Policy Interventions Research Articles

Determinants of health among Ukrainian refugees in Germany: comparison with other refugee groups

Abstract Background 6.5 million Ukrainian refugees have been displaced globally since 2022, with 1 million seeking asylum in Germany. Little is known about the health determinants for this group, limiting the evidence base for policy intervention. Methods We use a nationally representative survey of adult Ukrainian refugees in Germany (IAB-BiB/FReDA-BAMF-SOEP study; n = 5943), conducted in 2023, to analyse the effect of sociodemographic, pre-migration (experienced war intensity, traumatic experiences) and post-migration factors (time since arrival, accommodation, social networks) on self-rated health using multiple logistic regression. We contrast these findings with estimates of identical models obtained from a subset of the IAB-BAMF-SOEP-sample of non-Ukrainian refugees within one year of arrival (n = 1195). Results In the Ukrainian sample, post-migration factors are particularly critical for health, with those experiencing discrimination (OR 1.83; 95%CI: 1.51,2.21) and social isolation (OR: 2.70; 95%CI: 2.23, 3.28) affected by ill health, while those with high German proficiency (OR 0.34; 95%CI: 0.18, 0.64) and contact with Germans (OR: 0.66; 95%CI: 0.53,0.83) are protected. Pre-migration factors do not affect self-rated health. Among refugees from other countries of origin, post-migration factors are not associated with health within the first year of arrival, with exception of social isolation (OR: 2.03; 95%CI: 1.32,3.13). Discussion Despite the EU Temporary Protection Directive, the health of Ukrainian refugees in Germany is shaped by adverse post-migration circumstances. While other refugee groups may have had riskier escape journeys and worse arrival conditions, this is unrelated to self-rated health in the first year. This underscores the importance of considering pre-migration contexts when evaluating subjective health. Outreach services, communication campaigns and the expansion of medical interpreting services are needed to ensure access to the health system. Key messages • Despite the EU Temporary Protection Directive, the health of Ukrainian refugees in Germany is shaped by adverse post-migration circumstances. • Outreach services, communication campaigns and the expansion of medical interpreting services are needed to ensure access to the health system.

An international comparison of Long-term Care Facility outcomes during the COVID-19 pandemic

Abstract Background The COVID-19 pandemic has had huge repercussions for public health internationally and different countries had different outcomes based on preconceived policy interventions. Lessons influencing future policy have been learned, notably how best to manage vulnerable populations, particularly those living in long-term care facilities (LTCFs). In Ireland LTCF residents accounted for 56% of deaths during the first wave of the pandemic and it is imperative to establish the causes of this. International research has highlighted how factors including county incidence rate, facility size, occupancy, LTCF ownership and compliance with health inspection regulations influenced LTCF COVID-19 outcomes. The aim of this research is to explore the impact of these factors in an Irish context and compare to best international standards. Methods The main outcome considered was deaths per 100 beds. Data on crude mortality were available for 580 Irish LTCFs up to 28 May 2020. Data regarding occupancy, ownership, facility size and compliance with regulations were obtained for these LTCFs from a novel dataset of 1130 available LTCF regulatory inspection reports between 2018- 2022. Regression analysis was carried out to show how LTCF mortality was predicted by examined variables. Results The most significant predictor of deaths from COVID-19 in Irish LTCFs resulting from this research was LTCF occupancy (Odds ratio:1.029, significance <0.001). Regional community incidence, in concordance with international literature was also an important factor. Other stated predictors in this model were either non-significant or only marginally significant. These results are analysed in conversation with international research of the same variables. Conclusions To protect LTCF residents for potential future pandemics, attention should be paid to monitoring and suppressing local incidence rates and moves should be implemented towards designing smaller facilities with individual rooms for vulnerable residents. Key messages • Irish long-term care pandemic mortality was predicted by high occupancy of facilities and high regional COVID-19 incidence. • Comparing International COVID-19 outcomes in long-term care facilities can provide guidelines for the future.

Do changes in BMI during the COVID-19 pandemic persist in the post-pandemic period in a pediatric population attending health care clinics? A longitudinal study.

The long-term effect of the COVID-19 pandemic on body weight has not been sufficiently analyzed. This study aimed to analyze changes in body mass index (BMI) during and after the COVID-19 pandemic among a large pediatric population attending health care clinics. This retrospective longitudinal cohort study utilized electronic medical data of 106,871 children (52.1% males, median age 8.2 years at pre-pandemic assessment). Each child had at least one BMI measurement recorded pre-pandemic and two additional measurements: one during the pandemic and one post-pandemic. Obesity rates increased from 12.8% pre-pandemic to 15.4% during the pandemic, slightly decreasing to 15.0% post-pandemic. BMI-standard deviation scores (SDSs) increased during the pandemic, in both sexes, across all ages and all socioeconomic position (SEP) clusters, and in children with pre-pandemic underweight or normal weight (all P<0.001). Post-pandemic, BMI-SDS decreased but remained above pre-pandemic levels, particularly in younger children (aged 2-6 years) and those from low/medium SEP clusters (all P<0.001). BMI-SDS continued to increase in children aged 6.1-16 years, those of Arab ethnicity, and those in the high SEP cluster. The COVID-19 pandemic correlated with an overall increase in BMI-SDS, which decreased post-pandemic but remained above pre-pandemic levels. Effective policy interventions to prevent pediatric obesity are crucial.

7.P. Skills building seminar: Using health impact assessment for assessing tobacco control policies

Abstract Tobacco use is the largest contributor to premature death and preventable disease in Europe. Despite decreasing tobacco use in recent years, the European Commission estimates that the number of smokers in Europe is 26% in the population, and 29% among 15-24 year olds. This persistent public health risk is amenable to policy, but targeted and effective strategies are needed. Health impact assessment (HIA) methods can aid decision-makers in exploring the consequences of policy actions on select outcomes, providing a platform for informed, evidence-based policy design. Routine data collection on risk factors including smoking and tobacco use behaviour is common and available in Europe. Analysing and valorising these data can provide a better picture of vulnerable and target groups for which tobacco use is a persistent problem, or where the attributable disease burden is particularly high. These data can form the basis for robust projections and the application of HIA methods. In addition, a number of policy strategies exist for tobacco control including changes in packaging, taxation, labelling, ingredients, creation of smoke-free environments, and restrictions on advertising. These policies have a common goal in improving tobacco control, but may lead to differential effects across age groups, populations, and different measures of tobacco use. It is thus necessary to use robust tools to understand these effects and better coordinate and plan policy. HIA methods, each with their own strengths and limitations, have been applied successfully to estimate the impact of different tobacco control measures. Novel methodologies that make use of available data, computational power, and provide a low-cost way to explore policy interventions can be an essential tool to policy planning and in particular to tackle the intractable areas of tobacco control. This skills building workshop will present two key approaches, each with their own strengths and weaknesses, that have been applied in HIA studies on tobacco control - i.e., a static approach based on the calculation of potential impact fraction, and a dynamic approach based on microsimulation models. Furthermore, the workshop will demonstrate, using two real-life examples, how policy measures can be translated into effect size estimates - which is one of the most crucial steps in any HIA. By providing a step-by-step presentation of how HIA has been applied in practice, attendees will gain unique insights in the different ways by which HIA can be used to gain insights into the relative impact of policy strategies for tobacco control. Key messages • Tobacco use remains the largest contributor to preventable disease burden in Europe; a key area for analysing policies using health impact assessment. • Attendees will gain unique insights in the different ways by which HIA can be used to gain insights into the relative impact of policy strategies for tobacco control.

1.Q. Round table: Primary healthcare workforce crisis in Europe: global policy discourse and national implementation

Abstract Background Primary healthcare (PHC) has emerged as a powerful global concept, but little attention has been directed towards the pivotal role of the healthcare workforce and the diverse institutional setting in which they work. Recent WHO efforts have underscored the challenges in aligning the global PHC-oriented model with national health systems, highlighting the need for tailored approaches to fulfil diverse needs and contexts. Although significant progress has been made in advancing PHC, some gaps persist, particularly surrounding the integration of PHC and healthcare workforce debates and its prioritisation within national health agendas. These gaps lead to disconnects between PHC policy implementation and workforce considerations, exasperating the existing workforce crisis and obstructing effective service delivery. Objectives This workshop bridges the gap between PHC workforce policy and the ongoing healthcare workforce crisis, focusing on the European region and different types of health systems, socio-economic conditions, health labour markets and workforce compositions. We apply a health system and multi-level governance approach, arguing the need for greater attention to the implementation of global policy concepts and the diverse national and regional conditions, interests, and needs. The workshop begins with an overview of the PHC workforce situation, presenting novel results drawn from European comparative research and nine selected country case studies, followed by a panel discussion. The panellists provide in-depth evidence on various PHC workforce challenges and introduce illustrative examples of policy interventions and good-practice models coming from the case countries. Insights from the WHO Centre for Primary Health Care advance the debate by highlighting strategies and capacity for transformative PHC workforce policies, and the need for further investigation to critically align global and national approaches. The policy recommendations emerging from the panel will be critically reflected in a plenary discussion. The workshop will stimulate debate and improve knowledge exchange across countries, in particular in the WHO European region, as well as between research, policy and practice. It will strengthen both the PHC model and the healthcare workforce, and finally advance the building of resilient health systems. Key messages • Shift the primary healthcare debate from idealistic attributes to actionable implementation strategies, emphasising policy dynamics, political contexts, and diverse stakeholder interests. • Understand the various PHC-oriented models and their dynamics to determine the necessary quantity, competencies, and composition of HCWs and how they can be governed effectively to implement PHC.

Impact Evaluation Adoption Towards Coastal Communities with Ongoing East Coast Rail Link (ECRL) in Terengganu

Objective: This article focuses on ongoing ECRL development challenges in Terengganu, Malaysia, by adapting the All-Party Parliamentary Group Malaysia on Sustainable Development Goals (APPGM-SDG) impact evaluation framework, which can serve as a tool for policy intervention in reducing inequality and promoting partnership. Theoretical Framework: The role of the state theory, as applied to explain the initiative launched through state coordination, requires a multistakeholder approach or structuration process in order to assess the impact on the beneficiary's sustainability. Method: The methodology adopted for this research has included in-depth interviews, observations, and site-visit approaches with local people and authoritative informants, and is heavily supported by desk research. Results and Discussion: The result shows that local coastal communities of several towns in Setiu, Terengganu, are positively accepting of this ECRL development. Nevertheless, collaboration and further information are also needed to make themselves compatible with socioeconomic changes. Research Implications: The critical APPGM-SDG mechanism, based on its success story in terms prior impact evaluation, should be embraced in assessing ongoing ECRL and its development through government-to-government partnerships. Originality/Value: This study led to the three imperatives recommendations on the academic context of the development corpus, advocacy, and policy moral deliverables.

Parental concerns about the risks associated with harmful industries for their children

Abstract Background Harmful industries including tobacco, vaping, alcohol, and gambling are causing significant harms to communities, including children and young people. These industries try to resist reform by deflecting blame and shifting responsibility, often by suggesting that parents need to educate and protect their children. This study aimed to explore parents’ current concerns and risks relating to these industries and their children, and their attitudes about responses to prevent harm. Methods Australian parents (n = 455) who had at least one child aged between 11-17 years were invited through a panel company to complete an online qualitative survey. Participants were asked about their concerns and risks relating to each product, if and what they discuss about these products with their children, and who was responsible for protecting children from these industries. Thematic analysis was used to analyse the data. Results Parents were concerned about the short- and long-term consequences of their children engaging in these products. Many parents tried to talk to their children about the risks, however also believed that their child was influenced by their peers, and messages they see on social media. Although parents recognised their own role in protecting their children from harmful industries, they thought that a collective approach was needed, which included greater regulations and more effective education. Conclusions Parents are trying their best to protect their children from the harms associated with tobacco, vaping, alcohol, and gambling. However, they feel as though they are unable to counter the range of ways that their children are exposed to and influenced by these industries. Governments need to listen to parents and implement comprehensive regulations restricting marketing practices and increase evidence-based education that focuses on the tactics and harmful practices of these industries. Key messages • Harmful industries try to shift blame and put responsibility for protecting children onto parents. However, parents feel they are unable to counter the positive messages that their children see. • Parents are concerned about the range of risks these products could have for their children and want to see a collective response to address this issue, including government policy intervention.

Impact of Virtual Learning on Student Performance and Engagement in Remote Hilly Areas of Uttarakhand

The rapid shift to virtual learning during the COVID-19 pandemic brought significant changes to the education system, especially in geographically challenging regions like the remote hilly areas of Uttarakhand, India. This study explores how these shifts affected high school students' academic performance and engagement in virtual classrooms, given the unique challenges posed by limited infrastructure and connectivity. This study investigates the impact of virtual learning on student performance and engagement in the remote hilly areas of Uttarakhand, India. With the sudden shift to virtual education during the COVID-19 pandemic, schools in these regions faced unique challenges due to their geographic isolation, lack of internet access, and frequent power outages. The study aims to assess how these conditions have influenced the effectiveness of virtual learning and its impact on students' academic outcomes and engagement levels. A total of 51 high school students from 05 government schools in remote areas of Uttarakhand participated in this research. Data was collected through structured questionnaires, focusing on students’ experiences with virtual learning, their academic performance before and after the shift, and their engagement with online classes. The study used both quantitative and qualitative methods, including descriptive statistics, logistic regression, and MANOVA, to analyze the data. Findings indicate that while virtual learning provided an essential educational lifeline during the pandemic, students in remote areas encountered significant barriers that hindered their learning experiences. Limited internet access and frequent electricity cuts were among the primary obstacles reported. Despite these challenges, a majority of students found virtual classrooms useful for maintaining continuity in their education. The study also reveals that virtual learning positively influenced student engagement, particularly in subjects that incorporated interactive content. However, the overall academic performance showed mixed results, with some students struggling due to the absence of traditional classroom interaction and practical learning opportunities. This research highlights the need for improved infrastructure and policy interventions to support virtual education in remote regions. It concludes that while virtual learning has potential, addressing technological and logistical barriers is crucial for ensuring equitable and effective learning experiences for all students in such areas.

Regional Workforce Dynamics in West Virginia: Insights from Shift-Share and Location Quotient Analysis

West Virginia, home to approximately 1.77 million residents, has been grappling with significant economic challenges characterized by persistent poverty and sluggish growth. Despite ongoing development efforts, the state’s Gross State Product (GSP) has seen only a modest increase of 0.1% over the past five years, reaching USD 71.7 billion, while the unemployment rate remains at 4.0%. The annualized employment growth rate of 0.7% lags behind the national average, and only about 54% of West Virginia’s adult population is either employed or actively seeking employment, resulting in one of the lowest labor force participation rates in the nation. In contrast, certain industrial sectors, such as healthcare, social assistance, retail trade, and accommodation and food services, have shown intermittent growth at the county and regional levels. To explore the unique characteristics and significance of these regions in relation to employment growth, this study examines regional employment patterns in West Virginia from 2001 to 2020, focusing on the main regions of the state: Metro Valley, Mid-Ohio Valley, New River/Greenbrier Valley, Mountain Lakes, and Potomac Highlands. Utilizing shift-share and location quotient (LQ) analyses, this research identifies the sectors driving regional employment and assesses their performance. Key findings reveal strong sectoral performance in mining, manufacturing, and finance in the Mid-Ohio Valley; wholesale trade, transportation, and utilities in the Metro Valley; agriculture and administrative services in the New River/Greenbrier Valley; agriculture and manufacturing in the Potomac Highlands; and scientific services, healthcare, and utilities in the Mountain Lakes region. Based on these insights, this study recommends targeted policy interventions to address regional disparities, enhance sectors with significant short- and long-term benefits, and foster balanced economic development across the state.

Calculating potential impact fractions to assess the impact of tobacco control policies

Abstract This presentation will provide a straightforward and accessible method for evaluating the effectiveness of various tobacco control policies in reducing the smoking-associated disease burden. To estimate numbers and proportions of potentially avoidable disease cases under different policy intervention scenarios (such as cigarette tax/price increases, comprehensive marketing ban, and plain packaging), this approach entails the calculation of age- and sex-specific potential impact fractions, representing the percentage change in disease risk following changes in exposure to smoking. The approach can account for lag and latency periods between reductions in smoking prevalence and declines in disease excess risks. The future disease burden is estimated by combining data on the incidence or mortality of the disease of interest, published effect sizes of tobacco control policies, and national smoking prevalence data. Intervention scenarios are compared against a status quo scenario that assumes the continuation of recent smoking trends. The presentation will outline the approach, using the example of smoking-associated cancer, and discuss model assumptions, required data, and sensitivity analyses. This straightforward modelling framework enables the comparison of different health policy measures’ impacts, providing valuable insights for policymakers and public health officials regarding the potential public health impact of tobacco control policy measures.

Diabetes mellitus EU comorbidity index: using data from EHIS 2019 and GBD disability weights

Abstract Background Individuals with diabetes mellitus (DM) exhibit several of comorbidity burdens, with lower perceived quality of life also being a factor. Literature on the impact of DM is available, including studies on the index devised by (A. Andreella et al., 2023) for the assessment of comorbidities of health conditions. This study aims to adapt and validate this index for use as a standardized DM comorbidity index within the EU. Methods A cross-sectional study was carried out using microdata from the European Health Interview Survey (EHIS) 2019. The study included adults aged 25 years or older who reported having DM (n = 20,042) from 27 EU member states. Comorbidity index was calculated to assess the comorbidity of having 9 non-communicable diseases using disability weights obtained from the Global Burden of Disease 2019 and self-perceived general health using multiplicative approach. Beta regression analysis was used to evaluate the association between comorbidity index and several demographic, socioeconomic and lifestyle variables. Comorbidity index was calculated for each nomenclature of territorial units for statistics (NUTS 2). Results The comorbidity index ranged from 0.049 to 0.993. The results indicated that having a higher education and residing in urban areas were less likely to have a high comorbidity index. Being unemployed or in other employment statuses demonstrated a significant, positive association with the index. Income exhibited a gradual, positive association with each quintile, while consuming fruits and vegetables less than once a week was found to be associated with an increased index. The highest comorbidity index was observed in Calabria (Italy), followed by Lubuskie (Poland), and the lowest was observed in Antwerp (Belgium), followed by Övre Norrland (Sweden). Conclusions By identifying comorbidity burden, targeted interventions and regional-specific strategies can be implemented to improve the quality of life for individuals with DM. Key messages • Quantifying the burden of comorbidities allows understanding of health status of DM patients. • Comorbidity index shows geographic variation in the EU which contributes to tailored policy interventions.

Patterns of alcohol use in Belgium, 2013-2020

Abstract Despite numerous efforts worldwide to reduce the harmful effects of alcohol, its impact on health remains significant, contributing significantly to the loss of healthy life years. In Belgium, alcohol use is still a major public health concern, ranking among the highest in alcohol consumption across Europe. This study aims to use available nationally representative data to estimate and evaluate the time trends of alcohol use patterns in Belgium from 2013 to 2018. We used repeated cross-sectional survey data from the Belgian Health Interview Survey (BHIS), which includes self-reported alcohol use and sociodemographic data, to create a time series of annual consumption from 2013 to 2018. This included current and former drinkers, and lifetime abstainers by year, sex, region, and age groups. We applied a Bayesian hierarchical model, using the Integrated Nested Laplace Approximation to create the time series and forecast trends for 2020. In Belgium, the prevalence of current drinking remained at a similar level of 80% from 2013 to 2020, with similar rates observed in the Flemish (FL) and Walloon (WA) regions. However, the Brussels-Capital region (BR) had a slightly lower prevalence of 70%. Trends remained relatively stable across all regions during this period. The national level of former drinkers increased from 5% in 2013 to 8% in 2020, with BR and FL showing similar increases, while WA experienced a decline. Abstainer rates rose from 15% in 2013 to 19% in 2020 nationally, with varying increases in each region. Specifically, abstainer rates in FL increased from 13% to 17% and in WA from 14% to 20%, while BR saw an increase from 19% to 22%. Overall, declining trends were evident, with men exhibiting higher prevalence rates across all categories. Time trends from the BHIS reveal consistent and high use of alcohol in Belgium over 7 years, emphasizing the ongoing public health challenge. Urgent policy interventions are needed to reduce the impact of alcohol on health Key messages • Alcohol use in Belgium is still a pressing public health issue, with high prevalence rates of current drinking in the population. Different patterns of alcohol use can be seen between regions. • Understanding the role of alcohol on population health as an attributable burden can improve health monitoring.

Ultra-processed food consumption and risk of coronary heart diseases: UK Whitehall II cohort study

Abstract In recent decades, ultra-processed foods (UPFs) intake has increased drastically, sparking concerns about their potential impact on cardiometabolic diseases. However, large-scale cohort studies tracking UPF consumption at multiple time points remain limited. This study explores the prospective association between repeated measures of UPF intake and the risk of coronary heart disease (CHD), along with its secondary endpoints, within the UK Whitehall II study. The analytical sample tracked 7,138 midlife British participants without CHD from baseline. UPF consumption was measured using validated food frequency questionnaire (127 items) and classified by the NOVA system during three phases: 1991/1994 (phase 3), 1997/1999 (phase 5), and 2002/2003 (phase 7). This study assessed the onset of CHD and its secondary endpoints, including CHD and all-cause mortality, through medical exams and hospital records up to 2016 and 2021, respectively. Cox proportional hazards regression models adjusted for socio-demographics, lifestyle factors and total energy intake were used to explore the prospective association between cumulative average UPF intake (in quintiles) and CHD outcomes. During a median follow-up of 13 and 19 years, 589 cases and 1,314 deaths were documented. In multivariable adjusted cox models, the highest UPF consumption quintile versus the lowest quintile was associated with higher CHD incidence [HR:1.26; 95% Confidence Interval (CI): 1.02-1.55; p = 0.03]. Additional adjustment of total energy intake increased the CHD risk by 28% [HR:1.28; 95% CI: 1.03-1.58; p = 0.02]. No significant relationships were found between cumulative average UPF intake and CHD or all-cause mortality. In UK midlife adults, higher UPF intake is prospective associated with increased CHD risk. Although additional research is warranted, these findings emphasize the importance of public awareness and food policy interventions to reduce UPF intake for alleviating the population burden of CVD. Key messages • Our study suggests the need for increased efforts to implement population wide strategies on regulating food processing, such as taxation and front of package warning labelling of UPF. • Our study emphasizes UPF’s role in cardiovascular prevention, highlighting the need for nutrition counseling on UPF consumption for those at risk of CVD.

Enhancing Labor Market Participation of Older Adults: Health and Workplace Adaptations

Abstract Background The labor market dynamics for older adults have significantly shifted due to extended life expectancy and evolving socioeconomic conditions. This study examines the prerequisites for older adults to remain longer in the labor market across various European countries, emphasizing the interplay between health status, workplace adaptations, and economic factors. Methods This cross-sectional study analyzed data from several European surveys focusing on older workers. The methodology included logistic regression to evaluate the impact of health status and workplace adaptations on continued employment among older adults. Data were further stratified by country to assess regional differences in employment patterns for this demographic. Results Preliminary results indicate that older adults with access to workplace adaptations-such as flexible working hours and ergonomic interventions-show a significantly higher likelihood of remaining in the labor market (OR = 2.3, 95% CI 1.8-2.9). Additionally, those reporting good to excellent health were 1.5 times more likely to continue working compared to their peers with poor health outcomes. The results also highlight substantial regional variability, with Scandinavian countries showing higher employment rates among older adults compared to Southern European regions. Conclusions The data strongly support the need for policy interventions that promote health maintenance among older workers and encourage employers to implement adaptive measures. Such strategies are likely to enhance the labor market participation of older adults, contributing to economic stability and reducing the potential strain on social security systems. Innovative public health policies aimed at supporting aging workers are crucial for sustaining workforce productivity in the face of demographic shifts. NordForsk supports the study Sustainable working-life for aging populations in the Nordic-Baltic region, Project No.: 139986. Key messages • Workplace adaptations and good health significantly extend working life among older adults. • Regional differences in employment for older workers highlight the need for tailored public health policies.

The power of artificial intelligence for managing pandemics: A primer for public health professionals.

Artificial intelligence (AI) applications are complex and rapidly evolving, and thus often poorly understood, but have potentially profound implications for public health. We offer a primer for public health professionals that explains some of the key concepts involved and examines how these applications might be used in the response to a future pandemic. They include early outbreak detection, predictive modelling, healthcare management, risk communication, and health surveillance. Artificial intelligence applications, especially predictive algorithms, have the ability to anticipate outbreaks by integrating diverse datasets such as social media, meteorological data, and mobile phone movement data. Artificial intelligence-powered tools can also optimise healthcare delivery by managing the allocation of resources and reducing healthcare workers' exposure to risks. In resource distribution, they can anticipate demand and optimise logistics, while AI-driven robots can minimise physical contact in healthcare settings. Artificial intelligence also shows promise in supporting public health decision-making by simulating the social and economic impacts of different policy interventions. These simulations help policymakers evaluate complex scenarios such as lockdowns and resource allocation. Additionally, it can enhance public health messaging, with AI-generated health communications shown to be more effective than human-generated messages in some cases. However, there are risks, such as privacy concerns, biases in models, and the potential for 'false confirmations', where AI reinforces incorrect decisions. Despite these challenges, we argue that AI will become increasingly important in public health crises, but only if integrated thoughtfully into existing systems and processes.

Why aren't we teaching this? Smart local energy systems and the young person's perspective

AbstractWith the UK government's target of Net Zero by 2050, alongside the rising cost of energy in the UK, it is imperative that public opinion aligns with and promotes affordable, greener energy systems. Within this dialogue, young people's voices and lived experience are needed to deepen the impact of energy policy intervention strategies. This article stresses the importance of a formal curriculum that informs future generations on the subjects of Smart Local Energy Systems (SLES), and the digitalisation advances of energy systems. This paper explores the development of a toolkit to educate and engage young people in these subjects and reviews young people's attitudes and understanding from three schools in England, UK. We find through an interpretive qualitative analysis of both images drawn by the young people, and insights gathered from focus groups, that (i) for these young people, SLES are a useful innovation regarding energy management and distribution, (ii) young people recognise that the education system as it currently stands is not aware of, or informed by smart energy technologies and (iii) that despite being a generation that is the most integrated with personal assistance technology, these young people have significant concerns over the reliability and safety of AI in SLES. These findings are set alongside calls for widespread education in key stages 4 and 5 (ages 14–18) around the subject of SLES, and their benefits to wider society, thereby enabling a future that empowers young people to make change, encourage engineering and computer science‐based career options and secure a fairer, cleaner, sustainable energy transition in the future.

Understanding the Decision to Purchase Health Insurance Among Academicians

This study investigates various factors influencing the decision of academicians in Malaysia to purchase health insurance. Health insurance is a policy that gives coverage for medical expenses and hospitalization. In Malaysia, health policy is commonly known as medical policy and the term medical card is broadly used to represent health policy and the benefits available under the policy. Through qualitative interviews with six faculty members, the research uncovers the complexities of the decision-making process. The findings reveal that personal experiences, cultural values, social influences, and financial considerations significantly shape these decisions. However, the study's small sample size and regional specificity limit the generalizability of the results. Future research should address these limitations by incorporating a larger and more diverse sample to enhance the external validity of the findings. Such an approach would provide a more comprehensive understanding of the factors influencing health insurance decisions and inform policy interventions aimed at improving healthcare accessibility and affordability.

Rethinking stimulus-organism-response theory for residents’ behaviour in tourism

ABSTRACT This paper critically examines the application of the Stimulus-Organism-Response (S-O-R) theory in tourism research, addressing essential critiques and proposing avenues for theoretical refinement. The current study synthesizes existing literature to explore residents’ behaviour in tourism contexts. This work seeks to determine how residents’ place attachment influences their emotional connection with tourists (measured by the New Emotional Solidarity Scale abbreviated as NESS) and how NESS impacts their facilitations (active and passive), ultimately predicts support for tourism development through using S-O-R. The research involved 450 residents of Sivas, Turkey, and was conducted using random sampling. Notably, nine out of the ten proposed hypotheses were supported. Results indicated that place dependence and place identity were linked to NESS factors (communality and fairness), except for the insignificant relationship between place dependence and communality. Furthermore, NESS factors significantly determined facilitation factors that were ultimately significant predictors of support for tourism. This work contributes to the theoretical synthesis and practical insights for destination management and policy interventions in tourism. It also advances the understanding of residents’ behaviour and informs evidence-based decision-making in the tourism industry.

Wellbeing at the Edges of Ownership: The Impacts of Housing Tenure, Social Capital, and Institutions

This paper presents a three-country analysis of the relationship between housing, indicators of social capital, and life satisfaction (a proxy for wellbeing) using cross-sectional data from national surveys in Australia, the UK and the US. Addressing a key policy debate we construct, for each jurisdiction, models of life satisfaction as a function of housing and social capital, with a view to better targeting policy interventions to achieve wellbeing outcomes. First, we show that the wellbeing premium associated with homeownership remains resilient despite housing market instability early in the 21st century. Second, we find that while social capital is an important independent positive influence on life satisfaction, its effect is weaker than that of housing tenure. Third, we include two measures of housing risk (repayment risk and investment risk). These position mortgagors on a continuum across the edges of owner-occupation, placing them closer to, or further from, the ‘ideal’ of outright ownership. The impact of these measures varies across the three countries, raising questions about the way life satisfaction at the edges of ownership may be shaped by institutional forces.

Higher socioeconomic status is associated with higher ultra-processed food intake: a cross-sectional analysis

Objective: To explore the differences in ultra-processed food (UPF) consumption across different socioeconomic status (SES) levels. Methods: Data on UPF consumption (grams/day) were derived from the 2017–2018 National Health and Nutrition Examination Survey. The analysis controlled for age, marital status, race, and sex. A restricted cubic spline (RCS) model was applied to examine the nonlinear response curve. Results: UPF consumption increased with higher poverty income ratio (PIR), the ratio of household income to the established poverty line. Compared to the low PIR group, the medium group showed a non-significant increase (β = 34.23[95%CI: −28.81, 97.28], p = 0.287), while the high group exhibited a significant increase (β = 115.15[95%CI: 43.53, 186.76], p = 0.002). A linear positive correlation was observed in RCS analysis (p-nonlinear = 0.166, p-overall < 0.001). Conclusions: The study highlights that higher SES is associated with greater consumption of UPF in the US. The findings suggest that policy interventions should take SES into consideration.