Lifelong Health Research Articles

Physical literacy-based intervention for chronic disease management: a quasi-experimental study protocol

BackgroundAs chronic diseases proliferate globally, innovative interventions that promote sustainable physical activity are crucial. Physical literacy offers a holistic strategy for the promotion of lifelong health. This protocol describes a study investigating the effects of the integration of physical literacy principles in community-based physical activity group sessions in adults with chronic diseases. The primary outcome of this study is the physical literacy level (global physical literacy score and sub-scores) of participants.MethodsThis quasi-experimental study will compare three groups: a control group, a group taking part in traditional physical activity (TPA) group sessions tailored for adults with chronic disease focusing on physical fitness general improvement, and a group taking part in TPA sessions that incorporates physical literacy goals and intervention content in line with 6 core dimensions of physical literacy (TPA + PL). Intervention groups will take part in 12 one-and-a-half-hour sessions organised weekly over a 3-month cycle. The study will assess the impact of these interventions using a mixed qualitative and quantitative physical literacy assessment tool at baseline (physical tests for the physical competence dimension; questionnaire for the 5 other core dimensions), three months (post-intervention), and six months (follow-up).DiscussionThis studypresents an innovative intervention for chronic disease population through physical literacy, hypothesising that integrating physical literacy dimensions in tailored physical activity group sessions can significantly improve physical literacy to improve physical activity sustainability and health outcomes. Results from this study will provide insights into the efficacy of physical literacy interventions compared to traditional approaches, potentially guiding future public health initiatives and chronic disease management strategies.Trial registrationNCT06325306 (21/03/2024).

Exploring the link between age at menarche, anthropometry and body fat composition with type II diabetes in a Singapore multi-ethnic cohort

BackgroundEarly menarche is associated with lifelong health implications, including heightened risks for obesity, type 2 diabetes (T2D), cardiovascular disease, and overall mortality. This study explored the associations that link early menarche, major adiposity indices, and T2D in a group of multi-ethnic Asian women.MethodsA prospective, hospital-based study was conducted in Singapore. Two thousand seven hundred fifteen women were recruited from 2014 to 2016 (45–69 years old) and 1201 women were followed up from 2021 to 2023. At baseline, age at menarche (AAM) was divided into sub-categories: < 12 (early AAM), 12–13, 14–15 (reference), > 15 years. Major adiposity indices and glycemic profiles were assessed, including fat mass index (FMI), visceral adipose tissue (VAT), and HOMA-IR (homeostatic model assessment for insulin resistance). At the 6.6-year follow-up, T2D was assessed. One-way ANOVA and chi-square were performed for continuous and categorical variables, respectively. Multivariable regression analysis was performed to determine the association between AAM and primary outcomes, including adiposity measurements (FMI, VAT) and metabolic assessments (HOMA-IR) at baseline. Modified Poisson regression was performed to assess relative risk (RR) between AAM and T2D at follow-up. Serial mediation analysis was performed to determine potential mediators underlying the link between AAM and T2D. All analyses accounted for major confounders including age, ethnicity, and education.ResultsWomen with early AAM had significantly greater values in adiposity assessments, including increments in FMI (10.9 vs 10.3, p < 0.001), VAT (134 vs 113 cm2, p = 0.05) and HOMA-IR (1.20 vs 1.03, p = 0.08) at baseline. Early AAM (< 12 vs. 14–15 years) was associated with a 60% increased risk of developing T2D (RR 1.60 (95%CI: 1.04, 2.45)). Serial mediation analysis suggested a significant pathway underlying early AAM and T2D, which was firstly mediated by FMI, followed by VAT and lastly by HOMA-IR (p < 0.05).ConclusionsOur study provided valuable insight into the pathophysiology of T2D development amongst mid-life women with early AAM. The findings could potentially indicate strategies to target FMI and VAT among Asian women in the menopausal phase with early AAM, to prevent the development of T2D.

The chain mediating effect of self-efficacy and health literacy between proactive personality and health-promoting behaviors among Chinese college students

Health-promoting behaviors are essential for college students as they develop lifelong health habits. To investigate how to cultivate health-promoting behaviors among college students, this study aimed to investigate the influence of proactive personality on health-promoting behaviors and to explore the mediating roles of self-efficacy and health literacy through a cross-sectional study. A total of 664 college students from six colleges in Xinxiang, China, were conveniently sampled to complete questionnaires, including the Proactive Personality Scale, General Self-Efficacy Scale, 12-item Short-Form Health Literacy Scale, and Short-Form Health Promotion Scale. Path analysis indicated that proactive personality was directly associated with health-promoting behaviors (effect value: 0.146). The mediating roles of self-efficacy (effect value: 0.165) and health literacy (effect value: 0.080) were significant. A chain mediating effect of self-efficacy and health literacy was also observed (effect value: 0.028). The positive effect of proactive personality (β = 0.146, P < 0.001), self-efficacy (β = 0.421, P < 0.001) and health literacy (β = 0.234, P < 0.001) on health-promoting behaviors was significant. These findings suggest that self-efficacy and health literacy play a chain mediating role between proactive personality and health-promoting behavior. Future interventions should target proactive personality, self-efficacy, and health literacy to enhance health-promoting behaviors in college students.

Neonatal microbiota colonization primes maturation of goblet cell-mediated protection in the pre-weaning colon.

Regulated host-microbe interactions are a critical aspect of lifelong health. Colonic goblet cells protect from microorganisms via the generation of a mucus barrier structure. Bacteria-sensing sentinel goblet cells provide secondary protection by orchestrating mucus secretion when microbes breach the mucus barrier. Mucus deficiencies in germ-free mice implicate a role for the microbiota in programming barrier generation, but its natural ontogeny remains undefined. We now investigate the mucus barrier and sentinel goblet cell development in relation to postnatal colonization. Combined in vivo and ex vivo analyses demonstrate rapid and sequential microbiota-dependent development of these primary and secondary goblet cell protective functions, with dynamic changes in mucus processing dependent on innate immune signaling via MyD88 and development of functional sentinel goblet cells dependent on the NADPH/dual oxidase family member Duox2. Our findings identify new mechanisms of microbiota-goblet cell regulatory interaction and highlight the critical importance of the pre-weaning period for the normal development of protective systems that are key legislators of host-microbiota interaction.

The role of healthy lifestyle technologies in supporting young adults’ healthy active lifestyles

ABSTRACT Young people are increasingly using healthy lifestyle technologies (HLT) to support their healthy active lifestyles, yet little is known about how they use their digital skills and/or health knowledge to regulate their healthy behaviours and engage with HLT critically. Moreover, there is a dearth of literature on young adults’ perspectives and experiences of HLT use in this regard. This is noteworthy as this age group is more likely to use HLT to regulate their physical activity (PA) participation and health learning independently. Therefore, this study aims to explore young adults’ (aged 18–20) experiences of using HLT in supporting and regulating their healthy active lifestyles beyond a formal learning context. The research was undertaken with university students in central England, with 23 young adults participating in eight focus groups and 11 participating in individual interviews. An abductive thematic analysis approach was employed to analyse the data, and self-regulated learning theory was used as a theoretical framework to guide data analysis. Three analytical themes were conceptualised as follows: (1) The use of HLT to facilitate a healthy active lifestyle, (2) Barriers and concerns, and (3) Digital health strategies. The findings indicate that the young adults sought to foster healthy active lifestyles through a noticeable self-regulation process within the pedagogical environment afforded by HLT. This involved setting goals, selecting and implementing appropriate strategies, and monitoring and adjusting their PA participation and health learning as needed. Whilst the young adults had encountered various barriers and challenges in regulating their healthy active lifestyles via HLT, they had developed various digital health strategies to address or mitigate these. This research provides new empirical evidence on how and why young adults engage with HLT and develop strategies to support their healthy active lifestyles, thereby illustrating the potential of HLT to foster their lifelong PA participation and health learning.

Digital Parenting Program for Migrant Chinese Families: A Quasi-Experimental Study

Purpose: This study aimed to evaluate the effectiveness of a self-directed online program, Parenting for Lifelong Health for Young Children (PLH-YC), in enhancing positive parenting practices among migrant families in China. Methods: A quasi-experimental design was employed, with 67 parents of children aged 2–9 years assigned to either an intervention group ( n = 24) or a control group ( n = 43). Both qualitative and quantitative data were collected. Results: Parents in the intervention group showed significant improvements in proactive parenting strategies and parent–child relationships compared to those in the control group. However, the intervention had no significant impact on child maltreatment, externalizing behaviors, or other parenting outcomes. Qualitative assessment revealed themes including adopting positive parenting practices, enhancing parental mental health, and promoting desired parenting outcomes. Conclusion: The self-directed online PLH-YC program demonstrates its potential as a scalable, low-cost solution for disadvantaged parents in low- and middle-income countries.

Brushing Towards a Healthier Future: Promoting Clean and Healthy Living Habits in School-Age Children

Introduction: Oral health is a vital component of overall well-being, especially in school-age children who are in the critical stage of forming lifelong health habits. However, awareness and practice of proper toothbrushing remain low in many communities. Objective: This community service program aimed to improve knowledge and practices related to toothbrushing as part of Clean and Healthy Living Behaviors (PHBS) among school-age children. Method: The activity was conducted through interactive health education sessions at Babakan Pari Village involving 26 students aged 6-8 years old. The program included educational storytelling, demonstrations using dental models, and hands-on practice of proper toothbrushing techniques. Dental kits were distributed to encourage continued practice at home. Results: The program resulted in increased knowledge and improved toothbrushing skills among the participants, as observed through pre- and post-activity assessments. Teachers reported a higher level of student awareness and enthusiasm toward maintaining personal hygiene after the intervention. Conclusion: Educational interventions that are engaging and age-appropriate can significantly enhance oral hygiene behaviour in children. Collaboration with schools and families is essential to sustain PHBS practices and promote healthier futures for young generations.

Going Places: An Active Transportation Intervention to Increase Youth Physical Activity, Durham, North Carolina, 2023-2024.

Routine youth physical activity (PA) fosters healthy habits and lasting cardiometabolic benefits into adulthood; however, significant disparities in PA persist by race, ethnicity, and income. Active transportation is an optimal intervention target to promote youth PA equity by building transportation self-efficacy skills. Going Places, a multilevel transportation self-efficacy intervention, aims to increase underserved youth PA and cardiometabolic health. We demonstrate preliminary efficacy, based on increased levels of PA, improved transportation self-efficacy, and reduced barriers to transportation use and PA to support positive patterns for lifelong health. (Am J Public Health. 2025;115(5):693-697. https://doi.org/10.2105/AJPH.2025.308012).

Maternal childhood adversity accelerates epigenetic aging of children.

Although early adversity is strongly related to lifelong health disparities, it is unclear how adversity might confer risk across generations. To investigate, we tested the hypothesis that mothers' childhood adversity was associated with their epigenetic aging and that of their children and examined whether associations differed for Black and White mothers. Dyads (N = 215) of mothers (52% White, 48% Black, Mage = 39.2, SD = 1.1) and children (N = 215, 55% female, Mage = 8.3, SD = 4.0, range 2-17) provided saliva samples to assay the Horvath clock and pace of aging calculated from the epigenome epigenetic aging measures. Linear regressions were used to estimate the associations of maternal early adversity measures with the outcomes of maternal and child Horvath clock epigenetic age, as moderated by race. For Black, but not White mothers, any abuse before age 13, b = 0.81, p = .007, physical abuse before age 18, b = 1.69, p = .001, and sexual abuse before age 18, b = 1.17, p = .02, were associated with significantly greater Horvath age acceleration in their children. In contrast, there was no relation between maternal childhood adversity and mothers' epigenetic aging, and no significant findings for the pace of aging calculated from the epigenome. Maternal childhood adversity appears to have a greater effect on the epigenetic aging of the children of Black mothers. The effects of systemic racism on Black Americans may interact with maternal childhood adversity to confer additional risk for Black children. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Long term impact of formula choice in children with cow milk protein allergy: 6-year follow-up of the Atopic March Cohort Study.

Long term impact of formula choice in children with cow milk protein allergy: 6-year follow-up of the Atopic March Cohort Study.

Lack of Routine Health Care Among Adult Survivors of Childhood, Adolescent, and Young Adult Cancers (CAYA): A Nationally Representative Study of 4300 Survivors.

Survivors of childhood, adolescent, and young adult cancers (CAYA) experience lifelong health risks and accelerated aging. We examined routine health care (no routine checkup in the past year) among a nationally representative sample of CAYA survivors at different life stages. We pooled data from the Behavioral Risk Factor Surveillance System (BRFSS; 2012, 2014, 2016-2019). CAYA survivors (ages 0-39 at cancer diagnosis) were young adults (18-39 years), middle-aged (40-64 years), or older adults (≥ 65 years) at the time of the survey. We estimated the prevalence of: (1) not receiving routine health care and (2) not having a personal doctor, overall and by age at survey. We used multivariable Poisson regression to identify factors associated with these outcomes. We identified 4284 CAYA survivors: 884 young adults, 2201 middle-aged, and 1199 older adults. More young adults were uninsured and unable to afford care, compared to other age groups. A higher proportion of young adults did not receive routine health care (35.9%, 95% CI 30.3-41.9) or have a personal doctor (25.6%, 95% CI 20.5-31.4), compared to middle-aged or older CAYA survivors (p < 0.01). In multivariable models, being a young adult was strongly associated with (1) not receiving routine health care (aPR 1.82, 95% CI 1.24-2.67) and (2) not having a personal doctor (aPR 3.14, 95% CI 1.84-5.35). Younger CAYA survivors experience a triple threat of chronic conditions, modifiable risks, and disconnection from routine health care. Early interventions to facilitate care transitions are needed.

Associations of rumen and rectum bacteria with the sustained productive performance of dairy cows.

The gut bacterial community is essential for maintaining lifelong health and productivity in ruminants, but the relationship between the gut microbiota and the sustained productivity of ruminants remains inadequately understood. In this study, we selected long-lived dairy cows in mid-lactation (≥5 parities) with different levels of milk production (n = 10). Significant differences were observed in the rumen bacterial structures between the two groups of dairy cows, whereas no significant differences were detected in the rectum bacterial communities. Additionally, there were no significant differences in serum oxidative stress biomarkers, inflammatory markers, or immunological markers between the long-lived high-yield (LH) and long-lived low-yield (LL) dairy cows. Furthermore, the concentrations of propionate (Pr) in the rumen and butyrate (Bu) in the rectum were elevated in the high-yield group. Spearman correlation and microbial co-occurrence network analyses revealed that several rumen-enriched bacteria, such as Syntrophococcus, Lachnospira, Shuttleworthia, Erysipelotrichaceae_UCG-2, and Roseburiaare associated with rumen propionate (Pr) production. In the rectum, the reduced abundance of Christensenellaceae_R-7_group and Moryella favors butyrate production. Furthermore, Random Forest machine learning analysis demonstrated that six bacterial taxa in the rumen combined with one serum biomarker, as well as three bacterial taxa in the rectum combined with three serum biomarkers, can serve as potential biomarkers for distinguishing between LH and long- LL dairy cows, achieving prediction accuracies of 92 and 99%, respectively. The findings of this study indicate that rumen and rectum bacteria are associated with the milk production phenotypes of dairy cows with sustained productivity. The rumen microbes are closely linked to the long-term productive capacity of dairy cows and represent a key target for the development of gut microbiota-based interventions. The unique bacterial communities of the rumen and rectum of long-lived high-yielding dairy cows contribute to maintaining their productive capacity.

Investigating the Role of Early Nutritional Interventions in Shaping Long-Term Pediatric Health Outcomes: A Multidisciplinary Approach to Growth and Development

Background: Early childhood nutrition, particularly within the first 1,000 days of life, plays a pivotal role in determining lifelong growth, cognitive development, and disease risk, yet gaps remain in understanding the extent of long-term impacts of early nutritional interventions on pediatric health outcomes. Objective: This study aimed to investigate the role of early nutritional interventions, including exclusive breastfeeding, timely complementary feeding, and micronutrient supplementation, in shaping growth parameters, cognitive development, and morbidity patterns in children aged 5 to 10 years. Methods: A prospective observational study was conducted at Mother and Children Complex DHQ Sheikhupura, enrolling 105 children (n = 105) through non-probability purposive sampling between January 2024 and June 2024. Inclusion criteria encompassed children aged 5–10 years with documented early nutrition histories; children with congenital anomalies, preterm birth, or incomplete nutritional data were excluded. Data collection involved structured caregiver interviews, anthropometric measurements, and school academic records, with outcomes assessed using WHO growth charts and caregiver-reported developmental milestones. Ethical standards per the Declaration of Helsinki were observed, and informed consent was obtained. Statistical analyses were conducted using SPSS v26, employing chi-square tests, independent t-tests, and Pearson correlations, with significance set at p &lt; 0.05. Results: Children receiving optimal early nutrition exhibited significantly lower mean BMI (17.8 ± 2.1 kg/m² vs. 19.4 ± 2.6 kg/m², p = 0.01), higher height-for-age z-scores (0.45 ± 0.9 vs. −0.12 ± 1.1, p = 0.02), and better cognitive performance (85.7% vs. 64.3%, p = 0.004). Positive correlations were observed between breastfeeding duration and academic scores (r = 0.46, p &lt; 0.001), while formula use was associated with higher BMI (r = −0.29, p = 0.01). Clinically, optimal nutrition was linked to lower rates of anemia, infections, and obesity. Conclusion: Early nutritional interventions significantly influence long-term pediatric growth, cognitive outcomes, and morbidity profiles. These findings emphasize the clinical necessity of integrating nutritional counseling into maternal and child healthcare strategies to promote lifelong health and academic success.

Optimal amino acid system for early embryo development in sows based on response surface methodology and high-throughput screening cell models

BackgroundEarly embryo development plays a pivotal role in determining pregnancy outcomes, postnatal development, and lifelong health. Therefore, the strategic selection of functional nutrients to enhance embryo development is of paramount importance. In this study, we established a stable porcine trophectoderm cell line expressing dual fluorescent reporter genes driven by the CDX2 and TEAD4 gene promoter segments using lentiviral transfection.ResultsThree amino acid metabolites—kynurenic acid, taurine, and tryptamine—met the minimum z-score criteria of 2.0 for both luciferase and Renilla luciferase activities and were initially identified as potential metabolites for embryo development, with their beneficial effects validated by qPCR. Given that the identified metabolites are closely related to methionine, arginine, and tryptophan, we selected these three amino acids, using lysine as a standard, and employed response surface methodology combined with our high-throughput screening cell model to efficiently screen and optimize amino acid combination conducive to early embryo development. The optimized candidate amino acid system included lysine (1.87 mmol/L), methionine (0.82 mmol/L), tryptophan (0.23 mmol/L), and arginine (3 mmol/L), with the ratio of 1:0.43:0.12:1.60. In vitro experiments confirmed that this amino acid system enhances the expression of key genes involved in early embryonic development and improves in vitro embryo adhesion. Transcriptomic analysis of blastocysts suggested that candidate amino acid system enhances early embryo development by regulating early embryonic cell cycle and differentiation, as well as improving nutrient absorption. Furthermore, based on response surface methodology, 400 sows were used to verify this amino acid system, substituting arginine with the more cost-effective N-carbamoyl glutamate (NCG), a precursor of arginine. The optimal dietary amino acid requirement was predicted to be 0.71% lysine, 0.32% methionine, 0.22% tryptophan, and 0.10% NCG for sows during early gestation. The optimized amino acid system ratio of the feed, derived from the peripheral release of essential amino acids, was found to be 1:0.45:0.13, which is largely consistent with the results obtained from the cell model optimization. Subsequently, we furtherly verified that this optimal dietary amino acid system significantly increased total litter size, live litter size and litter weight in sows.ConclusionsIn summary, we successfully established a dual-fluorescent high-throughput screening cell model for the efficient identification of potential nutrients that would promote embryo development and implantation. This innovative approach overcomes the limitations of traditional amino acid nutrition studies in sows, providing a more effective model for enhancing reproductive outcomes.

The Impact of Probiotic Supplementation on the Development of the Infant Gut Microbiota: An Exploratory Follow-Up of a Randomised Controlled Trial.

Early-life establishment of the gut microbiota plays a role in lifelong health, with disruptions linked to heightened risks of metabolic and immune disorders. Probiotic supplementation may be used to modulate the infant gut microbiome to promote favourable development. Here, we evaluate how Lab4B probiotic supplementation shapes the development of the infant gut microbiome over the first 6 months. Faecal samples collected from infants enrolled in PROBAT (ISRCTN26287422), a randomised, double-blind, placebo-controlled trial, were analysed using culture-dependent and -independent (16S rDNA and metagenomic shotgun sequencing) techniques to examine the composition, diversity, and metabolic capabilities of the microbiome, as well as the abundance of antimicrobial resistance genes (ARGs). Probiotic supplementation encouraged the development of a microbiome with a distinct composition characterised by elevated abundances of Bifidobacteriaceae in the first 6 weeks (p = 0.006) and Lactobacillaceae throughout the first 6 months (p < 0.05 at every 6-week time point), accelerated microbial diversification, reduced abundance of beta-lactam- and cephalosporin-resistance genes, and differences in predicted metabolic capabilities at the start and end points. Supplementation of this neonatal population, which is at high risk of atopy, with the Lab4B probiotic significantly influenced the development of the infant gut microbiota during the first 6 months.

Understanding the determinants of malnutrition among adolescent girls in Pakistan: what needs to be done?

Adolescent girls are vulnerable and deserve the utmost attention to complement their nutrition. This scoping review endeavours to identify the determinants of malnutrition among adolescent girls in Pakistan and to comprehend the interventions to improve their health and nutritional status. This review of the literature was conducted using Google Scholar, PubMed/Medline, Scopus and Web of Science for articles published between 2015 and 2024. MeSH terms used for search were as follows: adolescent, youth, health, malnutrition, nutrition interventions, systems approach. In addition, reports from the WHO, the UN, the World Bank, the Government of Pakistan and other organisations were also critically reviewed. Moreover, this paper has used the Pathways framework, which advocates multi-sectoral approaches for poverty reduction. In most developing countries, the compromised nutritional status of adolescent girls, compounded by poverty, has life-long health and economic consequences, as well as their infants having nutritional deficits. They are expected to grow as stunted children. Abundant evidence has shown that nutrition-sensitive and nutrition-specific interventions can improve their nutritional status and that of subsequent generations. There is a dire need to involve key stakeholders from health, education, nutrition, population, women's development, social welfare and other relevant sectors. It is imperative to design interventions for adolescent girls in each country's context to break the intergenerational cycle of malnutrition and to improve economic productivity. Political commitment and effective governance along with policy coherence are required for their healthy transitions into adulthood.

Metabolic reprogramming of fetal hematopoietic stem and progenitor cells by maternal obesity

Maternal obesity, often linked to the consumption of a high-fat Western-style diet (WSD), poses significant risks to both maternal and fetal health. This review explores the impact of maternal obesity on fetal hematopoietic stem and progenitor cells (HSPCs), highlighting how metabolic and inflammatory shifts in the maternal environment affect HSPC proliferation, differentiation, and long-term immune system development. Maternal obesity leads to hormonal imbalances, increased inflammatory cytokines, placental insufficiency, and altered nutrient availability that disrupt normal HSPC function, potentially predisposing offspring to immune dysfunction, metabolic disorders, and cardiovascular diseases later in life. Notably, maternal obesity skews HSPC differentiation toward the myeloid lineage, which can impair adaptive immune responses and increase the risk of autoimmune diseases and infections. Furthermore, maternal diet-driven epigenetic and transcriptional reprogramming of fetal HSPCs exacerbates chronic inflammation, reinforcing a pro-inflammatory phenotype in downstream progeny that persists into postnatal stages. The review also emphasizes the need for further research to clarify the mechanisms underlying these effects across different species and developmental stages, as well as the potential for targeted interventions to mitigate the adverse impacts of maternal obesity on fetal hematopoiesis and lifelong health outcomes.

Association of adverse childhood experiences with physical illness and self-rated health in the population-based Tromsø Study.

Adverse childhood experiences (ACEs) are highly prevalent and associated with life-long health consequences. Here, we investigated the relationship of ACEs to adult-onset health outcomes in general population. We conducted a cross-sectional analysis using the seventh survey of the Tromsø Study, including 20 843 participants. Main exposure variables were exposure to at least one ACE, rumination related to adverse experiences, cumulative ACEs, and two clusters of ACEs, i.e. interpersonal and impersonal ACEs. Logistic and ordinal regression models were fitted to estimate the risk of adult-onset physical illness and poor self-rated health adjusted for birth year, sex, smoking, education, and income. We found that exposure to at least one ACE together with rumination was associated with increased risk of hypertension, heart failure, atrial fibrillation, diabetes, obesity, kidney disease, chronic obstructive pulmonary disease, asthma, rheumatoid arthritis, arthrosis, migraine, chronic pain, and poor self-rated health. We observed dose-effect relationships of cumulative ACEs to the aggregated risk of 14 among 16 health outcomes. While increased risk of heart failure, kidney disease, and rheumatoid arthritis was only linked to the interpersonal ACEs, increased risk of coronary artery disease was associated only with the impersonal ACEs. Our findings demonstrate that exposure to ACEs increases the risk of adult-onset physical illness and poor self-rated health in a dose-effect relationship, and rumination related to adverse experiences is associated with an aggravated risk. Inquiry into exposure to ACEs might inform about health risks. Early intervention approaches to promote positive experiences and increase resilience might alleviate life-long health burden.

Acceptability and cultural appropriateness of a parenting programme to reduce violence against adolescents in Tanzania delivered at scale: Implications for scale-up

ABSTRACT Although parenting programmes may be effective at reducing violence against children (VAC), there is a limited understanding on how acceptable and appropriate such programmes are among parents/caregivers (‘caregivers’) when delivered at scale. This paper explores the acceptability and cultural appropriateness of a parenting programme for caregivers and their adolescent girls, Parenting for Lifelong Health for Teens (PLH-Teens), which was delivered at scale in rural and semi-urban Tanzania. This paper employed a qualitative research design involving 18 focus group discussions (FGDs) with caregivers (N = 120) and adolescent girls (N = 60). Participants reported that the programme was acceptable, culturally appropriate, and beneficial. The use of participatory approaches and in-person group sessions was appealing to caregivers. However, several challenges hindered consistent engagement. These factors ranged from initial community mistrust about the programme, social norms on parenting, and group interactions to individual-level participant factors, stigma, and feeling of shame for being selected to join a programme. Overall, PLH-Teens programme was perceived as addressing the real parenting needs of caregivers and their adolescents. There is a need to address the challenges families experienced as these could hinder the acceptability, sustainability, and continued scale up of PLH-Teens in future programme delivery.

Mapping relationships among gross motor skills in 16,989 children using network analysis

The development of gross motor skills during childhood is crucial for shaping more complex movements and laying the groundwork for physical activity, and subsequently lifelong health and enhanced well-being. Performance in motor skills improves throughout development, with the greatest improvements occurring during childhood. Understanding the relationships between developing gross motor skills is essential for informing educational and intervention practices. A total of 16,989 children aged 3–11 years underwent assessment of gross motor skills. Using network analysis, gross motor skills networks were constructed for the entire sample, and stratified by age and sex. The accuracy and stability of the networks were assessed, and centrality and bridge statistics were estimated for each node. The results indicated that running and two-hand catching exhibited higher centrality and bridge statistics compared to the other nodes in the all-sample network. Additionally, it was observed that the strength between nodes decreased and their distance increased with age. These results highlight the importance of specific gross motor skills due to their significant role in relation to other skills within the network. Gross motor skills progress towards increased independence and specialisation during development, indicating the importance of early educational interventions where children could benefit from educational practices focused on catching and running.