Public Health Goals Research Articles

Descriptive norms about condom use predict odds of using a condom during last sexual experience in a large, national survey of adolescents from Australia.

Reducing sexually transmitted infections among adolescents is an important public health goal in Australia and worldwide. This study estimated the association between condom use during last heterosexual sexual experience with two descriptive norms among a large, national sample of secondary school students from Australia. A large, national online survey of 14- to 18-year-olds in Australia was conducted in 2018; a sub-analysis of sexually active participants (n =2989) used multivariable logistic regression to estimate the relationships between condom use during last sexual experience and condom use norms. The analysis controlled for the effects of age, sex, sexual orientation, religious affiliation, remoteness and knowledge of sexually transmitted diseases. Overall, 1673 (56.0% [95% confidence interval: 54.2%, 57.8%]) sexually active respondents reported using condoms during their last sexual experience. Perceiving that all same-age peers used condoms conferred higher odds of using condoms during their last heterosexual sexual experience (adjusted odds ratio: 3.06 [95% CI: 1.6, 6.0]). Perceptions about whether the suggestion to initiate condom use came from boys, girls, or both boys and girls was not associated with condom use. Differences in condom use related to socio-demographic characteristics are reported. As part of a holistic approach to sexuality education, health educators and service providers may emphasise that young people frequently choose to use condoms.

Налогообложение и регулирование табачной и инновационной никотинсодержащей продукции в России: новые проблемы и решения

Introduction: despite the progress in smoking reduction achieved over the past 10 years Russia is still among the leaders of the global anti-rating. the progress in reducing smoking achieved over the past 10 years Russia is still among the leaders of the global anti-rating. The effectiveness of the excise policy as the main instrument begins to decline from the illicit trade, which is expanding due to the inconsistency of the tax policy in the Eurasian Economic Union (EEU) countries. At the same time, the innovative nicotine delivery system market has been expanding, regulation of which is characterized by serious gaps. Objectives: to identify opportunities for improving regulation of traditional tobacco and innovative nicotinecontaining products markets to increase the collection of excises and achieve public health goals. Methods: comparative analysis, retrospective and counterfactual analysis, econometric estimations. Results: for the first time, econometric estimates for the Russian market were obtained on the aggregate regional (panel) data based on the simultaneous equations model using specially generated database “Addictive products in Russian regions”. The estimates show that, ceteris paribus, an increase of 1 p.p. the distance adjusted excise tax difference to the living cost ratio (DATDLC) leads to a reduction in the legal market by an average of 0.16 %. Price elasticity estimate of the legal aggregate demand is (-0.7), income elasticity is 0,8 and price elasticity of supply is 1,5. The analysis of budgetary and market statistics showed a low collection efficiency of excise taxes on ENDS; the problem of fiscal forestalling in this segment has been discovered. Conclusions: the results of the analysis allowed to propose several effective and feasible measures including the creation of an IT-system within the EEU for the exchange of information on excisable goods, the transfer of part of excise revenue to regional budgets, controlled legalization of nicotine pouches, anti-forestalling regulation in ENDS, etc.

Epidemic Surveillance of Influenza Infections: A Network-Free Strategy - Hong Kong Special Administrative Region, China, 2008-2011.

The ease of coronavirus disease 2019 (COVID-19) non-pharmacological interventions and the increased susceptibility during the past COVID-19 pandemic could be a precursor for the resurgence of influenza, potentially leading to a severe outbreak in the winter of 2022 and future seasons. The recent increased availability of data on Electronic Health Records (EHR) in public health systems, offers new opportunities to monitor individuals to mitigate outbreaks. We introduced a new methodology to rank individuals for surveillance in temporal networks, which was more practical than the static networks. By targeting previously infected nodes, this method used readily available EHR data instead of the contact-network structure. We validated this method qualitatively in a real-world cohort study and evaluated our approach quantitatively by comparing it to other surveillance methods on three temporal and empirical networks. We found that, despite not explicitly exploiting the contacts' network structure, it remained the best or close to the best strategy. We related the performance of the method to the public health goals, the reproduction number of the disease, and the underlying temporal-network structure (e.g., burstiness). The proposed strategy of using historical records for sentinel surveillance selection can be taken as a practical and robust alternative without the knowledge of individual contact behaviors for public health policymakers.

The Proportion and Type of Carbohydrates in the Diets of Children in Early Adolescence.

Background:Carbohydrates are mainly substrates for energy metabolism and can affect satiety, blood glucose levels, insulin secretion, and fat metabolism. Their amount and type in the diet affect metabolic responses. High-carbohydrate diets, particularly high sugar consumption, are considered particularly harmful because of their specific characteristics related to postprandial metabolism, effects on hunger and satiety, and thus on caloric intake and energy balance. The European Food Safety Authority has suggested that the reference intake for carbohydrates should be between 45 and 60% of total energy requirements and less than 10% should be added sugars, especially for children.Objective:Investigate the proportion and type of carbohydrates in the diets of children in early adolescence in two territorially distinct areas, the continental and the Mediterranean.Methods:The study was conducted as part of a longitudinal cohort study. The survey was conducted in elementary schools in two regions: continental and Mediterranean. The School Physical Activity and Nutrition Survey was used for research purposes. Descriptive and inferential statistical tests were applied for data analysis.Results:A total of 1,411 respondents of both sexes aged 12-15 years, 729 boys and 678 girls, participated in the study. The intake of carbohydrates in the total sample is represented in the daily intake of 59%. The proportion of natural sugar in the diet of boys is statistically significantly higher in the continental compared to the Mediterranean region at the age of 12-13 years (p = 0.002), 13-14 years (p = 0.049), and 14-15 years (p = 0.002). Added sugars in total carbohydrate intake are statistically significantly higher in girls in the Mediterranean region compared to the continental region at ages 12-13 years (p = 0.048), 13-14 years (p = 0.001), and 14-15 years (p = 0.001).Conclusion:The high intake of added sugars in children in the Mediterranean region is of concern, although the intake in the continental area is well above current recommendations. Therefore, one of the public health goals is to promote proper nutrition as well as the availability of healthy foods in schools, especially during early adolescence when proper eating habits are adopted.

Sustainable eating behavior

With the growing impact of agriculture and modern food processing on the natural environment and growing concerns about all aspects of their sustainability, urgent solutions are required to promote healthy, low-impact diets. Sustainable diets are those with low environmental impact and high availability that ensure food and nutritional security. A comprehensive overview of different approaches to the analysis of sustainable eating behavior is provided. It is argued that preserving the environment is critical, including in designing programs to improve health, address inequalities in affordability, food access and availability in food system models. However, dietary advice and food policy should not be based solely on the environmental aspect of sustainability and should be carefully formulated. Economy, culture and other sociological factors should be taken into account in appropriate policies when planning ways to provide adequate nutrition to the population. It is emphasized that building sustainable food systems that support healthy communities requires a multidimensional, interdisciplinary approach. A sustainable healthy diet is based on improving the energy balance and changing the diet towards a predominantly plant-based diet, which is in line with the data on healthy eating. Updating national guidelines to reflect the latest data on healthy diets may in itself be important for improving health and reducing environmental impact, and may not only clearly define but expand the criteria for sustainability. Key principles of environmental sustainability and well-being are applied in shaping a national sustainable food strategy and are directly related to food production and consumption. To implement an integrated health and environment modeling framework, it is necessary to take different approaches to sustainable nutrition, motivating environmental, food security and public health goals. To develop a methodology for assessing indicators of sustainable nutrition, it is important to simultaneously take into account all aspects: nutritional value of products, indicators of environmental impact, availability of products, climatic, geographic and national characteristics. This methodology will allow to make competent decisions in the field of food production and consumption, will help to minimize the negative impact on the natural environment through sustainable eating behavior.

Patterns of SARS-CoV-2 Testing Preferences in a National Cohort in the United States: Latent Class Analysis of a Discrete Choice Experiment.

BackgroundInadequate screening and diagnostic testing in the United States throughout the first several months of the COVID-19 pandemic led to undetected cases transmitting disease in the community and an underestimation of cases. Though testing supply has increased, maintaining testing uptake remains a public health priority in the efforts to control community transmission considering the availability of vaccinations and threats from variants.ObjectiveThis study aimed to identify patterns of preferences for SARS-CoV-2 screening and diagnostic testing prior to widespread vaccine availability and uptake.MethodsWe conducted a discrete choice experiment (DCE) among participants in the national, prospective CHASING COVID (Communities, Households, and SARS-CoV-2 Epidemiology) Cohort Study from July 30 to September 8, 2020. The DCE elicited preferences for SARS-CoV-2 test type, specimen type, testing venue, and result turnaround time. We used latent class multinomial logit to identify distinct patterns of preferences related to testing as measured by attribute-level part-worth utilities and conducted a simulation based on the utility estimates to predict testing uptake if additional testing scenarios were offered.ResultsOf the 5098 invited cohort participants, 4793 (94.0%) completed the DCE. Five distinct patterns of SARS-CoV-2 testing emerged. Noninvasive home testers (n=920, 19.2% of participants) were most influenced by specimen type and favored less invasive specimen collection methods, with saliva being most preferred; this group was the least likely to opt out of testing. Fast-track testers (n=1235, 25.8%) were most influenced by result turnaround time and favored immediate and same-day turnaround time. Among dual testers (n=889, 18.5%), test type was the most important attribute, and preference was given to both antibody and viral tests. Noninvasive dual testers (n=1578, 32.9%) were most strongly influenced by specimen type and test type, preferring saliva and cheek swab specimens and both antibody and viral tests. Among hesitant home testers (n=171, 3.6%), the venue was the most important attribute; notably, this group was the most likely to opt out of testing. In addition to variability in preferences for testing features, heterogeneity was observed in the distribution of certain demographic characteristics (age, race/ethnicity, education, and employment), history of SARS-CoV-2 testing, COVID-19 diagnosis, and concern about the pandemic. Simulation models predicted that testing uptake would increase from 81.6% (with a status quo scenario of polymerase chain reaction by nasal swab in a provider’s office and a turnaround time of several days) to 98.1% by offering additional scenarios using less invasive specimens, both viral and antibody tests from a single specimen, faster turnaround time, and at-home testing.ConclusionsWe identified substantial differences in preferences for SARS-CoV-2 testing and found that offering additional testing options would likely increase testing uptake in line with public health goals. Additional studies may be warranted to understand if preferences for testing have changed since the availability and widespread uptake of vaccines.

Science versus myths: the case of COVID-19 vaccine hesitancy

The coronavirus disease 2019 (COVID-19), caused by a new strain of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-COV-2) was first reported to the World Health Organization (WHO) from the first case in Wuhan, China on December 31, 2019. The WHO declared the disease a pandemic on March 10, 2020 due to the fast pace of its progression throughout the world. Given the high number of deaths and severe socio-economic consequences associated with the disease, and because of the limited uptake of public health measures designed to prevent the spread of the virus, it became evident that only the discovery of a vaccine would help prevent the community spread of the virus. In May 2020, the 73rd World Health Assembly issued a resolution recognizing the role of extensive immunization as a global public-health goal for preventing the transmission of SARS-COV-2 (WHO, 2020). Consequently, several scientific groups in various parts of the world began to work on developing vaccines against the virus. The first vaccines were introduced in September 2020, and since then the WHO has approved seven vaccines for use against COVID-19. These include 1) Biotech BBV152 COVAXIN vaccine, 2) Sinova-coronavac COVID-19 vaccine, 3) Pfizer BioNTech (BN T162 b2) COVID-19 vaccine, 4) Sinopharm COVID-19 vaccine, 5) Janssen Ad26.cov2.S COVID-19 vaccine, 6) the Oxford/AstraZeneca COVID-19 vaccine, and 7) the Moderna COVID-19 (mRNA-1273) vaccine.

A Progressive Nutrient Profiling System to Guide Improvements in Nutrient Density of Foods and Beverages.

Improving the nutrient density of processed foods is one way to bring the global food supply closer to the WHO Sustainable Development Goals. Nutrient profiling (NP) has emerged as the preferred method of monitoring the progress toward product innovation and reformulation. This paper presents PepsiCo Nutrition Criteria (PNC), a new internal NP model that was designed to guide and monitor improvements in nutrient density and overall nutritional quality of foods and beverages. The new PNC NP model assigns food products into four classes of increasing nutritional value, based on the content of nutrients to limit, along with nutrients and ingredients to encourage. The nutrient standards used for category assignment followed those developed by global dietary authorities. Standards are proposed for calories, sodium, added sugars, saturated, and industrially produced trans fats. Also included are minimum values for food groups to encourage, low-fat dairy, and for country-specific gap nutrients. Internal use of the NP model has spurred product changes that are consistent with WHO goals for industry transparency. An audited review of company products showed that 48% met added sugar, 65% met sodium, and 71% met saturated fat goals. By the end of 2020, in the top 26 regions in which products are sold, 48% of the total sales volume of global beverages had 100 kcal or less from added sugars per 355 ml serving representing 80% of beverage volume and over 90% of food volume sold globally. The PNC NP model is not consumer-facing but is specifically intended for internal use to motivate stepwise and incremental product innovation and reformulation. Transparent and published NP models further WHO goals of engaging industry stakeholders in the (re)formulation of processed foods and beverages consistent with public health goals.

Taxation options for nicotine and tobacco products in Switzerland - a review of tax policies.

Alternative nicotine products such as electronic nicotine delivery systems (ENDS) and tobacco heating systems have gained worldwide popularity. Findings suggest ENDS to be probably less harmful than combustible cigarettes, but evidence on long-term health effects is still lacking. The potential risk reduction by using tobacco heating systems instead of combustible cigarettes has largely been studied by tobacco industry-sponsored research. Evidence on the extent of risk reduction is key for risk-adapted taxation policies, which will be discussed soon in the Swiss parliament. Evidence on the effects of tax policies in the USA shows that the level of taxation of ENDS, tobacco heating systems and combustible cigarettes has an effect on switches between these products. Therefore, excise taxes influencing one another need to be considered. In Switzerland, tobacco heating systems are currently taxed at a level of 12%, whereas ENDS are not subject to tobacco excise taxation as yet, because they do not meet the legal definition of a tobacco product. This article analyses approaches for imposing taxes on tobacco and nicotine products and possible outcomes, depending on the intended public health goals. At least three tax models can be considered. Tax model A would apply a very small tax on ENDS and a higher tax for tobacco products, which could increase incentives for smokers to switch to vaping but comes with risks of increased vaping initiation among the youth and subsequent switch to or dual use of tobacco products. In contrast, model B would levy a moderate tax on ENDS and an increased tax on tobacco products, which could limit initiation among youth, incentivise to switch from smoking to vaping and discourage dual use. In model C, a comparable tax level for ENDS, tobacco heating systems and combustible cigarettes is levied. This could have overall positive effects in reducing tobacco- and nicotine-associated burden of disease by discouraging initiation in youth, overall consumption and dual use, but could discourage switching to less harmful products. When applying these tax models to current sales prices of these products we found that no public health goal, such as protecting youth and reducing tobacco-associated morbidity and mortality can be achieved. The price of tobacco products is too low to achieve any price differentiation that reflects the different risks associated with ENDS and tobacco products. In order to achieve any public health goal with one of these tax models, prices for tobacco products need to be increased substantially.

A population-level analysis of changes in Australian smokers’ preferences for smoking cessation support over two decades - from 1998 to 2017

SummaryBackgroundEncouraging and assisting smokers to quit remains a key public health goal. Government and commercial initiatives have nudged smokers towards supported cessation. We tracked long-term trends in Australian smokers’ quit attempt methods across 20 years.MethodsData from 11,917 smokers were collected from an annual, cross-sectional, face-to-face, random and representative population survey. The survey measured demographic characteristics, tobacco use, recent quit attempts, nicotine dependence, quit intentions, and recent methods used when attempting to quit. Quit attempt preferences were analysed over time and by smoker characteristics.FindingsEach year, more smokers attempted to quit than remained quit, with a stable trend over time. Socioeconomic disadvantage and mental health conditions are more likely among smokers, but there was no difference in quit attempts by these characteristics. Quit attempts have risen among those aged 60 years and over whereas other age groups have remained stable. Although trending downwards, unassisted quitting remained the most common method: 1998: 61% and 2017: 40%. Asking a doctor for help/advice (34%) was the most common assisted method in 2017, increasing from 18% in 1998. Methods of quitting varied by smoker characteristics, with supported methods used more often by older, more dependent, socio-economically disadvantaged smokers and those with a mental health condition.InterpretationThe relative stability of recent quit attempts, persistence in unassisted quitting, and fluctuating preferences for supported cessation methods indicate that it is important for clinicians and policy makers to continue to support quit attempts through a variety of options, tailored to smoker's needs.

COVID-19, International Human Rights Law and the State-Corporate Complex

Abstract Data-driven technologies (such as mobile phone-based tracing apps) have been at the forefront of public health responses to the COVID-19 pandemic. However, we have also seen high-level expressions of concern about how state actions ostensibly in pursuit of public health goals have in fact greatly accelerated existing human rights concerns about newer technologies, especially increased state and corporate surveillance. This article explores issues at the nexus of COVID-19 public health responses, civil-political rights under international human rights law, and the responsible governance of data-driven technologies. In particular, it offers a framework to evaluate the human rights compatibility of tech-assisted COVID-related state measures. The articles also explore analogies between COVID-related measures and post-2001 counter-terrorism actions taken by states in the name of public security. It cautions against exceptional measures becoming hardwired in ways that may unreasonably impact on pre-COVID freedoms. The article argues that the blurring of state and corporate surveillance and data-gathering and the often symbiotic relationship between tech firms and governments (the ‘state-corporate complex’) complicate efforts to assert clear frames of responsibility.

Causal role of high body mass index in multiple chronic diseases: a systematic review and meta-analysis of Mendelian randomization studies

BackgroundObesity is a worldwide epidemic that has been associated with a plurality of diseases in observational studies. The aim of this study was to summarize the evidence from Mendelian randomization (MR) studies of the association between body mass index (BMI) and chronic diseases.MethodsPubMed and Embase were searched for MR studies on adult BMI in relation to major chronic diseases, including diabetes mellitus; diseases of the circulatory, respiratory, digestive, musculoskeletal, and nervous systems; and neoplasms. A meta-analysis was performed for each disease by using results from published MR studies and corresponding de novo analyses based on summary-level genetic data from the FinnGen consortium (n = 218,792 individuals).ResultsIn a meta-analysis of results from published MR studies and de novo analyses of the FinnGen consortium, genetically predicted higher BMI was associated with increased risk of type 2 diabetes mellitus, 14 circulatory disease outcomes, asthma, chronic obstructive pulmonary disease, five digestive system diseases, three musculoskeletal system diseases, and multiple sclerosis as well as cancers of the digestive system (six cancer sites), uterus, kidney, and bladder. In contrast, genetically predicted higher adult BMI was associated with a decreased risk of Dupuytren’s disease, osteoporosis, and breast, prostate, and non-melanoma cancer, and not associated with Alzheimer’s disease, amyotrophic lateral sclerosis, or Parkinson’s disease.ConclusionsThe totality of the evidence from MR studies supports a causal role of excess adiposity in a plurality of chronic diseases. Hence, continued efforts to reduce the prevalence of overweight and obesity are a major public health goal.

Association between number of remaining teeth and healthy aging in Japanese older people: The Ohsaki Cohort 2006 Study

AimMaintaining ≥20 teeth is a public health goal worldwide. Healthy aging, which includes psychological and social well‐being, as well as physical indicators, has attracted a great deal of attention with the progression of aging societies. However, no studies have examined the association between the number of remaining teeth and healthy aging. This study aimed to investigate the association between the number of remaining teeth and healthy aging.MethodsThis community‐based longitudinal cohort study included 8300 Japanese people aged ≥65 years who were free of disability and depression in the baseline survey in 2006. The participants were categorized into four groups according to the number of remaining teeth at baseline: 0–9, 10–19, 20–24 and ≥25. The primary outcome was healthy aging (defined as meeting all four of the following criteria: free of disability, free of depression, high health‐related quality of life and high life satisfaction), as assessed by a questionnaire survey carried out in 2017. Multiple logistic regression was used to calculate the corresponding odds ratios and 95% confidence intervals.ResultsDuring about 11 years of follow‐up, 621 (7.5%) participants attained healthy aging. Participants with ≥20 remaining teeth showed a higher healthy aging rate. Compared with participants with 0–9 teeth, the multivariate‐adjusted odds ratios (95% confidence intervals) for 10–19, 20–24 and ≥25 teeth were 0.98 (0.77–1.26), 1.28 (1.01–1.63) and 1.59 (1.24–2.03), respectively.ConclusionsThese findings suggest that maintaining ≥20 teeth was associated with healthy aging. Geriatr Gerontol Int 2022; 22: 68–74.

Differences among racial and ethnic groups in vaccine hesitancy among parents of children with autism spectrum disorder

Achieving and maintaining recommended vaccination coverage is a major public health goal [1]. Indeed, rates of childhood vaccine coverage in the U.S. among young children have remained high and stable in recent years [2].

Defining Digital Public Health and the Role of Digitization, Digitalization, and Digital Transformation: Scoping Review.

BackgroundThe recent proliferation and application of digital technologies in public health has spurred interest in digital public health. However, as yet, there appears to be a lack of conceptual clarity and consensus on its definition.ObjectiveIn this scoping review, we seek to assess formal and informal definitions of digital public health in the literature and to understand how these definitions have been conceptualized in relation to digitization, digitalization, and digital transformation.MethodsWe conducted a scoping literature search in Ovid MEDLINE, Embase, Google Scholar, and 14 government and intergovernmental agency websites encompassing 6 geographic regions. Among a total of 409 full articles identified, we reviewed 11 publications that either formally defined digital public health or informally described the integration of digital technologies into public health in relation to digitization, digitalization, and digital transformation, and we conducted a thematic analysis of the identified definitions.ResultsTwo explicit definitions of digital public health were identified, each with divergent meanings. The first definition suggested digital public health was a reimagination of public health using new ways of working, blending established public health wisdom with new digital concepts and tools. The second definition highlighted digital public health as an asset to achieve existing public health goals. In relation to public health, digitization was used to refer to the technical process of converting analog records to digital data, digitalization referred to the integration of digital technologies into public health operations, and digital transformation was used to describe a cultural shift that pervasively integrates digital technologies and reorganizes services on the basis of the health needs of the public.ConclusionsThe definition of digital public health remains contested in the literature. Public health researchers and practitioners need to clarify these conceptual definitions to harness opportunities to integrate digital technologies into public health in a way that maximizes their potential to improve public health outcomes.International Registered Report Identifier (IRRID)RR2-10.2196/preprints.27686

Burns in India: a call for health policy action

Burns in India: a call for health policy action

Plumbojarosite Remediation of Soil Affects Lead Speciation and Elemental Interactions in Soil and in Mice Tissues.

Lead (Pb) contamination of soils is of global concern due to the devastating impacts of Pb exposure in children. Because early-life exposure to Pb has long-lasting health effects, reducing exposure in children is a critical public health goal that has intensified research on the conversion of soil Pb to low bioavailability phases. Recently, plumbojarosite (PLJ) conversion of highly available soil Pb was found to decrease Pb relative bioavailability (RBA <10%). However, there is sparse information concerning interactions between Pb and other elements when contaminated soil, pre- and post-remediation, is ingested and moves through the gastrointestinal tract (GIT). Addressing this may inform drivers of effective chemical remediation strategies. Here, we utilize bulk and micro-focused Pb X-ray absorption spectroscopy to probe elemental interactions and Pb speciation in mouse diet, cecum, and feces samples following ingestion of contaminated soils pre- and post-PLJ treatment. RBA of treated soils was less than 1% with PLJ phases transiting the GIT with little absorption. In contrast, Pb associated with organics was predominantly found in the cecum. These results are consistent with transit of insoluble PLJ to feces following ingestion. The expanded understanding of Pb interactions during GIT transit complements our knowledge of elemental interactions with Pb that occur at higher levels of biological organization.

The Sharp Rise in the Use of Low- and No-Calorie Sweeteners in Non-Alcoholic Beverages in Slovenia: An Update Based on 2020 Data.

Reducing added sugars in non-alcoholic beverages is an important public health goal, which can result in increased use of low- and no-calorie sweeteners (LNCS). The aim of this study was to investigate recent changes in the use of LNCS in non-alcoholic beverages in the Slovenian food supply. The national branded foods dataset was updated with beverages available in 2020, and compared with previous datasets. The data were extracted from food labels. In 2020, N = 1,650 unique beverages were found in shops from five different retailers, covering the majority of the national market. The use of LNCS increased from 13.2% in 2017 and 15.5% in 2019 to 20.2% in 2020, with a major growth in soft drinks (16.8, 19.6, and 26.7%, respectively). We observed a significant growth of beverages containing both LNCS and added sugar. Results were also consistent with sales data, which showed that increased offer of beverages with LNCS also resulted in similarly increased sales of such beverages. The average energy and total sugar content in non-alcoholic beverages decreased, which reflects both the higher percentage of beverages with LNCS, and also the reduction of the sugar content in beverages with only added sugar. Analyses of product-specific reformulation practices highlighted reduced sugar content in 16.8% of products, and in 3.6% with the use of LNCS. The most commonly used LNCS are acesulfame K, sucralose, and aspartame. Typically, combinations are used, however steviol glycosides, sucralose and saccharin are also used alone, in most cases combined with added sugar. The results indicated rapid changes in the use of LNCS in non-alcoholic beverages in the Slovenian food supply, making further monitoring of this area highly relevant.

Study protocol: evaluation of the addictive potential of e-cigarettes (EVAPE): neurobiological, sociological, and epidemiological perspectives

BackgroundTobacco use is the largest preventable cause of diseases and deaths; reducing tobacco intake is, therefore, an urgent public health goal. In recent years, e-cigarettes have been marketed as a 'healthier' alternative to tobacco smoking, whilst product features have evolved tremendously in the meantime. A lively scientific debate has developed regarding the potential benefits and risks of e-cigarettes although, surprisingly, there are few studies investigating the addictive potential of nicotine-containing e-cigarettes. The present work comprises three work packages investigating the addictive potential of e-cigarettes from different perspectives: (1) the neurobiological addictive potential of e-cigarettes; (2) the experience and perception of dependence symptoms among users of e-cigarettes in a social context; and (3) the epidemiological perspective regarding factors influencing the potential for dependence.MethodsWork package I: the neurobiological study will investigate the key elements of addiction in e-cigarettes compared to tobacco cigarettes using neurobiological and neuropsychological correlates associated with craving, incentive motivation, cue reactivity and attentional bias. Work package II: the sociological study part examines self-reports on the experience and perception of dependence symptoms in a social context, using focus group interviews and the analysis of posts in online discussion forums on e-cigarettes. Work package III: the epidemiological study part focuses on tolerance development and the role of psychosocial and product factors by analyzing longitudinal data from the International Tobacco Control Policy Evaluation Project (ITC).DiscussionThe present study offers a chosen mix of three methodological approaches, thereby comprehensively examining core symptoms of positive and negative reinforcement in addiction. Whether e-cigarettes are as reinforcing and addictive as combustible tobacco cigarettes is an important public health issue with implications for prevention and treatment programs.Trial registration: Work package I: Registered at clinicaltrials.gov/ct2/show/NCT04772014. Work package II: Registered at OSF Registries: https://osf.io/dxgya (2021, January 14).

Well-being of sport club members: the role of pro-environmental behavior in sport and clubs’ environmental quality

ABSTRACT Individuals’ mental health and subjective well-being have become increasingly important in public health policy. The purpose of this study was to investigate the effects of pro-environmental behavior in sport and clubs’ perceived environmental quality on the subjective well-being of sport club members in Germany. Data were collected using an online survey of club members in five team/racket sports (i.e., basketball, football, handball, ice hockey, and tennis; n = 3,038). The outcome of interest is subjective well-being which is measured with the WHO-5 scale. Pro-environmental behavior in sport is captured by the monthly carbon footprint resulting from traveling to training sessions and pro-environmental actions in sport. The results of regression analyses show that pro-environmental actions in sport have a positive effect on members’ well-being. Individuals producing a higher carbon footprint when traveling to training sessions report lower well-being, but the effect is overlapped by pro-environmental actions in sport. Members who perceived their clubs’ environmental quality as higher scored higher on well-being. The number of weekly sport hours had an inverse u-shaped effect on well-being, with the diminishing returns by additional sport hours being offset by pro-environmental actions. Collectively, these findings suggest that protecting the natural environment goes hand in hand with individuals’ well-being and public health goals in the field of mental health.