic

This study examined the prevalence of domestic elder abuse and examined factors in a province with a high aging index in Vietnam in 2025. Elder abuse was measured using the validated Vietnamese Domestic Elder Abuse Scale, covering psychological abuse, physical abuse, financial exploitation, neglect/abandonment. Logistic regressions identified factors associated with abuse. 29.44% of participants reported at least one abuse subtypes, with psychological abuse being the most common subtype (24.73%) and 9.82% experienced polyvictimization. Higher educational attainment was consistently associated with lower odds of all abuse subtypes. Having [&ge;]4 chronic conditions was associated with higher odds of psychological abuse compared with having none (OR= 2.79, 95%CI: 1.29-6.00). Difficulties in daily basic activities were associated with physical abuse (OR=5.42, 95%CI: 1.80-16.36), financial exploitation (OR=3.66, 95%CI: 1.34-10.01), and neglect/abandonment (OR=4.09, 95%CI: 1.72-9.70) compared with no difficulties. Findings highlight the need for stronger policy implementation and lifelong learning to prevent elder abuse in Vietnam.

Background: Childhood experiences contribute to health and wellbeing across the life course, yet research from low- and middle-income countries has largely focused on a few outcomes rather than broader patterns of adult wellbeing, behaviors, and social and financial circumstances. Methods: In this cross-sectional analysis, we used a nationally representative sample of adults in India (N = 12,765; aged [&ge;] 18 years) from the Global Flourishing Study (GFS) Wave 1 (2023) to examine associations between eight retrospectively reported childhood experience items, 45 adult outcomes, and two composite flourishing indices. Survey-weighted linear, logistic, and proportional-odds models adjusted for age, gender, education, and residential setting, with Bonferroni correction were used to assess associations and effect modification by gender. Findings: Although the breadth and strength of associations differed across childhood experiences, less favorable childhood experiences were generally associated with poorer wellbeing and flourishing, greater odds of adverse health outcomes, and reduced access to resources and safety in adult life. However, outcomes related to prosocial behaviors showed a different pattern: childhood abuse (physical or sexual) was associated with greater odds of volunteering (OR 1.31, 95% confidence interval or CI [1.13,1.51]), feeling like an outsider in one's family with greater odds of donating (OR 1.80, 95% CI [1.52,2.13]), volunteering (OR 1.53, 95% CI [1.28,1.82]), and helping a stranger (OR 1.49, 95% CI [1.27,1.74]). Associations were broadly similar between females and males, with little evidence of gender differences. Interpretation: Associations of childhood adversity with poorer health and increased prosocial behavior in adult life may reflect unmeasured social, cultural, or dispositional factors and heterogeneous life-course responses. Nevertheless, these findings support strengthening child-protection, financial assistance programs, and mental health services in India.

Background: Built environment characteristics have been associated with depressive symptoms, whilst active travel behaviour is linked to improved mental health. However, it remains unclear whether active travel buffers associations between increased exposure to the built environment and worse mental health. Methods: In this pre-registered study, participants were 10,310 mothers (mean age = 28.11, SD = 4.83) participating in the Avon Longitudinal Study of Parents and Children (ALSPAC). A latent built environment factor was measured at study enrolment, active travel behaviour at a 2-year follow-up, and depressive symptoms at a 4-year follow-up. Moderation was examined using adjusted linear regression models including an interaction term between the built environment factor and active travel behaviour. Results: The built environment factor was positively associated with depressive symptoms ({beta} = 0.023, p = .012). Active travel behaviour was not associated with depressive symptoms ({beta} = -0.002, p = .854) and did not moderate the association between the built environment factor and depressive symptoms ({beta} = -0.002, p = .865), after adjusting for covariates, including age, familial depressive history, socioeconomic risk factors, physical activity, baseline depressive symptoms and smoking. Conclusion: Contrary to expectations, active travel behaviour does not modify associations between the built environment and depressive symptoms. These findings provide no evidence that active travel mitigates mental health risks associated with the built environment in this population.

Background: Unpaid caregiving is a recognised social determinant of health, yet most research treats it as a fixed exposure measured at a single time point, and little is known about how patterns of caregiving transitions relate to health behaviours. Methods: Secondary analysis of the UK Household Longitudinal Study (waves 2 to 13, approximately 2010 to 2023; n=25,049). Latent class analysis was applied to binary caregiving status across 12 waves to identify caregiving trajectories. Associations between trajectories and four health behaviours (physical inactivity, fruit and vegetable consumption, problematic drinking, current smoking) at waves 7 to 13 were estimated using logistic and linear regression, adjusting for sociodemographic, health and baseline behavioural confounders. Results: An eight-class solution identified a non-caregiving class comprising 62.9% (n=15,760) of the sample. Among caregivers (n=9,289), trajectories were Temporary (20.0%), Former-short (20.2%), Former-long (10.9%), Emerging-short (15.4%), Emerging-long (11.6%), Long-term (15.7%) and Recurrent (6.3%). In fully adjusted models, Recurrent caregivers had higher odds of smoking (OR=1.67, 95%CI: 1.17 to 2.40) compared with non-caregivers but lower odds of physical inactivity (OR=0.65, 95%CI: 0.53 to 0.81) and problematic drinking (OR=0.75, 95%CI: 0.59 to 0.94). Associations for other trajectory classes were largely attenuated after adjustment. Conclusion: The pattern and timing of caregiving transitions are an under-explored dimension of the caregiving experience. Recurrent caregivers had a distinctive profile, with elevated smoking but lower physical inactivity and problematic drinking. Recurrent caregiving should be recognised alongside intensity and duration, and support systems better equipped for people who move into and out of care repeatedly.