Population Subgroups Research Articles

Ethnoracial Disparities in Nitrogen Dioxide Pollution in the United States: Comparing Data Sets from Satellites, Models, and Monitors.

In the United States (U.S.), studies on nitrogen dioxide (NO2) trends and pollution-attributable health effects have historically used measurements from in situ monitors, which have limited geographical coverage and leave 66% of urban areas unmonitored. Novel tools, including remotely sensed NO2 measurements and estimates of NO2 estimates from land-use regression and photochemical models, can aid in assessing NO2 exposure gradients, leveraging their complete spatial coverage. Using these data sets, we find that Black, Hispanic, Asian, and multiracial populations experience NO2 levels 15-50% higher than the national average in 2019, whereas the non-Hispanic White population is consistently exposed to levels that are 5-15% lower than the national average. By contrast, the in situ monitoring network indicates more moderate ethnoracial NO2 disparities and different rankings of the least- to most-exposed ethnoracial population subgroup. Validating these spatially complete data sets against in situ observations reveals similar performance, indicating that all these data sets can be used to understand spatial variations in NO2. Integrating in situ monitoring, satellite data, statistical models, and photochemical models can provide a semiobservational record, complete geospatial coverage, and increasingly high spatial resolution, enhancing future efforts to characterize, map, and track exposure and inequality for highly spatially heterogeneous pollutants like NO2.

Distribution and treatment needs of soil-transmitted helminthiasis in Bangladesh: A Bayesian geostatistical analysis of 2017-2020 national survey data.

In Bangladesh, preventive chemotherapy targeting soil-transmitted helminth (STH) infections in school-age children has been implemented since 2008. To evaluate the success of this strategy, surveys were conducted between 2017 and 2020 in 10 out of 64 districts. We estimate the geographic distribution of STH infections by species at high spatial resolution, identify risk factors, and estimate treatment needs at different population subgroups. Bayesian geostatistical models were fitted to prevalence data of each STH species. Climatic, environmental, and socioeconomic predictors were extracted from satellite images, open-access, model-based databases, and demographic household surveys, and used to predict the prevalence of infection over a gridded surface at 1 x 1 km spatial resolution across the country, via Bayesian kriging. These estimates were combined with gridded population data to estimate the number of required treatments for different risk groups. The population-adjusted prevalence of Ascaris lumbricoides, Trichuris trichiura, and hookworm across all ages is estimated at 9.9% (95% Bayesian credible interval: 8.0-13.0%), 4.3% (3.0-7.3%), and 0.6% (0.4-0.9%), respectively. There were 24 out of 64 districts with an estimated population-adjusted STH infection prevalence above 20%. The proportion of households with improved sanitation showed a statistically important, protective association for both, A. lumbricoides and T. trichiura prevalence. Precipitation in the driest month of the year was negatively associated with A. lumbricoides prevalence. High organic carbon concentration in the soil's fine earth fraction was related to a high hookworm prevalence. Furthermore, we estimated that 30.5 (27.2; 36.0) million dosages of anthelmintic treatments for school-age children were required per year in Bangladesh. For each of the STH species, the prevalence was reduced by at least 80% since treatment was scaled up more than a decade ago. The current number of deworming dosages could be reduced by up to 61% if the treatment strategy was adapted to the local prevalence.

Lifestyle Interventions to Prevent Type 2 Diabetes in Women with a History of Gestational Diabetes: A Systematic Review and Meta-Analysis through the Lens of Health Equity.

Type 2 diabetes mellites is one of the health problems disproportionally affecting people with low socioeconomic statuses. Gestational diabetes mellites increases the risk of type 2 diabetes by up to ten-fold for women. Lifestyle interventions prevent type 2 diabetes in women with prior gestational diabetes. However, it is unknown if similar effectiveness can be expected for all population subgroups. This study aims to assess the prevention of type 2 diabetes in women with prior gestational diabetes using population characteristics according to the PROGRESS (place of residence, race/ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status, and social capital) criteria. MEDLINE, CINAHL, EMBASE, PubMed, PsycINFO, Web of Science, and EBM Reviews databases were searched for interventional studies of diet, physical activity, or behavioural interventions published up to 21 February 2023. Random effects subgroup meta-analysis was conducted to evaluate the association of population characteristics and intervention effects. All studies were conducted in high-income countries or middle-income countries. Two-thirds of the studies reported on race/ethnicity and education level. Less than one-third reported on place (urban/rural), occupation, and socioeconomic status. None reported on religion or social capital. Studies from high-income countries (MD = -1.46; 95% CI: -2.27, -0.66, I2 = 70.46, p < 0.001) showed a greater reduction in bodyweight compared with the studies conducted in middle-income countries (MD = -0.11; 95% CI: -1.12, 0.89, I2 = 69.31, p < 0.001) (p for subgroup difference = 0.04). There are significant equity gaps in the evidence for the prevention of type 2 diabetes in women with prior gestational diabetes due to reports on population characteristics being poor. Interventions may be less effective in reducing bodyweight in women from middle-income countries compared to high-income countries. Collecting and analysing data related to equity is needed to understand the effect of lifestyle interventions on type 2 diabetes for different population subgroups.

Joint modeling HIV and HPV using a new hybrid agent-based network and compartmental simulation technique.

Persons living with human immunodeficiency virus (HIV) have a disproportionately higher burden of human papillomavirus infection (HPV)-related cancers. Causal factors include both behavioral and biological. While pharmaceutical and care support interventions help address biological risk of coinfection, as social conditions are common drivers of behaviors, structural interventions are key part of behavioral interventions. Our objective is to develop a joint HIV-HPV model to evaluate the contribution of each factor, to subsequently inform intervention analyses. While compartmental modeling is sufficient for faster spreading HPV, network modeling is suitable for slower spreading HIV. However, using network modeling for jointly modeling HIV and HPV can generate computational complexities given their vastly varying disease epidemiology and disease burden across sub-population groups. We applied a recently developed mixed agent-based compartmental (MAC) simulation technique, which simulates persons with at least one slower spreading disease and their immediate contacts as agents in a network, and all other persons including those with faster spreading diseases in a compartmental model, with an evolving contact network algorithm maintaining the dynamics between the two models. We simulated HIV and HPV in the U.S. among heterosexual female, heterosexual male, and men who have sex with men (men only and men and women) (MSM), sub-populations that mix but have varying HIV burden, and cervical cancer among women. We conducted numerical analyses to evaluate the contribution of behavioral and biological factors to risk of cervical cancer among women with HIV. The model outputs for HIV, HPV, and cervical cancer compared well with surveillance estimates. Model estimates for relative prevalence of HPV (1.67 times) and relative incidence of cervical cancer (3.6 times), among women with HIV compared to women without, were also similar to that reported in observational studies in the literature. The fraction attributed to biological factors ranged from 22-38% for increased HPV prevalence and 80% for increased cervical cancer incidence, the remaining attributed to behavioral. The attribution of both behavioral and biological factors to increased HPV prevalence and cervical cancer incidence suggest the need for behavioral, structural, and pharmaceutical interventions. Validity of model results related to both individual and joint disease metrics serves as proof-of-concept of the MAC simulation technique. Understanding the contribution of behavioral and biological factors of risk helps inform interventions. Future work can expand the model to simulate sexual and care behaviors as functions of social conditions to jointly evaluate behavioral, structural, and pharmaceutical interventions for HIV and cervical cancer prevention.

Association between oxidative balance score and kidney stone in United States adults: analysis from NHANES 2007-2018.

Purpose: To investigate the relationship between the Oxidative Balance Score (OBS) and kidney stone risk using NHANES 2007-2018 data, and to explore potential mechanisms and population-specific effects. Materials and methods: Data from the NHANES 2007-2018 were analyzed. OBS was calculated based on 16 dietary components and 4 lifestyle components. Multivariate logistic regression was employed to investigate the relationship between OBS and kidney stone. Further stratified analyses were conducted to examine the associations across different subgroups. Results: A total of 19,799 participants were included in the study. There was a consistent inverse association between OBS and the risk of kidney stones (OR = 0.97; 95% CI: 0.96-0.99). After dividing the participants into quartiles based on OBS, compared to the lowest quartile of OBS, the risk of kidney stones in the highest quartile of OBS was reduced by 33% (95% CI 0.50-0.89; p = 0.002). This association was consistent across both dietary and lifestyle OBS scores. The protective effect of OBS was notably pronounced among Non-Hispanic white and Other race groups, and among individuals with a higher level of education. However, the association was not significant among individuals with diabetes. Conclusion: A higher OBS, indicating a balance skewed towards antioxidants, is associated with a reduced risk of kidney stones, especially among specific population subgroups. These findings underscore the potential role of oxidative balance in kidney stone pathogenesis and highlight the importance of considering individual and population-specific factors in future research and preventive strategies.

Contact tracing: Characteristics of COVID-19 cases that provided contacts.

This cross-sectional study evaluated COVID-19 contact tracing efforts to identify variations in contact tracing outcomes in different population subgroups. Contact tracing was a critical tool to slow the COVID-19 epidemic. A literature gap evaluating contact tracing elicitation exits, particularly on prioritized groups. We analyzed data from COVID-19 cases linking statewide case management, immunization, laboratory testing, and hospitalization databases in New York State (NYS) outside of New York City from February 1 to November 30, 2021. Focus was cases in home-based residential settings (excluding congregate care) and prioritized groups (educational institutions, large households, close quarters, higher-risk persons, hospitalized). The primary outcome was completed interviews that provided a contact. Of the 550,850 cases interviewed during the study period, 316,645 (57.5%) provided at least one contact. Adults aged 18 to 49 years were most likely to provide contacts than those aged 65 years and older (adjusted odds ratio [aOR], 1.42; 95% confidence interval [CI], 1.39-1.45). Compared to unvaccinated cases, boosted individuals (aOR, 1.61; 95% CI, 1.50-1.73) were most likely to provide contacts, followed by persons with only a primary vaccine series (aOR, 1.3; 95%CI, 1.28-1.33) and partially vaccinated (aOR, 1.21; 95%CI, 1.18-1.24). Repeat cases (aOR, 1.07; 95%CI, 1.01-1.14), pregnant persons (aOR, 1.26; 95% CI, 1,19-1.34), those with underlying conditions (aOR 1.22; 95%CI, 1.20-1.23), and those in K-12 settings (aOR 1.55; 95%CI, 1.50-1.61) were more likely to provide contacts. There was no clear association between hospitalized, while zip code level income may (aOR, 1.006; 95%CI, 1.003, 1.009). Persons from larger households were more likely to provide contacts: aOR for two or more persons vs. one person households ranged from 2.49 to 4.7 (95%CI, 2.20-4.78). Our findings indicate success in eliciting contacts from prioritized groups and identify variable contact elicitation outcomes from different population groups. These results may serve as a tool for future contact tracing efforts.

Ten-Year Changes in the Physical Activity and Sedentary Behaviors of Adults: An Analysis of the 2 Cross-Sectional Observation of Cardiovascular Risk Factors in Luxembourg Studies.

Monitoring population physical activity (PA) and sedentary behavior over time is important to guide public health actions. The objective of this study was to investigate the changes in PA and sedentary behavior of adult residents in Luxembourg over 10years. We also investigated variations in change over time across sociodemographic subgroups. Two population-based cross-sectional studies of adults living in Luxembourg (Observation of Cardiovascular Risk Factors in Luxembourg [ORISCAV-LUX] [2007-2008] and ORISCAV-LUX 2 [2016-2018]) were considered. Multilevel mixed-effects models were used to investigate changes over time between the studies with regard to self-reported total PA (metabolic equivalent of task-min/week), PA levels (inactive/sufficiently active/highly active), total sitting time, recreational television viewing, and personal computer (PC) use outside of work (in minutes per day). The ORISCAV-LUX study included 1318 participants and the ORISCAV-LUX 2 study involved 1477 participants; 573 adults took part in both studies. The proportion of participants categorized as highly active increased over time by 6.9%. Total PA (761 metabolic equivalent of task-min/wk), television viewing (12min/d), and PC use outside of work (13min/d) also increased, whereas the total sitting time decreased by 25minutes per day. Variations in change over time were observed by sex, country of birth, education, employment status, and perceived financial difficulty. Over a 10-year period, PA increased and total sitting time decreased in adults living in Luxembourg. With regard to specific sedentary behaviors, television viewing, and PC use outside of work increased. Specific population subgroups will benefit the most from targeted efforts to increase PA and minimize sedentary behavior.

Economic evaluation and budgetary burden of mepolizumab in severe refractory eosinophilic asthma

ObjectiveMepolizumab is indicated as an additional treatment of severe refractory eosinophilic asthma. The observed differences in population subgroups according to plasma eosinophil count, the existence of patients with high levels of immunoglobulin E who are candidates of omalizumab and mepolizumab, as well as mepolizumab's economic impact, lead to make efficient economic studies for clinical decision making. The aim was to analyze mepolizumab's cost-efficacy and budget impact. MethodCost comparison and the use of mepolizumab's budgetary impact was performed, from the Spanish National Health System's perspective. Among the assessed alternatives, inhaled systemic corticosteroids, plus long acting beta agonist (β2) and/or oral systemic corticosteroids in patients with non immunoglobulin E-mediated severe allergic asthma, and said treatment along with omalizumab in patients with immunoglobulin E mediated eosinophilic allergic asthma were included. Its efficacy was evaluated through avoided clinically relevant exacerbations. The direct costs associated with exacerbation were assessed. ResultsMepolizumab's long run average incremental cost regarding omalizumab's is 797 euros per patient a year. Considering omalizumab's alternative discounted price, including mepolizumab for patients with immunoglobulin E mediated eosinophilic allergic asthma would increase public spending from 2.3 to 4.6 million euros. Given omalizumab's notified price, the gradual introduction of mepolizumab in the Spanish National Health System would save 3.6 million euros in three years. For non immunoglobulin E-mediated severe asthma patients, the avoided cost/exacerbation by introducing mepolizumab is 15,085 euros, assuming a gradual market penetration of mepolizumab. In patients with ≥ 500 eosinophils/µL, this cost decreases to 7,767 euros per avoided exacerbation with a budgetary impact of 183.2 million euros in three years with a progressive penetration of mepolizumab. ConclusionsThe cost comparison between mepolizumab and omalizumab in immunoglobulin E mediated eosinophilic asthma patients suggests a use of the lower cost drug, promoting price competition. Additionally, prioritizing its use among non immunoglobulin E-mediated severe refractory eosinophilic asthma patients and ≥ 500 eosinophils/µL plasma level patients, would improve its efficiency as well as reducing its budgetary impact.

Assessing vaccine hesitancy and health literacy using a new Italian vaccine confidence index and a modified Italian medical term recognition test: A cross-sectional survey on Italian parents

ABSTRACT The decline in children’s vaccination coverage and the resurgence of preventable infectious diseases draw attention to parents’ vaccine hesitancy. Our study introduces two validated tools to independently assess vaccine hesitancy and health literacy among parents with school-age children. We developed a Vaccine Confidence Index (VCI) from 10 Likert items, exploring their relationships through exploratory and confirmatory factor analyses. We modified the IMETER (Italian medical term recognition test) to measure health literacy. We assessed the internal consistency of the modified IMETER and the 10 Likert items using Cronbach’s alpha test (α) and McDonald’s omega total coefficient (ω) with good results (ω = 0.92, α = 0.90; ω = 0.87, α = 0.82 respectively). We used these tools within a questionnaire conducted on 743 parents recruited from pediatric clinic waiting rooms in Italy, collecting demographic data, information sources on vaccines and vaccine-preventable diseases knowledge. The VCI resulting from factor analyses consisted of six items on a ten-point Likert scale, reflecting the ratio of positive to negative items. The survey revealed significant variations in the VCI according to individual features such as education, use of social networks, or Health institutions as sources of information. Multivariate logistic regression identified an association between vaccine intention and the VCI. Health literacy was functional for 91.2% of participants, but knowledge about vaccine-preventable diseases was generally low. The VCI showed no significant association with health literacy and vaccine-preventable diseases knowledge. The VCI and the modified IMETER effectively assess vaccination attitude and health literacy, offering valuable public health tools for tailoring vaccination campaigns to hesitant population subgroups.

Life expectancy and years of potential life lost in people with mental disorders: a systematic review and meta-analysis

Mental disorders are associated with premature mortality. There is increasing research examining life expectancy and years-of-potential-life-lost (YPLL) to quantify the disease impact on survival in people with mental disorders. We aimed to systematically synthesize studies to estimate life expectancy and YPLL in people with any and specific mental disorders across a broad spectrum of diagnoses. In this systematic review and meta-analysis, we searched Embase, MEDLINE, PsychINFO, WOS from inception to July 31, 2023, for published studies reporting life expectancy and/or YPLL for mental disorders. Criteria for study inclusion were: patients of all ages with any mental disorders; reported data on life expectancy and/or YPLL of a mental-disorder cohort relative to the general population or a comparison group without mental disorders; and cohort studies. We excluded non-cohort studies, publications containing non-peer-reviewed data or those restricted to population subgroups. Survival estimates, i.e., life expectancy and YPLL, were pooled (based on summary data extracted from the included studies) using random-effects models. Subgroup analyses and random-effects meta-regression analyses were performed to explore sources of heterogeneity. Risk-of-bias assessment was evaluated using the Newcastle-Ottawa Scale. This study is registered with PROSPERO (CRD42022321190). Of 35,865 studies identified in our research, 109 studies from 24 countries or regions including 12,171,909 patients with mental disorders were eligible for analysis (54 for life expectancy and 109 for YPLL). Pooled life expectancy for mental disorders was 63.85 years (95% CI 62.63-65.06; I2=100.0%), and pooled YPLL was 14.66 years (95% CI 13.88-15.98; I2=100.0%). Disorder-stratified analyses revealed that substance-use disorders had the shortest life expectancy (57.07 years [95% CI 54.47-59.67]), while neurotic disorders had the longest lifespan (69.51 years [95% CI 67.26-71.76]). Substance-use disorders exhibited the greatest YPLL (20.38 years [95% CI 18.65-22.11]), followed by eating disorders (16.64 years [95% CI 7.45-25.82]), schizophrenia-spectrum disorders (15.37 years [95% CI 14.18-16.55]), and personality disorders (15.35 years [95% CI 12.80-17.89]). YPLLs attributable to natural and unnatural deaths in mental disorders were 4.38 years (95% CI 3.15-5.61) and 8.11 years (95% CI 6.10-10.13; suicide: 8.31 years [95% CI 6.43-10.19]), respectively. Stratified analyses by study period suggested that the longevity gap persisted over time. Significant cross-study heterogeneity was observed. Mental disorders are associated with substantially reduced life expectancy, which is transdiagnostic in nature, encompassing a wide range of diagnoses. Implementation of comprehensive and multilevel intervention approaches is urgently needed to rectify lifespan inequalities for people with mental disorders. None.

Do experts and citizens perceive party competition similarly?

Researchers frequently rely on expert surveys to acquire information about political ideology and political parties, which they then use to explore a range of political phenomena such as proximity voting and satisfaction with democracy. Yet it is unclear whether experts and citizens place the parties similarly, which may have important implications for studies that rely on expert data. To what extent do citizens share expert views regarding political party placements? Using original data from Canada, we use multidimensional scaling techniques to examine and compare the responses of academic and journalist experts against a random sample of Canadians to a range of party placement questions. Our results suggest there is considerable variation between citizens and experts, and among specific subgroups of the general population. These findings have important implications for studies of party competition, voting behavior, and government responsiveness.

Effects of risk perception on commuters’ mode choice behavior during the COVID-19 pandemic: Evidence from Shenzhen, China

Coronavirus disease 2019 (COVID-19) has influenced and is still influencing people’s daily lives worldwide. The infection rate and health and safety countermeasures may influence people’s epidemic risk perception, thus influencing their travel mode choice. It is critical to understand epidemic risk perception and its impact on travel mode choice behavior to ensure the timeliness and effectiveness of health and safety policy implementation. In this study, we conducted an online survey to investigate how commuters’ epidemic risk perception affects travel mode choice behavior in Shenzhen. The online survey mainly includes Likert scale questions and a stated preference experiment with three scenarios to capture commuters’ epidemic risk perceptions and travel mode choice behaviors. First, confirmatory factor analysis was used to obtain three dimensions of epidemic risk perception from the Likert scale questions. Then, three subpopulation groups, including risk-sensitive commuters, risk-insensitive commuters and cautious commuters, were classified based on their risk perception using clustering analysis. Finally, a latent class choice model was estimated to capture the influencing factors of mode choice behavior. Three classes of mode choice behavior were identified, including those who can accept using public transportation, those who avoid using public transportation and tend to bicycles/electric bicycles and those who avoid using public transportation and tend to personal cars. The obtained results can provide valuable support for decision-making during and after an epidemic. Firstly, by offering insights into the intricate risk perception characteristics of Shenzhen residents, these findings can contribute to the effective management of epidemic risks during an epidemic. Secondly, by revealing the factors that influence individuals' preferences for travel modes, these results play a pivotal role in enhancing the market share of the public transportation system after the epidemic.

Knowledge and attitudes towards vaccination in the Croatian adolescent population

Abstract Background Adolescents are a large and vulnerable group for infectious and other diseases. A good insight into their specific needs and their understanding of disease and prevention is necessary to adapt vaccination strategies for this population subgroup characterized by constant change and evolution. This study aimed to explore knowledge and attitudes about vaccination among the Croatian adolescent population. Methods This online cross-sectional questionnaire study was conducted from January 2021 to April 2021 in a convenient sample of adolescents from the northwestern part of Croatia. The knowledge was assessed through a specially designed validated questionnaire. The Vaccination Attitudes Examination Scale (VAX) was used to assess attitudes towards vaccination in the study population, where the higher scores on the VAX scale reflect more negative attitudes toward vaccination. Results The study included 1012 adolescents (29.2% males and 70.8% females). The median age of all subjects was 17.0 (interquartile range 17.0 - 18.0) years. According to the knowledge, there were 29.5% of students with poor, 53.9% of students with average and 16.6% of students with good knowledge about vaccination. The median VAX scale score was 50.0 (interquartile range 43.0-59.0). Male adolescents more frequently had poor knowledge about vaccination (P = 0.028), while female adolescents had more negative attitudes towards vaccination (P = 0.001). The study revealed that there was a positive correlation between poor knowledge and more negative attitudes towards vaccination in the studied population (P &amp;lt; 0.001; rs = 0.260). Conclusions The study showed that a large proportion of Croatian adolescents have poor knowledge about vaccination and negative attitudes toward vaccination. Public health programs specially designed for this vulnerable population subgroup are needed to successfully tackle observed negative indicators. Key messages • Public health interventions directed towards the suppression of negative attitudes about vaccination must involve younger population subgroups, such as adolescents. • Positive attitudes as well as better knowledge about vaccination among adolescents are crucial preconditions for adequate vaccination coverage.

Nutrition and food supply after the Covid-19 pandemic: results from the Specchio cohort study

Abstract Background To contain the COVID-19 pandemic, countries put in place lockdown measures, causing disruption of daily life and changes in lifestyle. Our objective was to explore whether potential changes in diet quality and food supply persisted after the release of lockdown measures, and how these differed according to individual characteristics. Methods The analysis relies on the Geneva (Switzerland) population-based Specchio cohort. In March 2022, an online questionnaire was designed to characterize health behaviors. Nutrition-related changes were assessed through two questions “Today, compared to before the pandemic, would you say that the quality of your diet: • Improved • Improved slightly • Did not change • Deteriorated slightly • Has deteriorated” and “Comparing the current period with that before the pandemic, have you significantly changed your habits regarding your food supply? •Yes •No.” Nutrition-related changes and their determinants were investigated using logistic regression. Results The analysis included 4065 participants (response rate 46%). Mean age was 54 years, 59% were women. 17% of participants reported that their diet had improved or slightly improved compared to before the pandemic. Our results showed a clear age gradient, with younger participants having higher odds of reporting an improved diet (aOR 0.98 (0.97-0.98) per year, p &amp;lt; 0.001). Participants who reported not paying attention to their health did not report an improved diet (aOR 0.29 (0.16-0.49), p &amp;lt; 0.001); those who reported significant changes in their food supply habits had greater odds of reporting they improved their diet (aOR 3.37 (2.76-4.11), p &amp;lt; 0.001). The most popular changes were going more frequently to markets or to small shops. We found no significant differences by sex or by education. Conclusions As reported from other countries, our results showed improved diet quality compared to before the pandemic in certain population subgroups, mainly due to changes in local food supply. Key messages • Favorable changes in diet quality and food supply during the Covid-19 pandemic were observed in certain population subgroups. • With health behavior changes due to pandemic, including nutrition, digital population-based cohorts such as Specchio become a rich resource to produce novel and timely evidence over time.

Quality of life and resilience among Muslim minority in Israel: Implications for global health

Abstract Background Health-Related Quality of Life (HRQoL) indicators can reveal unmet health needs and disparities in various population subgroups. Minority communities often experience lower HRQoL and community resilience (CR) levels compared to majority populations. In Israel, Muslims constitute approximately 18% (1.669 million) of the total population, confronting challenges related to healthcare access, social determinants of health, and CR. This study aims to investigate the HRQoL in different Muslim subgroups in Israel and its association with CR, providing insights of broader global implications for public health policies addressing minority communities. Methods A survey was conducted among three Muslim subgroups in Israel, including Arab-Muslims, Bedouin-Muslims, and Circassians Muslims. The survey assessed demographics; HRQoL measured by the World Health Organization Quality of Life (WHOQOL) tool; personal resilience; and CR measured by the Conjoint Community Resiliency Assessment Measure (CCRAM). Data analysis included descriptive and analytic statistics. Pearson's correlation coefficient determined the association between WHOQOL levels and CCRAM scores. Results Of 461 participants, Circassian Muslims reported the highest levels of quality of life (M = 3.74±0.34), while the Bedouin sub-group reported the lowest (M = 3.37±0.46). CR was significantly higher among Circassians Muslims (M = 3.81±0.64) compared to Arab-Muslim (M = 2.58±0.74) and Bedouin-Muslim (M = 2.48±0.74) subgroups. HRQoL was positively associated (p &amp;lt; 0.001) with CR for the entire Muslim population. Conclusions This study highlights the relationship between social determinants of health, lifestyle, and unique characteristics of sub-groups within the Muslim minority in Israel. The findings demonstrate the diversity among Muslim minority populations and suggests that there is a need for tailored and customized interventions focused on the variable needs of vulnerable subgroups, like the Bedouin Muslims. Key messages • Minority health study in Israel emphasizes diverse HRQoL &amp; CR, urging tailored public health policies. • Focused on minority health, Bedouin Muslims need customized interventions to improve HRQoL &amp; CR.

Labour market effects of the COVID-19 pandemic: A Dutch longitudinal study

Abstract Background The COVID-19 crisis has caused profound impact on societal, economic, and healthcare systems. The nature and distribution of these impacts, especially over longer periods of time, is still in need of further investigation. We aim to examine the prevalence of and determinants for poor labour market outcomes during the COVID-19 pandemic among adult workers in the Northern Netherlands. Methods We conducted a longitudinal study based on data from the Lifelines COVID-19 cohort. Data from 23 waves (March 2020 - November 2021) were used. Participants were workers between 18 and 64 years of age (n = 22,378). Dependent variables were labour market outcomes, i.e., unemployment, hours of work, quality of work and sickness absence. Independent variables are sociodemographic and work characteristics, pre-existing health conditions, COVID-19 disease, and government support measures. We employed logistic Generalised Estimating Equations (GEE) to estimate population effects. Results Decrease in hours and quality of work, and requiring sickness absence were markedly present in our sample. While the former seems to show partial recovery throughout the pandemic, the two latter seem to vary over time. The prevalence of unemployment was low. Using GEE, we have found erratic patterns of risk for the four labour market outcomes. Pointing to the vast heterogeneity of experiences and impacts on the labour market outcomes of workers. Women, for example, had higher odds of becoming unemployed (OR: 1.48, 95% CI: 1.23-1.79), but lower odds of decreasing their work hours (OR: 0.90, 95% CI: 0.86-0.93). Discussion The results of this study point to the unequal and heterogeneous impact of the COVID-19 pandemic, as well as the presence of less visible negative outcomes among workers, such as decrease in quality of work. For a complete rebound from this crisis, policy should be aimed at addressing these differential impacts among the population. Key messages • The impact of the COVID-19 pandemic on the labour market is more pervasive than can be attested by looking at unemployment rates. • The impact of the COVID-19 pandemic differed by labour market outcome and population subgroup, and policies should aim to address these differential impacts.

Environmental Impact of Diets in 10 European countries

Abstract Background A growing consensus suggests that dietary changes have the potential to lessen the environmental impacts of food production. We performed a cross-country comparison of dietary patterns and their associated environmental impact in Europe, including by socio-demographic factors. Methods We analyzed pooled cross-sectional 24/48/72-hour dietary records collected during 2010-2018 from 10 European countries using the European Food Safety Authority (EFSA) Comprehensive European Food Database (16,508 adults; age 18-79 years). Each food consumed was mapped to the corresponding environmental impact data using the SHARP Indicators Database, which provides greenhouse gas emission (GHGE kgCO2-eq/day) and land use (LU m2*year/day) values for approximately 900 foods. Multivariable linear regression models were used to compare diet-associated GHGE and LU between population subgroups (gender, age, education, and diet type) with country-level fixed effects. We also analyzed the contributions of major food groups to the mean daily total of GHGE and LU for each country. Results The mean dietary GHGE and LU per capita ranged from 4.0 kgCO2eq and 5.0 m2*year in Spain to 6.5 kgCO2eq and 8.2 m2*year in France. Diet-related GHGE and LU (per Kg/food) were lower amongst females (2.6kgCO2eq, B=−0.08, P &amp;lt; 0.01; 3.2m2*year, B=−0.11, P &amp;lt; 0.01), people aged 66-79 (2.6kgCO2eq, B=−0.03, P &amp;lt; 0.01; 3.4m2*year, B=−0.4, P &amp;lt; 0.01), people following vegetarian diets (1.7kgCO2eq, B=−0.07, P &amp;lt; 0.01; 2.0m2*year, B=−0.07, P &amp;lt; 0.01), and higher amongst individuals with secondary education (2.7kgCO2eq, B = 0.04, P &amp;lt; 0.01; 3.6m2*year, B = 0.05, P &amp;lt; 0.01). Conclusions The impact of specific food groups on environmental footprints varies across countries and between different socio-demographic groups, signaling that cultural, literacy and generational factors possibly contribute to determine consumers’ environmental footprints. Key messages • The environmental impact varies across nations and socio-economic groups, highlighting the significant role played by cultural and generational factors in shaping consumers’ environmental footprints. • The study findings are crucial for the development of country-specific food policies aimed at promoting environmentally friendly diets.

Delving into vaccine hesitancy through multicentre studies: VAX-TRUST and INF-ACT projects’ insights

Abstract Vaccine hesitancy is a wide and varied phenomenon and represents a challenge for healthcare professionals (HCPs), who may encounter obstacles in building trusting relationships with parents and patients. Depicting the multifaceted aspects of hesitancy and finding effective tools that could help HCPs in addressing this issue are major public health priorities. This presentation will provide insights about two multicentre research initiatives that aim to respond to these needs. The “VAX-TRUST - Addressing Vaccine Hesitancy in Europe” project (funding from European Union's Horizon 2020 research and innovation program under Grant Agreement No. 965280) involves several institutions across Finland, Belgium, Poland, the Czech Republic, Italy, Portugal, and the UK. One of the goals of VAX-TRUST is to assist HCPs in dealing with hesitancy by implementing tailored interventions, specific for each target region. The process of development of interventions, starting from data supporting the planning up to the final intervention framework, will be discussed. The INF-ACT project (Next Generation EU funding within the MUR PNRR Extended Partnership initiative on Emerging Infectious Diseases, Project no. PE00000007) is a multicentre collaboration including universities and institutions throughout Italy. Within this project, the EPI-MOD node will contribute to realize novel monitoring methods to gather information on human behaviours during outbreaks and evaluate vaccine hesitancy levels and determinants. Among the main objectives, EPI-MOD will examine features and applications of immunization registries and will delve into vaccine hesitancy through a broad Italian nationwide survey, profiling subgroups of population at high risk for vaccine hesitancy. Overall, the results of these two large projects will allow to integrate novel data into information for action by identifying interventions that could be used to support HCPs and vulnerable groups that may require additional attention.

Adverse Childhood Experiences and Sexual Orientation: An Intersectional Analysis of Nationally Representative Data

This study compared the prevalence of adverse childhood experiences across intersections of sexual orientation, gender, race/ethnicity, and economic status. Data collected between 1994 and 2018 from 12,519 participants in the National Longitudinal Study of Adolescent to Adult Health were analyzed in 2023 to generate adverse childhood experience prevalence estimates. Unadjusted 1-way ANOVAs and multivariate regressions were performed to compare differences in independent and cumulative adversity measures by sexual orientation, gender, race/ethnicity, and poverty status. A multilevel analysis of individual heterogeneity and discriminatory accuracy was conducted to estimate adversity scores across 24 groups that were stratified by sexual orientation, gender, race/ethnicity, and poverty status. Adolescents with same-sex attractions and adults who identified with a sexual minority group reported more adverse childhood experiences overall than straight participants, although associations varied by type of adversity. Strikingly, adversity scores were higher among White youth with same-sex attractions than among Black youth with same-sex attractions, among more economically advantaged bisexual adults than among poorer ones, and among poor White participants than among poor Black and Hispanic participants, suggesting that the combination of disadvantaged and marginalized statuses does not necessarily correspond with greater childhood adversity. A multilevel analysis of individual heterogeneity and discriminatory accuracy interaction model showed that sexual orientation and poverty status contributed significant variance to cumulative adversity scores, whereas gender and race/ethnicity did not. The results show that disparities in adverse experiences can be more fully and accurately represented when sexual orientation and other social identities are modeled as intersectional configurations. Given that adverse childhood experiences are linked to morbidity and mortality, the findings have salient implications for understanding health disparities that affect population subgroups.

A systematic review of real-world contact tracing strategies at the onset of the COVID-19 pandemic

Abstract Background Contact tracing (CT) represented one of the core activities for the prevention and control of COVID-19 in the early phase of the pandemic, before the availability of effective vaccines. Poor evidence is available on the real-world implementation of CT strategies and adoption of CT digital tools during the initial phase of the emergency. Methods We aimed to provide a comprehensive picture of the organizational aspects of CT activities during the first wave of the pandemic, through the identification and description of CT strategies used in different settings during the period March-June 2020 and of digital tools adopted in the early phase. A systematic review of published studies describing organizational models of COVID-19 CT strategies and digital tools used in real-world settings was conducted. PubMed, Embase and Cochrane Library were searched. Results We retrieved a total of 1,637 studies, 30 of which met all our inclusion criteria. Seven studies target the general population, 10 studies described CT activities carried out in specific population subgroups, 13 described the use of CT apps in real world settings. Main activities implemented to rapidly scale-up CT activities included decentralization of CT, involvement of trained non-public health resources (e.g. University students, civil servants), use of digital tools for CT management, inter-agency collaboration, community engagement. Digital apps proved to be a useful supplementary component in CT strategies, however their acceptability was hampered by privacy, equity and effectiveness's concerns. Conclusions Despite the lack of data on CT effectiveness, available evidence provides indication on coordination mechanisms and use of human and technical resources needed for the rapid scale up of CT activities. Further research on real world implementation of CT strategies during the COVID-19 pandemic would be needed to contribute to a more robust evidence-making process. Key messages • Decentralization of CT activities, involvement of trained non public health professionals, intersectoral collaboration were the key components of early COVID-19 CT strategies. • The use of smartphone apps and other digital tools proved to be a substantial support for CT activities. However, privacy, ethics and equity issues must be clearly addressed.