Evidence-based Public Health Policy Research Articles

Infectious disease surveillance needs for the United States: lessons from Covid-19.

The COVID-19 pandemic has highlighted the need to upgrade systems for infectious disease surveillance and forecasting and modeling of the spread of infection, both of which inform evidence-based public health guidance and policies. Here, we discuss requirements for an effective surveillance system to support decision making during a pandemic, drawing on the lessons of COVID-19 in the U.S., while looking to jurisdictions in the U.S. and beyond to learn lessons about the value of specific data types. In this report, we define the range of decisions for which surveillance data are required, the data elements needed to inform these decisions and to calibrate inputs and outputs of transmission-dynamic models, and the types of data needed to inform decisions by state, territorial, local, and tribal health authorities. We define actions needed to ensure that such data will be available and consider the contribution of such efforts to improving health equity.

Temporal trends in population attributable fractions of modifiable risk factors for dementia: a time-series study of the English Longitudinal Study of Ageing (2004–2019)

BackgroundInterest in modifiable risk factors (MRFs) for dementia is high, given the personal, social, and economic impact of the disorder, especially in ageing societies such as the United Kingdom. Exploring the population attributable fraction (PAF) of dementia attributable to MRFs and how this may have changed over time remains unclear. Unravelling the temporal dynamics of MRFs is crucial for informing the development of evidence-based and effective public health policies. This investigation examined the temporal trajectories of MRFs for dementia in England.MethodsWe used data from the English Longitudinal Study of Ageing, a panel study over eight waves collected between 2004 and 2019 (76,904 interviews in total). We calculated the PAFs for twelve MRFs (including six early- to mid-life factors and six late-life factors), as recommended by the Lancet Commission, and the individual weighted PAFs (IW-PAFs) for each risk factor. Temporal trends were analysed to understand the changes in the overall PAF and IW-PAF over the study period. Subgroup analyses were conducted by sex and socioeconomic status (SES).ResultsThe overall PAF for dementia MRFs changed from 46.73% in 2004/2005 to 36.79% in 2018/2019, though this trend was not statistically significant. During 2004–2019, hypertension, with an average IW-PAF of 8.21%, was the primary modifiable determinant of dementia, followed by obesity (6.16%), social isolation (5.61%), hearing loss (4.81%), depression (4.72%), low education (4.63%), physical inactivity (3.26%), diabetes mellitus (2.49%), smoking (2.0%), excessive alcohol consumption (1.16%), air pollution (0.42%), and traumatic brain injury (TBI) (0.26%). During 2004–2019, only IW-PAFs of low education, social isolation, and smoking showed significant decreasing trends, while IW-PAFs of other factors either did not change significantly or increased (including TBI, diabetes mellitus, and air pollution). Upon sex-specific disaggregation, a higher overall PAF for MRFs was found among women, predominantly associated with later-life risk factors, most notably social isolation, depression, and physical inactivity. Additionally, hearing loss, classified as an early- to mid-life factor, played a supplementary role in the identified sex disparity. A comparable discrepancy was evident upon PAF evaluation by SES, with lower income groups experiencing a higher dementia risk, largely tied to later-life factors such as social isolation, physical inactivity, depression, and smoking. Early- to mid-life factors, in particular, low education and obesity, were also observed to contribute to the SES-associated divergence in dementia risk. Temporal PAF and IW-PAF trends, stratified by sex and SES, revealed that MRF PAF gaps across sex or SES categories have persisted or increased.ConclusionsIn England, there was little change over time in the proportion of dementia attributable to known modifiable risk factors. The observed trends underscore the continuing relevance of these risk factors and the need for targeted public health strategies to address them.

Distilling the Fundamentals of Evidence-Based Public Health Policy.

Public health policy interventions are associated with many important public health achievements. To provide public health practitioners and decision makers with practical approaches for examining and employing evidence-based public health (EBPH) policy interventions, we describe the characteristics and benefits that distinguish EBPH policy interventions from programmatic interventions. These characteristics include focusing on health at a population level, focusing on upstream drivers of health, and involving less individual action than programmatic interventions. The benefits of EBPH policy interventions include more sustained effects on health than many programs and an enhanced ability to address health inequities. Early childhood education and universal preschool provide a case example that illustrates the distinction between EBPH policy and programmatic interventions. This review serves as the foundation for 3 concepts that support the effective use of public health policy interventions: applying core component thinking to understand the population health effects of EBPH policy interventions; understanding the influence of existing policies, policy supports, and the context in which a particular policy is implemented on the effectiveness of that policy; and employing a systems thinking approach to identify leverage points where policy implementation can have a meaningful effect.

Advancing Evidence-Based Public Health Policy: How Core Component Thinking Can Illuminate the Multilevel Nature of Public Health Policy.

A growing body of literature uses the concept of core components to better understand small-scale programmatic interventions. Instead of interventions being viewed as unitary "black boxes," interventions are viewed as configurations of core components, which are the parts of interventions that carry their causal potential and therefore need to be reproduced with fidelity to produce the intended effect. To date, the concept of core components has not been as widely applied to public health policy interventions as it has to programmatic interventions. The purpose of this topical review is to familiarize public health practitioners and policy makers with the concept of core components as applied to public health policy interventions. Raising the profile of core component thinking can foster mindful adaptation and implementation of public health policy interventions while encouraging further research to enhance the supporting evidence base. We present 3 types of multilevel interactions in which the core components of a public health policy intervention produce effects at the population level by (1) seeking to directly affect individual behavior, (2) facilitating adoption of programmatic interventions by intermediaries, and (3) encouraging intermediaries to take action that can shape changes in upstream drivers of population health. Changing the unit of analysis from whole policies to core components can provide a basis for understanding how policies work and for facilitating novel evidence-generating strategies and rapid evidence reviews that can inform future adaptation efforts.

MOBILE HEALTH (MHEALTH) INNOVATIONS FOR PUBLIC HEALTH FEEDBACK: A GLOBAL PERSPECTIVE

In recent years, Mobile Health (mHealth) innovations have emerged as a transformative force in the realm of public health, revolutionizing the way healthcare is delivered and monitored worldwide. This review presents a comprehensive overview of the latest advancements in mHealth technologies, focusing particularly on their role in soliciting and utilizing public health feedback on a global scale. The proliferation of smartphones and mobile applications has paved the way for novel approaches to healthcare delivery, monitoring, and data collection. Through leveraging the ubiquity and connectivity of mobile devices, mHealth initiatives have facilitated enhanced communication between healthcare providers and patients, enabling real-time monitoring of health metrics, adherence to treatment regimens, and timely interventions. One of the key aspects of mHealth innovations is their capacity to engage diverse populations and solicit feedback regarding various aspects of public health, ranging from disease outbreaks to healthcare service quality. Through interactive platforms and user-friendly interfaces, individuals can provide valuable insights, report symptoms, and participate in surveys, thereby contributing to the generation of actionable data for public health interventions. Furthermore, mHealth solutions have demonstrated significant promise in overcoming barriers to healthcare access, particularly in underserved and remote communities. By delivering health information, diagnostic tools, and remote consultations via mobile platforms, these innovations have expanded the reach of essential healthcare services, thereby bridging gaps in healthcare delivery and improving health outcomes on a global scale. However, challenges such as privacy concerns, technological literacy, and disparities in digital access persist, underscoring the importance of equitable deployment and user-centered design in mHealth initiatives. Moreover, the integration of mHealth solutions into existing healthcare infrastructure requires careful coordination among stakeholders, including policymakers, healthcare providers, and technology developers. Mobile Health (mHealth) innovations hold immense potential to revolutionize public health feedback mechanisms on a global scale. By harnessing the power of mobile technologies, these initiatives can empower individuals, enhance healthcare delivery, and inform evidence-based public health policies for a healthier future.
 Keywords: Mobile Health, mHealth, Public Health, Healthcare, Innovation, Review.

Data resource profile: nutrition data in the VA million veteran program.

The Department of Veterans Affairs (VA) Million Veteran Program (MVP) nutrition data is derived from dietary food/beverage intake information collected through a semiquantitative food frequency questionnaire (SFFQ). Estimates of dietary energy, nutrient, and non-nutritive food components intakes data were derived from an extensively validated SFFQ, which assessed the habitual frequency of consumption of 61 food items, added sugar, fried food frequency, and 21 nutritional supplements over the 12 months preceding questionnaire administration. Complete nutrition data was available for 353,418 MVP participants as of 30th September 2021. Overall, 91.5% of MVP participants with nutrition data were male with an average age of 65.7 years at enrollment. Participants who completed the SFFQ were primarily White (82.5%), and Blacks accounted for 13.2% of the responders. Mean ± SD energy intake for 353, 418 MVP participants was 1428 ± 616 kcal/day, which was 1434 ± 617 kcal/day for males and 1364 ± 601 kcal/day for females. Energy intake and information on 322 nutrients and non-nutritive food components is available through contact with MVP for research collaborations at www.research.va.gov/mvp. The energy and nutrient data derived from MVP SFFQ are an invaluable resource for Veteran health and research. In conjunction with the MVP Lifestyle Survey, electronic health records, and genomic data, MVP nutrition data may be used to assess nutritional status and related risk factors, disease prevalence, and determinants of health that can provide scientific support for the development of evidence-based public health policy and health promotion programs and services for Veterans and general population.

Understanding global research trends in the control and prevention of infectious diseases for children: Insights from text mining and topic modeling.

The emergence of novel infectious diseases has amplified the urgent need for effective prevention strategies, especially ones targeting vulnerable populations such as children. Factors such as the high incidence of both emerging and existing infectious diseases, delays in vaccinations, and routine exposure in communal settings heighten children's susceptibility to infections. Despite this pressing need, a comprehensive exploration of research trends in this domain remains lacking. This study aims to address this gap by employing text mining and modeling techniques to conduct a comprehensive analysis of the existing literature, thereby identifying emerging research trends in infectious disease prevention among children. A cross-sectional text mining approach was adopted, focusing on journal articles published between January 1, 2003, and August 31, 2022. These articles, related to infectious disease prevention in children, were sourced from databases such as PubMed, CINAHL, MEDLINE (Ovid), Scopus, and Korean RISS. The data underwent preprocessing using the Natural Language Toolkit (NLTK) in Python, with a semantic network analysis and topic modeling conducted using R software. The final dataset comprised 509 journal articles extracted from multiple databases. The study began with a word frequency analysis to pinpoint relevant themes, subsequently visualized through a word cloud. Dominant terms encompassed "vaccination," "adolescent," "infant," "parent," "family," "school," "country," "household," "community," "HIV," "HPV," "COVID-19," "influenza," and "diarrhea." The semantic analysis identified "age" as a key term across infection, control, and intervention discussions. Notably, the relationship between "hand" and "handwashing" was prominent, especially in educational contexts linked with "school" and "absence." Latent Dirichlet Allocation (LDA) topic modeling further delineated seven topics related to infectious disease prevention for children, encompassing (1) educational programs, (2) vaccination efforts, (3) family-level responses, (4) care for immunocompromised individuals, (5) country-specific responses, (6) school-based strategies, and (7) persistent threats from established infectious diseases. The study emphasizes the indispensable role of personalized interventions tailored for various child demographics, highlighting the pivotal contributions of both parental guidance and school participation. The study provides insights into the complex public health challenges associated with preventing and managing infectious diseases in children. The insights derived could inform the formulation of evidence-based public health policies, steering practical interventions and fostering interdisciplinary synergy for holistic prevention strategies.

Determinante namere vakcinisanja protiv humanog papiloma virusa kod učenika

Introduction: Human papillomavirus (HPV) is the virus that is most often associated with cancers. Cervical cancer is one of the leading public health problems, especially in developing countries. In the Republic of Serbia, cervical cancer is the fifth most common cancer in the female population amongst all malignant diseases, and HPV infection is the most important risk factor for the occurrence of this disease. This study aims to identify the determinants of adolescent HPV vaccination intention. Materials and methods: The study was conducted as a cross-sectional study including a total of 748 students, aged 12 -19 years, from one high school and two elementary schools in Šabac. The research instrument was a questionnaire, particularly constructed for this study. Multiple regression analysis was applied to examine the predictive model for explaining the HPV vaccination intention in young people. Results: The proposed model explains 66% of HPV vaccination intention in young people. The strongest predictor of HPV vaccination intention in young people relates to the subjective norm, i.e., social pressure from peers and other people who are important to them. Distrust of the benefit of vaccination, concern about commercial profiteering, and belief in a "vaccine conspiracy" have a significantly smaller but statistically significant contribution in explaining HPV vaccination intention amongst our youth. Conclusion: Increasing social pressure to get vaccinated, as well as changing certain attitudes and beliefs about vaccines in general, may lead to an increase in the intention of young people to get vaccinated against HPV. Understanding the key aspects of the attitudes of young people in Serbia towards HPV vaccination opens the possibility of creating evidence-based public health policies and planning targeted health-educational interventions directed at the identified findings.

Pharmacoepidemiology: An Overview.

The aims of this review are to provide a comprehensive overview of the definition and scope of pharmacoepidemiology, to summarize the study designs and methodologies used in the field, to discuss the future trends in the field and new methodologies to address bias and confounding, and finally to give some recommendations to clinicians interested in pharmacoepidemiologic research. Because drug efficacy and safety from randomized clinical trials do not reflect the real-world situation, pharmacoepidemiological studies on drug safety monitoring and drug effectiveness in large numbers of people are needed by healthcare professionals and regulatory institutions. We aim to highlight the importance of pharmacoepidemiologic research in informing evidence-based medicine and public health policy. The development of new designs and methodologies for the generation of valid evidence, as well as new initiatives to provide guidance and recommendations on how to incorporate real-world evidence into the drug development process, are reported on. In addition, we have touched on the implication of artificial intelligence in the management of real-world data. This overview aims to summarize all important aspects to consider when conducting or interpreting a pharmacoepidemiologic study.

Probability of outbreaks and cross-border dissemination of the emerging pathogen: a genomic survey of Elizabethkingia meningoseptica.

The emerging infectious agent Elizabethkingia meningoseptica is associated with life-threatening infections in immunocompromised individuals. However, there are limited data on its geographic distribution, phylogenetic evolution, pathogenesis, and transmission. In this study, we comprehensively analyze and compare the genomic features, evolutionary history, emergence date, and transmission networks of global E. meningoseptica. Geographical distribution reveals the presence of the emerging bacteria in Asia, Europe, and North America, three continents with similar latitudes. Phylogenetic analyses show no relationship between the strain's evolutionary history and its location, origin, or source, despite the presence of genetic diversity. Analysis of the emergence timeline suggests that America is the most likely source of E. meningoseptica with the common ancestor of this pathogen dating back 90 years. Putative transmission networks indicate that E. meningoseptica bacteria can spread within the same hospital and even across borders. Minor variations in resistance genotypes and virulence genes are observed, supporting existing evidence of inherent resistance and pathogenicity in E. meningoseptica. Additionally, minocycline and doxycycline demonstrate potent antimicrobial activity against this pathogen, making them promising candidates for treating E. meningoseptica infections. Our research highlights the potential for severe nosocomial outbreaks caused by E. meningoseptica with horizontal transmission occurring between countries worldwide. To prevent future outbreak infections, increased genomic surveillance of global E. meningoseptica populations is necessary. IMPORTANCE Elizabethkingia meningoseptica is an emerging infectious agent associated with life-threatening infections in immunocompromised individuals. However, there are limited data available on the genomic features of E. meningoseptica. This study aims to characterize the geographical distribution, phylogenetic evolution, pathogenesis, and transmission of this bacterium. A systematic analysis of the E. meningoseptica genome revealed that a common ancestor of this bacterium existed 90 years ago. The evolutionary history showed no significant relationship with the sample source, origin, or region, despite the presence of genetic diversity. Whole genome sequencing data also demonstrated that E. meningoseptica bacteria possess inherent resistance and pathogenicity, enabling them to spread within the same hospital and even across borders. This study highlights the potential for E. meningoseptica to cause severe nosocomial outbreaks and horizontal transmission between countries worldwide. The available evidence is crucial for the development of evidence-based public health policies to prevent global outbreaks caused by emerging pathogens.

Experimental Analysis of Passenger Comfort with Variable Preloaded Rear Springs on a Low-Cylinder Motorcycle.

The present study contains an experimental analysis of the vibratory response in a low-cylinder engine motorcycle at varying suspension preloads. Three different speed bumps of varying heights were used to subject the motorcycle to different vibrations. The analysis was carried out in three domains: time, frequency, and time-frequency. A triaxial accelerometer was used to measure the vibrations at the seat of the vehicle. The results indicated that the suspension system became more differentiated as the height of the bumps increased. However, for lower bumps, the action of the three spring preloads studied was quite similar. Quantitatively, only the higher bump showed a significant difference between the set preloads. The spectral distribution revealed that the frequency of interest was below 20 Hz for all the studied cases, which is in the same range of human body natural frequencies. The findings of this research can be utilized to enhance the design of low-cost motorcycles, thereby improving the safety and comfort of their drivers and passengers. This study constitutes a significant step towards developing an affordable system capable of gathering sufficient data to support the creation of evidence-based public health policies and propose new transport industry standards based on field measurements.

Functional forms of socio-territorial inequities in breast cancer screening – A French cross-sectional study using hierarchical generalised additive models

To reduce the breast cancer burden, the French National Organised Breast Cancer Screening Programme (FNOBCSP) was implemented in 2004. The recommended participation rate has never been achieved and socio-territorial inequities in participation have been reported on several occasions. We investigated the functional forms and consistency of the relationships between neighbourhood deprivation, travel time to the nearest accredited radiology centre and screening uptake. We used two-level hierarchical generalised additive models in 8 types of territories classified by socio-demographic and economic factors. The first level was 368,201 women aged 50–72 invited to the 2013–2014 screening campaign in metropolitan France. They were nested in 41 départements, the level of organisation of the FNOBCSP. The effect of travel time showed two main patterns: it was either linear (with participation decreasing as travel time increased) or participation first increased with increasing travel time to a peak around 5–15 min and decreased afterward. In nearly all types and départements, the probability of participation decreased linearly with increasing deprivation. Territorial inequities in participation were more context-dependent and complex than social inequities. Inequities in participation represent a loss of opportunity for individuals who already have the worst cancer outcomes. Evidence-based public health policies are needed to increase the effectiveness and equity of breast cancer screening.

Psychological well-being, mental distress, metabolic syndrome, and associated factors among people living in a refugee camp in Greece: a cross-sectional study.

Forcibly displaced people face various challenges and are therefore at higher risk of being affected by mental and physiological distress. The present study aimed to determine levels of psychological well-being, PTSD symptom severity, metabolic syndrome, and associated factors among forcibly displaced people in Greece in response to WHO's call for evidence-based public health policies and programs for forcibly displaced people. We conducted a cross-sectional study among n = 150 (50% women) forcibly displaced people originating from Sub-Sahara Africa and Southwest Asia living in a Greek refugee camp. Self-report questionnaires were used to assess psychological well-being, symptoms of PTSD, depression, generalized anxiety disorder and insomnia, perceived stress, headache, and perceived fitness. Cardiovascular risk markers were assessed to determine metabolic syndrome, and cardiorespiratory fitness was measured with the Åstrand-Rhyming Test of Maximal Oxygen Uptake. The prevalence of mental distress and physiological disorders was overall elevated. Only 53.0% of participants rated their psychological well-being as high. Altogether, 35.3% scored above the clinical cut-off for PTSD, 33.3% for depression, 27.9% for generalized anxiety disorder, and 33.8% for insomnia. One in four (28.8%) participants met criteria for metabolic syndrome. While the prevalence of moderate or severe insomnia symptoms and metabolic syndrome differed little from the global population, the risk of being affected by mental distress was markedly increased. In multivariable analysis, higher perceived fitness was associated with higher psychological well-being (OR = 1.35, p = 0.003) and a decreased likelihood for metabolic syndrome (OR = 0.80, p = 0.031). Participants with elevated psychiatric symptoms were less likely to report high psychological well-being (OR = 0.22, p = 0.003) and had increased odds for higher PTSD severity (OR = 3.27, p = 0.034). Increased stress perception was associated with higher PTSD symptoms (OR = 1.13, p = 0.002). There is an elevated risk for mental distress compared to the global population and an overall high mental and physiological burden among people living in a Greek refugee camp. The findings underpin the call for urgent action. Policies should aim to reduce post-migration stressors and address mental health and non-communicable diseases by various programs. Sport and exercise interventions may be a favorable add-on, given that perceived fitness is associated with both mental and physiological health benefits.

Unpacking assertions made by the alcohol industry and how they make them: An analysis of submissions into Australia's National Alcohol Strategy.

Alcohol is a leading cause of morbidity and mortality globally. One significant barrier to the implementation of evidence-based alcohol policy is alcohol industry opposition. Making submissions to national policy processes is one way in which the industry exert influence. The aim of this study was to analyse alcohol industry submissions into Australia's National Alcohol Strategy to determine key assertions made by the alcohol industry and the ways in which they use evidence and refute the effectiveness of public health policies to make their claims. Submissions made by alcohol industry actors (n = 12) were analysed using content analysis to determine key industry assertions. A pre-existing framework on alcohol industry use of evidence was then applied to analyse the evidentiary practices used to make these assertions. Five common industry assertions were identified: 'Drinking alcohol in moderation has health benefits'; 'Alcohol isn't the cause of violence'; 'Targeted initiatives, not population level alcohol policies, are needed'; 'Strong alcohol advertising regulations are not necessary'; and 'Minimum unit price and pricing and taxation policies more broadly are not needed'. The industry systematically manipulated, misused and ignored evidence throughout their submissions. The alcohol industry is misusing evidence in their submissions to government consultations to make their assertions about alcohol policy. It is therefore essential that industry submissions are scrutinised and not accepted on face value. Additionally, it is suggested that the alcohol industry requires a distinct model of governance similarly to that which regulates the tobacco industry to prevent their attempts to undermine evidence-based public health policy.

Uncovering COVID-19 infection determinants in Portugal: towards an evidence-based spatial susceptibility index to support epidemiological containment policies

BackgroundCOVID-19 caused the largest pandemic of the twenty-first century forcing the adoption of containment policies all over the world. Many studies on COVID-19 health determinants have been conducted, mainly using multivariate methods and geographic information systems (GIS), but few attempted to demonstrate how knowing social, economic, mobility, behavioural, and other spatial determinants and their effects can help to contain the disease. For example, in mainland Portugal, non-pharmacological interventions (NPI) were primarily dependent on epidemiological indicators and ignored the spatial variation of susceptibility to infection.MethodsWe present a data-driven GIS-multicriteria analysis to derive a spatial-based susceptibility index to COVID-19 infection in Portugal. The cumulative incidence over 14 days was used in a stepwise multiple linear regression as the target variable along potential determinants at the municipal scale. To infer the existence of thresholds in the relationships between determinants and incidence the most relevant factors were examined using a bivariate Bayesian change point analysis. The susceptibility index was mapped based on these thresholds using a weighted linear combination.ResultsRegression results support that COVID-19 spread in mainland Portugal had strong associations with factors related to socio-territorial specificities, namely sociodemographic, economic and mobility. Change point analysis revealed evidence of nonlinearity, and the susceptibility classes reflect spatial dependency. The spatial index of susceptibility to infection explains with accuracy previous and posterior infections. Assessing the NPI levels in relation to the susceptibility map points towards a disagreement between the severity of restrictions and the actual propensity for transmission, highlighting the need for more tailored interventions.ConclusionsThis article argues that NPI to contain COVID-19 spread should consider the spatial variation of the susceptibility to infection. The findings highlight the importance of customising interventions to specific geographical contexts due to the uneven distribution of COVID-19 infection determinants. The methodology has the potential for replication at other geographical scales and regions to better understand the role of health determinants in explaining spatiotemporal patterns of diseases and promoting evidence-based public health policies.

Everyone Wins: Vaccine Lotteries Can Cost-Effectively Increase COVID-19 Booster Vaccination Rates.

Booster vaccination remains a key strategy to address the ongoing threat ofcoronavirus disease 2019 (COVID-19). However, take-up has been slow. By the fall of 2022, less than 50% of eligible US residents had received a booster dose. It is a central tenet in health economics that incentives or penalties are necessary to reach optimal vaccination rates. Six rigorous real-world studies provide evidence that COVID-19 vaccine lotteries cost-effectively raised vaccination rates at an estimated cost of $49 to $82 per additional dose. The 5 studies that found no impact of lotteries used statistical methods that underestimated the impact: They were statistically underpowered to detect a small yet cost-effective impact and did not adequately address selection bias. Vaccine lotteries are cost-effective because they not only provide financial incentives but also influence the public via nonfinancial channels: They garner media attention, tap into social networks, combat procrastination, and signal the importance of sustaining high vaccination rates. In fact, vaccine lotteries are likely to be more effective for booster vaccination than for initial doses because barriers to vaccination are higher. The ongoingthreat of COVID-19 presents a unique opportunity to develop and implement innovative, evidence-based public health policies like vaccine lotteries to address current challenges.

Video Game Addiction among College Students in Bangladesh

Objectives: The objective of the study was to assess video game addiction among college students in Bangladesh. Methods: A descriptive cross-sectional study was conducted at Sharonkhola Govt. Degree College, Bagerhat, Bangladesh from July 2022 to June 2023. 112 participants were recruited using a convenient sampling method. Data were collected by self-administered questionnaires. After data collection, it was analyzed by using descriptive and inferential statistics. Results: It was found that nearly one-third (27.7%) of the students are addicted to video games. Student’s age; gender; family type; day gaming frequency; duration of playing mobile games; time of playing the mobile game; year of the class; and smartphone use starting age were significantly associated with video game addiction. Conclusion: The study findings produce baseline information that can be used in formulating evidence-based public health policies in the country and is expected to help mental health nurses reduce addiction among college students.

Moral framing in health promotion: lessons from an Indonesian case study.

In this article we illuminate the important, yet typically underreported, role played by moral framing in public health messaging. We present case studies from West Java, Indonesia to demonstrate how moral framing is used to motivate health volunteers and to promote behavior change in line with government health policies. We used qualitative research including participant observation, job shadowing, interviews and focus groups with health promotion workers and community members. Findings were analyzed using thematic and discourse analysis. We identified three moral frameworks typically used to encourage shifts in normative health practices in Indonesia: Islamic values, right to health, and evidence-based public health policy, represented as indicative of modernity. Health workers tailor these moral frameworks to audiences in their health promotion work. While the immediate goal is to meet health performance targets, the broader goal is to generate forms of health citizenship commensurate with Indonesia's political environment of democratic decentralization. COVID-19 presents an opportune moment for the public health community to reevaluate the power of moral framing in health messaging, and how it can be used both as a compelling means of establishing community norms toward the common good, as seen in our Indonesia case study, and also as a mechanism used by counterpublics to challenge these norms and appeal to alternative values and versions of reality.

Competing public narratives in nutrition policy: insights into the ideational barriers of public support for regulatory nutrition measures

BackgroundEnacting evidence-based public health policy can be challenging. One factor contributing to this challenge is a lack of public support for specific policies, which may stem from limited interest or conviction by policy arguments. This can happen when messaging strategies regarding policy do not resonate with the target group and/or policy narratives compete in public discourse. To understand how policy messaging can better resonate with a target audience, we examined the frames and narratives used by the Australian public when discussing nutrition policies.MethodsWe conducted 76 street intercept interviews in urban and regional settings in Queensland, Australia. Quantitative data were analysed using mean agreement scores and t-tests, and the qualitative data were analysed using an adapted qualitative narrative policy framework (QNPF). The QNPF is used to illustrate how competing narratives vary in the way they define different elements. These elements often include setting, characters, plot, policy solution and belief systems.ResultsLevel of support for all nutrition policies was generally moderate to high, although nutrition policies perceived to be most intrusive to personal freedoms were the least popular among the public. The value of fairness was consistently invoked when participants discussed their support for or opposition to policy. Using the QNPF, two distinct settings were evident in the narratives: concern for the community or concern for self. Villains were identified as either “other individuals, in particular parents” or “Big Food”. Victims were identified as “children” or “the food industry, in particular farmers”. Frequently used plots focused on individuals making poor choices because they were uneducated, versus Big Food being powerful and controlling people and the government.ConclusionsThe study examined the frames and narratives used by the Australian public when discussing nutrition policies. By examining these frames and narratives, we gained insight into multiple strategies which may increase public support for certain nutrition policies in Australia.

Determining Factors Influencing Specialty Preferences of Iranian Medical Doctors: A Qualitative Study.

Background: The medical specialty choice of physicians directly affects the healthcare system, community wellbeing, and their own professional life. It is therefore important to identify its underlying factors to predict such medical career choices and to draw up a comprehensive evidence-based public health policy and health human resources planning. The present qualitative study aimed to identify these determinants of career choices through semi-structured interviews with medical doctors in the context of country-specific social and cultural characteristics.Methods: The present qualitative study was carried out in 2019-2020 at Shiraz University of Medical Sciences (Shiraz, Iran). The target population was medical students, junior doctors, and medical residents. The purposive sampling method was used to recruit the participants and sampling continued until data saturation, i.e., no new information could be extracted. Data were collected through individual, face-to-face, semi-structured interviews and analyzed using the conventional content analysis method. Inductive thematic analysis was used to interpret the data based on which a thematic map was developed illustrating the factors influencing medical specialty preferences in Iran. Data trustworthiness was assessed according to the criteria proposed by Guba and Lincoln.Results: Analysis of the interview data resulted in three main themes and fourteen sub-themes. The main themes were “Personal determinants”, “Career-related factors”, and “Interpersonal influences”. The most important sub-themes were personal interests, income, and prestige.Conclusion: The determinants influencing the specialty preferences of Iranian medical doctors are identified. Our findings will facilitate the development of a comprehensive evidence-based public health policy, health human resources planning, and appropriate medical education policy.