Based on national mortality surveillance data (2004–2021), this study analyzed breast cancer mortality trends in China using Joinpoint regression. Among 110,224 recorded deaths, female crude mortality (7.26/10⁵) far exceeded male (0.14/10⁵), with significant urban-rural disparities. Age-standardized rates highlighted a widened gender gap (female ASMR: 8.10/10⁵; male: 0.17/10⁵). Female crude mortality rose steadily (AAPC = 2.21
The double burden of malnutrition (DBM)—the coexistence of micronutrient deficiencies and overweight/obesity—poses a growing challenge in pediatric populations. This cross-sectional study examined divergent associations of vitamin D, vitamin A, zinc, and iron deficiencies with cardiometabolic risk factors in Chinese children and adolescents (Causality cannot be inferred from these observational data). This cross-sectional study analyzed data from 9,585 children and adolescents aged 6–17 years from the Nutrition and Health Survey in Zhejiang Province (2022–2024). Micronutrient status was assessed using established cut-offs. Cardiometabolic outcomes included seven binary risk factors and the continuous metabolic syndrome score (cMetS). Modified Poisson regression with robust standard errors and multiple linear regression were used, adjusted for age, sex, residence, and energy intake. Vitamin D deficiency was associated with higher risk of hypertriglyceridemia (RR = 1.13, p = 0.005) and low HDL-C (RR = 1.45, p < 0.001), yet lower risk of hypercholesterolemia (RR = 0.85, p = 0.007) and hypertension (RR = 0.88, p = 0.022). Vitamin A deficiency was inversely associated with overweight/obesity (RR = 0.68, p < 0.001), hypertriglyceridemia (RR = 0.35, p < 0.001), and hypertension (RR = 0.68, p = 0.032). Zinc deficiency risk showed divergent associations: lower risk of overweight/obesity (RR = 0.85, p = 0.033) and hypertension (RR = 0.66, p < 0.001), yet higher risk of impaired fasting glucose (RR = 2.27, p < 0.001) and low HDL-C (RR = 1.62, p < 0.001). Iron deficiency was inversely associated with overweight/obesity (RR = 0.74, p = 0.002), hypertriglyceridemia (RR = 0.75, p = 0.005), and low HDL-C (RR = 0.38, p < 0.001). In the blood pressure subsample (n = 3,492), cMetS was higher with vitamin D deficiency and zinc deficiency risk (β = 0.356 and 0.515) but lower with vitamin A and iron deficiencies (β = − 0.700 and − 0.374; all p ≤ 0.013). The inverse associations for vitamin A and iron were attenuated after additional adjustment for BMI z-score, whereas the adverse associations for vitamin D and zinc remained robust. Micronutrient deficiencies showed nutrient-specific, bidirectional associations with cardiometabolic risk in this cross-sectional study. Vitamin D and zinc deficiencies were consistently associated with adverse profiles, whereas the inverse associations for vitamin A and iron should not be interpreted as evidence of protective effects of deficiency; they likely reflect adiposity-driven metabolic and inflammatory alterations. Precision nutrition approaches that account for metabolic context warrant evaluation for micronutrient screening and supplementation in youth with obesity.
Obesity is a significant global public health issue, traditionally linked to adverse health outcomes. However, the “obesity paradox” suggests that in certain populations, obesity may be associated with better prognosis. This study investigates the relationship between waist-to-hip ratio (WHR), a marker of central obesity, and cancer incidence, all-cause mortality, and cancer-specific mortality in a large prospective cohort from Northern China. Data from the Kailuan Cohort, comprising 94,139 participants, were analyzed. WHR was categorized by sex (low, normal, high), and its associations with cancer incidence, all-cause mortality, and cancer-specific mortality were evaluated using multivariate Cox proportional hazards models. Higher WHR was significantly associated with increased risks of all-cause mortality (7
Older adults are among the groups most vulnerable to disasters, yet the General Disaster Preparedness Belief (GDPB) scale has not been psychometrically evaluated in this group. We evaluated the construct validity, reliability, and sex-based measurement invariance of the 31-item GDPB scale in adults aged 60 and over, identified components requiring refinement, and examined sociodemographic correlates. Four hundred three community-dwelling adults aged 60 and over in Kepez, Antalya, Türkiye, completed the 31-item GDPB scale in January–February 2026 in this cross-sectional study. Confirmatory factor analysis (WLSMV) compared correlated six-factor, single-factor, higher-order, and bifactor models. Convergent and discriminant validity (AVE, composite reliability, Fornell–Larcker, HTMT), reliability, and ordinal sex invariance were examined, and sensitivity analyses excluded misfitting subscales. Correlates of the total score were analysed with multiple linear regression (HC3 robust standard errors; education modelled categorically). The six-factor model outperformed the single-factor model (scaled Δχ² = 942.73, Δdf = 15, p < .001); a higher-order model was retained, with CFI and TLI below 0.90 (CFI = 0.878, TLI = 0.867, RMSEA = 0.064, SRMR = 0.091). Misfit concentrated in perceived severity (second-order loading − 0.23). A 28-item version excluding severity met the CFI, TLI, and RMSEA thresholds (CFI = 0.910, TLI = 0.901, RMSEA = 0.060; SRMR = 0.081), with higher reliability (alpha = 0.865, omega = 0.903), hierarchical omega = 0.83, and r = .98 with the full total. After merging sparse response categories, threshold and loading invariance across sex held for the 28-item version but not for the severity items. Education was the strongest correlate, following a threshold rather than a linear pattern (nonlinearity p < .001): adjusted means were 65–68 up to secondary education versus 85–106 for high school and above (R² = 0.538, adjusted 0.524), replicating with the 28-item total. In older adults, the general GDPB dimension received partial support, but subscale-level validity was limited, and the perceived severity items, which undermined the 31-item total, may require age-sensitive redevelopment. The 28-item total is proposed as a provisional scoring form pending independent confirmation, and older adults with primary education or less, who showed uniformly low belief, may warrant priority attention.
Teenage pregnancy is a global public health priority, yet evidence from fragile and post-conflict states remains sparse. In Somalia, adolescent fertility significantly hinders progress toward Sustainable Development Goals (SDGs) 3, 4, and 5. This study aimed to determine the spatial variation and multilevel determinants of teenage pregnancy to provide a geographic roadmap for targeted interventions. We conducted a secondary analysis of the 2020 Somali Health and Demographic Survey (SHDS), utilizing a nationally representative weighted sample of 3,277 adolescent girls (aged 15–19 years). An integrated analytical approach was employed: multilevel mixed-effects logistic regression was used to identify individual and community-level drivers, while spatial autocorrelation (Global Moran’s I, LISA, and Getis-Ord G_i^* ) was used to identify localized hotspots and geographic clustering of pregnancy risk. The prevalence of teenage pregnancy in Somalia was alarmingly high at 49.49
To quantify annual U.S. cardiovascular disease costs attributable to absence of muscle‑strengthening exercise and to describe variation by condition, age, and sex. A population attributable fraction framework combined etiologic risk from cohort meta‑analyses (any muscle‑strengthening exercise versus none pooled relative risk 0.83; inverted to 1.20, 95
On 31 January 2023, the province of British Columbia (BC), Canada implemented a three-year “Decriminalization Pilot” in response to a toxic drug supply public health emergency, which removed criminal sanctions for the personal possession of some drugs below a cumulative total of 2.5 g. We sought to measure frequency of police drug seizures without arrest before and during the Decriminalization Pilot, and to determine potential relationships between police drug seizures and nonfatal overdose in the urban setting of Vancouver, BC. We drew from a prospective cohort study and employed multivariable generalized estimating equations models. We used data collected between March 2022 and February 2024 among a prospective cohort of people who use drugs. Among study participants (n = 490), the quarterly prevalence of police-enforced drug seizures without arrest in the past month ranged from 0.8
Rising global divorce rates have increased the prevalence of non-intact families, which may be associated with adolescents’ behaviors and mental health. Non-intact family types (NIFTs) and health-risk behaviors (HRBs) are both associated with adolescent mental health, yet previous studies have often examined these factors separately. Evidence remains limited regarding the clustering of HRBs, distinctions among specific single-parent and reconstituted family types, and the role of grandparent-headed families. This study examined HRB clustering among adolescents in Shandong Province and evaluated the independent and joint associations of five NIFTs and HRB classes with depressive, anxiety, and comorbid symptoms. From 2023 to 2024, a cross-sectional survey of 292,536 students from junior, senior, and vocational high schools across all 136 districts/counties in Shandong, China, was conducted using self-administered questionnaires on sociodemographic characteristics, 10 HRBs, and 5 non-intact family types. Latent class analysis identified HRB classes. Logistic regression was used to estimate the independent associations of family type and HRB classes, as well as the joint associations of their combined categories, with depressive, anxiety, and comorbid symptoms. Four HRB classes were identified, with the Unhealthy Diet class most prevalent (40.13
The rapid expansion of digital technologies has sparked debate over whether they exacerbate or alleviate existing health inequalities, yet empirical evidence from developing countries remains inconclusive. This study investigates the association between digital technology adoption and relative health deprivation, and examines the mediating pathways and heterogeneous associations underlying this relationship. Using data from the 2020 China Family Panel Studies—comprising 17,082 adults aged 16 and above—this study employs ordinary least squares, Tobit, and two-stage least squares estimations to examine the relationship between digital technology and relative health deprivation. Relative health deprivation is measured using the Kakwani relative deprivation index based on Body Mass Index, with self-rated health used for robustness checks. Bootstrap mediation analysis is conducted to test the mediating roles of physical activity and digital information seeking, and interaction models are employed to examine heterogeneity across gender, age groups, and household registration. Digital technology adoption is significantly and negatively associated with relative health deprivation. The association remains robust across multiple specifications, including alternative estimators and health indicators. Mediation analysis reveals that physical activity and digital information seeking partially mediate this relationship, with digital information seeking accounting for a larger share of the total effect. Heterogeneity analysis indicates that the association is more pronounced among women, middle-aged and older adults, and rural residents. Regarding usage patterns, the users-only analysis reveals that the intensity-health associations are particularly pronounced for consumption and learning. This study provides empirical evidence that digital technology is associated with lower levels of relative health deprivation, with physical activity and digital information seeking serving as mediating pathways. These findings suggest that digital technology may serve as a compensatory mechanism for structural health disadvantages—a pattern consistent with resource substitution theory—and have implications for digital health policies aimed at promoting health equity among disadvantaged populations.
Personality traits influence eating behaviors and dietary quality, and given the high prevalence of unhealthy eating habits among university students and the benefits of mindful eating, the relationship between personality dimensions and mindful eating in this population represents an area requiring further research. The aim of this study was to investigate the associations between personality traits and mindful eating behaviors in university students. This cross-sectional study conducted in Türkiye via an online survey from October to November 2025 involved 875 university students (80.1
Lung cancer remains the leading cause of cancer-related mortality worldwide, with stage at diagnosis significantly influencing survival outcomes. This systematic review evaluates global variations in lung cancer stage distribution at diagnosis and examines the associations of socioeconomic factors and screening programs with these disparities. We conducted a systematic review following PRISMA guidelines, searching PubMed, Embase, and grey literature up to August 14, 2024, to identify population- or hospital-based cancer registry data on lung cancer staging. Data from 36 countries were analyzed, focusing on the proportion of distant metastatic cases. We assessed associations with Human Development Index (HDI) and Socio-Demographic Index (SDI) using case-number-weighted linear regression model and evaluated time trends in countries with and without screening programs. Subgroup analyses explored variations by sex, age, and tumor type. Among the 35 countries analyzed in the main study, the median proportion of lung cancer cases diagnosed with distant metastasis was 50.8
This study is part of the Skills for life project, which aims to develop, test, and evaluate a practical university dietary life skills course to foster students’ food literacy and a healthy diet. The Developmental Origins of Health and Disease (DOHaD) framework emphasises the importance of preconception health (PCH), including dietary health, in shaping pregnancy outcomes and reducing the risk of chronic diseases. Approximately 70
Transgender and gender diverse (TGD) youth experience significant inequities in healthcare access, safety, and quality. Caregivers play a critical role in facilitating access to care; however, they also experience emotional burden and cumulative stress when navigating complex healthcare systems for their children. A comprehensive understanding of both youth and caregiver perspectives is needed to inform more equitable healthcare. To synthesise qualitative evidence on the healthcare experiences of TGD youth from the perspectives of both youth and their caregivers, and provide recommendations for more equitable care based on this evidence. A scoping review was conducted in accordance with PRISMA-ScR guidelines. PsycINFO, CINAHL, PubMed, Scopus, and Google Scholar were searched for primary, peer-reviewed studies including qualitative data published in the past 10 years. Data were analysed using thematic synthesis. Forty-six studies representing 664 youth and 932 caregivers were included. Five themes were generated: (1) limited access to timely, affordable and competent care; (2) fragmented systems and unclear care pathways; (3) balancing in-person and telehealth care; (4) the importance of affirming and patient-centred care; and (5) negotiating care in the context of unequal power and control. Healthcare experiences for TGD youth, as reported by young people and their caregivers, are often complex and challenging. Access to appropriate and safe care depends on supportive caregivers who advocate for their children’s needs, and providers who are accepting and knowledgeable. To improve health equity for TGD youth, four recommendations are offered: enhancing provider education, implementing inclusive clinical practices, adopting a relational model of care, and advancing practitioner-led structural advocacy.
Climate change is a pressing global public health concern of the twenty-first century. Though the crisis affects everyone, its severity on children and adolescents is disproportionate. This umbrella review synthesized evidence from existing reviews on the impacts of climate change on children's and adolescents' health, identified vulnerability factors, and evaluated available public health interventions. Following Arksey and O'Malley's framework and PRISMA-ScR guidelines, we conducted an umbrella review, searching five databases (PubMed, Scopus, Web of Science, ScienceDirect, JSTOR) and Google Scholar for peer-reviewed reviews published between January 2000 and December 2025. Four authors, supported by 10 graduate students, independently screened records, extracted data, and assessed quality using the AMSTAR tool. Thematic content analysis synthesized findings on climate exposures, health impacts, vulnerability factors, and interventions. Twelve reviews (six scoping, three systematic, and three other types of review) were included from 1,962 initial records. Climate exposures affecting children and adolescents included extreme weather events, temperature extremes, air pollution, changes in disease vectors, and indirect exposures through food and water insecurity and psychological stress. Health impacts spanned mental, physical, and developmental domains. Vulnerability factors included biological susceptibility, socioeconomic disadvantage, and geographic location. Effective interventions included educational programs, mental health support, heat action plans, early warning systems, and climate mitigation policies that yield health co-benefits through improved air quality. Climate change poses severe, immediate threats to child and adolescent health, disproportionately affecting vulnerable populations in LMICs. Evidence shows a triple burden: biological, socioeconomic, and geographic vulnerabilities compound to create cumulative health risks. Critical research gaps remain in LMICs, slow-onset exposures, intervention effectiveness, and standardized measurement tools. Urgent action on mitigation and adaptation is essential to prevent the reversal of decades of progress in child and adolescent health.
Across the western world, men tend to have lower life expectancy compared to women and have higher mortality rates for most of the leading causes of deaths at all ages. Though not fully accounting for the disparity, biological factors and the fact that men engage less with traditional healthcare services contribute meaningfully to men’s heightened vulnerability to certain diseases and health conditions. Men are conscious and take responsibility of their health when engaged in ways that are meaningful, strengths-based and aligned with their interests, identities and social contexts. Community sport settings have emerged as particularly promising environments for health promotion, providing opportunities for physical activity (PA), social connection, belongingness and positive engagement among men who may be less likely to engage with traditional healthcare services. The Football Association of Ireland (FAI) plans to bring an evidence-based, Danish, 12-week Football programme (renamed ‘Football for Life’ [FfL]) to men in Ireland to improve their overall health and wellbeing. This study will inform the replication of the FfL programme across the FAI Club network for the benefit of the male population health. Adopting a pragmatically controlled design within a Social Return on Investment (SROI) framework, this study proposes to assess the feasibility of the FfL programme delivered in two FAI clubs. The study employs mixed methods approach whereby each step of the seven steps of the SROI framework will be treated as a separate study; steps 1, 2 and 3 will adopt a qualitative approach to develop Theories of Change (Toc) for each stakeholder group, while steps 4, 5 and 6 will adopt quantitative approaches to measure, value and rank outcomes. Step 7 will detail the processes involved in the calculation of the final SROI figure. The findings from this study will inform fidelity of delivery and equitable benefits for participants when the FfL programme is replicated. The use of SROI and adherence to the 5C framework strengthens the case for investment while providing insights into how gender-responsive Evidence Based Practices (EBPs) can be designed, implemented and replicated in other settings. This study has been registered with the ‘International Standard Randomised Controlled Trial Number’ registry [ISRCTN14888262] as of the 2nd of July 2025.
Chronic pain is an established risk factor for chronic lung disease (CLD). However, previous studies have mainly focused on pain intensity or the number of pain sites, with limited attention to long-term pain trajectories. This study aimed to investigate the associations of pain status, longitudinal pain transitions and trajectories, and cumulative pain exposure with incident CLD. Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS), including participants aged ≥ 45 years. Pain was assessed longitudinally using four approaches: baseline pain status (2015), pain status transitions (2015–2018), long-term pain trajectories (2015–2020), and cumulative pain exposure. Incident CLD was followed through 2020. Multivariable Cox proportional hazards models were used to evaluate associations of baseline pain status and pain transitions with CLD risk, while logistic regression models assessed associations of long-term pain trajectories and cumulative pain exposure with CLD risk. Sensitivity analyses were conducted to test robustness. Baseline pain was significantly associated with increased CLD risk (HR 1.25, 95
Smoking and heavy drinking often co‑occur, but their joint effects on lung and liver function in the general population are unclear. We examined their separate and combined associations, dose‑response relationships, and additive interactions. Data came from 1,512 adults who had a health examination in 2025. Smoking was measured in pack‑years, alcohol as pure mL/week. Poor lung function was defined as FEV₁/FVC < 0.7 plus FEV₁
Digital health literacy (DHL) and self-efficacy are increasingly recognized as important behavioural determinants of hypertension management, yet evidence on their combined association with blood pressure control in sub-Saharan Africa remains limited. This study investigated the cross-sectional association between DHL, self-efficacy for hypertension self-management, and blood pressure control among adults living with hypertension in Mampong Municipality. A cross-sectional study was conducted among 360 adults living with hypertension in Mampong Municipality. DHL was measured using the 8-item eHealth Literacy Scale (eHEALS; Cronbach’s α = 0.871), and self-efficacy (SE) using the 8-item Self-Efficacy for Hypertension Self-Management Scale (SE-HTA; α = 0.783). Multivariable logistic regression was used to examine associations between study variables and uncontrolled blood pressure. Model performance was assessed using the Hosmer-Lemeshow test and the area under the receiver operating characteristic curve (AUC). Out of the 360 participants, 74.2
Suicide risk is elevated in agricultural populations, and pesticide use intensity has been proposed as a potential contributing factor. However, nationwide ecological evidence linking pesticide use intensity to suicidal behavior remains limited. This study examined ecological associations between pesticide use intensity and hospitalized suicide-attempt rates among agricultural populations in France. Department-level pesticide use indicators were obtained from French Ministry of Agriculture open databases, and hospitalized suicide-attempt data were obtained from the French agricultural health insurance system (MSA) for 2020–2022. Associations between pesticide use intensity and hospitalized suicide-attempt rates were examined using Poisson regression models adjusted for MSA population size and historical standardized suicide mortality. Additional sensitivity analyses adjusted for territorial covariates. Higher pesticide use intensity was consistently associated with higher suicide-attempt rates across the three study years. Associations remained robust in sensitivity analyses adjusting for MSA population structure, healthcare-access indicators, socioeconomic indicators, rurality, and overall departmental suicide-attempt rates in the general population. Associations were strongest for conventional chemical pesticide use, whereas herbicide-specific associations were weaker and less consistent. Greater agricultural pesticide use intensity was associated with higher hospitalized suicide-attempt rates among MSA affiliates in France. Limitations include the ecological design, the absence of individual exposure and method-specific suicide-attempt data, and the inability to identify the underlying mechanism. Further individual-level and longitudinal research is needed to clarify the pathways underlying this association.
Health literacy (HL) is an important factor associated with health outcomes and health equity. The relationship between social determinants and HL remains underexplored in Gonabad County, Iran. Therefore, this study aimed to describe HL levels and examine associated social determinants among adults registered at three participating urban–rural Comprehensive Health Service Centers in Gonabad County, Iran. We conducted a cross-sectional study among 496 individuals aged 18 years or older who were registered at three urban–rural Comprehensive Health Service Centers in Gonabad County, Iran, in 2022–2023. Participants were selected using stratified random sampling and completed the Health Literacy Instrument for Adults (HELIA) and a sociodemographic questionnaire. Linear regression was used to examine associations between sociodemographic and socioeconomic factors and HL. The mean age of participants was 35.48 years (SD = 12.60), and 58.9
