Preventive Medicine

Background: Adults with severe mental health conditions (often referred to as severe mental illness, SMI) experience 15 to 20 year mortality gap relative to the general population, with lung cancer a significant contributor. National cancer policy targets earlier diagnosis but does not explicitly address how pathways function for this group. Aims: This study aimed to describe lung cancer risk, prevalence, screening eligibility, referral activity and diagnostic pathway performance for adults with SMI in South East London (SEL), and to examine where along the pathway inequalities arise. Methods: Co-designed with experts with lived experience and voluntary sector, this exploratory mixed-methods service evaluation combined quantitative analysis of routinely collected data from the Quality Outcomes Framework (QOF), SMI Register and Cancer Waiting Times Record (April 2023-March 2024) with semi-structured qualitative interviews (n=11 clinical staff) and focus groups (n=6 adults with lived experience of SMI). Quantitative and qualitative data were analysed using descriptive statistics and framework-based thematic analysis respectively, and findings were integrated using a joint display approach, organised by the Consolidated Framework for Implementation Research (CFIR). Results: Lung cancer prevalence was approximately double among adults with SMI (0.17% vs 0.09% in the general population). Despite Urgent Suspected Cancer (USC) referral rates being more than twice as high in the SMI population (63 vs 28 per 100,000), fewer cancers were detected via planned general practice (GP) routes (11% vs 20%), the 28-day Faster Diagnosis Standard was not met for any SMI patient diagnosed with lung cancer during the study period; overall FDS performance was 76% in the SMI population compared with 84% in the general population; and appointment non-attendance was more than double that in the general population (6% vs 3%). Qualitative findings identified individual, service and system-level mechanisms, including stigma, diagnostic overshadowing, fragmented coordination, and rigid pathway protocols, that compound disadvantage across lung cancer pathway stages. Conclusions: Inequality in lung cancer outcomes for adults with SMI accumulates across the pathway rather than arising at a single point of failure. Addressing this requires proportionate adaptations within existing cancer pathways, alongside routine reporting of cancer outcomes stratified by SMI population. Keywords: severe mental health conditions, lung cancer, health inequalities, cancer screening, diagnostic pathway, mixed methods

Importance: Loneliness is associated with premature mortality and poor mental health and was declared an epidemic by the US Surgeon General in 2023, but national surveillance has relied on state-based or experimental online surveys. In 2024, the National Health Interview Survey measured loneliness directly for the first time. Objective: To estimate the national prevalence of loneliness among US adults, identify the sociodemographic groups with the highest burden, and quantify associations with mental health, health status, and health care use. Design: Cross-sectional analysis of the 2024 National Health Interview Survey, a nationally representative household survey conducted continuously from January to December 2024. Setting: US households; face-to-face and telephone interviews. Participants: 32 629 sampled civilian noninstitutionalized adults aged 18 years or older (response rate, 47.9%); 31 470 (96.4%) had valid loneliness data. Exposures: Frequent loneliness, defined as feeling lonely always or usually on a 5-category item (always, usually, sometimes, rarely, never). Main Outcomes and Measures: Survey-weighted prevalence of loneliness overall and by sociodemographic characteristics, and associations of frequent loneliness with serious psychological distress (Kessler 6 scale score 13 or higher), frequent feelings of depression and anxiety, life dissatisfaction, fair or poor self-rated health, receipt of counseling or therapy, cost-related unmet mental health care need, and emergency department use. Results: In 2024, 4.9% (95% CI, 4.6%-5.2%) of US adults, an estimated 12.2 million people, felt lonely always or usually, and 23.7% (95% CI, 23.1%-24.3%), an estimated 59.3 million, felt lonely at least sometimes. Prevalence of frequent loneliness was highest among adults with family income below the federal poverty level (10.3%), adults with disability (13.6%), adults living alone (9.0%), and American Indian or Alaska Native adults (12.2%). Adults aged 65 years or older had the lowest prevalence of any age group (4.0%) and adults aged 18 to 29 years the highest (6.3%). After adjustment for sociodemographic characteristics, frequent loneliness was associated with serious psychological distress (adjusted odds ratio, 14.5; 95% CI, 12.1-17.3), life dissatisfaction (9.0; 95% CI, 7.6-10.8), cost-related unmet mental health care need (4.3; 95% CI, 3.5-5.2), and emergency department use (1.8; 95% CI, 1.5-2.0). Conclusions and Relevance: Loneliness among US adults was patterned by poverty, disability, and household structure rather than older age. These estimates from the nation's principal household health survey provide a benchmark for monitoring loneliness and suggest that strategies for social connection should address material hardship and access to mental health care.

Background YouTube highlights packages are a major and growing route to football consumption, particularly among children and young people, but brand exposure within them has not been quantified. We measured unhealthy commodity brand exposure in English Premier League (EPL) and FIFA World Cup (WC) highlights. Methods We coded brand appearances lasting two or more seconds in 10 Sky Sports EPL highlights (final 10 games of the 2025/26 season) and 19 official FIFA 2026 WC highlights, recording commodity category, placement, and match moment, alongside pre-roll YouTube adverts. Data were collected between 4 June and 27 July 2026. Five highlights were double-coded (Cohen's kappa 0.85). Results Overall brand density was similar across competitions (13.1 vs 13.9 references per minute), but composition differed markedly. Unhealthy commodity branding occupied 38.0% of EPL screen time versus 18.7% at the WC, a difference driven almost entirely by gambling (32.6% vs 1.5%). Gambling appeared in every EPL package, mainly on pitchside boards and LED screens (50.4%), with front-of-shirt accounting for 27.1%. WC exposure was more evenly spread across HFSS food (13%), alcohol (4%) and trading/crypto/prediction markets (3.7%), and appeared almost exclusively pitchside. Gambling brands accounted for ten of twelve pre-roll EPL adverts (123 of 153 seconds); no gambling adverts preceded WC highlights. Conclusions Gambling dominates unhealthy commodity exposure in EPL highlights, both in-video and in pre-roll advertising. Because most appearances occur away from the front of shirt, the voluntary front-of-shirt sponsorship withdrawal will leave the majority of this exposure intact. The WC comparison shows that tighter central control of the advertising environment produces lower and more diffuse exposure, and that governments and governing bodies with such control could restrict unhealthy categories altogether.

ABSTRACT Background: Despite its high prevalence and established impact on women's health, the long-term biological effects of Intimate Partner Violence (IPV) remain poorly understood. In particular, its potential role in increasing cancer risk has received limited attention. This review examines whether IPV may be associated with elevated cancer risk in women. Methods: We conducted a systematic review and meta-analysis in accordance with PRISMA and MOOSE guidelines to evaluate whether IPV may be associated with cancer risk. Eligible studies included adult women ([≥]18 years) with documented IPV exposure and cancer or precancerous outcomes. We searched PubMed, Web of Science, Scopus, and Google Scholar for articles published from 2000 to 2025. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). A random-effects meta-analysis was performed on longitudinal studies reporting adjusted risk estimates. Results: Thirteen studies were included in the qualitative synthesis, but only two met criteria for meta-analysis, both reporting on cervical cancer. The pooled odds ratio was 3.00 (95% CI: 2.05 - 4.38; I2 = 0%). A separate pooled prevalence analysis of six retrospective studies showed that 32.2% of women with cancer reported a lifetime history of IPV. Study quality ranged from low to high. Conclusions: This review underscores the limited and heterogeneous nature of the existing evidence on IPV as a potential cancer risk factor. While preliminary findings suggest a possible association, particularly with cervical cancer, the scarcity of high-quality longitudinal studies and the methodological variability in the studies reviewed prevent definitive conclusions regarding causal linkage. Further research, particularly prospective and mechanistic studies, is needed to clarify the relationship between IPV and oncogenesis across different cancer types and to identify underlying biological pathways.

Social relationships are an important social determinant of health. Loneliness, the perceived gap between one's actual and desired relationships, has emerged as an important mechanism through which social relationships impact health. Like other intrapersonal-level factors associated with health, loneliness is influenced by broader social and structural factors, including characteristics of one's neighborhood social environment. Although neighborhood-level protective and risk factors for loneliness and for mental health have been identified, prior studies have often focused solely on self-reported perceptions of the neighborhood environment. Further, few have considered aspects of the neighborhood social environments, such as neighborhood stability (i.e., stability of the community with long or short-term residents), independent of neighborhood socioeconomic conditions. In the current analysis, we explored longitudinal patterns of loneliness in conjunction with neighborhood stability among women with HIV (WWH) enrolled into the MACS/WIHS Combined Cohort Study (MWCCS) from 2014-2019 (N2019=1,394) to examine whether trajectories of loneliness and neighborhood stability were associated with depressive symptoms, non-prescription substance use, past-year cannabis use, number of alcoholic drinks per week, and several domains of quality of life. Loneliness at baseline (Betas = 0.24 - 0.54) and changes in loneliness over time (Betas = 0.11 - 0.26) were associated with each outcome, except for the association between changes in loneliness over time and drinks per week (Beta=0.13, p = 4.14x10-2), which did not persist after correcting for multiple comparisons. Neighborhood stability at baseline was associated with past year cannabis use (Beta=0.26, p = 1.00x10-2), depressive symptoms (Beta=-0.12, p = 1.54x10-3), and overall self-reported health (Beta=-0.08, p = 2.05x10-2). Changes in neighborhood stability across time were not associated with any outcome. Neighborhood stability moderated the association between changes in loneliness and general health perceptions. Our results demonstrate both overall loneliness and changes in loneliness over time have implications for current mental health in WWH, while changes in neighborhood stability did not.

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.

Background: Suicide is the second leading cause of death in US adolescents aged 10-24. Method use strongly influences lethality and design of prevention strategies, but recent trends remain unclear. We therefore aimed to investigate trends in suicide mortality rates by method, age group, and sex. Methods: This cross-sectional study used suicide mortality data from the National Center for Health Statistics for a quarter-century period, between 1999 and 2024. All individuals aged 10-24 years at the time of death, with suicide as the underlying cause, were included. We estimated suicide mortality rates (i.e., the number of suicide deaths per 100,000 people) and annual percent change by method (firearm, asphyxiation, poisoning, other), age group (10-14, 15-19, 20-24), and sex. Changing trend time points were determined using Joinpoint regression models Results: From 1999 to 2024, 159,241 suicide deaths occurred among individuals aged 10-24. While suicide rates declined across all age groups between 2017 and 2024, the male-to-female gap narrowed by 18.9%. Among 10-14-year-olds, declining rates among males masked a consistent increase in female suicide rates since 2011. Although asphyxiation-related suicides decreased across all groups since 2018, firearm suicide rates increased for females in the 10-14 and 20-24 age groups. Albeit not as common as firearms or asphyxiation, poisoning suicide rates increased in the 15-19 and 20-24 age groups. Since 1999, suicide rates by other less common methods (e.g., jumping) showed significant increases, for both sexes, especially among individuals aged 20-24. Suicide rates were consistently highest in the 20-24 age group across all study years. Conclusion: The decrease in suicide mortality rates among individuals aged 10-24 was largely driven by declines in males and reductions in asphyxiation-related suicides. However, increasing female suicide rates in the 10-14 age group, as well as increasing rates of death by less common means, warrant close attention. While suicide prevention efforts like structural interventions and means restriction have shown effectiveness among male adolescents, priority should now be given to adapting these approaches for female adolescents, particularly those aged 10-14.

BackgroundObservational comparisons of former smokers who use non-combusted nicotine products with former smokers who quit without them require that two quantities be measured precisely: which product is being used, and how long ago cigarette smoking stopped. Neither quantity is recorded by the National Health Insurance Service (NHIS) screening instrument used in a recent Korean cohort study of post-cessation e-cigarette use and lung cancer risk. We characterized both quantities in a contemporaneous, nationally representative survey of the same population. MethodsWe analyzed the public-release microdata of the Korea National Health and Nutrition Examination Survey (KNHANES), 2018 to 2023, restricted to adults aged 19 years and older. Former smokers were identified by smoking status, and cessation duration was taken from the item recording months since the last cigarette. Former smokers currently using a heated tobacco product (HTP) or an e-cigarette (EC) were compared with former smokers using neither. KNHANES 2018 asked a generic e-cigarette question and, separately, a checklist naming HTP brands, allowing the two product classes to be separated. Distributions were compared with rank-based methods, the age-duration relationship with Theil-Sen regression, and residual imbalance by restricting the comparison group to respondents age-matched to within two years. ResultsThe 2018 analytic sample comprised 1,348 former smokers, of whom 43 currently used HTP or EC and 1,305 used neither. Among the product-using former smokers, 58% reported HTP use without e-cigarette use, 21% reported both, and 21% reported e-cigarette use without HTP use; 79% reported any HTP use. Median cessation duration was 0.7 years (IQR 0.25 to 1.5) among product users and 12.0 years (IQR 5.0 to 20.0) among those using neither (Kolmogorov- Smirnov D = 0.76, P < 0.001), with the product user having quit more recently in 92% of cross-group pairs. The separation persisted within the short-term (<5 year) stratum (D = 0.34, P < 0.001; 73% of pairs) and after age matching, where the residual gap was 9.3 years. Cessation duration rose with age among those using no product (Theil-Sen slope +0.30 years per year) but was flat among product users (-0.01). Restricting to the screening-eligible stratum used in the cohorts high-risk analysis did not attenuate the imbalance: among those aged 50 to 80, median cessation among no-product quitters rose to 15.5 years (n = 858), and adding a 20 pack-year criterion left 421 no-product quitters with a median of 11.0 years against three HTP/EC users who had quit 0.25, 1.0 and 2.0 years earlier, despite closely matched cumulative exposure (mean 37.6 vs 37.7 pack-years). The overall contrast reproduced in every wave from 2018 to 2023, with an age-matched residual of 9 to 11 years. ConclusionsIn a nationally representative survey of the same population and the same calendar year as the NHIS screening cohort analyzed by Kim et al., Korean former smokers using non-combusted nicotine products differed from other former smokers in two respects that bear directly on how such comparisons should be read. First, they were predominantly HTP users: 79% reported any HTP use, and only 21% reported e-cigarette use without HTP use. Second, they had stopped smoking approximately a decade more recently, a difference that survived stratification at five years and exact age matching. Neither quantity is recorded in the NHIS screening instrument. Cohort estimates comparing post-cessation product users with other quitters should therefore be interpreted with caution if they do not precisely characterize product composition and to time since cessation, and future studies should measure both directly.

Background: Deaf and hard of hearing (HoH) experienced complex challenges during the COVID19 pandemic, including obscured visual communication from mask mandates, inaccessible public health messaging, and inadequate interpreter availability. We examined whether hearing status predicted nonmedical COVID19 impact on a global level. Methods: We conducted a nested cross-sectional analysis within a global study collecting data across two waves (April to May 2020 and July to August 2022) from 184 countries. Participants (N=7,998) were categorized as Deaf (n=304), Hard of Hearing (HoH; n=951), or Hearing (n=6,743). The primary outcome was a composite COVID-related non-medical Personal Impact TScore derived from 14 items across employment, resource access, and healthcare domains. Multinomial logistic regression models progressively adjusted for demographic, structural, and psychosocial variables. Results: Deaf participants reported substantially higher rates of pandemic-related job loss (28.9% vs. 9.6% hearing), healthcare cancellations (39.9% vs. 24.6%), and inability to obtain basic supplies. Over half (55.9%) of Deaf participants scored above the median composite impact index, compared to 39.2% of hearing participants. In the fully adjusted model, Deaf status remained an independent predictor of high non-medical impact (aOR=1.6, 95% CI: 1.1 to 2.4). HoH status showed no statistically significant difference from hearing participants in any model. Conclusions: People identifying as Deaf experienced significant disparities during COVID19 when compared with HoH or hearing people, driven by language access barriers and institutional exclusion rather than hearing loss per se. These experiences underscore the importance for systemic interventions centering on accessible communication, Deaf-centered needs, and reducing audism in Deaf-hearing interaction.

Objective We characterized social determinants of health (SDOH) in U.S. children who ever and never had Long COVID. Methods We used cross-sectional data from the 2022-2023 National Health Interview Survey (N=14,993 children 0-17 years). Parents reported child- and household-level information. Long COVID was defined as ever experiencing symptoms lasting [&ge;]3 months that were not present prior to having COVID-19. We produced weighted prevalence estimates by Long COVID status for 3 SDOH domains (Social and Community Context, Healthcare Access and Quality, and Economic Stability) and used Rao-Scott chi-squared tests to examine differences. Results In Social and Community Context, children who ever had Long COVID more often resided in single parent households (33.2% vs. 20.3%; p<0.0001), with someone with severe depression or mental illness (18.5% vs. 8.3%; p<0.0001) or substance abuse (16.7% vs. 8.1%; p<0.0001) or had a lifetime of being disparaged by adults in the home (9.2% vs. 3.9%; p=0.0009). In Healthcare Access and Quality, children who ever had Long COVID more often had public insurance (e.g., Medicaid) (51.3% vs. 41.6%; p=0.02), higher healthcare use, and difficulty paying medical bills (23.2% vs. 12.2%; p<0.0001). In Economic Stability, children who ever had Long COVID had lower parental education, lower food security, and higher participation in social safety net programs (p<0.01 for all comparisons). Conclusion Children who ever had Long COVID more frequently experienced adverse SDOH compared to their peers who never had Long COVID. These findings may help identify children who may benefit from additional resources related to their Long COVID care.

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.

Introduction The Tobacco and Vapes Act 2026 provides the UK government powers to ban vaping in public places. Proposals include extending existing indoor smoke-free legislation to also being vape-free and making public children's playgrounds and outdoor areas of education settings vape-free. We examined adults' and adolescents' views on vape-free places. Methods Two UK-wide cross-sectional online surveys were conducted in 2026, one with adult (18+) current and former nicotine users (n=2,851), and one with adolescents aged 11-17 years (n=2,123). We measured (1) perceived acceptability of vaping in public places, (2) views on whether vapes should/should not be allowed in public places, and (3) perceived likelihood of public compliance with vaping bans. Results Adults considered it unacceptable to vape on public transport (85.9%), on school grounds (outdoors) (83.6%), outside hospital entrances (59.2%), and inside pubs (57.8%) and nightclubs (52.5%). A minority considered it unacceptable to vape at open air playparks (40.6%). Most adolescents viewed vaping as unacceptable in all locations. Perceived acceptability of vaping in each place was associated with current vaping and/or smoking. Adults and adolescents believed vaping should not be allowed on public transport (88.9%; 93.8%) or outdoors on school grounds (85.8%; 93.5%). Adults and adolescents perceived likely compliance on public transport, school grounds and in pubs, but not in nightclubs, outside hospital entrances and at open air playparks. Conclusion The findings indicate public support for some vape-free places among adults and adolescents, particularly on public transport and school grounds, and less so for a ban at open air playparks.

Tobacco control treaties were written for billboards and television, not for the people now selling lifestyles to young Africans. As mobile internet saturates East African cities, social media influencers have become an unmeasured channel, especially when it comes to tobacco promotion. We assessed the prevalence of tobacco use, its association with influencer exposure, and how urban youth interpret that exposure in two capitals with different tobacco laws. We conducted a comparative mixed-methods study among youth aged 18-29 years in Kampala, Uganda, and Nairobi, Kenya (January-August 2025), combining (i) a cross-sectional survey using systematic sampling at youth-dense venues (n=772), (ii) four online focus group discussions (FGDs; n=40), and (iii) content analysis of 30 tobacco-related posts from high-reach influencers (greater than 50,000 followers). We used chi-square tests and multivariable logistic regression, thematic analysis (Braun and Clarke), and descriptive engagement metrics. Ever tobacco use among urban youth in East Africa was 29.3% (226/772), similar in Kampala (30.7%) and Nairobi (28.0%; p=0.409). After adjustment, exposure to influencers promoting tobacco independently predicted ever use (adjusted odds ratio [aOR] 1.90, 95% confidence interval [CI] 1.29-2.82; p=0.001), alongside male sex (aOR 2.35) and age 26-29 years (aOR 1.99). Tertiary education (aOR 0.45) and never seeing tobacco content (aOR 0.26) were protective. Posts framed tobacco as aspirational lifestyle; 77% of sampled comments were positive and 47.5% expressed interest in trying the product. Influencer exposure behaved as a modifiable risk factor of a magnitude comparable to established demographic drivers. Tobacco control in the region must move from print-era advertising bans to platform governance, mandatory disclosure of paid promotion, and youth-led counter-marketing.

This cross-sectional study aimed to examine the prevalence of alcohol use and its sociodemographic correlates among adults with cardiovascular disease (CVD). We analyzed data from two large US cohorts: the All of Us Research Program (2017-2023) and the National Health and Nutrition Examination Survey (NHANES, 1999-2016). Both CVD diagnosis and past-year alcohol consumption were self-reported. Risky drinking was defined as exceeding moderate drinking or binge drinking (All of Us), or moderate/heavy drinking (NHANES). Multivariable logistic regression was used to exam associations with sociodemographic and lifestyle factors. Among 32,788 current drinkers with CVD in the All of Us cohort, 15% exceeded moderate drinking thresholds and 26% reported binge drinking. Older age, female sex, and higher socioeconomic status were inversely associated with risky drinking, while smoking was positively associated. In NHANES, moderate drinking rose from 47.3% to 57.2% and heavy drinking from 6.7% to 7.2%. Moderate/heavy drinking was positively associated with age <65 but inversely with age [&ge;]65. Higher education and income were linked to moderate drinking, while current smoking was strongly associated with heavy drinking. These results highlight the need to integrate holistic screening for alcohol use, tobacco use, and social context into routine cardiovascular care.

Medical discrimination may alter how patients relate to health information sources following adverse care encounters. We examined whether discrimination experience is associated with selective erosion of institutional health trust and with compensatory digital health engagement, using nationally representative data from the Health Information National Trends Survey (HINTS) 6 (2022; n=6,252) and HINTS 7 (2024; n=7,278). Survey-weighted modified Poisson regression estimated prevalence ratios (PRs) for binary high-trust outcomes, and survey-weighted ordinary least squares estimated coefficients for continuous outcomes; jackknife replicate weights (50 replicates) provided variance estimates. Discrimination was associated with substantially lower probability of high trust in the healthcare system (PR=0.39; 95% CI 0.30-0.52) and physicians (PR=0.85; 95% CI 0.77-0.94), with no significant association for trust in scientists, government, family, or religious organisations. The clinical-institutional pattern replicated in HINTS 6, which additionally showed reduced trust in scientists for race/ethnicity-based discrimination. Contrary to a disengagement hypothesis, discrimination-exposed adults showed higher probability of online health information seeking (PR=1.06), health app use (PR=1.11), and online provider messaging (PR=1.13); these associations persisted after adjustment for trust in physicians. Discrimination was independently associated with lower health self-efficacy (b=-0.271). Medical discrimination selectively erodes trust in clinical institutions while leaving broader epistemic trust largely intact. Despite this, discrimination-exposed patients engage more actively with digital health channels, consistent with compensatory reorientation toward non-clinical information sources. These findings describe engaged but institutionally alienated patients, with implications for restoring clinical trust and for equity-centred digital health design.

Homicide is a leading cause of preventable death in the United States and disproportionately affects Black and Indigenous communities. Structural racism and neighborhood disinvestment are central drivers of these disparities, yet national evidence on whether the association between neighborhood opportunity and homicide risk varies by race/ethnicity remains limited. Using 2020 data from the restricted-use National Violent Death Reporting System linked to Child Opportunity Index (COI 3.0) scores and Census population denominators across 30,077 ZIP codes in 48 states, we estimated age-adjusted log-linked generalized linear models to examine racial/ethnic disparities in homicide rates and their interaction with neighborhood opportunity. Black men experienced homicide rates nearly 20 times those of White men; Indigenous men experienced rates approximately 6 times higher. Higher neighborhood opportunity was independently associated with lower homicide risk across all groups and explained 43-59% of excess risk for Black and Indigenous individuals. Crucially, the association between neighborhood opportunity and homicide was nonlinear and significantly heterogeneous by race/ethnicity, with the steepest rate reductions occurring at the lowest opportunity levels for Black and Indigenous men. These findings suggest that place-based investments in severely deprived communities may yield the greatest reductions in homicide and racial/ethnic health inequities.

Short-form video platforms increasingly shape how young audiences encounter health information. Generative artificial intelligence can produce standardized avatar-based messages at scale, but randomized evidence for tobacco prevention is scarce. In this three-arm randomized online intervention study with pre-post assessment, participants aged 16 years or older were assigned to an AI avatar video emphasizing short-term smoking consequences, an AI avatar video presenting long-term cancer-related information matched to an American Cancer Society fact sheet, or the same fact sheet in written form. The primary outcome was post-intervention intention to avoid smoking and secondhand smoke exposure, adjusted for baseline intention. Among 400 randomized participants, 272 had complete data for the primary baseline-adjusted analysis. Intention increased from baseline to post-intervention in all conditions, with no statistically significant between-group differences. These findings support AI avatar videos as a scalable, social-media-compatible format for digital tobacco prevention, while not establishing superiority or equivalence.

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.

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.

While the public perceives e-cigarettes as less harmful than combustible tobacco, little is known about their specific health concerns regarding vaping. We demonstrate a data-driven strategy to discover the public's health concerns about vaping e-cigarettes expressed on social media. We obtained all public posts from the largest e-cigarette-related subreddit, r/electronic_cigarette, from its inception on September 17, 2008, through April 1, 2022 (N = 10,403,433). We identified health concerns attributed to vaping by (a) selecting all cause phrases containing "cause" and its inflections, (b) calculating the empirical frequency ratio of words and bi-grams occurring in these phrases relative to random phrases, (c) retaining the 10% of words with the greatest empirical frequency of occurring in cause phrases, and (d) annotating this sample for health-relevant concerns and their subjects. In total, 76,342 posts contained cause phrases, with increased volume over time. Of the 425 words most strongly associated with cause phrases compared to random phrases, 53.4% (95%CI, 48.7-58.1) were identified as health-relevant. The top health-related concern was lipoid pneumonia, cited in 5.9% (95%CI, 5.0-6.8) of all cause phrases, followed by pneumonia (4.1%; 95%CI, 3.3-4.9), and nausea (2.7%;95%CI, 2.0-3.4). The top health concern subjects were respiratory, representing 23.7% (95%CI, 18.5-29.5) of all cause phrases, followed by gastrointestinal (12.7%; 95%CI, 8.8-17.2) and cardiovascular (8.5%; 95%CI, 5.3-12.3) concerns. Other subjects included neurological, dermatological, oral health, sexual health, psychiatric, oncologic, addiction, and sleep concerns. Because our strategy relies on data-driven techniques, our analysis can be integrated into routine social media monitoring and applied across different types of social media and text data, potentially leading to more timely identification of emerging concerns and a broader understanding across platforms. As a result, experts can craft messaging that accounts for current perceptions held by the public using our method.