Health Disparities Research Articles

Intersecting Pathways: Understanding Dementia, Hearing Loss, and Health Disparities

Abstract Background Dementia is a major public health concern, affecting care dependency and disability in older ages. In Europe, around 14.1 million people live with dementia, a number that is expected to increase to 15.9 million by 2040. Hearing loss (HL), followed by education, has been proposed as the most important modifiable risk factor for dementia. This study aims to investigate how sex, educational attainment and HL intersect to influence dementia-free life expectancy (DemFLE) in older adults. Methods Using population register data covering all Finnish residents aged 50 years or older from 2010 to 2019, we apply discrete-time multistate Markov models. Transition probabilities between states, such as HL and dementia, are estimated with multinomial logit models stratified by sex and education. Multistate life tables are used to compute sex- and education-specific DemFLE. Results We identified 316,361 individuals with a diagnosis of dementia and 317,115 individuals with a diagnosis of HL, representing 1,449,873 and 2,738,970 person-years respectively. 14% of individuals with HL were eventually diagnosed with dementia, compared to only 8% of individuals without HL. We hypothesise that DemFLE will vary significantly by sex and education, with additional modulation by the presence of HL. Specifically, we expect that the presence of HL will further reduce DemFLE, and that the magnitude of this reduction will be relatively greater among those with lower educational attainment. Conclusions This study contributes to the emerging literature on the impact of hearing loss on dementia. While both dementia and hearing loss are irreversible health conditions, hearing loss can be managed by hearing aids. If we find evidence that hearing loss is associated with different levels of risk of dementia by educational attainment, it would suggest avenues for effective interventions and public health policies to ensure more equal ageing processes in the population. Key messages • Hearing loss may intersect with education and sex in the risk of dementia, providing evidence for the importance of addressing hearing health inequalities in dementia prevention efforts. • Understanding the interactions between hearing loss, education and sex can inform policies to promote healthy ageing and reduce the burden of dementia on individuals and health systems.

Immigrants and nurses’ perspectives on the barriers in using health promotion services in Finland

Abstract Background The incidence of chronic diseases and health disparities is high among immigrants. Lack of access to health promotion services targeting the needs of the immigrant population was reported. This study aimed to explore the perspectives of immigrants and nurses on the barriers to using health promotion services in Finland. Methods A qualitative study with 12 focus group interviews was conducted in various cities across Finland. A total of 69 participants, including 46 adult immigrants and 23 registered nurses, were selected through purposive sampling. A semi-structured interview was used. Interviews were transcribed verbatim and analyzed using content analysis. Results The analysis generated four themes: insufficient individual factors (i.e., knowledge, skills), restraining cultural norms (i.e., unhealthy cultural habits, gender disparities), inadequate health promotion services (i.e., lack of resources, structural limitations), and negative environmental impacts on health behavior (i.e., sweet foods and beverages, cold weather). Conclusions The findings suggest reinforcing health promotion services to prevent chronic diseases among the immigrant community. Providing health education resources that are culturally tailored helps improve immigrants’ knowledge to make healthier decisions in their own lives after migration. Moreover, it is recommended to introduce the health care system of the host country and healthy habits during the integration process, along with language training. Key messages • Improving equity in using health promotion services for immigrants requires reforms. • More strategies are needed to prevent chronic diseases among immigrants in Finland.

Nationwide prevalence and trends in high-risk drinking among adult men the disabled and non-disabled

Abstract Background Excessive drinking is an important public issue that causes various levels of physical, psychological, behavioral problems. Especially for the disabled, it matters in that it could lead to poor health and secondary health conditions. Methods This study analyzed high-risk drinking (HRD) behaviors over a 9-year period in adult South Korean men according to disability presence, severity, type. We linked national disability registration data with the National Health Insurance claims data. Age-standardized prevalence of HRD were analyzed for each year and the odds of current HRD were determined by multivariate logistic regression after adjusting for income level, residence, insurance type, Charlson comorbidity index. Results The age-standardized HRD prevalence of the mildly disabled was higher than that among the non-disabled. Among the mildly disabled and physically disabled, younger aged group showed higher prevalence of HRD than that of non-disabled. In multivariate logistic regression analysis, the mildly (aOR=1.26, 95% CI = 1.24-1.29), physically (aOR=1.31, 95% CI = 1.28-1.33), communication disabled (aOR=1.12, 95% CI = 1.07-1.17) had higher prevalence of HRD than the non-disabled. Conclusions The prevalence of HRD was higher among the young mildly disabled than the non-disabled, this was more evident in young men physically disabled, communication disabled. This may be a result of the physical and social limitations of severely disabled and should be interpreted with caution. Social activities should be supported, and health policies on alcohol consumption should be implemented to prevent secondary conditions and reduce health disparities. Funding: This research was supported by the National Research Foundation of Korea (NRF) grant funded by the Ministry of Education (No. 2022R1I1A3070074) and by a grant of Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HC23C0165). Key messages • The prevalence of high-risk drinking was highest among the mild disabled, especially the mild, physical, communication disabled in younger aged men. • Health policies and efforts to improve health disparities aimed at reducing alcohol consumption among people with disabilities are needed.

Implementing patient navigation for cancer prevention among individuals with mentally ill-health

Abstract Issue In Europe, over 80 million people experience mental ill-health and there are 4 million new cancer diagnoses each year. Individuals experiencing mental ill-health exhibit higher rates of cancer morbidity and mortality, with this excess attributed to risky health behaviors and obstacles encountered when accessing often fragmented healthcare systems. Description of the problem The aim of Co-CAPTAIN is the pilot implementation and evaluation of the Patient Navigation Model (PNM) for the improvement of primary cancer prevention in individuals with mental ill-health, adapted through participatory co-design in the European context. The project will adopt a cohort-based study design, commencing data collection at baseline and succeeded by three follow-ups (6 weeks, 9 months, 18 months). It will utilize a mixed-methods approach, combining quantitative and qualitative methodologies to assess diverse outcomes of PNM, facilitating both exploratory and confirmatory research. Qualitative data will be obtained through semi-structured interviews, while quantitative data will be collected using validated questionnaires and items developed ad hoc. The project will involve four pilot sites in Europe (Austria, Greece, Poland and Spain), where the PNM will be adapted to the specificities of national healthcare and support systems. The implementation phase is expected to begin in June 2024. Results During implementation, gathering both quantitative and qualitative data will offer valuable insights into feasibility and effectiveness, establishing a baseline for reshaping health and social care policies for individuals with mental ill-health across Europe. Lessons Co-CAPTAIN project aims to reduce health disparities for individuals with mental ill-health by improving overall health and reducing cancer burdens, leading to cost reductions in European health and social care systems. Key messages • The project aims to deliver an innovative solution based on the PNM, to address health disparities among individuals with mental ill-health by reducing cancer burden. • Combination of qualitative and quantitative methodologies to assess diverse outcomes.

Health disparities among in multicultural and non-multicultural families in South Korea

Abstract South Korea has experienced significant immigrant growth, with international marriages playing a key role in this demographic change. In 2019, international marriages accounted for 10.3% of all marriages, increasing the number of multicultural households. Multicultural families in Korea faced controversies over accepting new members in a society traditionally considered racially and ethnically homogenous. In rural areas, where patriarchal and conservative values prevail, there is greater discrimination and negative perception towards foreigners compared to urban areas, impacting access to healthcare. This potentially adversely affects the health of married immigrants. However, research on this issue is limited. This study aims to examine the differences in health behaviors, access to care, and health status between multicultural and non-multicultural families in rural and urban areas. Using a cross-sectional study design based on the 2023 Community Health Survey, the sample included 228,216 adults from non-multicultural families and 3,373 adults from multicultural families. Adjusted differences in outcome were estimated using regression models, including linear probability and logistic models. Overall, there were minimal or no differences in health behaviors and health status between adults from multicultural and non-multicultural families. However, significant differences were observed in access to care, such as annual health check-ups (0.72 [0.64, 0.81]) and vaccinations (0.84 [0.76, 0.94]). Non-multicultural families showed regional differences in all outcomes, whereas multicultural families exhibited minimal or no regional differences. These findings suggest that multicultural families may face barriers beyond regional environments, limiting their access to care and potentially leading to long-term negative health outcomes. Targeted policy development for multicultural families in Korea is necessary to address this issue. Key messages • Access to health care may vary for individual and local factors, especially for people with different ethnicities or cultures. • Multicultural families may encounter greater barriers than individual and regional characteristics, requiring the development of tailored policies for immigrants and multicultural families.

Syndemic vulnerability in Dutch urban cities: investigating health disparities and intersectionality

Abstract Background Syndemics, the clustering of health and social issues, disproportionately affect marginalized communities. While prior research indicates sex-specific variations in syndemic vulnerability, current research often overlooks other sociodemographic characteristics and their interaction. An intersectionality-informed syndemic approach could offer more insights into the mechanisms in syndemic suffering, providing a deeper understanding and identifying groups most affected by structural inequalities. Methods Our study focused on adult residents in Leiden and The Hague, the Netherlands, registered at different general practices. Using existing routine health data linked with Central Bureau for Statistics information, we included adults who were registered with a general practitioner in 2018 and 2019, had a minimum of two registered health conditions documented by their general practitioner, lived in Leiden or The Hague, and were at least 18 years old in 2018. Results A total of 43340 adults were included for analyses. Distinct health condition clusters were observed within sex and age groups. Women experiences a broader range of health issues, often characterized by mental and psychosomatic symptoms like mood/anxiety disorders and abdominal complaints. Conversely, men exhibited a higher prevalence of specific physical conditions, including hypertension, diabetes, and cardiovascular diseases. Conclusions The findings align with previous research, suggesting the importance of further exploration into the role of intersectionality in syndemics. Currently, we are investigating the foundations of these disparities, including interaction analyses and Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA). Using MAIHDA, we will examine the relationship between intersectionality and syndemic vulnerability, quantifying intersecting factors (sex, ethnicity, SES) and exploring their impact at individual and group levels. Key messages • Understanding intersectionality in health disparities is crucial for addressing syndemic vulnerabilities. • Tailored interventions informed by intersectionality may promote equitable health outcomes.

Addressing Regional Health Disparities: Estonia’s Approach to Burden of Disease Studies

Abstract Background Estonia, a small country defined by NUTS2 regions, faces challenges in assessing health disparities across its different counties when using global health data such as the Global Burden of Disease (GBD). Recognizing this limitation, Estonia initiated independent burden of disease studies in Estonia since 2013, with the findings being biennially published through the health statistics database of the National Institute for Health Development. The objective of this research is to assess the strengths and limitations inherent in various methods when calculating the years of life lost due to premature mortality (YLLs). Methods The approach to assess the burden of disease in Estonia differs somewhat from the Global Burden of Disease (GBD) methodology. One key distinction lies in our utilization of a national life expectancy table and our presentation of results at the LAU1 regional level. These burden of disease studies utilize region-specific life tables supplied by Statistics Estonia, categorized by county and gender, to compute Years of Life Lost (YLLs), offering an opportunity to pinpoint and tackle regional health issues. Results Since the calculation of YLL (Years of Life Lost) in these past studies has relied upon Estonia’s regionalized life tables, categorized by county and gender, the results exhibit substantial disparities when juxtaposed with the Global Burden of Disease study conducted by the Institute for Health Metrics and Evaluation (IHME). Conclusions This research aims to delve deeper into these variations, examining the challenges related to methodology, the availability, and the quality of data, and most importantly, knowledge translation. Our own burden of disease studies empowers us to formulate informed policy recommendations precisely tailored to the distinctive needs of each county, thereby facilitating targeted interventions, and driving improvements in overall public health outcomes.

Impact of digital health literacy on public health: an umbrella review

Abstract Background Digital health literacy (DHL) is increasingly important for public health initiatives in the digital era. However, its impact on public health outcomes remains unclear. This umbrella review synthesizes evidence on relationships between DHL and public health. Methods Electronic databases were searched from 2010 to January 2024 for reviews evaluating associations between DHL and public health outcomes. Two independent reviewers screened records and extracted data. Results were narratively synthesized and screened respect quality using Amstrar 2 check list. Results 12 reviews met the inclusion criteria. Higher population DHL was consistently linked to positive health behaviors like preventive screening uptake, medical adherence, chronic disease management, and vaccination. However, lower DHL correlated with health disparities and exacerbated risk of mis/disinformation. DHL interventions improved eHealth skills and health status. Conclusions Digital Health Ltieracy shapes engagement with digital public health tools and programs. Integrating DHL assessments into planning can help identify at-risk groups and optimize interventions. Developing population DHL through education represents an avenue to advance health equity and resilience against digital health threats. However, more evidence and more digital maturity of tools appear to be necessary. Key messages • Digital Health Literacy as milestone of next health generation. • Health outcomes are clearly linked to digital and digital health literacy.

A Lifeline to Fill the Silence of Homelessness: Person-Centered Analysis of Digital Coping and Links to Mental and Physical Health.

Individuals experiencing homelessness are among the most vulnerable population for mental and physical health disparities. Despite navigating numerous stressors on a day-to-day basis, they are vastly underrepresented within coping research. Using a person-centered approach, this study addresses ways in which technology is leveraged to manage ongoing stressors associated with the experience of homelessness. We employed a two-step and k-means cluster analysis within a sample of unhoused individuals (n = 66). Two distinct clusters emerged, revealing unique patterning of digital coping, stress, self-efficacy, and technology use. Resulting clusters were validated across numerous health outcomes, including mental and physical health problems, as well as digital service use and experience of homelessness. High digital engagement/low self-efficacy individuals (65% of sample) reported high levels of digital self-efficacy, yet lower levels of general self-efficacy. In contrast, low digital engagement/high self-efficacy individuals (35% of sample) engaged in relatively lower digital coping and technology use, with lower stress and higher general self-efficacy. High digital engagement/low self-efficacy individuals, in turn, reported more mental and physical health problems; whereas low digital engagement/high self-efficacy reported somewhat decreased digital access. Relatively few differences emerged between the clusters on experiences of homelessness. Due to the transient nature of unhoused people, reaching such vulnerable populations via technology to support their digital coping and subsequently enhance well-being outcomes represents a critical next step for digital equity. This population is poised to benefit from digital equity efforts, with critical implications for reduced health disparities.

Perspectives on intersectoral collaboration and citizen participation in community-based prevention

Abstract Background Challenges in healthcare, such as rising healthcare costs, shortages of healthcare staff, and health disparities, have made many countries focus on intersectoral collaboration (IC) and citizen participation (CP) in community-based prevention (CBP) and health promotion (HP). Previous research on IC and CP has addressed the importance of exchanging perspectives to arrive at a shared vision and ambition. Our study is part of a long-term action research project conducted in two neighborhoods in the Netherlands. It aims to provide insight into stakeholders’ perspectives on IC and CP in CBP and HP to facilitate building partnerships. Methods Data collection takes place from March to June 2024. As part of a Q-study, we perform post-sort interviews. The Q-methodology is based on sorting statements concerning various aspects of IC and CP in CBP and HP (e.g., roles and tasks, involvement of citizens, communication, perceived barriers, etc.). We aim to include 40-50 participants from the aforementioned neighborhoods with diverse backgrounds. Participants sort 40 statements (Q-set) into a fixed-scaled framework ranging from -4 (disagree) to + 4 (agree). The interview is about individual sorting and perspectives on their own role within the collaboration. Results So far, the results of 10 participants with backgrounds in health care, social work, sports, local authority, volunteer work, and public health have been analyzed.Preliminary data synthesis shows six themes concerning shared purpose, collaboration partners, social collaboration competencies, personal motivation, conditions, and collaboration organization. Conclusions The preliminary themes overlap with findings from previous research. We will adapt existing models to reflect on our findings and enrich the literature with new themes or insights in the specific context. The interviews will help interpret the Q-sorts and develop follow-up actions in the action research projects in the participating neighborhoods. Key messages • Insights in stakeholders’ perspectives are valuable for building local collaborative partnerships. • Shared purpose, collaboration partners, social collaboration competencies, personal motivation, conditions, and collaboration organization are themes of interest to intersectoral collaboration.

Digital Health Literacy Enhancement Strategies Across Diverse Groups: A Scoping Review

Abstract Background The COVID-19 pandemic has accelerated the use of digital health technologies. Digital health literacy (DHL) is essential for effectively understanding and applying electronic health information. However, unequal access and use of these technologies require interventions to improve DHL for fair healthcare access. Objectives This scoping review aimed to identify strategies to enhance DHL in patients and the general population. Methods The review used the Joanna Briggs Institute Scoping Review Methodology and PRISMA-ScR guidelines. Eligibility criteria included a wide population, interventions aimed at improving DHL, with no restrictions on outcomes. The search strategy included electronic databases (MEDLINE, PsycINFO, Web of Science), and AI-based software, AS Review, was used for screening. Results The review found 5149 articles, 44 met the eligibility criteria. Studies focused on different demographic groups and health conditions. Most interventions were in North America and Europe. The study designs varied. Interventions via mobile apps, online platforms, and in-person sessions aimed at various conditions yielded positive results, including increases in DHL, self-management skills, and health-related behaviors. These interventions involved either independent interventions that focused on DHL or integrated interventions that were part of another intervention that aimed at a health outcome and had an element of DHL enhancement. Conclusions The review highlights the importance of DHL in informed decision-making and navigating digital health environments. While many interventions had positive outcomes, methodological limitations challenge the findings, emphasizing the need for more rigorous study designs. Future research should address sustainability, scalability, and the impact of DHL on health disparities, considering cultural sensitivity when developing interventions. Key messages • Scoping review identifies strategies to enhance Digital Health Literacy (DHL), crucial for effective use of health technology. • Despite positive outcomes, methodological limitations exist. Future research should focus on sustainability and scalability.

1.K. Scientific session: Health literacy of children and adolescents across Europe

Abstract Health literacy is developed throughout the life course. Enhancing health literacy at an early age is especially important since it may impact both current and future health skills and outcomes. Low health literacy in child and adolescent populations has been linked to worse health outcomes and health disparities in Europe, making health literacy of children and adolescents an important public health topic. Developing and delivering targeted interventions and services for these age groups requires insight and data on the development and state of health literacy in early age. However, child and adolescent health literacy is still an under-researched topic. This is partly due to a lack of appropriate measurement instruments and methods to involve children in research. In the past years, new studies on child and adolescent health literacy have emerged in several European countries. In this workshop, innovative studies from Germany, the Netherlands and the UK on HL in childhood and adolescence are introduced and discussed. Both methodological findings as well as empirical data will be presented. In Germany, an instrument to measure child health literacy was developed and validated for primary school children. This instrument, the HLS-Child-Q15, has been used both in Germany and in the Netherlands to study the relationship between children’s health literacy and their health behaviors and outcomes. In the UK, methods of involving primary school children in health literacy research were studied. Experiences with a Children’s Advisory Group will be shared. Another study in the Netherland focuses on the health literacy profiles and needs of adolescent patients with rheumatic diseases. The format of this workshop will be 4x10-minute presentations (including questions) followed by a 20-minute interactive discussion, reflecting on the relevance of these results to further research, health promotion and health services. which will be followed by Q&A and an open discussion with the audiences. This workshop offers a forum for researchers, health educators, practitioners and policy-makers interested in health literacy measurement and research in children and adolescents. Key messages • Child and adolescent health literacy is an important, yet under-researched public health topic. • Child health literacy is an important predictor of their health behavior and outcomes.

11.D. Scientific session: Participatory approaches and co-creation in complex interventions to reduce inequity in health

Abstract Health disparities are linked to social inequalities, necessitating health researchers to address the health gaps that exist between different social groups, particularly in the realm of health interventions. This workshop delves into the significance of co-creation processes and participatory approaches in complex health interventions to reduce social inequities in health outcomes. Through empirical cases illustrating co-creation processes in intervention research, the workshop aims to enlighten the audience on the continuum of participatory approaches. The MRC/NIH framework of complex interventions highlights the importance of engagement with relevant stakeholders throughout the research phases to enhance the likelihood of developing or identifying interventions that can positively impact health outcomes. However, the extent and nature of stakeholder involvement may vary depending on the specific context and stage of the research. While stakeholder involvement has been a longstanding focus, the concept of co-creation, where stakeholders actively participate in the entire process of intervention development, implementation, and evaluation, has emerged more recently. This shift from creating interventions for the target population to collaborating with them in the intervention’s creation has led to the emergence of more inclusive health interventions that are contextually relevant and tailored to the local settings where they are intended to create change. Yet, introducing participatory approaches in intervention research may raise new questions about decision-making and power dynamics. While interventions led solely by experts and researchers may overlook the empowerment and capacity-building potential among stakeholders and intervention sites, co-creation processes have the capacity to empower stakeholders and address health inequities effectively. However, challenges persist in ensuring equal collaboration between researchers and participants, especially in disadvantaged groups. This workshop aims to prompt reflection on ethical issues arising from traditional health intervention approaches and approaches to ensure participants’ ownership of interventions when they are adapted in new contexts. Moreover, this workshop will discuss the design of participatory interventions: What methods can we use to co-create? What stakeholders to involve? At what stages of the intervention should co-creation occur? The workshop program begins with an introductory presentation of participatory approaches and co-creation in health intervention research, with examples from a school-based intervention. Next, three empirical cases of co-creation processes introduced in interventions in different contexts are presented. Finally, the audience is invited to a take part in a discussion focusing on how participatory approaches among disadvantaged populations can potentially contribute to reduced social inequity in health. Key messages • The involvement of stakeholders in the development, implementation and evaluation of health interventions can take many forms, and what is meaningful for the specific context needs to be considered. • Co-creation approaches in health interventions empower participants and address unequal power dynamics between those who deliver and those who receive health interventions.

1.O. Scientific session: Trans & Gender-Diverse Individuals’ Mental & Behavioral Health Risks & Intervention Needs

Abstract Transgender and gender-diverse (TGD) individuals are at a greater risk for various poor mental and behavioral health outcomes than cisgender individuals, including higher rates of suicide, psychiatric diagnoses, and behavioral health problems. For example, research has documented a seven-fold increased risk for lifetime suicide attempts among young TGD people, compared with the general population. Less is known about the age of onset of such mental and behavioral health disparities and how these disparities may vary across other intersectional socio-demographic variables. It has been well-documented that trans and gender-diverse individuals often encounter discrimination and transphobia across various social, educational, professional, administrative, and healthcare settings. This discrimination, as highlighted in the literature, frequently poses obstacles to accessing both general and trans-specific healthcare services due to experiences of discrimination (e.g., misgendering, refusal of care, lack of adequate services). The right and ability to self-determine and the accessibility to gender-affirming care without discrimination are key to closing the gap in TGD individuals’ mental and behavioral health outcomes, and for them to live authentically and thrive. Tailored and affirming mental and behavioral health interventions to reduce these health inequities are pivotal for TGD individuals to achieve the highest attainable standard of physical and mental health: a key fundamental human right. Considerable gaps in the literature remain concerning the onset and determinants of gender identity-based health disparities and healthcare approaches that are respectful, inclusive, non-pathologizing, and grounded in human rights principles for TGD individuals. This workshop intends to address these knowledge gaps by delving into the mental and behavioral health needs of TGD individuals. The workshop seeks to further foster dialogue on strategies to overcome resistance to implementing approaches that uphold the human rights and well-being of these communities. Dr. Richard Bränström (Karolinska Institutet) will present a study that explores the age at which gender identity-based disparities in psychiatric diagnoses and treatment can be first identified. Dr. Gonzales (Vanderbilt University) will examine disparities in mental health and social determinants of health among TGD individuals with private insurance. Dr. Moleiro (Lisbon University Institute) will review TGD persons’ ways of identifying with the choices and trajectories in social, legal, and affirmative healthcare processes in Portugal. Dr. Lelutiu-Weinberger (Columbia University School of Nursing) will present findings from a study that assessed tobacco use and cessation attitudes, facilitators, and barriers to quitting, and intervention components and delivery modality acceptability among TGD individuals, as well as sexual minority individuals, in Romania to inform a tailored and affirming smoking cessation intervention. Key messages • Transgender and gender-diverse are at increased risk for a variety of poor mental and behavioral health compared with the general public. • There is a critical need to foster healthcare services for transgender and gender-diverse individuals that are tailored and affirming.

What works to reduce regional health inequalities? A case of East vs West Germany post reunification

Abstract Regional inequalities in mortality are rising across the globe. The case of German reunification offers a unique opportunity to explore how such inequalities can be reduced, or even eliminated: following reunification, a long-standing life expectancy gap between East and West Germany was closed for women and markedly reduced for men in a period of less than 15 years. Drawing from theory on health inequalities, we investigate the contribution of material, behavioural and psychosocial factors likely related to the narrowing of the life expectancy gap between East and West Germany following reunification. We used regional data from official national statistics covering the period 1994-2020 for 15 regions in East and West Germany. Using fixed-effects models with an interaction term for regions in the East, we investigated whether within-region changes in key hypothesised factors (social security expenditure, healthcare improvements, changes in alcohol consumption, and life satisfaction), have had differential impacts on life expectancy at birth and at 65 years. We find that increases in social security benefits in the East following reunification has been the most important factor for lowering inequalities between the two parts of Germany: for every standard deviation increase in social security benefits, life expectancy at birth increased by an additional 0.20 [0.07,0.33] years for males and by 0.15 [-0.01,0.31] years for females in East relative to West Germany. We find the protective effect of social security benefits also for women at 65 years (additional 0.14 years [0.006,0.268]) but not for men. Overall, our findings suggest that increasing social security expenditure could be an effective policy-based tool for reducing health disparities across regions with different levels of economic development. This provides additional support for the relevance of the materialist hypothesis and the political economy of root causes of health inequalities. Key messages • Our findings suggest that increasing social security expenditure could be an effective policy-based tool for reducing regional health disparities. • We find support for the materialist and political economy approaches to explaining health inequalities.

10.O. Scientific session: Breaking Barriers: Advancing Vaccine Access for Newly Arrived Migrants in Europe

Abstract Health disparities are particularly evident in Europe among Newly Arrived Migrants (NAM), in accessing healthcare systems and navigating vaccination services. The AcToVax4NAM project emerged as a pioneering initiative aimed at identifying solutions to overcome system barriers, following a life-course approach. These solutions consist of a broader strategy to promote organisational vaccination literacy and enhance vaccine uptake among NAM. Employing a participatory approach, the project engaged with professionals FOR health (PFH) and ΝΑΜ to ensure the relevancy of the practices developed, along with the widespread acceptance of proposed solutions and tools tackling access to vaccination services. This workshop is not just about showcasing the outcomes and impact of the AcToVax4NAM project; it’s about equipping PFH with practical tools and strategies that are immediately applicable and will ultimately increase vaccine literacy and uptake. By delving into the challenges encountered, strategies employed, and recommendations formulated, the workshop offers invaluable insights for professionals seeking to address similar issues in their respective contexts. We believe that by sharing our experiences and best practices, we can empower others to make a real difference in their communities. The workshop will contain 5 presentations that follow the functional structure of the project, starting with a presentation on the General Conceptual Framework, the foundational element guiding project activities. Following this, we will discuss the development of a migrant-centered and migrant-sensitive tool aimed at improving the communication skills of PFH by providing definitions of vaccine-related terms in an easily digestible way. The third presentation will detail the development of action-oriented flowcharts across consortium countries validated through focus group discussions with PFH; the flowcharts are linked to a comprehensive repository of 359 tools. The workshop will then explore the consortium’s efforts in providing vaccine literacy and cultural competency training to more than 200 healthcare professionals. Finally, the outcomes of the pilots implemented in consortium countries will be presented, and recommendations will be made that summarize the evidence-based accumulation of improved access to vaccinations for NAM and, consequently, increase vaccine uptake. This workshop fosters dialogue among stakeholders and showcases collaborative efforts to promote vaccination literacy and uptake among NAMs in Europe. Sharing experiences and best practices empowers PFH to address similar challenges in their communities, offering insights into effective strategies for improving healthcare access and promoting health equity. Finally, insights from the presentations and discussions can inform evidence-based policymaking and shape the development of immunization public health strategies at the local, national, and European levels, inspiring real change in communities. Key messages • Equipping Professionals for Health with strategies to Enhance Vaccine Access for Newly Arrived Migrants. • Equity through Collaborative Efforts in Promoting Vaccination among Newly Arrived Migrants.

The Effect of Text messages and Education on Cancer Screening in Women Aged 30-65

Abstract Background Despite it is known that cancer screenings reduce cancer-related deaths, screening rates are still inadequate. The aim of this study is to examine the effect of text messaging and training on cancer screening in women aged 30-65. Methods This non-randomized controlled trial was conducted with 120 women aged 30-65 between November 2023 and April 2024 in Tekirdağ, Türkiye. Participants were divided into the text message group (TMG) (n = 60), the training group (TG) (n = 60), and the control group (CG) (n = 60). In the text message group, every participant received text messages about cancer and importance of screening procedures, one a day for ten days. The training group was educated for a session that lasted 45 min. Data was collected both before and 3 months after the intervention, using a questionnaire that included two parts (sociodemographic characteristics and stages of change for cancer screening practices). Data was analyzed using the Marginal Homogeneity test. Results The rates of those who had a pap smear test, breast self-examination (BSE), mammography, and stool occult blood screening were found to be significantly higher in both the text message group and the training group in the post-test than the pre-test. (p<.001). In the text message group, there was an increased rate of 43.4% for pap smear test, 25% for BSE, 17.3% for mammography, and 10% for stool occult blood screening. In the training group, there was an increased rate of 31,7 % for pap smear test, 26,7% for BSE, 13,3% for mammography, and 23,4 % for stool occult blood screening. There was no change in the control group. Conclusions The results showed that both text messages and training about cancer screening are effective in increasing the rate of cervix, breast, and colorectal cancer screening. Key messages • Text messaging about cancer screening is as effective as training in increasing the rate of cervix, breast, and colorectal cancer screening. • Text messaging interventions may be an effective and practical way to increase cancer screening rates in populations most affected by health disparities.

Socio-economic gradients in urban green space access and respiratory health

Abstract Background This study investigates social disparities as one of the drivers influencing the access to green spaces and exposure to natural environments, potentially exacerbating disparities in respiratory health in children. Methods Longitudinal ELSPAC birth cohort study data included 4384 complete case participants born in cities of Brno and Znojmo, examined throughout the years 1990-2010. Estimates on socio-economic status (SES) scores of children’s parents and their education were used as socio-economical predictors. Tree cover density (TCD) calculated as mean canopy closure percentage in the individual walking distance neighbourhoods and the ownership and accessibility of a garden were used as indicators of green space accessibility. Multiple logistic regression models were employed to estimate odds ratios for predictors of respiratory health outcomes, controlling for several confounders. Results Parents’ SES was found to be positively associated with neighbourhood TCD, and this effect was even more pronounced for garden owners. Higher tree cover was then significantly negatively associated with development of acute bronchitis (OR 0.88, CI 95 % 0.84-0.94 for 1 SD of tree cover), while not having a garden (OR 1.81, CI 95 % 1.42-2.33) and living in area with lower tree cover (OR continuously decreasing from 1.88 to 1.68 for lowest and highest quartile respectively) was significantly associated with progression of acute bronchitis into chronic bronchitis in a fully adjusted model. Vice versa, higher tree cover was statistically significantly positively associated with development of allergic rhinitis (OR 1.09, CI 95 % 1.03-1.15), suggesting viability of the novel method of estimation of individual neighbourhood greenness. Conclusions The results suggest protective effect of access to urban green spaces against adverse respiratory outcomes in children. The socially uneven distribution of access emphasizes the importance of urban policies in promoting urban health. #NGEU Key messages • There is a significant protective effect of access to green spaces against respiratory diseases and their progression. • There’s an unequal, but varied distribution of access to green spaces, and social gradient in health, highlighting the importance of urban green space distributive politics.

6.O. Scientific session: The unmet needs of LGBTQ+ persons and communities: perspectives from across the globe

Abstract Lesbian, gay, bisexual, transgender and queer persons suffer from rising anti-LGBTQ+ stigma. Such stigma entails laws that punish being LGBTQ+ such as in Uganda, Russia, Ghana, Iran, etc. The stigmatizing contexts have numerous health-harming effects, including perpetrating mental health harms and creating environments that hamper access & quality of services. Rising global anti-LGBTQ+ stigma and the adverse health impacts require more data on the topic to adequately dispel LGBTQ+ mis- and dis-information. This workshop will give examples of studies that examine LGBTQ+ disparities and inequities in health across different social and cultural contexts, drawing from research in Czechia, Kenya, Rwanda, and Sweden. The workshop will first outline the relevant social and cultural contexts of LGBTQ+ persons in various countries, such as attitudes, beliefs, and values. The workshop will then discuss LGBTQ+ inequities and disparities that arise from health-harming attitudes, beliefs, and values. Afterward, the workshop will discuss public health-oriented solutions & policy directions, including using data for interpretation and advocacy labs and efforts, enhancing data collection, improving knowledge and attitudes, and other implications for public health practice and policy. The workshop will open a session that will situate LGBTQ+ public health for the audience. The first study will be by Andreas Malm from the Karolinska Institute, Sweden, examining LGBTQ+ differences in mental health and treatment disparities in Sweden. This will be followed by Luis Roxo from the Karolinska Institute and Universidade NOVA de Lisboa, Portugal, discussing stressors and symptoms that shape inequalities in mental health service use. Then, Michal Pitonák from the National Institute of Mental Health, Czechia, will present treatment and outcome gaps in the mental health of LGBTQ+ persons in Czechia. Lastly, Emmy Kageha Igonya from the African Population Health Research Center, Kenya, will showcase work from a mixed-methods study with LGBTQ+ people in Rwanda and Kenya, examining access to and use of healthcare services. After the individual presentations, which will each last 7-8 minutes, the audience will be invited to a moderated 20-25-minute open discussion on the papers & how the findings can help inform public health practice & policy to address the unmet needs of LGBTQ+ populations globally. The continuing rise in anti-LGBTQ+ sentiments across the globe is problematic from a public health standpoint, given the severe health-harming effects across numerous physical and mental health states and domains. Our workshop aims to facilitate a conversation on understanding the structural situations that shape LGBTQ+ health and identifying strategies to reduce gaps in services and needs that disproportionately burden LGBTQ+ persons. Key messages • LGBTQ+ people across the globe are experiencing rising stigma and discrimination. • Rising anti-LGBTQ+ backlash disproportionately harms LGBTQ+ physical and mental health and creates gaps in care.

What long-term health outcomes can we anticipate for children who have been in social care?

Abstract The concept of cumulative disadvantage suggests that setbacks in one area of life not only lead to further challenges within that domain but also increase vulnerability to adversities across different domains, as highlighted in life course studies. In the context of children with a history of childhood social care (CSC) experience, research consistently shows poorer long-term health outcomes compared to peers without such experiences. This disparity persists into middle age and can affect subsequent generations, underscoring the enduring impact of early-life adversity. Dr Viviane S. Straatmann, a social epidemiologist based in Sweden and enriched by her experience in studying the health and social life of vulnerable children in diverse international settings, will offer insights from life-course and intergenerational epidemiological studies. She will explore the intricate web of disadvantages preceding children’s entry into social care, shedding light on the complex interplay between early-life adversity, cumulative disadvantage, and long-term health outcomes. Participants will engage in reflective dialogue on pertinent questions, such as how cumulative disadvantage informs interventions for children with CSC backgrounds, the potential mechanisms underlying the contribution of early-life adversities to long-term health disparities, and the ways intergenerational studies can inform strategies for breaking the cycle of disadvantage.