Preventive Medicine

Background and AimsDespite advances in cervical cancer prevention through HPV vaccination and self-collection screening options, participation remains disproportionately low among culturally and linguistically diverse (CALD) women in Australia. Despite national policy efforts, uptake remains low. This study aims to bridge the gap between policy and lived experience by synthesising evidence and capturing perspectives to understand why screening remains inaccessible - and how it can be transformed. MethodsA narrative review of peer-reviewed and grey literature (2015-2024) was conducted to identify structural and cultural barriers affecting cervical screening participation in CALD populations. Key themes were mapped against the socio-ecological model. In parallel, semi-structured interviews were conducted with eight multicultural health workers and cultural advisors across South Australia. Thematic analysis was used to identify recurring patterns, community insights, and practice-level solutions. Ethics approval was granted by the University of South Australia Human Research Ethics Committee. ResultsLiterature consistently reported language barriers, lack of culturally safe information, and limited awareness of self-collection options. Interviewees deepened this with lived insight, describing mistrust, stigma, and fear, especially among women from refugee and faith-based communities. They proposed actionable strategies: co-designed messaging, partnerships with cultural leaders, and embedding screening education into womens community spaces. Importantly, the disconnect between national messaging and local realities was seen as a critical barrier to meaningful engagement. Conclusions and Significance/ImpactThis study reveals that closing the cervical screening gap for CALD women requires more than information -- it demands cultural trust, community leadership, and policy grounded in real-world experience. By combining evidence with voice, it offers a roadmap for developing inclusive, community-led screening programs. The findings advance translational public health by demonstrating how innovation begins with listening -- and leads to systems that truly work for all.

Society is becoming increasingly dependent on survey research. However, surveys can be impacted by participants who are non-attentive, respond randomly to survey questions, and misrepresent who they are and their true attitudes. The impact that such respondents can have on public health research has rarely been systematically examined. In this study we examine whether Americans began to engage in dangerous cleaning practices to avoid Covid-19 infection. Prior findings reported by the CDC have suggested that people began to engage in highly dangerous cleaning practices during the Covid-19 pandemic, including ingesting household cleansers such as bleach. In a series of studies totaling close to 1400 respondents, we show that 80-90% of reports of household cleanser ingestion are made by problematic respondents. These respondents report impossible claims such as recently having had a fatal heart attack and eating concrete for its iron content at a similar rate to ingesting household cleaners. Additionally, respondents frequent misreading or misinterpreting the intent of questions accounted for the rest of such claims. Once inattentive, mischievous, and careless respondents are taken out of the analytic sample we find no evidence that people ingest cleansers to prevent Covid-19 infection. The relationship between dangerous cleaning practices and health outcomes also becomes non-significant once problematic respondents are taken out of the analytic sample. These results show that reported ingestion of household cleaners and other similar dangerous practices are an artifact of problematic respondent bias. The implications of these findings for public health and medical survey research, as well as best practices for avoiding problematic respondents in surveys are discussed.

BackgroundOnline misinformation has grown significantly with the widespread use of the internet and the ease of sharing content through social media, often without rigorous fact-checking or scientific validation. In this context, trust in scientists and conspiracy beliefs may affect online misinformation susceptibility and fake news detection. ObjectiveTo examine the effect of trust in scientists and conspiracy beliefs on online misinformation susceptibility and fake news detection. Additionally, we investigated the association between demographic variables and online misinformation susceptibility and fake news detection. MethodsA cross-sectional study was carried out in Greece, with data collected through an online survey in August 2025. Trust in scientists was assessed using the Trust in Scientists Scale. Conspiracy beliefs were measured using the Conspiracy Mentality Questionnaire. Participants susceptibility to online misinformation was evaluated using the Online Misinformation Susceptibility Scale. Their ability to detect online fake news was assessed through the fake news detection scale. ResultsOur multivariable analysis identified that lower trust in scientists is associated with higher online misinformation susceptibility. Participants who believed in conspiracy behaviors showed also higher levels of misinformation susceptibility. Moreover, lower financial status and lower interest in politics were associated with misinformation susceptibility. We found a positive association between trust in websites and misinformation susceptibility. Also, we found a negative association between age and misinformation susceptibility. Our multivariable linear regression model showed that participants who believe in conspiracy beliefs had a lower ability to detect fake news. Moreover, we found a positive association between trust in sciences and fake news detection. Finally, we found a negative association between interest in politics and fake news detection. ConclusionOur findings showed associations between trust in scientists, conspiracy beliefs, online misinformation susceptibility and fake news detection. Moreover, several demographic variables were associated with misinformation susceptibility and fake news detection. Identification of predictors of misinformation susceptibility and fake news detection is crucial to define high-risk groups and develop appropriate interventions to confront these issues.

ObjectivesTo characterize prevalence and impact of long COVID. MethodsWe conducted a population-representative survey, June 30-July 2, 2022, of a random sample of 3,042 United States adults. Using questions developed by the United Kingdoms Office of National Statistics, we estimated the prevalence by sociodemographics, adjusting for gender and age. ResultsAn estimated 7.3% (95% CI: 6.1-8.5%) of all respondents reported long COVID, approximately 18,533,864 adults. One-quarter (25.3% [18.2-32.4%]) of respondents with long COVID reported their day-to-day activities were impacted a lot and 28.9% had SARS-CoV-2 infection >12 months ago. The prevalence of long COVID was higher among respondents who were female (aPR: 1.84 [1.40-2.42]), had comorbidities (aPR: 1.55 [1.19-2.00]) or were not (versus were) boosted (aPR: 1.67 [1.19-2.34]) or not vaccinated (versus boosted) (aPR: 1.41 (1.05-1.91)). ConclusionsWe observed a high burden of long COVID and substantial variability in prevalence of SARS-CoV-2. Population-based surveys are an important surveillance tool and supplement to ongoing efforts to monitor long COVID.

BackgroundSeveral social trends in the United States (US) suggest an increasing risk for political violence. Little is known about support for and personal willingness to engage in political violence and how those measures vary with lethality of violence, specific circumstances, or specific populations as targets. Design, Setting, ParticipantsCross-sectional nationwide survey conducted May 13 to June 2, 2022; participants were adult members of the Ipsos KnowledgePanel. Main Outcomes and MeasuresWeighted, population-representative proportions endorsing an array of beliefs about American democracy and society and the use of violence, including political violence, and extrapolations to the US adult population. ResultsThe analytic sample included 8,620 respondents; 50.6% (95% Confidence Interval (CI) 49.4%, 51.7%) were female; mean (SD) age was 48.4 (18.0) years. Two-thirds of respondents (67.2%, 95% CI 66.1%, 68.4%) perceived "a serious threat to our democracy," but more than 40% agreed that "having a strong leader for America is more important than having a democracy" and that "in America, native-born white people are being replaced by immigrants." Half (50.1%) agreed that "in the next few years, there will be civil war in the United States." Among 6,768 respondents who considered violence to be at least sometimes justified to achieve 1 or more specific political objectives, 12.2% were willing to commit political violence themselves "to threaten or intimidate a person," 10.4% "to injure a person," and 7.1% "to kill a person." Among all respondents, 18.5% thought it at least somewhat likely that within the next few years, in a situation where they believed political violence was justified, "I will be armed with a gun"; 4.0% thought it at least somewhat likely that "I will shoot someone with a gun." Conclusions and RelevanceCoupled with prior research, these findings suggest a continuing alienation from and mistrust of American democratic society and its institutions. Substantial minorities of the population endorse violence, including lethal violence, to obtain political objectives. Efforts to prevent that violence, which a large majority of Americans already reject, should proceed rapidly based on the best evidence available. Further research will inform future prevention efforts.

There is an urgent need to track the early and ongoing impact of the COVID-19 pandemic on population health from local to global scales. At the same time, there is an overall lack of U.S. state-specific surveillance data tracking social determinants of health (SDOH) and associations with population well-being, individual mitigation and coping strategies, family dynamics and other economic shocks of the pandemic in populations. Statewide data can offer important insights into how SDOH shape the long-term effects of COVID-19 in the population since implementation of many policies and programs varied widely early on in the pandemic. In May of 2020, the Survey of the Health of Wisconsin (SHOW) program launched a statewide online/phone survey of early and ongoing impacts of COVID-19 on health and well-being across diverse communities and families. The goal of this study is to provide descriptive data including perceived COVID-19 risks, access to and results of COVID-19 antigen testing, individual mitigation and coping strategies, family dynamics and other economic shocks of the pandemic on health and mental health in populations. Key findings include higher rates of testing and perceived past infection from COVID-19 among non-white respondents. Higher economic shifts and job changes in female vs male respondents. Families with children reported overall higher levels of stress, and stress from the pandemic. There were urban and rural differences in changes to access to care. Rural regions, which had a lower prevalence of infections early in the pandemic as compared to urban areas, also reported fewer delays or missed appointments due to COVID-19. Key findings show that SDOH are shaping impacts of health and well-being early on in the pandemic and future longitudinal follow-up will be important to shape policies and programs well into the future.

BackgroundThe US Preventive Services Task Force updated colorectal cancer (CRC) screening guidelines in 2021, recommending screening for adults aged 45-49. This study aimed to evaluate CRC screening prevalence among this newly eligible population and examine associations with healthcare provider supply and CT colonography facility availability in 2022. MethodsUsing 2022 Behavioral Risk Factor Surveillance System data (n=25,592), we estimated CRC screening prevalence among adults aged 45-49. We examined associations between screening rates and state-level healthcare provider supply using 2021-2022 Area Health Resources File data. Spearman rank-order correlations assessed relationships between provider supply, CT colonography facility availability, and screening prevalence. ResultsOverall CRC screening prevalence was 34.5% (95% CI: 33.4%-35.8%). Endoscopic tests were most common (74.9%), followed by stool-based tests (9.3%) and CT colonography (0.5%). Significant variations in screening modalities were observed across sociodemographic factors. Gastroenterology physician supply positively correlated with overall CRC screening prevalence ({rho}=0.42, P=.002) and endoscopy screening prevalence ({rho}=0.39, P=.005). CT colonography facility availability weakly correlated with CT colonography screening prevalence ({rho}=0.18, P=.22). ConclusionsCRC screening rates among newly eligible adults aged 45-49 appear to be suboptimal in 2022. Disparities in screening methods across sociodemographic factors highlight potential access barriers. The association between gastroenterology physician supply and screening rates emphasizes the importance of addressing projected workforce shortages. Targeted efforts are needed to increase CRC screening uptake in this age group and ensure equitable access to screening services.

Prospective home injuries (HIs) and detailed exposure information are generally scarce to study risk factors. We assessed the associations between physical household environment, behaviours and Do-It-Yourself (DIY), gardening and domestic activities and HIs risk in a prospective cohort study. The MAVIE observatory is an e-cohort conducted among volunteers of the French general population. Poisson mixed models were fitted and Risk Ratios estimated to assess the determinant of the number of HIs prospectively recorded during the follow-up. A total of 6146 dwelling adults aged 15 or more were followed up for 4.0 years on average and 12% reported at least one HI during follow-up. Adjusting on socio-demographics variables and self-perception of physical and mental health, no characteristic of the physical environment measured at baseline were associated with HI risk. Storing household products out of their original packaging, DIY activities and using a stool to reach high places were significantly associated with HI with attributable fractions of 12.1%, 6.4% and 6.9% respectively.

ImportanceDisease prevalence estimation is highly sensitive to sample characteristics shaped by recruitment and data collection strategies. Using follow-up study modules that require active participant engagement may introduce participation bias, affecting the accuracy of disease prevalence estimation. ObjectiveTo estimate the prevalence of ischemic heart disease (IHD) and stroke using electronic health records (EHR) and the self-reported Personal Medical History (PMH) survey collected in the All of Us Research Program. Design and settingsCross-sectional study aimed at estimating the prevalence of IHD and stroke among 266,472 participants with EHR in the latest release of the All of Us Registered Tier Curated Data Repository (R2022Q4R9). Main outcomes and measuresPrimary outcomes were IHD and stroke, ascertained using expert-curated diagnostic and procedure codes recorded in EHR. Secondary outcomes were IHD and stroke, ascertained using responses from the PMH survey. To mitigate the impact of participation bias in the PMH survey responses, we applied poststratification weighting based on annual household income and education. ResultsOf the 266,472 participants with EHR, 17,054 (6.4%) were identified as having IHD and 7,461 (2.8%) as having stroke based on the EHR definitions. Among PMH survey respondents, the EHR-based prevalence was lower at 5.6% (95% CI, 5.4-5.7) for IHD and 2.2% (95% CI, 2.1-2.3) for stroke, compared to 7.2% (95% CI, 7.0-7.3) for IHD and 3.3% (95% CI, 3.2-3.4) for stroke among non-respondents. The PMH survey-based prevalence among respondents was 5.9% (95% CI, 5.7-6.0) for IHD and 3.6% (95% CI, 3.5-3.7) for stroke, with higher estimates among non-Hispanic White participants after applying poststratification weights. Conclusion and relevance: Our findings suggest that while the current All of Us cohort with EHR reflects the general US population for IHD and stroke prevalence, participants completing the PMH survey are skewed toward higher socioeconomic status and medical literacy. Future research should refine bias mitigation strategies when using voluntary follow-up data to estimate disease prevalence in this cohort. Key PointsO_ST_ABSQuestionC_ST_ABSWhat is the prevalence of ischemic heart disease (IHD) and stroke in the All of Us Research Program cohort with electronic health records (EHR), and in the subset of these participants who also completed the Personal Medical History (PMH) survey? FindingsThe EHR-based prevalence estimates of IHD and stroke were 6.4% and 2.8%, respectively. They were significantly lower among PMH survey respondents but higher among non-respondents. MeaningParticipants who complete follow-up study modules, such as the PMH survey, may disproportionately represent those with higher socioeconomic status and better health, potentially leading to an underestimation of IHD and stroke prevalence.

BackgroundRapid coronavirus 2019 (COVID-19) testing in symptomatic cases is extremely important for preventing the spread of COVID-19 infection and early therapeutic intervention. In contrast, whether symptomatic patients are tested depends largely on their health literacy, interpretation, and knowledge of COVID-19. We aimed to investigate the rate of COVID-19 testing avoidance despite having common cold symptoms in patients with cardiovascular disease and examine factors related to testing avoidance. MethodsA large-scale epidemiological questionnaire survey, the Japan COVID-19 and Society Internet Survey 2022 (JACSIS), was conducted online from April to May 2022. The rate of COVID-19 testing avoidance was investigated in patients aged 20 to 80 years with cardiovascular risk factors (hypertension, dyslipidemia, or diabetes) or a history of cardiovascular disease (angina, myocardial infarction, or stroke), only those exhibiting common cold symptoms during the 2 months in the survey. ResultsOf the 1,565 eligible patients, 58% (909 patients) did not undergo COVID-19 testing. Multivariate analysis revealed that older age, obesity, non-walking regularly, long sedentary time, eating alone, frequent snacking, and having received 4 COVID-19 vaccinations were independently associated with testing avoidance. ConclusionsIn the chronic phase of the COVID-19 pandemic, prompt COVID-19 testing at the time of symptomatic disease is important, and strategies to reduce testing hesitancy should be considered.

BackgroundCOVID-19 has negative impacts on mental health in all populations. Individuals with a history of cancer have an increased risk of catching and having more severe symptoms of COVID-19 than the general public. The objective of this study was to examine how cancer history and concern for catching COVID-19 relate to anxiety. MethodsThis cross-sectional study is part of the "Impact of COVID-19 on Behaviors across the Cancer Control Continuum in Ohio" project conducted from June to November 2020. The sample consisted of 7012 participants who completed survey online, by phone, or by mail. Self-reported concern for catching COVID-19 and anxiety over the last 7 days were used. Linear and logistic regression models were performed to determine the association between demographics, cancer history, concern for catching COVID-19, and anxiety. ResultsIn our study sample, most participants rated their concern for catching COVID-19 as moderately high or high (56%) and reported anxiety for one day or more (63%). Individuals with a cancer history were more likely to report moderate-high or high concern for catching COVID-19 (59% vs.54%, P<0.001) but less likely to report anxiety (58% vs. 67%, P<0.001) compared to those without a cancer history. Individuals with higher SES were less likely to report anxiety (middle vs. low SES: OR=0.68, 95%CI=0.59-0.79; high vs. low SES: OR=0.70, 95%CI=0.61-0.82). Additionally, increased concern for catching COVID-19 was associated with higher likelihood of reporting anxiety (moderate-low vs. low: OR=1.65, 95%CI=1.42-1.92; moderate-high vs. low: OR=2.98, 95%CI=2.53-3.50; high vs. low: OR=4.35, 95%CI=3.74-5.07). ConclusionsOur findings suggest individuals with a cancer history reported higher concern for catching COVID-19. Higher concern for catching COVID was associated with anxiety. These findings indicate that healthcare providers should pay special attention to the different populations to reduce concerns for catching COVID-19 and provide strategies to improve mental health during a pandemic outbreak. FundingThis study was supported by a supplement to The Ohio State University Comprehensive Cancer Center (OSUCCC) core support grant (P30 CA016058), and the OSUCCC The Recruitment, Intervention and Survey Shared Resource (RISSR)(P30 CA016058).The Ohio State University Center for Clinical and Translational Science grant support (National Center for Advancing Translational Sciences, Grant UL1TR001070) in publications relating to this project. This work was supported by the National Cancer Institute (F99CA253745 to X.Z.).

ObjectivesLoneliness and social isolation pose significant risks for an individuals physical, mental, and social health including higher incidence of cardiovascular disease (CVD), poorer patient reported outcomes, and earlier mortality compared to those not experiencing loneliness or social isolation. The objective of this study was to assess loneliness and social and emotional support among adults aged 18 years and older who have CVD in the US. DesignUsing the 2023 Behavioral Risk Factor Surveillance Systems social determinants and health equity module, we examined the distribution of US adults with CVD, compared the prevalence of CVD by Hispanic ethnicity, and conducted multivariable logistic regressions assessing the relationship of independent variables with loneliness and social and emotional support. ResultsThe proportion of adults with CVD who felt lonely sometimes, usually, and always was 44.6%. Hispanic adults who felt lonely (56.3% vs. 43.0%; P<0.0001) and did not receive needed social and emotional support (13.7% vs. 9.8%; P=0.0162) experienced a higher prevalence of CVD than their non-Hispanic adult counterparts who felt lonely and did not receive needed social and emotional support. Adults with CVD who reported rarely or never receiving needed social and emotional support (odds ratio [OR]: 1.42; confidence interval [CI]: 1.14-1.77) had 42% higher odds of feeling lonely, compared to adults who indicated receiving social and emotional support sometimes, usually, or always. Among Hispanic adults with CVD, widowed/divorced/separated adults (OR: 2.30; CI: 1.46-3.61), urban residents (OR: 2.14; CI: 1.05-4.36), and unemployed adults (OR: 3.26; CI: 1.93-5.51) had higher odds of feeling lonely compared to married, rural, and employed adults. ConclusionThis study demonstrates significant disparities in loneliness and social and emotional support in CVD among US adults, with Hispanics experiencing a disadvantage in both outcomes. Future studies should examine strategies to improve social connection for those experiencing disparities.

BackgroundTo advance precision medicine and improve population health, the All of Us Research Program aims to collect data, including a survey of social determinants of health (SDOH), from over 1 million participants. This report (1) outlines the process used to construct the All of Us SDOH survey and (2) presents the psychometric characteristics and scoring recommendations for SDOH survey measures. MethodsA consensus process was used to select a definition of SDOH and conceptual frameworks to develop inclusion and exclusion criteria and priorities for construct consideration. Cognitive interviewing was used to provide an assessment of SDOH survey item performance in English and Spanish. Scales and scored items were constructed in alignment with validated literature. Item non-response was calculated, and Cronbach s alpha was used to analyze the psychometric properties of each scale, overall and by demographic characteristics. Multivariable logistic regression models were used to examine if demographic categories were associated with item non-response. ResultsTwenty-nine percent (N=117,783) of All of Us participants submitted SDOH survey data by June 30, 2022. Among those who provided any SDOH survey data, item non-response was infrequent, with most scales having less than 5% incalculable scores due to item non-response. Item non-response varied most along the lines of racial identity, educational attainment, and the language in which the survey was administered (Spanish or English). In our regression models, for most scales, patterns of missing data due to item non-response were seen by racial identity, educational attainment, income level, and age. Internal consistency reliability was greater than 0.80 for almost all scales, with variability by racial identity, educational attainment, and the language of survey administration. ConclusionThe SDOH survey demonstrated good to excellent reliability across several measures of SDOHs and within multiple population groups that are underrepresented in biomedical research. Bias due to survey non-response and item non-response should be monitored and addressed as the survey is fielded more completely.

PurposeGuided by the intersectionality framework, we examined the differential in breast cancer care experience across population subgroups in England. MethodsSecondary data analysis using the 2017/2018 English National Cancer Patient Experience Survey (NCPES). We applied disaggregated descriptive statistics (mean, standard errors, 95% confidence interval) to analyse 26,030 responses from female breast cancer patients to a question relating to overall care experience categorised by age, ethnicity, and sexual orientation in their intersection with deprivation status. We then applied multivariable logistic regression (odds ratios, 95% confidence intervals) to ascertain the relationship of reporting a positive care experience adjusting for patient, clinical, and trust-level factors. ResultsPoorer breast cancer care experience was mostly reported by the most deprived younger and minoritised ethnic groups. Similar findings were observed in adjusted multivariable analyses. Younger respondents were less likely than older patients to rate their care favourably. Pakistani, Indian, Chinese, and Black African women were less likely than White British women to rate their care favourably. Respondents from the most socioeconomic deprived backgrounds were less likely than the most affluent ones to rate their care favourably. ConclusionThere is evidence of inequity in overall cancer care experience among female breast cancer patients in England, particularly among women living at the specific intersection of age, ethnicity and socioeconomic position. Future research is necessary to understand the mechanisms underlying breast cancer inequities. Policymakers, commissioners, and providers should consider the existence of multiple forms of marginalization to inform improvement initiatives targeting patients at higher risk of vulnerability.

BackgroundPeople with disabilities (PWDs) face disparities in the healthcare system that lead to poorer health outcomes. A lack of health information and accessible communication with healthcare professionals is linked to these health inequities. PWDs report lower health literacy, technology use, and different access needs that limit effective health-related communication. Due to the broad spectrum of disabilities, the barriers PWDs face with accessing health information vary greatly. MethodsWe conducted an existing data analysis using the nationally representative Health Information National Trends Survey (HINTS) conducted in 2024. We estimated adjusted odds ratios (aORs) using logistic regression for five different cancer-related health information outcomes among US civilian, non-institutionalized adults who included disability status (weighted n=250,488,318). ResultsPrimary findings indicated that PWDs--especially those with multiple disabilities, chronic pain, or deafness--had disparities in their health information seeking experiences compared to people without disabilities. People with multiple disabilities had higher odds of reporting frustration and difficulty understanding health information, as well as not searching for health information in the first place. ConclusionPeople with disabilities experience barriers to seeking health information but these barriers differ on the type of disability. This study is novel in the ability to compare different types of disabilities to different health information outcomes, but true disability representation is likely not possible due to inaccessible survey design. The findings in this study highlight the need for accessible health information, surveys, and more interventions that include PWDs in public health programming.

While the Monkeypox outbreak is growing, little is known about the general publics levels of knowledge, their trusted sources of information and attitudes towards a Monkeypox vaccine. In our representative survey of the US general public, we find that almost half the respondents (47%) feel that their knowledge level about Monkeypox is poor or very poor. The most trusted sources of information about the outbreak are healthcare professional and officials, but also known doctors and researchers with a large online following. Being vaccinated against COVID-19 was a strong predictor of willingness to receive a Monkeypox if recommended (adjusted Odds Ratio 32.1, 95% Confidence Interval 16.7-61.7). Our findings point to the urgent need for clear communication.

Ethnic minority populations faced a disproportionate impact of the COVID-19 pandemic. Loneliness, a significant public health issue, was exacerbated during the pandemic. Most previous studies used aggregated ethnic groups and overlooked underrepresented groups. This study explored ethnic inequalities in loneliness across 21 disaggregated ethnic groups in Britain during the COVID-19 pandemic. It used cross-sectional data (February to November 2021) from the Evidence for Equality National Survey (EVENS), with 14215 participants aged 18-75 from 21 ethnic groups in Britain. Weighted logistic regression models examined ethnic inequalities in loneliness across 21 disaggregated and 6 aggregated groups, both unadjusted and adjusted for socio-demographics. This study found higher odds of loneliness among most ethnic minority groups, with nuanced differences that were overlooked in aggregated analyses. Socio-demographics explained disparities for some ethnic groups, while differences in others remained after adjustment, suggesting additional factors driving these differences.

ObjectiveTo characterize associations between tattooing and health status. MethodsWe used data from [~]27,000 respondents to the 2020-2022 Utah Behavioral Risk Factor Surveillance System (BRFSS). Multivariable Poisson regression was used to calculate prevalence ratios (PR) and 95% confidence intervals (CI) associating ever receiving a tattoo with physical/mental health status. ResultsIn this cross-sectional study, ever receiving a tattoo was associated with self-reported "poorer" vs. "excellent" overall health, particularly among women (PR=3.08 [95% CI: 2.26- 4.21]). Tattooing was also associated with obesity (women, PR=1.40 [95% CI: 1.22-1.61]; men, PR=1.21 [95% CI: 1.04-1.40]) and chronic pain (women, PR=1.59 [95% CI: 1.43-1.77]; men, PR=1.55 [95% CI: 1.37-1.76]). Tattooed individuals were more likely to have been diagnosed with a depressive disorder (women, PR=1.64 [95% CI: 1.53-1.75]; men, PR=1.55 [95% CI: 1.39-1.73]) and to have had six or more teeth removed, vs. none (women, PR=2.18 [95% CI: 1.61-2.96]; men, PR=2.88 [95% CI: 2.10-3.95]). ConclusionsPublic health entities may consider partnering with tattoo studios and conventions to provide information about nutrition, exercise, dental care, mental health resources, and health screenings.

Introduction Social media is a central part of young people's lives, yet research on its mental health effects remains mixed. We posit that these inconsistencies stem in part from treating youth as a homogeneous group, obscuring distinct behavioral patterns associated with divergent mental health and wellbeing trajectories. Objectives This study aimed to: (1) explore heterogeneity in social media engagement styles among U.S. youth aged 15-24; and (2) examine how these engagement styles are embedded within a broader system of mental health, wellbeing, emotional regulation, belonging, family and neighborhood context, and stress and adversity. Methods Data were drawn from a 2024 nationally representative cross-sectional survey of 2,563 U.S. youth, conducted as part of the Youth Mental Health Tracker initiative. We employed unsupervised clustering to identify five distinct social media engagement profiles. Subsequently, we used Bayesian network-based causal discovery to examine (a) upstream factors that emerge as drivers of engagement styles and (b) downstream outcomes influenced by profile membership in the learned system. Results Five profiles were identified: the Perpetually Plugged-In (31.3%), characterized by near-constant multifaceted social media use, for both positive and negative purposes across multiple domains of life; the Burned-Out Browsers (21.9%), with high exposure to negative and comparison-based content with frequent attempts to disengage; the Practical Navigators (20.7%) who engage in structured, goal-oriented use focused on learning, hobbies, and maintaining connections; the Positive Engagers (13.6%) with high social and identity-driven engagement; and the Light Touch Users (12.5%) who have low overall engagement and limited reliance on social media for connection, identity, or support. Causal analyses revealed that the Perpetually Plugged-In and Burned-Out Browsers had the worst mental health and wellbeing, with their engagement driven by different reasons. While both engagement profiles were influenced by similar psychosocial risk factors, they were distinguished by their dominant drivers: contemporaneous social stressors (bullying, discrimination, and emotional dysregulation) for Perpetually Plugged-In youth, versus adverse childhood experiences for Burned-Out Browsers. In contrast, Positive Engagers reported high social media engagement alongside the highest levels of social wellbeing, using social media for identity exploration and social support within a context of low cumulative stress and adversity. Conclusions Findings suggest that youth social media risk is not driven by intensity of use alone, but by the interaction between engagement style and offline emotional and social conditions. Policies focused solely on restricting access risk overlooking these differences and may inadvertently sever important sources of connection for many youth. Strategies should identify experiential risk signals while strengthening supportive contexts that enable healthier engagement. Overall, youth social media use is best understood as part of a broader psychosocial system, and recognizing this heterogeneity is essential for designing more targeted, equitable, and evidence-based interventions.

This study investigated the impact of non-physical intimate partner violence (IPV), including emotional and verbal abuse, and coercive/controlling behaviors, on Ontario Health Insurance Plan costs, the universal healthcare provider in the province of Ontario, Canada. Women exposed to non-physical IPV alone had 17% higher healthcare costs over 10 years compared to those not exposed, translating to CA$686 million in additional annual costs, challenging the perception that non-physical IPV is less harmful than physical forms. We argue for prevention of non-physical IPV and improved screening in healthcare settings is vital to mitigate its long-term impacts on individuals and healthcare systems.