Journal of Public Health

Objective: To examine railway suicide trends and change points in Australia and across states/territories. Methods: We identified railway suicides that occurred in Australia between 2001 and 2023, using data from the National Coronial Information System. We performed negative binomial regression analysis to examine railway suicide trends and joinpoint regression analysis to identify potential change points at both national and state/territory levels. Results: Between 2001 and 2023, railway suicide in Australia declined by 54% (Incidence rate ratio [IRR] 0.98, 95% Confidence Interval [CI] 0.97 to 0.99). Substantial declines were observed in Victoria (-62%, IRR 0.97, 95% CI 0.96 to 0.99) and New South Wales (-67%, IRR 0.97, 95% CI 0.96 to 0.99), and, to a lesser extent, in Queensland (-25%, IRR 0.97, 95% CI 0.95 to 0.99). Nationally, one change point was identified. Between 2017 and 2023, the annual percent change was -8.8% (95% CI -24.5 to -3.3). In Victoria, railway suicide rates decreased annually by 13.6% between 2018 and 2023 (95% CI -38.5 to -4.3). In Western Australia, railway suicide rates increased annually by 10.3% between 2002 and 2010 (95% CI 1.5 to 58.8) and decreased annually by 5.4% between 2010 and 2023 (95% CI -19.8 to -1.8). No change point was identified for other states/territories. Conclusion: Australian railway suicides have declined substantially, with this trend largely driven by reductions in Victoria and New South Wales. These findings demonstrate that railway suicide is preventable through multisectoral initiatives and suggest that interventions should be continued to reduce railway suicide.

Objective: To evaluate the road safety impact arising from Scotlands 2014 reduction in the legal blood alcohol concentration (BAC) limit for drivers, and to assess whether the effect of the reform varied across different spatial contexts. Design: A quasi-experimental statistical longitudinal study using a Synthetic Difference-in-Differences (SDID) approach. Setting: Small-area panel data for Great Britain, with areas (Middle-layer Super Output Areas, MSOAs, in England and Wales and Intermediate Zones, IZs, in Scotland) classed into control and treatment groups according to whether they were exposed to Scotlands BAC reform. The control and treatment groups comprise 7088 spatial units in England and Wales and 852 spatial units in Scotland, respectively, observed over the period 2008-2019. Participants: The study primarily analyses police-reported road traffic collision data from the UK Department for Transports STATS19 system. Data were analysed at the MSOA/IZ level. This is a secondary dataset, and we therefore did not involve patients or the public in formulating the research question, determining outcome measures, or designing and conducting the study. Main Outcome Measures: The main outcome measures were log-transformed rates of total road traffic crashes, and (weekend) night-time crashes (22:00-04:00) per 100,000 population. The latter is used as a proxy measure for drunk driving. Results: Our results indicate that the reduction in the legal BAC limit led to statistically significant declines in road traffic crash rates. Aggregate estimates suggest reductions of 12.0% (95% confidence interval (CI): [-13.7%, -10.3%]) in total crashes, 15.6% (95% CI: [-20.7%, -10.2%]) in night-time crashes, and 12.4% (95% CI: [-16.7%, -7.9%]) in weekend night-time crashes. We also find substantial heterogeneity in treatment effects across spatial contexts. Effects were strongest in rural and less densely populated areas, where reductions exceeded 16% (95% CI: [-18.7%, -13.9%]) for total crashes and reached up to 29.6% (95% CI: [-35.8%, -22.8%]) for night-time and 21.4% (95% CI: [-28.3%, -13.9%]) for weekend night-time crashes. Moderate but statistically significant effects were also observed in dense urban areas, whereas effects in suburban and transitional areas were smaller and not statistically significant. Conclusions: Our analysis suggests that lowering the legal BAC limit in Scotland led to meaningful reductions in road traffic crashes, particularly during higher-risk periods and in rural areas. The findings further suggest that the effectiveness of BAC regulation may vary across local contexts, highlighting the importance of accounting for spatial heterogeneity when evaluating road safety policies.

Background: Rising rates of young people Not in Education, Employment, or Training (NEET) in the UK have recently coincided with declining youth physical and mental health but no study has asked whether this reflects a growing proportion of young people with health problems (prevalence) or those with health problems becoming more likely to be NEET (penalty). Methods: Using 15 years of Understanding Society data (2009-23), we analysed 15,242 respondents aged 16-24 (66,160 observations). We employed three complementary approaches: descriptive trends, Blinder-Oaxaca-Kitagawa (BO) probit decomposition comparing 2009-2013 and 2019-2023 against a 2014-2018 reference period, and fixed-effects (FE) Poisson models with lagged health status. Exposures included self-reported health conditions or disability (SRHD), psychological distress , diagnosed conditions and socio-demographic factors. Findings: NEET rates were lowest in 2014-18 (10.5-11.5%) and higher in 2009-13 (12-15%) and 2019-23 (15-16%). Higher prevalence of SRHD, psychological distress, diagnosed depression and multimorbidity explained changes in NEET prevalence across both the 2009-13 to 2014-2018 and 2014-18 to 2019-23 periods. No change in penalty was observed for any health variable across periods, except for an increase in the penalty for SRHD between the 2009-13 to 2014-18 periods. Interpretation: Rising NEET rates among UK youth are driven largely by more young people having physical and psychological ill health. Whilst labour market and education accommodations remain important, reducing NEET rates will require reversing the decline in youth health, not just accommodating it.

Aims: The COVID-19 pandemic has significantly impacted global mental health. At the onset of the pandemic (2020), Belgians experienced increased anxiety, depression, and psychological distress compared to 2018 due to the outbreak and the associated public health measures. Understanding the drivers of this distress is crucial for mitigating mental health effects in future crises. This study examines determinants of psychological distress in Belgium during the March 2020 lockdown, using data from the Great Corona Study (GCS). Methods: Data were drawn from the second wave of the GCS, a citizen science initiative conducted in Belgium on March 24, 2020, with 332,169 respondents. Psychological distress was measured using the General Health Questionnaire-12 (GHQ-12), applying a 2/3 cutoff to classify distress levels. To identify predictor variables, a random forest algorithm and literature review reduced 207 initial variables to 16. A generalized linear model was then used to examine associations between predictors and psychological distress Results: Psychological distress was significantly associated with various demographic, social, occupational, and health-related factors. Younger individuals, women, and residents of Wallonia or Brussels exhibited higher odds of distress. Household composition, and the frequency of real-life social interactions significantly influenced distress levels. Occupational status played a key role, with part-time employees and working students exhibiting higher levels of distress. At the same time retired individuals with no current occupation showed lower odds. Perceived workplace safety and compliance with public health measures also significantly impacted distress levels. Lastly, individuals experiencing influenza-like or COVID-19 symptoms had substantially higher odds of psychological distress. Conclusions: Our findings highlight significant sociodemographic, occupational, and health-related predictors of psychological distress during the initial COVID-19 lockdown in Belgium. Young adults, women, individuals with limited in-person interactions, and those experiencing influenza-like illness or COVID-19 symptoms were particularly vulnerable. Additionally, perceptions of others' adherence to preventive measures played a crucial role in mental well-being. These results highlight the complex interplay between individual and environmental factors in shaping psychological distress, providing valuable insights for future public health policies and mental health interventions during crises.

Objective: In 2021, a large-scale survey highlighted that in a subset of biomedical journals, a few authors -often serving on the editorial board- published disproportionately and experienced shorter acceptance times. Our study aims to specifically quantify editors research articles within the journals in which they operate. Methods: We selected journals indexed in Open Editors, a dataset that collects publicly available information on journal editorial boards through web scraping. Journals not indexed in PubMed, mega-journals, and those with very low publication volume were excluded. For the remaining journals, we linked the 2022 editorial boards from Open Editors to authors of research articles (i.e., original articles, case reports, and reviews) published between 2020 and 2023. For each journal, we then computed indicators describing publication patterns: the percentage of research articles (i) by the most prolific editor, (ii) with at least one editor, and (iii) by the most prolific author, as well as publication lags for each article. Results: Across the 1,623 journals studied, the median and 95th percentile of research articles are 1.78% and 6.7% for those co-authored with the most prolific editor, 12.1% and 41.1% for those with at least one editor, and 2.5% and 7.9% for those with the most prolific author. An editor was among the most prolific author(s) in 45.0% of the journals. For authors, the median and 5th percentile publications lags are 99 and 35 days; for editors, it is 95 and 33 days; and for editors-in-chief, it amounts to only 84 and 12 days. An in-depth examination of journals where the most prolific editor co-authored more than 6.7% (95th percentile) found a median impact factor of 3, and a median h-index of 42 for their most prolific editor(s). Conclusion: In 5% of cases, an editor contributes to approximately >7% of the articles published in their own journal. In nearly half of the journals, the most prolific author is an editor. These results need to be complemented by a qualitative approach to examine whether research articles authored by editors appropriately address potential conflicts of interest, as required by COPE recommendations, and to better understand the motivations underlying this practice.

OBJECTIVE To examine parents perceptions regarding the introduction of a social media ban for children and to identify factors associated with these attitudes. METHOD A cross-sectional study was carried out in Greece in April 2026. Potential predictors of parents views on a social media ban included (a) sociodemographic variables (such as gender, age, educational attainment, and financial status), (b) social media usage patterns (number of accounts, daily usage duration, and posting frequency), and (c) level of political engagement (how often participants follow political news and discuss political issues). Outcome variables comprised parents agreement with the ban, level of awareness about its implementation, perceived necessity for additional measures, confidence in the ban effectiveness, perceived effects on children lives, and parents familiarity with digital parental control tools. RESULTS Overall, 68.0% of parents supported implementing a social media ban for children under 15. A large majority (91.8%) expressed the need for more governmental information regarding the ban. Additionally, 89.3% believed that further measures beyond the ban are required to effectively address the issue. Suggested measures included digital literacy courses in schools (86.1%), active parental involvement in digital literacy (74.6%), prohibition of inappropriate content (77.9%), reasonable parental limits on social media use (73.8%), and restriction of addictive platform features (73.0%). Older parents demonstrated greater confidence in the effectiveness of the ban. Furthermore, age, financial status, number of social media accounts, and time spent online were positively associated with perceived impacts of the ban. Younger age was linked to greater parental familiarity with digital control tools, while having more social media accounts was also positively associated with such familiarity. CONCLUSIONS There is a clear need for comprehensive, evidence-based policy approaches that combine regulation, education, and shared responsibility among stakeholders. Policymakers should leverage existing public support for child protection while investing in digital literacy initiatives, empowering parents, and strengthening regulatory oversight of social media platforms to achieve long-term and equitable results.

Introduction Hearing loss (HL) affects over 1{middle dot}5 billion people globally and India shares a disproportionately high burden including Disabling Hearing Loss (DHL). HL affects an Individual socio-economically, but there are limited studies on the broader societal economic consequences of HL in India.Methods Using Cost-of-Illness (COI) approach, we studied the societal economic burden of HL in India. This study uses epidemiological and macroeconomic data and modelling to estimate the loss of Gross National Income (GNI) due to HL and DHL across three economic pathways. Uncertainty is evaluated using deterministic and Probabilistic Sensitivity Analyses (PSA).Results The model estimates that there are in India, 289 million and 85{middle dot}9 million people with HL and DHL respectively. Direct Loss of GNI and Indirect Loss of GNI (Caregiver burden) are estimated as INR 4,648{middle dot}4 billion (USD 55{middle dot}6 billion) and INR 3,268 billion (USD 39 billion) respectively. The Loss of GNI due to Low Education amongst those with HL is estimated as INR 1,041{middle dot}9 billion (USD 12{middle dot}45 billion).Discussion Economic burden of HL is presented across three pathways with Direct Loss of GNI due to DHL being the greatest. It also presents age stratified caregiver economic burden. The findings of the study help in estimating similar cost pathways, advocacy, and policy decisions towards reducing HL prevalence in India and LMICs. This study also highlights the need for India specific estimations related to the HL attributable low education, state-wise disaggregates, and prevalence studies. Funding This study has not received any funding.

Background: High rates of young people who are not in education, employment or training (NEET) are a major societal concern in the UK. Whilst other studies have highlighted that adolescent health can predict NEET status in young adulthood, robust and recent longitudinal evidence remains limited. Methods: This study used data from the Millennium Cohort Study, a longitudinal study of people born in the UK in the early 2000s, to estimate the extent to which mental health conditions, physical health conditions and health behaviours during adolescence predict NEET status in early adulthood (median age: 23). Co-occurrence of exposures was also considered and population attributable fractions were calculated to account for differences in exposure prevalence. Results: Among 8,374 young people, 12.5% were NEET at age 23; approximately two thirds were seeking work and one third were economically inactive. Estimates adjusted for demographic factors indicated that multiple health exposures increased risk of being NEET at age 23, with mental health conditions predicting greater risk than physical health conditions and health behaviours. For instance, a longstanding mental health condition more than doubled the risk of being NEET (adjusted relative risk [aRR] = 2.39, 95% CIs = 1.85, 3.09), while autism (aRR = 3.60, 95% CIs = 2.69, 4.83) and ADHD (aRR = 3.25, 95% CIs = 2.38, 4.44) more than tripled the risk. A greater number of reported adolescent mental health conditions was associated with greater risk of being NEET in young adulthood. Obesity predicted being NEET at age 23 (aRR = 1.54, 95% CIs = 1.18, 2.01) and obesity accompanied by a mental health condition further increased risk (aRR = 2.01, 95% CIs = 1.38, 2.93). Follow-up analyses indicated that associations between adolescent mental health and young adult NEET status were more pronounced for females than males and for the economically inactive than those seeking work. Conclusions: Findings indicate that adolescent health, especially mental health, strongly predicts being NEET in early adulthood. Early, integrated health and education interventions may help reduce later educational and labour market disengagement.

Background: Internationally, workforce planning models are focussed on balancing supply and demand, rarely addressing factors such as demographic shifts and evolving health needs. There is a clear imperative for improved workforce planning to ensure adequate staff numbers to deliver audiology safely and effectively but there is still no consensus on safe minimum staffing levels or the optimal skill mix for high-quality audiology services. Methods: This research aimed to establish markers of quality in audiology service provision and estimate the audiology workforce requirements to meet current and projected demand for services, based on population changes and anticipated changes in demand. Following stakeholder engagement, a needs-based model was developed by (1) analysing NHS England's national Audiology stocktake dataset to determine current workforce, (2) creating an epidemiological model to predict changes in service population over next 5 and 10 yrs (3) use of BAA endorsed estimates delivered in East of England on staff grade required per activity. [SR1.1] Results: The estimates for 10-year adult and paediatric audiology whole time equivalent (WTE) safe minimum staffing levels for England (bands 2-7, current waiting times maintained) based on a population change model (Model 1), and two further models for paediatrics specifically (Model 2 and Model 3) were as follows: for adult audiology Model 1 estimates a 7.40% increase by 2035 (to 1125.18 WTE). For paediatric audiology Model 1 estimates a -6.3% (to 593.47 WTE) decrease due to underlying paediatric population decline in England, whereas the case complexities considered in Model 2 (1072.33 WTE) and Model 3 estimate a 10-year increase of 71.23% ( to 1072.33 WTE) and 59.17% (to 996.82 WTE) respectively. Conclusions: This is the first study to conduct a needs-based assessment of workforce requirements for audiology services. Given the substantial need for audiology staff, investment in workforce recruitment and training is essential to ensure that future activity levels meet population needs. Consideration of changing demographics is required for planning future workforce specialisation. Further analysis to address workforce equity, the impact of changes in skill mix and service delivery models and local area demographics/prevalence variation is required alongside potential efficiencies.

Background: Public services are increasingly delivered through digital platforms. Although digital health may improve access and scalability, they may also widen inequalities for people who lack reliable access, confidence, skills, affordability or trust. Objective: This study examined the prevalence of self-reported digital exclusion among UK veterans and assessed its association with depression, anxiety and loneliness. Methods: A cross-sectional online survey was conducted between July 2025 and March 2026. Participants were UK Armed Forces veterans and resident in the UK. The survey collected sociodemographic, military service, digital access and health data. Self-reported digital exclusion was defined as reporting feeling excluded or disadvantaged due to lack of digital access or skills. Probable depression, anxiety and loneliness were assessed using the PHQ-2, GAD-2 and three-item UCLA Loneliness Scale, respectively. Associations between digital exclusion and each outcome were examined using adjusted multivariable logistic regression. Results: Of 1,911 responses received, 1,607 were included after data quality exclusions. Among participants with valid responses to the primary digital exclusion item, 553 (41.7%) reported digital exclusion. Digital exclusion was more common among females, younger veterans and those with lower household income. Probable depression, anxiety and loneliness were more prevalent among digitally excluded participants than among non-excluded participants. In adjusted models, self-reported digital exclusion was associated with higher odds of probable depression (AOR 1.38; 95% CI 1.04 to 1.83; p=0.028), probable anxiety (AOR 1.63, 95% CI 1.23 to 2.16; p<0.001), and probable loneliness (AOR 1.85; 95% CI 1.43 to 2.40; p<0.001). Conclusion: More than two-fifths of veterans with valid exposure data reported digital exclusion, despite high reported device access and confidence. Self-reported digital exclusion was associated with poorer mental health and loneliness, although causality cannot be inferred from these cross-sectional data. Digital-first services for veterans should include routine digital needs screening, targeted support and clear non-digital routes to care.

Preventive health is a crucial health systems component for managing disease burden and achieving health promotion policy goals. However, effective prevention relies on the modification of relevant risks, often requiring systemic health behaviour change. Australia's National Preventive Health Strategy (NPHS) prioritises seven focus areas: tobacco and nicotine, healthy diet, physical activity, cancer screening, immunisation, alcohol and other drugs, and mental health. The readiness of community members in Australia to address health behaviours relating to these areas has not been fully examined. In response, six focus groups were conducted with 27 adults from the Australian general population to explore their perspectives and experiences of preventive health information and behaviours relating to the seven NPHS focus areas. Themes and sub-themes were identified using an applied descriptive framework. Participants described motivations, barriers and experiences surrounding preventive health through the themes of 'Making informed health choices', 'Facilitating behaviour change and the role of support systems' and 'Spreading the preventive health word'. Sub-themes detailed processes of prioritisation, risk-benefit assessment, critical appraisal, sociocultural influence and support-seeking to understand and personalise preventive health information, implement behavioural change, and share information with others. The focus areas participants engaged with most strongly were healthy eating and physical activity, while cancer screening was discussed less often. These findings indicate high preventive health engagement in the Australian community, alongside challenges navigating and adapting relevant information to personal needs. These insights can support policymakers, healthcare providers and others to effectively enact the NPHS through more targeted preventive health information and care delivery.

Background: Open science (OS) offers opportunities to address challenges in the editorial and peer review processes of traditional, complementary, and integrative medicine (TCIM) journals. This study assessed TCIM journal editors' perceptions of OS and the perceived benefits and challenges of integrating OS into editorial and peer review processes. Methods: A cross-sectional survey was distributed to editors-in-chief, associate editors, and editorial board members of 115 TCIM journals. The survey examined demographics, current use and familiarity with OS, perceived advantages and obstacles, and future perspectives on OS in academic publishing. Quantitative data were analyzed descriptively, and qualitative data were examined using thematic analysis. Results: A total of 267 respondents completed the survey, with most identifying as faculty members or academic research staff (n = 201/335, 60.0%). Most respondents were familiar (n = 128/212, 60.3%) or very familiar (n = 64/212, 30.2%) with OS practices, although many had received no formal OS training (n = 94/210, 44.8%). Respondents were most familiar with open access (n = 131/213, 61.5%) and preprints (n = 92/211, 43.6%). Among the seven OS practices examined, open access was viewed most favorably, with many considering it "very important" (n = 97/206, 47.1%) and strongly agreeing that it enhances the accessibility of research findings (n = 118/195, 60.5%). Conclusion: Most respondents were familiar with OS but held varying perceptions regarding the importance, advantages, and disadvantages of different OS practices. These findings may inform the development and implementation of evidence-based practices and policies that meet the needs of the TCIM research community.

Background: Suicide rates are highest among older adults. Yet, little is known regarding differences in suicide risk of older adults in Austria. This nationwide, retrospective cohort study aimed to characterize suicides among older adults in Austria during 2014-2023 and examine differences those who were young-old (65-74), middle-old (75-84), and oldest-old (85 +). Methods: We applied a cohort design to individual-level linkage data on all residents in Austria aged 65 years and older during 2014-2022 (N = 2,442,939). We compared characteristics of individuals who died by suicide and other causes of death, as well as by age group (i.e., young-old, middle-old, oldest-old) using trend tests and odds ratios. We calculated crude incidence rates of suicide per age group and sex. Results: During 2014-2023, 4,724 older adults died by suicide in Austria. The overall suicide rate was 23.4 per 100,000 person-years, while males had higher rates than females. Suicide rates increased with age and peaked among the oldest-old (33.2/100,000). Hanging, firearms, and jumping were the predominant methods, and the prevalence of hanging increased relative with increasing age. With increasing age, also widowhood and cardiovascular and genitourinary disorders were more prevalent among those who died by suicide. Conclusions: In Austria, oldest-old adults have the highest suicide rates, especially for males. whereas rates were considerably lower and did not change throughout old age for females. Distinct differences in suicide rates with respect to marital status, health conditions, and suicide methods. This emphasizes the need for preventive strategies to target older adults at different stages of life.

Background: Guidelines on pre-pregnancy counselling are primarily clinical, and although recommendations and policy documents on preconception care exist in Australia, they place little or no emphasis on the preconception health of adolescents and young adults. Objective: To identify and prioritise unanswered questions and evidence uncertainties concerning preconception health needs of adolescents and young adults residing in Australia. Design: Research priority exercise Setting and Participants: Participants included young interest-holders (18-24 years) and professional interest-holders from the academics, healthcare, policy, community and government sectors residing in Australia. Methods: We followed the James Lind Alliance (JLA) methodology to identify research priorities for preconception health of adolescents and young adults. The process was led by a multidisciplinary steering committee comprising young interest-holders and professional interest-holders (including academics and clinicians). A rapid literature review was conducted from which 80 research questions were developed across ten domains, which were refined through consultation and prioritised via two rounds of online surveys on Qualtrics using a 9-point Likert scale. Results: The participants included 14 young interest-holders in each survey round, with 22 professional interest-holders in the first round and 33 in the second. Participants from across Australia participated in the survey, but most were from South Australia. In the first survey round, 28 questions across seven domains were prioritised by both professional and young interest-holders. This was followed by a reprioritisation exercise, resulting in the final top 10 research questions spanning five domains. The highest-priority research questions identified by the interest-holders concentrated in the domains of violence and mental health; early intervention and prevention; smoking, tobacco, alcohol, and substance use; access to preconception care and the healthcare system; and priority populations. Conclusion: The study identified the top 10 priority research questions informed by professional and young interest-holders. It promotes new research and collaboration while offering guidance on future research investments and on designing preconception interventions for adolescents and young adults in Australia. Turning these priorities into research could improve the health outcomes for adolescents and their future generations.

Background Access to exercise facilities is particularly important for the health, wellbeing, and social participation of people with disability. However, many facilities remain difficult for them to access. Methods This research used a mixed-method case study of twenty-three gyms in New Zealand. Quantitative accessibility audits based on the requirements of NZS4121:2001 were used to assess the compliance of accessible parking, entrances, interiors and bathrooms. Interviews with staff or managers at each gym provided qualitative data on operational practice and awareness of inclusivity. Results The most accessible aspects include parking spaces, footpaths, entrance doors and bathrooms with features such as clear signage, well-designed ramps, and evacuation protocols demonstrating best practice inclusivity. Improvements in service counters, lifts, tactile and auditory communication are needed. Community gyms and university gyms are the most inclusive and their staff have the most comprehensive experience in interacting with people with different disabilities. Small private gym owners know little about accessibility barriers and financial constraints limit their ability to improve access features. Conclusion The main recommendations for improving gym accessibility for people of all abilities include strategies to facilitate their joining gyms and strategies to support them as long-term gym members. The involvement of healthcare professionals in prescribing regular exercise and monitoring the health effects, coupled with subsidised gym membership will make it easier for people with disability to join gyms. More extensive staff training, targeted exercise programs, inclusive signage and communication and regular maintenance of the facility will improve the ongoing experience. Participating in regular exercise and social environments will help improve the physical and psychological health of people with disability.

Background Child marriage/cohabitation before 18 years of age disproportionately affects girls worldwide, but its impacts on mental health are poorly understood. Existing research is mostly cross-sectional, hence unable to estimate causal impacts or longer-term outcomes of child marriage. Methods We analysed longitudinal cohort data across Ethiopia, India, Peru, and Vietnam from Young Lives to investigate the relationship between child marriage/cohabitation and life satisfaction and emotional symptoms. We used linear regression, difference-in-differences estimation (DiD), and propensity score matching (PSM) to examine short and longer-term impacts from age 19 to 29. Findings Across countries 5% (Peru) to 20% (India) of girls were child brides. Child marriage/cohabitation predicted lower life satisfaction -- pooled estimates at age 19 (-0.25 [95%CI=0.40,-0.10]), across 19-29 (-0.22 [95%CI=-0.32,-0.13]), and heterogeneity estimates suggest consistently negative impacts across countries. However, child brides have lower life satisfaction at age 8 even before marriage occurs, likely due to pre-existing disadvantages such as poverty that increase child marriage likelihood. DiD and PSM analyses confirm that most of the differences are due to pre-existing vulnerability and there is a small additional impact of child marriage on worse life satisfaction at age 19 (pooled matched estimate -0.09 [95%CI=-0.19, 0.00]). No differences in emotional symptoms were observed, nor any differences by age of marriage within the child-married sample. Interpretation Child brides have lower life satisfaction from childhood through to early adulthood, which is mostly explained by prior disadvantages and risk factors, with a small additional impact of child marriage itself.

Background Despite existing road safety regulations, commercial motorcycle riders commonly referred to as "Boda Bodas" in Uganda continue to experience high rates of injuries due to road traffic accidents resulting from unsafe riding behaviours, contributing significantly to morbidity and mortality among both riders and passengers. Safe riding behaviours are less well documented, as well as factors associated with the observance of those behaviours. This study aimed to determine factors associated with safe riding behaviors for both boda-boda riders and their passengers in Kampala Central Division. Methods A cross-sectional survey study design was conducted using a convergent parallel mixed-methods design guided by the PRECEDE model. Quantitative data were collected from 424 riders through structured questionnaires administered by trained research assistants. Binary Logistic regression was used to determine the independent predictors of safe road riding behaviors, and Adjusted Odds ratios (AORs) have been reported. Data were analyzed using descriptive and inferential statistics, with a p-value <0.05 considered statistically significant. Qualitative data were collected simultaneously with quantitative data through in-depth semi-structured interviews with 10 passengers to capture perceptions of rider behaviors and safety practices. Thematic analysis was applied, and results were triangulated to highlight convergences and divergences between quantitative and qualitative findings, providing a comprehensive understanding of safety determinants for both riders and passengers. Results Of the 424 riders (mean rider age was 29.56 {+/-} 5.71), overall, 276 (65.1%) of riders exhibited unsafe riding behaviors. In the bivariate analysis with Logistic regression, predisposing factors (education, marital status, religion, and willingness to obey traffic regulations), and reinforcing factors (family encouragement) were significantly associated with safe riding behaviors. However, in the adjusted model, secondary (AOR=0.50; 95% CI:0.30-0.85) and post-secondary education (AOR=0.57; 95% CI:0.33-0.98), being married (AOR=0.56; 95% CI:0.34-0.91), Christian religion (AOR=2.98; 95% CI:1.63-5.47), willingness to obey traffic regulations (AOR=0.41; 95% CI:0.24-0.70), union advocacy (AOR=1.76; 95% CI:1.03-3.01), and well-maintained roads (AOR=1.65; 95% CI:1.07-2.55) were significant predictors of safe riding behaviors. Qualitative interviews further highlighted barriers to safety, including a lack of helmets, over-speeding, disregard for traffic regulations, and poor road infrastructure. Conclusions Rider and passenger safety is still low, interdependent, and influenced by multiple factors. Integrated interventions focusing on education, stronger families, religious affiliations, union safety advocacy, and stricter enforcement of traffic regulations are vital for enhancing safety for both riders and passengers.

Background: Limited evidence motivated us to examine risk of suicide after partner loss among older adults in Austria. Methods: All married older adults aged [&ge;]65 years and living in Austria (N=1,293,557) were followed during 2014-2023. Risk ratios (aRRs) for partner loss were calculated based on adjusted cumulative incidence functions. Results: A total of 357 suicides occurred among widowed older adults. Incidence rates among widowed and not widowed were 56.9 and 29.4 per 100,000 person-years, respectively. High rates were found among widowed males (170.8/100,000) and widowers aged [&ge;]85 (94.1/100,000). Suicide risk was highest in the first month (aRR, 13.6; 95%-CI: 8.7,22.4) but remained elevated up to five years after partner loss (aRR, 2.5; 95%-CI: 2.1, 2.8). Conclusion: Recently bereaved older adults had elevated risks of suicide suggesting monitoring and psychosocial support may be beneficial when bereaved.

Objective This study evaluated how well subjective life expectancy (SLE) predicts mortality and actual life expectancy (ALE), along with factors associated with inaccurate expectations. Methods Using panel data on approximately 2,000 individuals with up to 28 years of follow-up from a nationally representative sample of older Japanese adults, we examined relationships among SLE, actual mortality, and ALE by survival analysis. We also evaluated health and socioeconomic disparities using concentration indices and investigated factors influencing SLE and ALE discrepancies and focal-point (i.e. rounded or anchored estimates) and do-not-know responses. SLE was measured as a self-reported point estimate, whereas ALE mainly came from official records and family reports. Results SLE was significantly associated with both actual mortality and ALE, even after accounting for demographic and socioeconomic variables. Nonetheless, significant inaccuracies remain: approximately 59% of individuals surpassed their expected lifespan. SLE was positively associated with ALE; however, the association was inelastic. Women and those with higher education levels were more likely to outlive their SLE, whereas those in poorer health were less likely to do so. Higher education correlated with fewer focal point responses to the SLE question. Discussion SLE effectively predicts ALE; however, gaps are non-negligible and differ across gender and socioeconomic groups. Offering more precise data, such as sex- and age-specific remaining life expectancy, can enhance SLE formation and lead to more informed economic choices.

Universities provide a key opportunity to deliver social prescribing, a care pathway that aims to connect people with non-medical forms of support within the community to address their social, emotional, and practical needs. However, it is unclear whether students in the UK are aware of social prescribing and whether it would be an acceptable form of support. We surveyed 775 university students across the UK who completed a questionnaire measuring awareness and perceptions of social prescribing. We described awareness and attitudes and used logistic regression to explore how they differed according to individual characteristics. We found an awareness-attitude paradox. Only 25% of students were aware of social prescribing, but attitudes were overwhelmingly positive once explained: 97% thought it could support mental health and wellbeing; 95% believed universities should offer it; and 89% would accept social prescribing if offered by a healthcare professional. Students who were older, postgraduates, and had English as their first language were among those with higher odds of being aware of social prescribing, but positive attitudes were more evenly reported across the sample. Our findings indicate that implementation efforts should prioritise awareness-raising and clear referral pathways, rather than increasing students' willingness to engage with social prescribing.