Development Of Public Health Interventions Research Articles

Zoonotic Spillover: Global Diversity Of Mammals And Distribution Of Hantaviral Strains In Synathropic Animals And The Perspective For Public Health

Introduction: Viral hemorrhagic fevers (VHF) refer to a group of diseases caused by different viral families. Rodents represent 42% of the world’s mammalian biodiversity and are reservoir hosts for a wide range of disease agents. Hantaviruses are harbored in numerous mammalian reservoirs, including rodents. To prevent and mitigate possible outbreaks of zoonotic diseases, it is necessary to know the geographic distribution, intra-specific relationships, diversity and identity of the incriminated species. Objectives: To describe the ecology, epidemiology, epizootiology and natural history of hemorrhagic infections caused by hantavirus serotypes and their respective reservoirs. Methodology: Bibliographical consultations and online articles were carried out in the databases relating the highlighted subjects. Results: Rodents from the subfamilies Murinae, Arvicolinae, Neotominae and Sigmodontinae are the main reservoirs of hantavirus disease. Orthohantaviruses are the most studied group, highlighting the Hantaan, Seoul, Puumala and Dobrava serotypes. Rodents of the genus Oligoryzomys, include several species and have parasite-host relationships reported for the genus Hantavirus. Other species of mammals, such as bats, squirrels and opossums, have already been described as possible reservoirs. Conclusion: Hantavirus infections occur as a result of close interactions between humans and animals. One Health approaches highlight concerns through interdisciplinary collaboration and development of public health interventions when animals become vectors of infections, with the aim of achieving global results by recognizing the interconnection between wildlife, humans and the environment.

Masking (Not Masking) Up: An STS Visual-Intersectional Approach to Understanding Publics and Science in Times of Rapid Change

In this paper we argue that a visual-intersectional approach can advance the field of science and technology studies (STS). Although there is a small but important body of work using visual methods in STS, it has rarely incorporated intersectional approaches. We use visual imagery about mask wearing during the COVID-19 pandemic as a case study to illustrate the potential power of a visual-intersectional approach in STS. We chose masks for three reasons. First, debates about mask-wearing were rich with visual imagery, from home-made signs posted in homes and businesses to professionally designed and printed imagery circulated by public health agencies. Second, recommendations about face coverings outside of healthcare settings changed dramatically in the first 18 months of the COVID-19 pandemic, providing an opportunity to analyze how rapidly changing scientific recommendations were debated in the public sphere. Finally, as masks entered the public sphere, they quickly became evocative technologies, deeply imbued with cultural and political meanings. By focusing on signs about masks in the United States, we demonstrate how integrating visual methods of data collection and an intersectional, visual analytical lens can strengthen STS by developing deeper understandings of (a) publics and science in times of uncertainty, (b) public health as a distinct form of scientific expertise, and (c) the role of humor and place-specific messaging in science. We close with analytic priorities for future research on mask use that could advance STS theories of the collective construction of scientific knowledge and productively inform the development of public health interventions.

Optimising a co-production framework for developing public health interventions: application and testing of school-based Research Action Groups

Existing frameworks for developing public health interventions have limited guidance for researchers on how to work with stakeholders to co-produce context-specific interventions. To address this, a promising framework for the co-production of public health interventions was developed through a previous review of school-based co-production. The present study aimed to optimise this co-production framework through applying and testing it in real-world secondary school contexts. Within schools, Research Action Groups (RAGs) were established with multiple school stakeholders supported by an external facilitator to use school data to produce school-specific mental health and wellbeing interventions. A mixed method process evaluation of two contextually diverse case study secondary schools in the UK was used to optimise the co-production framework. The process evaluation sought the views of those involved (students, school staff, school Senior Management Team (SMT) members, and the external co-production facilitator/researcher) on the co-production functions they were involved in so they could be modified, if needed. Data collected for the process evaluation during co-production were a researcher diary (n = 45 entries), and observations of student photography (n = 21) and RAG meetings (n = 8). Post co-production, interviews, and surveys with RAG students (n = 18) and staff (n = 8), and two school-specific SMT focus groups (n = 10) were conducted. The study identified four recommendations to optimise and integrate co-production into real world practice. They include the need to: assess schools for their readiness to undertake co-production; more effectively communicate the necessity to have stakeholders from the whole system involved; work with SMTs throughout co-production functions; involve stakeholders outside the school to support producing solutions to change school mental health and wellbeing priorities. The framework is intended to be used by researchers to integrate stakeholders into a shared decision-making process to develop interventions that meet the needs and contexts of individual schools. It could be transferred to other settings to support the development of public health interventions for other health areas, and populations. Further evaluation to test its use in other settings is needed.

Climate change perception and its association with cancer screening intent.

As the climate crisis deepens, its adverse effects on human health are becoming evident, including impacts on cancer pathogenesis and treatment. This study explored the link between individuals' awareness of the health impacts of climate change and interest in cancer screening. Using the 2021 Health Information National Trends Survey, our study demonstrated astatistically significant association between recognition of climate change as a personal health threat and interest in cancer screening. Although the study's retrospective nature and self-reported data pose some limitations, these findings signal a promising avenue for future research on the intersection of climate and cancer risk. This research supports the development of public health interventions that incorporate components of environmental health literacy alongside cancer screening efforts.

Parental anxiety and pediatric vaccine refusal in a US national sample of parents

ObjectivesUnderstanding vaccine hesitancy among parents is of emerging interest and of rising importance for promoting vaccine uptake to prevent pediatric illness. Here, we examine associations between pediatric vaccine refusal and parental symptoms of anxiety. MethodsOur cross-sectional survey assessed pediatric vaccine refusal in 1699 parents in a US national sample. Participants completed a sociodemographic questionnaire, the Vaccine Hesitancy Scale, and symptoms of anxiety (GAD-7). ResultsThe prevalence of pediatric vaccine refusal was 15.5 %. Parent symptoms of anxiety were related to vaccine refusal (OR = 1.07 [1.03, 1.10]). Mild (1.88 [1.39, 2.54], p <.001) and clinically significant (2.14 [1.39, 3.31], p <.001) symptoms of anxiety were also related to pediatric vaccine refusal.Parental anxiety was also associated with perceived risks of vaccines and reduced confidence. ConclusionsFindings highlight the need to consider parental anxiety in the development of public health interventions that address substandard pediatric vaccine uptake.

Clustering of diet, physical activity and sedentary behaviour and related physical and mental health outcomes: a systematic review

BackgroundPhysical activity (PA), sedentary behaviour (SB) and diet play an important role in the physical and mental health of young people. Understanding how these behaviours cluster, and the impact of clusters on health is important for the development of public health interventions. This review examines the prevalence of clusters of PA, sedentary time, and dietary behaviours, and how clusters relate to physical and mental health indicators among children, adolescents and young adults.MethodsElectronic (PubMed, Web of Science and Scopus) and manual searches were conducted for articles that were (i) observational studies including children, adolescents and/or young adults aged 5–24 years, (ii) examined the 'patterning', ‘clustering’, or ‘co-existence’ of each of PA, dietary behaviour and SB, and (iii) published in English up to and including July 2022. In addition to information on clustering, data on physical and mental health outcomes were extracted where reported. Included studies were assessed using the Cochrane risk of bias for observational studies. A narrative synthesis was conducted due to high heterogeneity. This review was registered with PROSPERO (CRD42021230976).ResultsForty-nine cross-sectional studies and four prospective cohort studies from eighteen countries reporting data from 778,415 individual participants were included. A broad range of clusters (n = 172) were found (healthy, unhealthy, and mixed). Mixed clusters were common (n = 98), and clusters of high diet quality, low PA and high SB were more prevalent in girls, while mixed clusters of high PA, high SB and low diet quality were more prevalent in boys. Unhealthy clusters comprising low moderate to vigorous PA, low consumption of fruits and vegetables, and high screen time were prevalent, particularly in those from lower socioeconomic status families. Compared to those with healthy behavioural clusters, those with unhealthy and mixed clusters had a higher adiposity, higher risk of cardiovascular disease, poorer mental health scores, and lower cardiorespiratory fitness.ConclusionsPA, SB and diet cluster in healthy, unhealthy and mixed patterns in young people that differ across sociodemographic characteristics. Unhealthy clusters are associated with poorer health outcomes. Intervention strategies targeting un-clustering multiple unhealthy behaviours should be developed and evaluated for their impact on health outcomes.

Lifestyle Factors in the Association of Shift Work and Depression and Anxiety

Shift work may lead to adverse health outcomes. Whether shift work is associated with depression and anxiety, and to what extent lifestyle mediates the associations, remains unknown. To explore the associations of shift work, its type, frequency, and working years with anxiety and depression and to examine the potential mediating role of lifestyles. This cohort study included 175 543 employed or self-employed workers who participated in the UK Biobank baseline survey (2006-2010). Data analysis was conducted from November 2022 to January 2023. Employment and shift work status information was obtained from baseline. Lifestyles included smoking, physical activity, alcohol consumption, dietary characteristics, sleep duration, sedentary time, and body mass index (BMI). Depression and anxiety were identified based on electronic health records. Cox proportional hazard regression models were used to calculate the association of shift work with anxiety and depression, and cause mediation analyses we used to test the mediating role of lifestyle factors in this association. Of the 175 543 included participants (mean [SD] age, 52.6 [7.1] years; 88 290 men [50.3%]; 167 495 White participants [95.4%]), 27 637 participants (16.2%) reported shift work. During a median (IQR) follow-up of 9.06 (8.35-9.75) years, 3956 workers (2.3%) developed depression and 2838 (1.7%) developed anxiety. In the fully adjusted model, individuals who reported engaging in shift work, or shift workers, had a higher risk of depression (HR, 1.22; 95% CI, 1.12-1.33; P < .001) and anxiety (HR, 1.16; 95% CI, 1.04-1.28; P < .001), and the risk was positively associated with shift frequency. Among shift workers, there was no significant difference between night shifts and nonnight shifts. In the dose-association analyses, years of shift work were negatively associated with the risk of depression and anxiety. Smoking, sedentary time, BMI, and sleep duration were identified as the main potentially modifiable mediators. These mediators together explained 31.3% of the association between shift work and depression and 21.2% of the association between shift work and anxiety. In this cohort study, shift work was significantly associated with a higher risk of depression and anxiety, and lifestyle factors partially mediated the associations. These findings not only support that shift work should be considered an occupational hazard, but also provide evidence for the urgent need for the development of public health interventions that promote healthy lifestyles aimed at improving the mental health of shift workers.

Toward Community-Based Natural Language Processing (CBNLP): Cocreating With Communities.

Rapid development and adoption of natural language processing (NLP) techniques has led to a multitude of exciting and innovative societal and health care applications. These advancements have also generated concerns around perpetuation of historical injustices and that these tools lack cultural considerations. While traditional health care NLP techniques typically include clinical subject matter experts to extract health information or aid in interpretation, few NLP tools involve community stakeholders with lived experiences. In this perspective paper, we draw upon the field of community-based participatory research, which gathers input from community members for development of public health interventions, to identify and examine ways to equitably involve communities in developing health care NLP tools. To realize the potential of community-based NLP (CBNLP), research and development teams must thoughtfully consider mechanisms and resources needed to effectively collaborate with community members for maximal societal and ethical impact of NLP-based tools.

A Longitudinal Analysis of Residential Mobility and Experience of Client Violence Among Women Who Exchange Sex in Baltimore.

Residential mobility remains an underexplored yet critical construct that may influence the risk of violence among women who exchange sex. This study examined the longitudinal relationship between residential mobility and experience of client-perpetrated physical or sexual violence among women who exchange sex in Baltimore, Maryland. Participants were at least at 18 years of age, were cisgender women, reported having engaged in transactional sex three or more times within the last 3 months, and were willing to be contacted for 6-, 12-, and 18-month follow-up visits. Analyses of responses from 370 women who exchange sex participating in at least one study visit were conducted. Unadjusted and adjusted Poisson regression models of the association over time between residential mobility and recent experience of physical or sexual violence were fit. Generalized estimating equations with an exchangeable correlation structure and robust variance estimation were used to account for clustering of participants' responses over time. Findings demonstrated that those who had lived in at least four places in the past 6 months had a 39% increased risk of client-perpetrated physical violence (aRR: 1.39; 95% CI: 1.07-1.80; p < .05) and a 63% increased risk of sexual violence (aRR: 1.63; 95% CI: 1.14-2.32; p < .01) compared to their less-mobile counterparts. These findings provide necessary evidence of correlations over time between residential mobility and experience of client-perpetrated violence among women who exchange sex. Strengthening our understanding of how residential mobility intersects with violence is critical for the development of public health interventions that are relevant to women's lives and needs. Future interventions should explore including residential mobility, a critical pillar of housing instability, with efforts to address client-perpetrated violence.

P-384 Advanced paternal age: a mapping of the ethical issues

Abstract Study question What are the ethical issues raised by advanced paternal age? Summary answer Advanced paternal age is an ethically challenging phenomenon at the intersection of perinatal ethics, public health ethics, research ethics and policymaking. What is known already Although there is no clear indication on when begins advanced paternal age (APA), there is a tendency to consider 40 years old and over as a turning point in male reproduction. APA is now associated with several risks for male fertility, miscarriages, future child health and psychological development. Clinicians, scientists, social science researchers and ethicists have pointed several ethical issues raised by APA. For the moment, the scope of this discussion has not been fully assessed in a systematic way. Study design, size, duration To support a comprehensive evaluation of APA, we propose a mapping of the ethical issues of APA. Participants/materials, setting, methods First, we conducted a systematic literature review to identify ethical issues pointed by researchers and clinicians. Second, this first list of issues was discussed by a panel of experts (N = 23) through a web survey. The results from both data collections were triangulated by qualitative analysis into an integrated list of issues. Main results and the role of chance Six groups of issues emerged from data analysis. The first group relates to issues associated with the family project. In other words, how to balance the risks of APA with the benefits of the family project. The second group looks at the issues for healthcare professionals, i.e., how to support the family project while respecting the professional duty to protect their patients’ wellbeing. The third group refers to the gender justice issues and how APA generates inequities between gendered reproductive roles. The fourth group covers the public health dimension of APA and the justification to create intervention to respond to a collective and potentially intergenerational phenomenon. The fifth group is concerned about ways to develop sound and fair policies to respond to the challenges of APA. The sixth group encompasses research ethics issues on how to respectfully develop the field of research on APA. Limitations, reasons for caution APA is a burgeoning field of research, and it faces two principal limitations: (1) there is no clear understanding of the molecular mechanism of APA effect, and (2) data on the psychosocial dimension of APA is scarce. For these reasons, the ethical reflection is still speculative. Wider implications of the findings These findings offer a roadmap for future research on the ethics of APA. They provide a comprehensive understanding of issues that can be discussed during preconception counselling. At last, they suggest indications for the development of public health interventions or policies dedicated to address the most challenging aspects of APA. Trial registration number not applicable

Pod-based e-cigarette use among US college-aged adults: A survey on the perception of health effects, sociodemographic correlates, and interplay with other tobacco products.

E-cigarette use among youth and young adults remains of public health concern. Pod-based e-cigarettes, including JUUL, significantly changed the e-cigarette landscape in the US. Using an online survey, we explored the socio-behavioral correlates, predisposing factors, and addictive behaviors, among young adult pod-mod users within a University in Maryland, USA. In total, 112 eligible college students aged 18-24 years, recruited from a University in Maryland, who reported using pod-mods were included in this study. Participants were categorized into current/non-current users based on past-30-day use. Descriptive statistics were used to analyze participants' responses. The mean age of the survey participants was 20.5 ± 1.2 years, 56.3% were female, 48.2% White, and 40.2% reported past-30-day (current) use of pod-mods. The mean age of first experimentation with pod-mods was 17.8 ± 1.4 years, while the mean age of regular use was 18.5 ± 1.4 years, with the majority (67.9%) citing social influence as the reason for initiation. Of the current users, 62.2% owned their own devices, and 82.2% predominantly used JUUL and menthol flavor (37.8%). A significant proportion of current users (73.3%) reported buying pods in person, 45.5% of whom were aged <21 years. Among all participants, 67% had had a past serious quit attempt. Among them, 89.3% neither used nicotine replacement therapy nor prescription medications. Finally, current use (adjusted odds ratio, AOR=4.52; 95% CI: 1.76-11.64), JUUL use (AOR=2.56; 95% CI: 1.08-6.03), and menthol flavor (AOR=6.52; 95% CI: 1.38-30.89) were associated with reduced nicotine autonomy, a measure of addiction. Our findings provide specific data to inform the development of public health interventions targeted at college youth, including the need for more robust cessation support for pod-mod users.

Carlos E Rodríguez-Díaz: community centred public health scientist

“I am a community centred scientist, meaning I don’t do any public health work that is not relevant to the community”, says Carlos E Rodríguez-Díaz, Associate Professor and Vice Chair of the Department of Prevention and Community Health at George Washington University–Milken Institute School of Public Health in Washington, DC, USA. His research focuses on public health intervention development with and for populations made socially vulnerable in Puerto Rico, the Caribbean region, and the USA, including people with HIV, incarcerated individuals, Latinx people, and sexual and gender minority groups.

Relationship between Menstrual Hygiene Management and Lower Reproductive Tract Infections among Adolescent Girls in Informal Settlements in Nakuru County, Kenya

Infections of the lower reproductive tract are a public-health concern. However, in Sub-Saharan Africa, the link between menstrual hygiene, water, sanitation and hygiene variables and lower reproductive tract infection has not been appropriately explored. This study sought to determine the menstrual hygiene management practices associated with occurrence of lower reproductive tract infections among adolescent girls in Informal Settlements in Nakuru County. The study used a community-based cross-sectional design targeting adolescent girls in informal settlements in Nakuru County. Multi-stage and simple random sampling methods were used to obtain a sample size of 385 adolescent girls. The findings showed that the proportion of lower respiratory tract infections (LRTIs) among the participants was 59.71% Regarding the menstrual hygiene management practices, adolescents who changed absorbent material more than twice a day were 0.22 times less likely to report experiencing a LRTI compared to those who changed once a day, (p=0.005), those who dried their reusable absorbent material outside the house were 0.26 times less likely to be infected with LRTI compared to those who dried inside the house, (p=0.014), and those who reported bathing  3times during menstruation were 0.27 less likely to report occurrence of LRTI compared to those who bath once, (p=0.012). The study found significant association between type of absorbent material, frequency of changing absorbent material, frequency of bathing, presence of hand washing equipment and presence of anal cleansing material in toilets and lower reproductive tract infections. A study in this population that incorporate comprehensive microbiological and clinical assessments so as to get a better estimate of the prevalence of LRTI would be recommended, this will also support development of public health interventions. Keywords: Menstrual Hygiene Management, Lower Reproductive Tract Infections, Adolescent Girls

The urban exposome profile of Limassol, Cyprus: integration of biomonitoring data with drinking water and quality of life indicators

Background and aim: Cities currently host the majority of the global population and generate more than 80% of the global gross domestic product. Societal changes, e.g., urbanization and migration shape population health, quality of life and urban exposures. Extending the human exposome framework, the urban exposome can be defined as the totality of environmental and health indicators that shape quality of life and urban populations’ health, using the city and smaller, intra-city areas as measurement units. The aim of this study is to describe the urban exposome profile of Limassol in summer 2017. Methods: A cross-sectional study was conducted in the municipality of Limassol, Cyprus with collection of household tap water samples, urine samples and questionnaire data from residents. We integrated data on drinking water and quality of life indicators with urinary data on untargeted metabolomics and biomarkers of pyrethroid and neonicotinoid pesticides. We mapped the urban exposome parameters (i.e., water quality, urinary pesticides, green space access) across the urban center and explored associations among them. Results: Overall, 132 residents participated in the study, 83% of which provided two urine samples (different days). 89% of the participants self-reported very good or good health. 64% reported living close to green spaces, which based on their assessment were not well-maintained, and thus, not used. Overall, 2% of households’ tap water exceeded 100 &amp;#x3bc;g/L of total trihalomethanes and less than 1% were outside the parametric values for E. coli and Enterococci spp (zero CFU/100 mL). Correlations between all parameters were explored and linear-mixed effect models described associations among the urban exposome variables. Conclusions: The application of urban exposome concept and its exposomic tools allowed continuous monitoring of urban health indicators to inform policy makers for the development of public health interventions for healthier living in sustainable societies. Keywords: urban health; exposome; metabolomics; epidemiology

Assessment of human milk in the era of precision health.

Precision health provides an unprecedented opportunity to improve the assessment of infant nutrition and health outcomes. Breastfeeding is positively associated with infant health outcomes, yet only 58.3% of children born in 2017 were still breastfeeding at 6 months. There is an urgent need to examine the application of precision health tools that support the development of public health interventions focused on improving breastfeeding outcomes. In this review, we discussed the novel and highly sensitive techniques that can provide a vast amount of omics data and clinical information just by evaluating small volumes of milk samples, such as RNA sequencing, cytometry by time-of-flight, and human milk analyzer for clinical implementation. These advanced techniques can run multiple samples in a short period of time making them ideal for the routine clinical evaluation of milk samples. Precision health tools are increasingly used in clinical research studies focused on infant nutrition. The integration of routinely collected multiomics human milk data within the electronic health records has the potential to identify molecular biomarkers associated with infant health outcomes.

Dietary Patterns in Colombia: An Exploratory and Confirmatory Factor Analysis

This study aimed to construct and validate dietary patterns in Colombian individuals aged between 15 and 64 years. The study sample consisted of 16,216 individuals who participated in the 2015 National Survey on the Nutritional Situation of Colombia (ENSIN). To identify dietary patterns, an exploratory analysis was first conducted with 16 food groups with 70% of the study sample, followed by a confirmatory analysis with the remaining 30%. Four eating patterns were identified, referred to as traditional, industrialized, conservative, and grilled foods/drinks. The traditional pattern presented the highest variance (17.65%), followed by the industrialized (14.36%), conservative (10.74%), and grilled foods/drinks (7.57%) patterns. Regarding the frequency of food consumption, the preference for the consumption of rice/pasta and panela/sugar/honey was evident. In contrast, low consumption of whole foods, energizers, light foods, supplements, and salt was observed. The dietary patterns in Colombia continue to be characterized by a high consumption of panela/sugar/honey and low consumption of fruits/vegetables, which is why the development of public health interventions to improve these habits, such as health promotion and chronic disease prevention tools, is considered necessary.

Within-Host Genetic Variation in Neisseria gonorrhoeae over the Course of Infection.

ABSTRACTKnowledge of within-host genetic variation informs studies on transmission dynamics. We studied within-host genetic variation in Neisseria gonorrhoeae over the course of infection and across different anatomical locations. Isolates were obtained during a clinical trial, and isolates from consecutive time points reflected persistent infections after treatment failure. We compared sequence types (STs) and recombination unfiltered- and filtered core genome single nucleotide polymorphism (SNP) distances in 65 within-host isolate pairs from the same anatomical location over time—obtained with a median interval of 7 days—and 65 isolate pairs across different anatomical locations at one time point. Isolates with different Multi-Locus Sequence Types (MLST), NG-Sequence Types for Antimicrobial Resistance (NG-STAR) and NG-Multi Antigen Sequence Types (NG-MAST) had a median of 1466 recombination filtered SNPs, whereas a median of 1 SNP was found between isolates with identical STs or a different NG-MAST only. The threshold for differentiating between strains was set at 10 recombination filtered SNPs, showing that isolates from persistent infections could have different NG-MASTs. Antibiotic pressure applied through treatment did not lead to an increase in genetic variation in specific genes or in overall extent of variation, compared to variation across anatomical locations. Instead, within-host genetic variation was proposedly driven by the host immune response, as it was concentrated in genomic regions encoding surface exposed proteins involved in host-microbe interaction. Ultimately, 15/228 (6.5%) between-host pairs contained a single strain, suggesting between-host transmission. However, patient reported data are needed to differentiate within-host persistence from between-host transmission.IMPORTANCE Understanding transmission dynamics of Neisseria gonorrhoeae (Ng) is based on the identification of transmission events. These can be identified by assessing genetic relatedness between Ng isolates, expressed as core genome SNP distances. However, a SNP threshold to differentiate between strains needs to be defined, using knowledge on within- and between-host genetic variation. Here, we assessed within-host genetic variation, using a unique set of within-host Ng isolates from the same anatomical location over time or across different anatomical locations at one time point. The insights in genetic variation that occurred during the infection period contribute to the understanding of infection dynamics. In addition, the obtained knowledge can be used for future research on transmission dynamics and development of public health interventions based on bacterial genomic data.

Developing public transport messaging to provide crowding information during COVID-19: Application of the COM-B model and behaviour change wheel

The COVID-19 outbreak meant that using public transport was potentially unsafe for risk of catching and transmitting the virus. UK anxiety is high with lockdowns preventing a normal way of life for over a year. A lack of ability to travel freely causes numerous declines in quality of life including social isolation and poor physical and mental health. People need crowding information to choose safer travel options and subdue coronavirus. To provide effective guidance, it is essential to empirically formulate messaging to create clarity and trust which can be acted upon in confidence. Behaviour Change Techniques incorporating the Behaviour Change Wheel and COM-B model have been utilised in vast areas of public health intervention development and messaging. There is consensus that public transport information needs to be clearer and more accessible but BCTs have not been utilised in the development of public transport advice. This paper outlines the development of crowding messaging for public transport on a platform available to UK travellers. Barriers and facilitators were explored; related behaviours, intervention functions and behaviour change techniques were mapped. Specific message phrasing was developed utilising the mapped functions and advice from the literature. With the COVID-19 outbreak, having accessible and effective messaging for safely using public transport is a continuation of the work recently conducted examining the best ways to present public health information. It is important to be transparent when developing messaging and interventions accessible to the public and this work forms a basis for continued exploration and development in this area.

What Are the Barriers to Adoption of a Lifestyle Associated with Optimal Peak Bone Mass Acquisition? A Qualitative Study of Young Adults in New Zealand

Objective: This study aimed to investigate the barriers to adopting lifestyle factors other than physical activity important for optimal peak bone mass (PBM) acquisition—namely, dietary factors, avoidance of cigarette smoking, and keeping alcohol consumption within recommended limits. Materials and Methods: University students and staff aged 18–35 years were recruited. Six semi-structured, in-depth focus group interviews were conducted with a total of 28 participants. The interviews were digitally recorded and transcribed. A thematic approach for data analysis using a constant comparative method was performed using NVivo software. Results: Three major themes emerged: socio-cultural barriers (peer pressure and cultural norms); personal barriers (time, cost, and diet preferences); and other barriers (medical illness and lack of symptoms associated with low bone mass density). Conclusions: We identified several barriers to adoption of lifestyle behaviours that might be beneficial to PBM acquisition. These data might facilitate the development of public health interventions designed to help young adults embrace osteoprotective lifestyles, and hence reduce the burden of osteoporotic fracture in later life.

Integrating a simple and brief home-based exercise programme within a UK stop smoking service: a mixed method feasibility study

BackgroundSmoking remains a leading cause of morbidity and mortality. Exercise improves physical health and reduces cigarette cravings and nicotine withdrawal symptoms, but has required attendance at multiple sessions using specialised equipment that limits delivery in a service. The purpose of this study was to test the feasibility of delivering a simple and brief home-based exercise intervention with existing smoking cessation support in a stop-smoking service. MethodsWe used a mixed-methods approach in a UK stop-smoking service operating from general practitioner surgeries and libraries near the most deprived areas in Surrey. Smokers recruited through the service gave written consent and received a 12-week exercise programme that included 5 min of home-based jumping activities and an activity diary with educational instructions 1 week before their quit date. Feasibility was assessed by recruitment, retention, adherence to the exercise programme, and follow-up and completion of assessments. Semi-structured interviews with trial participants (n=16), people who declined to take part (n=21), and smoking cessation advisors (n=10) assessed views and attitudes to participation and delivery of the intervention. Interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis (NVivo, version 12.0). Findings30 eligible trial participants consented, with 14 (47%) lost to follow-up, 16 participants (eight females, eight males; mean age 48 years [SD 11]) completed a mean of 47 (SD 18) of 74 prescribed exercise sessions over the 12-week period, resulting in 63% adherence. The exercise programme was received positively by most who engaged with it; fitting into their daily routine was an important outcome for completion. Of the participants who declined to take part (15 females, six males; mean age 48 years [SD 12]), many were positively disposed to the idea of participation, especially if the programme could be offered later in their treatment. All smoking cessation advisors (six females, four males; mean age 48 years [SD 20]) were supportive of the exercise programme, but several favoured the delivery by someone independent of the service. InterpretationA simple and brief exercise intervention may be feasible for smokers receiving smoking cessation treatment in a UK stop-smoking service. However, substantial attrition and non-compliance, along with some delivery components, need to be addressed before to a definitive trial. FundingMedical Research Council Public Health Intervention Development Scheme (MR/P017142/1).