Public Health Objectives Research Articles

Understanding health and illness among incarcerated persons in the Slovenian correctional system: A qualitative study

Understanding the perspectives of incarcerated persons on health and illness, as well as the social contexts influencing these perspectives, is important for developing healthcare interventions that effectively address their specific needs and improve overall well-being. The aim of this study was to explore and understand the complex, multi-dimensional experiences of health and illness among incarcerated persons within the Slovenian correctional system. This study employed an interpretative descriptive design. Using purposive sampling, ten incarcerated persons—five females and five males—were invited to individual, face-to-face, semi-structured interviews. Thematic analysis was conducted in accordance with the interpretative description analytical process. Four major themes were identified: (1) Perspectives on health and illness during incarceration, (2) Healthcare access and self-care during incarceration, (3) Social contacts and their impact on health, and (4) Programmes and activities to enhance well-being. The findings highlighted a shift in perception among participants from a traditional view of health as merely the absence of illness to a more dynamic and holistic understanding, encompassing physical, mental, and social determinants of health. The structured environments within prisons can sometimes paradoxically improve physical health by promoting positive health behaviours, yet they often exacerbate mental health challenges due to restricted freedom and social isolation. The study's implications are significant for policy-making, suggesting that integrated health strategies can significantly improve health outcomes for incarcerated populations, aligning with public health objectives and ensuring better community reintegration.

Collaborative approaches to health education: perspectives of parents and teachers on self-care and managing common health issues in UK primary schools

BackgroundHealth education in primary schools plays a critical role in equipping children with essential self-care skills, fostering health literacy, and addressing social determinants of health. This study explores the perspectives of parents and teachers on teaching self-care and managing common health issues in UK primary schools. Despite the recognized importance of health education, there is limited research on how self-care education is perceived and implemented in the primary school setting.MethodsA qualitative study was conducted using semi-structured interviews with 18 participants, including 9 generalist primary teachers and 9 parents from diverse educational and socioeconomic contexts in the West Midlands, East Midlands, Northwest, and London of England. Participants were recruited via social media and professional networks, and interviews were conducted via video conferencing platforms. Data were thematically analysed using NVivo 12 to identify recurring themes related to the delivery and impact of self-care education in primary schools.ResultsTeachers and parents highlighted key self-care topics, including hygiene, managing common illnesses like colds and cuts, and mental well-being. There was a consensus on the importance of self-care education, but views diverged on whether the responsibility should lie primarily with schools, parents, or a collaborative approach. Teachers expressed concerns about their preparedness to teach sensitive topics, citing a lack of training and resources. Socioeconomic and religious contexts further influenced perceptions, with participants emphasising further importance of school-led self-care education for children from lower socioeconomic backgrounds. Strengths were identified in current self-care education efforts, particularly in practical lessons that empower children with age-appropriate skills.ConclusionsThis study highlights the critical need for comprehensive and collaborative health education in primary schools to promote health literacy and reduce health disparities. Enhancing teacher training, integrating self-care topics into the primary curriculum, and fostering stronger partnerships between schools and families are essential to improving the quality and consistency of self-care education. Policymakers should consider implementing mandatory health education training in teacher education programs and providing ongoing professional development to support teachers. By addressing these gaps, schools can play a pivotal role in preparing children for lifelong health management, reducing the burden on healthcare services, and supporting public health objectives.

Enhancing preparedness by developing robust implementation

Abstract In EUVABECO, a goal is defined as a public health objective that motivates a vaccination practice. A vaccination practice encompasses specific methods or approaches used in vaccination efforts, while a tool refers to a tangible resource or software developed to support the implementation of these practices. EUVABECO is undertaking a series of structured activities from January 2024 until mid-2026. These include mapping innovative practices, deriving requirements for tools and validation plans, developing implementation plans, and facilitating their adoption by European MS. The project will also evaluate, validate, and verify these plans to ensure their efficacy and sustainability. EUVABECO’s methodology is informed by the Systems Development Lifecycle (SDLC) framework, utilizing the V-model to ensure a strong linkage between the development and testing phases, thereby guaranteeing a cohesive workflow. Each implementation plan developed will feature comprehensive policy recommendations and a workplan that covers the necessary organizational, technical, legal, and ethical aspects required for the tool’s deployment. Additionally, these plans will include tailored strategies to enhance the tool’s functionality during outbreaks, criteria for verifying implementation effectiveness, and financial considerations critical for supporting adoption. The implementation plans will undergo a rigorous validation process to assess their suitability, transferability, and sustainability across MS. The ultimate goal is to disseminate validated plans whilst ensuring a parallel multistakeholder engagement approach to ensure MS are actively involved in key project phases, thus, facilitating rapid uptake of said plans across EU MS and a transformation of the vaccination ecosystem across Europe.

Driving policy changes: RISE-Vac lessons learnt and recommendations

Abstract The RISE-Vac project consortium applied evidence-based public health methods to collate, assess, and analyze all the evidence generated through project activities, including literature review and prospective data collection on quantitative and qualitative aspects of vaccine services implementation in prison settings. A multi-sectorial and inter-disciplinary group of experts was set-up including health professionals, statisticians, social scientists and people with lived experience from civil society organisations, health services, prison administrations, academia and international agencies. A set of recommendations, advice, and policy options on how to increase vaccine uptake, targeted to people in prison and using a citizen-centred approach, were developed and tailored to specific needs profiles of different prison population subgroups. Vaccinations to be considered in prison settings were grouped according to target population and/or public health objective into: Seasonal vaccinations and vaccination during outbreak; Childhood life-course vaccinations (booster doses); Vaccinations for cancer prevention; Vaccination for older population groups and people with chronic conditions. In consideration of the diversity of the countries participating in the project, their epidemiological context and available resources and infrastructures, a multi-tiered approach for the development and implementation of models for vaccination services implementation in prison settings was devised, encompassing core vaccinations, such as HBV, Flu, COVID-19 and tetanus, as well as expanded vaccination offer to respond to enhanced health needs and to promote equity of health outcomes, including e.g. HPV vaccination.

Could We Prevent Tobacco Products in Young Populations?

The well-documented detrimental effects of tobacco on children and adolescents make it imperative to prevent tobacco use in young populations, which is a critical public health objective. Youth are particularly susceptible to nicotine’s addictive properties, and they are more susceptible to developing an addiction to tobacco products if they begin using them at a young age, according to research. The reduction of tobacco use among young people can be achieved by implementing evidence-based strategies, including increasing the minimum legal age for purchasing tobacco products, increasing taxation on these products, restricting marketing aimed at youth, and facilitating comprehensive school-based prevention programs, etc. Furthermore, prevention initiatives may be further bolstered by initiatives to encourage smoke-free environments and offer access to smoking cessation resources. In order to effectively prevent tobacco use in young populations and promote healthier outcomes for future generations, it is necessary to target various levels of intervention and involve multiple sectors, including healthcare professionals, educators, policymakers, and community leaders.

Co-planning as a public health tool: the Milan Health Protection Agencies’s Local Gambling Plan

Abstract Issue/problem Gambling represents a public health, social, and economic problem. Lombardy Region, according with national and regional law, has approved the Regional Plan for the prevention and contrast of Pathological Gambling. The Health Protection Agencies (HPA) of the Metropolitan City of Milan, as the other HPAs, implemented the Local Gambling Plan, based on a context analysis and in synergy with all the actors involved. Description of the problem Since 2019, the Milan HPA’s Local Gambling Plan has been implemented through collaboration with non-profit entities (TSEs), which are involved via public tendering. The implementation of the new Italian ‘Code of the Third Sector’ changed the TSEs engagement modalities. For this reason, a complex co-planning process has been initiated in order to increase the level of active citizenship and to enhance public health, in line with horizontal subsidiarity principle. Results The Co-planning procedure promoted the integration among local health services, non-profit entities and municipalities with the aim of gambling prevention and contrast, ensuring the continuity of prevention programs and the involvement of local stakeholders in addressing a public health issue. During the co-planning, 9 working groups were established to define objectives, project actions, monitoring and evaluation methods, ensuring the common interest of all actors involved. Lessons For the health and social system, the co-planning procedure becomes an opportunity to translate what is foreseen by the regulations into local actions. It allow the active participation of local stakeholders involved into the co-construction and achievement of public health objectives and the promotion of communities’ empowerment. Key messages • Co-planning is both a process and a tool for local welfare. • Co-planning involved multiple actors, among which the public institution that ensures satisfaction of health needs through governance actions.

Impact of SiGe pocket on different shape TFET structures for gas sensing application

Gas sensing requires highly sensitive and selective sensor technologies for environmental monitoring, industrial safety, and public health objectives. Although conventional MOSFET-based gas sensors are widely utilized, their detection of low quantities of gases, such as ammonia, is hindered by a number of severe constraints. TFET is emerged as the better device than MOSFET, particularly for the sensing applications. In this work we discussed the source engineered and shape engineered techniques to improve the performance of TFETs, specifically for ammonia gas detection. Comprehensive simulations on SILVACO TCAD and compared the four TFET structures SiGe-pocket DGTFET, SiGe-pocket vertical TFET SiGe-pocket Z-shape TFET, and SiGe-pocket U-shape TFET structure on the basis of various electrical characterization parameters. Significant improvements in efficiency and sensitivity are obtained by adjusting the work function of the molybdenum (4.40–4.60 eV) catalytic gate metal to find the optimal values. The findings reveal that the SiGe-pocket U-shape TFET structure exhibits superior performance, demonstrating an ION of 8.01 × 10−4 A/μm, an ION/IOFF ratio of 1.25×1013, and an OFF current sensitivity (SOFF) of 1.262. These results highlight the enhanced sensitivity and efficacy of the proposed SiGe-pocket U-shape tunnel FET in ammonia gas sensing applications, making it a promising candidate for practical uses in environmental monitoring and industrial safety.

Dementia Friendly communities (DFCs) to improve quality of life for people with dementia: a realist review

BackgroundCurrently, there are more than 55 million people living with dementia worldwide. Supporting people with dementia to live as independently as possible in their communities is a global public health objective. There is limited research exploring the implementation of such interventions in the community context. The aim of the review was to create and refine programme theory – in the form of context mechanism-outcome configurations – on how the characteristics of dementia-friendly communities (DFCs) as geographical locations interact with their social and organisational contexts to understand what works for whom and why.MethodsThis realist review sourced literature from 5 electronic databases: Cochrane Library, CINAHL, Medline, Scopus, PsychINFO and Google Scholar, as well as relevant websites such as Alzheimer’s Society to identify grey literature. Methodological rigour was assessed using the Joanna Briggs Institute critical appraisal tool.ResultsSeven papers were included in this realist review that focused on DFCs in a geographical context The implementation of DFC interventions emerged as a process characterised by two pivotal implementation phases, intricately linked with sub-interventions. The first intervention, termed Hierarchy Commitment (I1a/b), involves the formalisation of agreements by businesses and organizations, along with the implementation of dementia-friendly action plans. Additionally, Educational Resources (I1c) play a significant role in this phase, engaging individuals with dementia and their caregivers in educational initiatives. The second phase, Geographical/Environmental Requirements (I2), encompasses the establishment of effective dementia-friendly signage, accessible meeting places, and community support.ConclusionsThis realist review highlighted a theoretical framework that might guide the development of dementia-friendly communities to enhance the experiences of individuals with dementia and their caregivers within DFCs. Emphasising the need for a theoretical framework in developing geographical DFCs, the review outlines contextual elements, mechanisms, and outcomes, providing a foundation for future studies. The ultimate goal is to establish a robust body of evidence for the sustainable implementation of dementia-friendly communities, thereby improving the quality of life for those with dementia.Study registrationThis study is registered as PROSPERO 2022 CRD42022317784.

Hypertension in children and adolescents: perspectives in Japan.

Hypertension in children and adolescents is associated with increased risk of hypertension and cardiovascular disease (CVD) in adulthood. Therefore, preventing hypertension among children and adolescents is an important public health objective worldwide. Although the importance of hypertension in children and adolescents has increasingly been recognized, the field of research is relatively new and evidence for etiologies, prevention and treatment is sparse. This review mainly summarizes the content regarding hypertension in children and adolescents published in Hypertension Research in 2023/24. Highlights include the following: The prevalence of hypertension was higher in female than male Japanese junior high school students (13.7% vs. 4.7%), but there was no significant gender difference among Japanese senior high school students (7.4% vs. 5.4%). Hematological parameters, including red blood cell counts, hemoglobin counts, hematocrit and iron levels, were positively associated with blood pressure (BP) levels in healthy children and adolescents. Higher-risk longitudinal BP trajectories in early life were associated with increased risk of target organ damage (TOD) and higher combined TOD load in midlife. BP phenotypes (e.g., masked hypertension, white-coat hypertension) assessed using office and 24-h ambulatory BP monitoring were not highly reproducible in children. The salt check sheet was a useful tool for evaluating the approximate dietary salt intake in Japanese children and adolescents. It is recommended that healthcare providers screen for hypertension in children and adolescents and recognize the importance of early intervention for those with elevated BP levels. Beginning in childhood, continuous education on hypertension and proper dietary salt intake are key to reducing the risk of hypertension and decreasing the burden of CVD in adulthood.

Manejo da Doença Renal Crônica: Importância do diagnóstico precoce e monitoramento contínuo

Introduction: Chronic Kidney Disease (CKD) is a serious public health problem, affecting about 10% of the world's population. It is characterized by progressive and irreversible loss of kidney function, often caused by diabetes mellitus and hypertension. Early diagnosis of CKD is essential to slow its progression, improve patients' quality of life, and reduce treatment costs. Markers such as glomerular filtration rate (GFR) and albuminuria are critical for early detection. Methods: A comprehensive literature review was conducted on advances in early diagnosis and continuous monitoring of CKD. The search included studies published between 2013 and 2023, indexed in the PubMed, Lilacs, and SciELO databases, using terms such as "Chronic Kidney Disease management", "early diagnosis", and "continuous monitoring". 20 articles were selected after applying strict inclusion and exclusion criteria, with the final analysis of the full texts. Results: The analysis of the selected studies highlighted the importance of solid protocols for early diagnosis and continuous monitoring in the management of CKD. The introduction of new biomarkers, such as Leucine-Rich α-2-Glycoprotein 1 (LRG1), complements traditional methods, offering more accurate detection of CKD. In addition, remote monitoring via telemedicine has been shown to be effective in reducing hospitalizations and improving treatment adherence, particularly in patients on home dialysis. The combination of these strategies not only improves patients' clinical outcomes, but also reduces the financial burden on health systems. Conclusion: The review highlighted the need for robust protocols for early diagnosis and continuous monitoring in the management of CKD. The integration of new biomarkers and telemedicine technologies represents a significant advance, allowing for more effective and economically viable interventions. Such practices can improve patients' quality of life and provide a more sustainable approach to health systems, aligning with public health objectives.

Ensuring High-Quality Professional Training for Future Tactical Air Force Pilots in Combat Flight through the Pedagogical System's Effectiveness Justification

This article presents an in-depth analysis of the efficacy of the pedagogical system in providing high-quality professional training for prospective tactical air force pilots. The study encompasses the evaluation of cognitive, operational, motivational and conative, and physical components of professional training for combat flights through an extensive pedagogical experiment. Two distinct groups, namely the experimental group (EG) and the control group (CG), comprising a total of 190 participants, were established for the experiment. The assessment of professional readiness among KNAFU student pilots for combat flights involved the examination of criteria, indicators, and levels associated with each component. The experimental process entailed both quantitative measurement and qualitative interpretation of the outcomes. The study uncovered noteworthy enhancements in professional training for future tactical air force pilots, encompassing intellectual domain, simulator training quality, operational proficiency, motivational and conative aspects, physical capabilities, and psychophysiological elements. These findings contribute to the progression of military pilot education and carry positive implications for public health. By refining the training programs and pedagogical approaches for military pilots, the implemented measures can indirectly impact public health by ensuring the deployment of highly skilled and mentally resilient pilots to safeguard national security. This study underscores the interdependence between professional training for tactical air force pilots and broader public health objectives, underscoring the significance of holistic education and training approaches in the military domain.

Public health contributions of entomological surveillance of West Nile virus (WNV) and other mosquito-borne arboviruses in a context of climate change.

Climate change is likely to increase the risk of human transmission of arboviruses endemic to Canada, including West Nile virus (WNV), Eastern equine encephalitis virus (EEEV) and California serogroup virus (CSV), calling for enhanced surveillance, including entomological surveillance targeting mosquito vectors. A scoping review was carried out to document the public health contributions of entomological surveillance of arboviruses of importance in Canada. The Ovid® and EBSCO platforms and the grey literature were searched to identify documents published between 2009 and 2023, in English or French, dealing with entomological surveillance of arboviruses of interest, conducted annually for human health purposes under the aegis of a government authority, with specified public health objectives and actions. The 42 selected publications mainly reported two public health objectives of adult mosquito surveillance: early warning of viral circulation and assessment of the level of risk of human transmission. Recommended actions included clinical preparedness, risk communication, promotion of personal protection measures and vector control. The main objectives of immature mosquito surveillance were to identify sites with high larval densities, in order to reduce/eliminate them and target the application of larvicides. In a context of climate change favouring the spread of arboviruses, this study highlights the potential public health contributions of regular entomological surveillance of endemic arboviruses of importance in Canada. It helps support concrete actions to protect the health of the population from the risks of arboviral transmission.

Exogenous Increases in Basic Income Provisions Increase Preventive Health-Seeking Behavior: A Quasi-Experimental Study

IntroductionUniversal Basic Income (UBI) policies have the potential to promote a wide range of public health objectives by providing those who qualify with direct cash payments. One overlooked mechanism of particular importance to health researchers is the possibility that guaranteed income might increase consultation of primary and preventive care (e.g., annual doctors’ visits; regular vaccination against infectious disease) by providing people with both the time and monetary resources to do so, thereby improving general health. MethodsThis study assesses the effects of an exogenous shock to Alaska's UBI payments to all state residents: a 2022 decision to reclassify dividend “energy relief” provisions as non-taxable (thereby increasing payments by approximately $2,000 inflation-adjusted dollars). It estimates quasi- experimental treatment effects (in 2022 vs. 2021) via mixed linear probability models that compare pre/post policy change in primary care seeking behavior in Alaska vs. the US adult population; controlling for respondent-level fixed effects and state-level random effects. Data were collected in 2021-2022, and analyzed in 2024. ResultsThe likelihood that Alaskans sought primary care post-reform (relative to beforehand) increased by 6pp, which was significantly greater than the same difference (2pp) observed across all other (non- UBI) US States (∆ = 4pp, p < 0.01). The study provides suggestive evidence that comparatively fewer Alaskans had difficulty affording primary care during this period, with less-consistent evidence of increased flu vaccine uptake. ConclusionsEnhanced UBI payments ought to be thought about as a form of health policy, as they have the potential to advance a wide range of health objectives related to preventive care.

HPV vaccine development: Cervical cancer and broader implications for HPV-related malignancies

Cancer of the cervical region, which is caused by highly susceptible HPV types and serves as the fourth leading malignancy to develop in women worldwide, is the main public health objective of the HPV vaccine. Furthermore, it is imperative that you prevent genital warts and malignancies, including anal, oral, and vaginal cancers, that are associated with high risk HPV. Currently, nevertheless, there exist regional and national differences in the prevalence of HPV infection and vaccination as well as within various populations. In order to provide relevant recommendations for future research on the relevant situation, this paper analyzes the literature on the mechanism of action and application of the nine-valent and quadrivalent HPV vaccines, in addition to the technological innovation and development of vaccine R&amp;D, challenges associated with vaccine R&amp;D, and future development trends. Though future research can concentrate on the study of other cancers produced by HPV in other pertinent directions, this publication concentrates on the study of cervical cancers caused by high-risk HPV strains. Future research can look on linked cancers.

The Intersection of Intellectual Property and Public Health

Purpose: The general objective of this study was to investigate the intersection of intellectual property and public health. Methodology: The study adopted a desktop research methodology. Desk research refers to secondary data or that which can be collected without fieldwork. Desk research is basically involved in collecting data from existing resources hence it is often considered a low cost technique as compared to field research, as the main cost is involved in executive’s time, telephone charges and directories. Thus, the study relied on already published studies, reports and statistics. This secondary data was easily accessed through the online journals and library. Findings: The findings reveal that there exists a contextual and methodological gap relating to the intersection of intellectual property and public health. Preliminary empirical review revealed that intellectual property laws, while designed to promote innovation, often created barriers to accessing essential medicines and technologies, particularly in low-income regions. It highlighted how patent protections, while incentivizing pharmaceutical development, led to high drug prices that limited access and exacerbated health disparities. The study emphasized the need for a balanced approach to IP regulations that would encourage innovation while ensuring that new treatments are affordable and accessible. It called for a re-evaluation of IP frameworks to align better with public health objectives and promote global health equity. Unique Contribution to Theory, Practice and Policy: The Theory of Intellectual Property as a Public Good, Theory of Technological Determinism and the Theory of Access to Medicines and Health Equity may be used to anchor future studies on the intersection of intellectual property and public health. The study recommended several key actions to address the issues identified. It suggested revising IP policies to include more flexibility, such as compulsory licensing and support for generic drug production, to improve access to essential medicines. The study advocated for international collaboration to balance IP protections with health needs and proposed that policymakers craft regulations that support both innovation and accessibility. It also emphasized the importance of ongoing research and evidence-based decision-making to guide IP reforms and promote global health equity. Additionally, it recommended fostering partnerships between governments, international organizations, and pharmaceutical companies to enhance healthcare access and address disparities.

Design and Implementation of a Course to Meet the Demand for a Skilled Public Health Workforce to Address the Needs of People With Disabilities

People with disabilities experience a higher burden of chronic diseases compared to people with no disabilities. To emphasize the importance of addressing health-related disparities affecting this population, multiple objectives of Healthy People 2030 focus on people with disabilities. Accomplishing these objectives requires a culturally competent public health workforce knowledgeable about the health issues and health-related factors affecting people with disabilities and evidence-based public health strategies for effective interventions. To prepare future public health professionals to be a part of efforts of diversity, equity, and inclusion, we developed and implemented a course on disability which was offered as an upper-level elective to students pursuing undergraduate training in public health. We structured the course around selected objectives of Healthy People 2030 and evidence-based strategies mapped to these objectives. The course framework allows for the development of proficiency and competency in these areas through learning about the basic disability-related terms, health issues, health-related behaviors, and social determinants of health affecting people with disabilities. We also aligned the course with the specific accreditation criteria outlined by the Council on Education for Public Health and disability competencies. There is an urgent need for future public health professionals to understand the challenges experienced by people with disabilities and be able to address them. Designing and implementing courses meeting the accreditation criteria and aligned with the national public health objectives could help strengthen the appropriate knowledge and skills of the future public health workforce.

From destination choice to departure: analysing French tourists’ behaviours facing health risks from COVID-19

ABSTRACT During a pandemic, individuals react both cognitively and emotionally, leading them to adopt self-protective behaviours. Governments, meanwhile, face a delicate balancing act between safeguarding public health and mitigating the socioeconomic impact. In the tourism industry, this translates to reducing infection risk while minimizing mass cancellations. Past research suggests that providing updated information can help achieve these objectives. This study examines two pre-departure behaviours of French tourists in response to health risks from COVID-19: (1) seeking or not seeking information about COVID-19 indicators and protective measures at the chosen destination; (2) continuing with the planned stay or cancelling it. Seeking information and cancelling trips are voluntary actions driven by various factors, including tourists’ emotional state, particularly their worry about contracting and transmitting COVID-19. We find that worry motivates both behaviours, with worry about contracting exerting the strongest influence. Information-seeking, regardless of whether analysed as ordinal or nominal, tends to promote cancellations. This suggests a potential conflict between public health and tourism objectives. Our findings highlight the critical need for tourism managers to reassure tourists about health safety and tailor communication strategies accordingly. In this vein, we discuss some propositions that could be considered in the event of future pandemics.

Key considerations in the adoption of Artificial Intelligence in public health.

The integration of Artificial Intelligence (AI) into public health has the potential to transform the field, influencing healthcare at the population level. AI can aid in disease surveillance, diagnosis, and treatment decisions, impacting how healthcare professionals deliver care. However, it raises critical questions about inputs, values, and biases that must be addressed to ensure its effectiveness. This article investigates the factors influencing the values guiding AI technology and the potential consequences for public health. It outlines four key considerations that should shape discussions regarding the role of AI in the future of public health. These include the potential omission of vital factors due to incomplete data inputs, the challenge of balancing trade-offs in public health decisions, managing conflicting inputs between public health objectives and community preferences, and the importance of acknowledging the values and biases embedded in AI systems, which could influence public health policy-making.

The Impact of Online Gambling on Mental Health in New Zealand: A Comparative Study

Online gambling has witnessed exponential growth globally, facilitated by the proliferation of internet access and digital platforms. This phenomenon has sparked significant concerns regarding its potential impact on mental health, particularly in regions like New Zealand where gambling is popular. This paper endeavors to investigate the relationship between online gambling and mental health outcomes within the unique socio-cultural context of New Zealand, comparing these impacts with those of traditional forms of gambling. The introduction of online gambling has revolutionized the accessibility and convenience of participating in gambling activities. In New Zealand, as in many other jurisdictions, this shift has prompted regulatory responses aimed at managing potential risks while balancing consumer demand and industry growth. Despite these efforts, the pervasive nature of online gambling introduces distinct challenges that may exacerbate issues related to mental health. The study will begin by reviewing existing literature on global trends in online gambling and its documented effects on mental health. This will include an analysis of regulatory frameworks implemented in various countries to address these concerns, highlighting successes and challenges in consumer protection and harm minimization strategies. Psychological theories and models explaining addictive behaviors associated with online gambling will be explored to provide a theoretical foundation for understanding the observed impacts. A key focus of this research will be a comparative analysis between online gambling and traditional forms of gambling prevalent in New Zealand, such as land-based casinos and sports betting. By contrasting these modalities, the study aims to elucidate whether online gambling uniquely intensifies mental health risks or presents analogous challenges to traditional gambling activities. Methodologically, the study will employ a mixed-methods approach. Quantitative analysis will draw upon national gambling prevalence surveys and data from online gambling platforms to assess the prevalence of online gambling in New Zealand and profile its participants. Qualitative research will involve in-depth interviews with online gamblers and mental health professionals to capture nuanced insights into the psychological and emotional impacts experienced. Findings from the study are expected to contribute empirical evidence on the prevalence of online gambling in New Zealand, alongside comparative assessments of mental health outcomes between online and traditional gamblers. Specific risk factors associated with online gambling addiction and deterioration in mental health will be identified, shedding light on mechanisms through which these impacts manifest. The implications of these findings for policy and regulation will be discussed, emphasizing the need for adaptive strategies that safeguard mental well-being without stifling technological innovation or economic contributions from the gambling sector. Recommendations will be made for enhancing existing regulatory frameworks to ensure they adequately address the unique challenges posed by online gambling while promoting responsible gambling practices. This research seeks to advance understanding of the complex interplay between online gambling and mental health in New Zealand. By elucidating comparative impacts and exploring regulatory responses, the study aims to inform evidence-based interventions that support public health objectives while fostering a sustainable gambling environment.

Effectiveness of a School- and Primary Care–Based HPV Vaccination Intervention

The human papillomavirus (HPV) vaccine is safe and effective, yet vaccination coverage remains below public health objectives in many countries. To examine the effectiveness of a 3-component intervention on HPV vaccination coverage among adolescents aged 11 to 14 years 2 months after the intervention ended, each component being applied alone or in combination. A cluster randomized trial with incomplete factorial design (PrevHPV) was conducted between July 1, 2021, and April 30, 2022, in French municipalities receiving 0, 1, 2, or 3 components of the intervention. Randomization was stratified by school district and municipalities' socioeconomic level. Analyses were carried out on 11- to 14-year-old adolescents living in all participating municipalities, regardless of what had been implemented. The PrevHPV intervention had 3 components: (1) educating and motivating 11- to 14-year-old adolescents in middle schools, along with their parents; (2) training general practitioners (GPs) on up-to-date HPV information and motivational interviewing techniques; and (3) free HPV vaccination at school. The primary outcome was HPV vaccination coverage (≥1 dose) 2 months after the intervention ended among 11- to 14-year-old adolescents living in participating municipalities, based on the French national reimbursement database and data collected during the trial in groups randomized to implement at-school vaccination. A total of 91 municipalities comprising 30 739 adolescents aged 11 to 14 years (15 876 boys and 14 863 girls) were included and analyzed. Half the municipalities were in the 2 lowest socioeconomic quintiles and access to GPs was poor in more than two-thirds of the municipalities. Thirty-eight of 61 schools (62.3%) implemented actions and 26 of 45 municipalities (57.8%) had at least 1 trained GP. The median vaccination coverage increased by 4.0 percentage points (IQR, 2.0-7.3 percentage points) to 14.2 percentage points (IQR, 9.1-17.3 percentage points) at 2 months. At-school vaccination significantly increased vaccination coverage (5.50 percentage points [95% CI, 3.13-7.88 percentage points]) while no effect was observed for adolescents' education and motivation (-0.08 percentage points [95% CI, -2.54 to 2.39 percentage points]) and GPs' training (-1.46 percentage points [95% CI, -3.44 to 0.53 percentage points]). Subgroup analyses found a significant interaction between at-school vaccination and access to GPs, with a higher effect when access was poor (8.62 percentage points [95% CI, 5.37-11.86 percentage points] vs 2.13 percentage points [95% CI, -1.25 to 5.50 percentage points]; P = .007 for interaction). In this cluster randomized trial, within the context of the late COVID-19 pandemic period and limited school and GP participation, at-school HPV vaccination significantly increased vaccination coverage. The trial did not show a significant effect for training GPs and education and motivation, although it may be observed after more time has elapsed after the intervention. ClinicalTrials.gov Identifier: NCT04945655.