Background: Cannabis vaping has emerged as a rapidly expanding mode of marijuana consumption in the United States. Although cannabis use has been linked to adverse mental health outcomes, nationally representative evidence examining the association between psychological distress and cannabis vaping among adults remains limited. Methods: This cross-sectional study analyzed data from 45,133 U.S. adults participating in the 2023 National Survey on Drug Use and Health, representing approximately 257.5 million adults nationally after applying survey weights. Past-month cannabis vaping and past-month psychological distress were assessed using standardized NSDUH measures. Survey-weighted prevalence estimates were calculated, and Rao–Scott chi-square tests were used to compare groups. Survey-weighted logistic regression models estimated adjusted odds ratios (AORs) and 95% confidence intervals (CIs), controlling for sociodemographic characteristics, medical marijuana law status, past-month alcohol use, past-month tobacco use, and past-year mental health support group participation. Results: The weighted prevalence of past-month cannabis vaping was 4.9% (95% CI, 4.6–5.2) among adults without psychological distress and 16.5% (95% CI, 14.9–18.0) among those with distress (p < 0.001). After adjustment, psychological distress was associated with significantly higher odds of cannabis vaping (AOR = 1.85; 95% CI, 1.55–2.21; p < 0.001). Conclusions: Psychological distress was strongly associated with cannabis vaping among U.S. adults. Integrating mental health considerations into cannabis-related prevention and screening efforts may be important as vaping products continue to evolve and expand. Keywords: Cannabis vaping; Psychological distress; NSDUH; Substance use; Mental health; United States
The rapid diffusion of large language models (LLMs) is reshaping many aspects of biomedical research, prompting reflection on the evolving role of biostatisticians in a changing landscape. This commentary addresses this transformation from two complementary perspectives. First, we examine how LLMs can assist biostatisticians in professional practice, highlighting their potential to enhance efficiency, support complex analytical reasoning, and facilitate communication and training. Second, we discuss the limitations and risks associated with LLM use, including challenges to reproducibility, susceptibility to bias, data protection and regulatory constraints, and limited accountability. Finally, we outline a vision for the role of scientific societies in actively guiding this transition. By promoting methodological competence, ethical awareness, and professional identity, they can help ensure that generative AI becomes an instrument of responsible innovation rather than a source of methodological bias and epistemic uncertainty.
Background: School-age children in low and middle-income countries face high risks of malnutrition, affecting their growth, cognition, and long-term health. This study compared the nutritional status of government and private primary school pupils in Dutse, Jigawa State, Nigeria, using raw anthropometric indices and World Health Organisation (WHO) AnthroPlus Z-score indicators. Methods: A cross-sectional comparative study was conducted among 500 children aged 5–12 years selected from one government and one private primary school. Weight, height, body mass index (BMI), waist circumference and hip circumference were measured using standardised procedures. Mean differences by sex, age group, and school type were assessed using independent t-tests. Weight-for-age (WAZ), height-for-age (HAZ), and BMI-for-age (BAZ) Z-scores were generated using WHO AnthroPlus and interpreted according to WHO reference standards. Results: Raw anthropometric measures showed limited differences between groups, with BMI largely comparable across schools and sexes. In contrast, WHO AnthroPlus Z-scores revealed substantial undernutrition. Stunting prevalence was considerably higher among government school pupils than private school pupils, particularly among children aged 10–12 years (65.1% vs. 38.2%). Government school girls aged 10–12 years exhibited the highest burden of stunting, with over 80% below −2 standard deviation for HAZ. Conclusion: WHO AnthroPlus Z-scores detected significant growth deficits not revealed by crude anthropometric measures. Routine use of standardised growth references is essential for accurate nutritional assessment, and targeted interventions should prioritise government school pupils, particularly girls, among Nigerian school-aged children.
Background: In Cameroon, malaria is a significant public health issue, with heterogenous distribution and seasonal change making control and containment harder to plan. Medium-term projections are needed to provide reliable early warning and optimal prevention resource allocation. Traditional methods, including ARIMA and SARIMA, are dogged by noisy surveillance data as well as structural non-stationarity, and the hybrids currently being applied rarely measure the uncertainty in the forecasts. Methods: We introduce a multi-step hybrid forecasting pipeline to combine wavelet-based denoising, robust Seasonal-Trend decomposition with Loess (STL), and state-of-the-art remainder modeling. The remaining component was decomposed by using ARIMA, SARIMA, or Bayesian Structural Time Series (BSTS) and forecasts were recreated out of all components. The analysis was conducted on monthly malaria incidence in the ten administrative regions of Cameroon and 24-month future projections were developed. RMSE, MAE, R2, and information criteria were used to evaluate model performance, and uncertainty was measured using analytical intervals (ARIMA/SARIMA) and posterior predictive distributions (BSTS). Results: The Wavelet STL preprocessing significantly enhanced model stability, and model accuracy in all regions. ARIMA and SARIMA models performed similarly, and R2 values were typically between 0.49 and 0.77, indicating the usefulness of STL in eliminating seasonal effects. In many areas BSTS was significantly higher or as large as ARIMA/SARIMA, and obtained higher R2 values. Notably, BSTS offered probabilistic predictions that were calibrated, which allowed to effectively measure the forecast uncertainty. The results presented in this paper indicate that the hybrid pipeline suggested is both noisy and uncertain, and can provide forecasts of malaria cases in the villages of Cameroon over a period of 24 months with high confidence. Conclusion: The Wavelet-STL hybrid model is the next step in malaria prediction by combining the denoising, structural decomposition, and probabilistic models. Its deployment in the regions of Cameroon shows innovative methodological value and direct applicability to early warning systems. The method can be easily extended to other infectious diseases with seasonal spread and noisy surveillance data.
We focus on how combining questionnaire’s items to derive a score. Data simulation and real data were used to compare questionnaires’ scores derived by sum of items and scores derived from a confirmatory factor analysis. We investigated the equivalence of the sum of items and the latent factor scores from confirmatory factor analysis in simulative and empirical studies. We investigated to what extent the derivation of the score may have influenced the assumptions of linear model analysis. Deriving the questionnaire’s scores using the sum of items or the application of the confirmatory factor analysis is equivalent. This evidence is confirmed in the simulation settings and by empirical data.
Background: Ambient air pollution is a major public health threat, especially to children. Fine particulate matter (PM₂.₅) has been associated with anemia through decreased haemoglobin concentrations by inducing oxidative stress and inflammation. In low- and middle-income countries (LMICs), where malnutrition, infections, and air pollution overlap, anemia is still a leading health issue. Method: This meta-analysis considers the relationship between exposure to PM₂.₅ and anemia in children across studies published within the period from 2010 to 2023. Results from various geographical regions, including India, Latin America, and Sub-Saharan Africa, were incorporated. Results: A total of 745 records were identified through the database search and 10 studies were included in the qualitative synthesis based on the inclusion criteria. The heterogeneity between included studies was considerable, with a Tau² of 0.03, a Chi² of 42.55, and an I² of 79%. This degree of heterogeneity implies significant differences between studies, possibly because of differences in pollution levels, population characteristics, and study design. The overall impact (N = 6,550; SMD = 1.19; 95% CI: 1.07–1.30; p < 0.00001) was significant, suggesting that exposure to pollution has a quantifiable adverse effect on haematological well-being in children. Increased levels of PM₂.₅ correspond with lower haemoglobin and risk of anemia. Children with high levels of pollution in regions are at more risk, particularly those with any underlying health complication. Susceptibility to pulmonary infections is also increased by air pollution, hence additional health danger. Conclusion: This research critically assesses the relationship between contemporaneous air pollution and childhood anemia. Implications underscore the imperative for policies on the environment and health to counteract the effects of air pollution on the health of children.
Aim: The global incidence rate of gout has shown a consistent increase, requiring an in-depth study of potential risk factors at the national and regional levels. This study uses data from the 2021 Global Burden of Disease, Injury, and Risk Factors Study to analyze the incidence trend of gout, in order to reveal the global disease burden of gout and provide a basis for optimizing prevention and control strategies for healthcare systems. Subject and Methods: This study collected data on gout from 1990 to 2021. Conduct decomposition analysis and frontier analysis to determine the changing trends of various indicators and their influencing factors. Results: According to global data in 2021, the number of incidence cases of gout reached 9,401,585 (95% uncertainty interval [UI]: 7,438,817-11,731,815 cases), and the number of prevalence cases was 56,474,572 (95% UI: 45,161,987-70,288,316 cases). The number of cases of DALYs was 1,747,546 (95% UI: 1,186,175-2,484,547 cases), an increase by 17.15-21.86% since 1990. Further analysis of the data from 1990 to 2021 showed that the estimated annual percentage changes (EAPCs) of the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and age-standardized disability-adjusted life-year rate (ASDR) were 0.67 (95% UI: 0.61-0.73), 0.87 (95% UI: 0.8-0.95), and 0.86 (95% UI: 0.78-0.93), respectively. There were more male cases than female cases, and the growth rate was higher in males than in females. However, the rising trend of the global incidence and disability burden of gout in women needs attention. Conclusion: With social progress, the burden of gout increases, mainly due to population growth and aging. Gout is associated with a high body mass index. Weight loss diets and lifestyle adjustments need to be promoted to reduce health burdens and prevent recurrences.
Aims: This study examines how digital information environments, genetic testing experiences, health behaviors, and psychological distress influence cancer-related worry among adults in the United States. It further considers the public health implications of elevated or reduced cancer worry for prevention and risk communication. Methods: Data were drawn from a nationally representative survey of 6,252 U.S. adults. Measures included reliance on social media for health decision-making, smoking status, history of genetic testing, and psychological distress. Multivariable analyses assessed associations between these factors and levels of cancer worry. Results/Findings: Reliance on social media for health decisions was associated with greater cancer worry, indicating that exposure to misinformation or amplified risk cues may heighten anxiety. Smoking was also linked to increased worry, consistent with higher perceived vulnerability. In contrast, individuals who had undergone genetic testing reported lower cancer worry, suggesting that structured risk information can reduce uncertainty. Psychological distress emerged as the strongest predictor of extreme cancer worry, highlighting the central role of mental health in shaping risk perceptions. Conclusions: Cancer worry is influenced by the interaction of digital information sources, behavioral risk factors, and psychological distress. Public health efforts should focus on strengthening digital health literacy, countering online misinformation, and incorporating mental health assessment into cancer prevention and communication strategies. These approaches may help support balanced risk appraisal and reduce unnecessary distress in the population.
Background: Gambling on the National Lottery in Ireland peaked recently at an annual gross spend of over €1 billion. There is ample evidence of underage participation in the lotto. Youth participation in gambling is associated with problematic gambling in adulthood. A recent examination of the National Lottery’s website identified child-friendly Halloween themed advertising. Objectives: This research sought to investigate National Lottery advertisements to identify potentially child and youth-oriented marketing. Methods: Quantitative content analysis of 127 video advertisements hosted on the National Lottery YouTube website were examined, using a pre-constructed six item framework. Results: There was evidence relating to three of the six categories of content examined. In total 21.3% (n=27) of the videos examined made direct use of signs, symbols, themes, drawings, fictitious characters, or real people of primary or particular appeal to children. A total of 6.3% (n=8) of the videos examined included children, while 0.8% (n=1) featured adolescent, juvenile, or loutish behaviour. Conclusions: Child-friendly marketing is present in National Lottery advertising. A more robust assessment of all National Lottery marketing materials is required. The Gambling Regulation Act, 2024, should be extended to oversee all gambling in Ireland, including the National Lottery. A public health approach to gambling is required across all state agencies and the Government.
Background: The increasing aging population [1] has increased the demand for caregiving in daily living activities (ADLs), positioning informal caregivers as key figures in care models [2,3,4]. Objective: This protocol outlines a systematic review, which is grounded in Smith’s Caregiving Effectiveness Model [5], designed to identify and categorize the skills transferred through educational interventions by healthcare professionals that improve informal caregivers’ quality of life (QoL). Study Design: Systematic review protocol following PRISMA-P guidelines [6]. Methods: We will search six databases (PubMed, CENTRAL, Scopus, Web of Science, ERIC, and CINAHL) for randomized controlled trials, cluster-RCTs, and quasi-experimental studies involving skill-improvement interventions aimed at informal caregivers of individuals dependent on ADLs. Outcomes of interest include caregiver QoL, burden, anxiety, stress, self-efficacy, and depression. Risk of bias will be assessed via RoB 2 and ROBINS-I tools [7,8]. Data will be synthesized narratively according to the domains in Smith’s Caregiving Effectiveness Model [5]. Registration: PROSPERO CRD42024607229 Keywords: Informal caregiver, caregiver training, quality of life, ADL, protocol, systematic review, caregiving skills, skill mix, primary care, public health
The emergence of antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a worrying global phenomenon, with major implications for public health. This study, a cross-sectional analysis of an open cohort, explored the risk factors associated with multidrug-resistant (MDR) gonococcal infections in the province of Québec, Canada, using data from the sentinel surveillance network from 2017 to 2019. The data comprised sociodemographic, epidemiological, and clinical information, collected through self-administered questionnaires, direct case interviews and chart reviews coupled with laboratory AMR data for five antibiotics: azithromycin, tetracycline, ciprofloxacin, cefixime, and ceftriaxone. Missing data were handled using multiple imputation with chain equations (MICE); generalized estimating equations (GEE) were used to assess correlates of MDR. The analysis included 714 participants with a total of 775 cases. We observed very frequent resistance to ciprofloxacin (74.3%), while resistance to tetracycline and azithromycin was 19.9% and 21.3%, respectively. MDR was found in 12.5% of cases. Multivariate analysis indicated that having five or more sexual partners in the past two months (aPR=1.61, 95%CI: 1.07-2.41) was associated with MDR. In conclusion, our results show an association between the number of sexual partners and MDR, supporting the hypothesis that resistance can develop more rapidly in dense sexual networks. It is crucial to address the issue of circulating resistant strains through ongoing surveillance, research, and targeted interventions to manage and contain them before they become widespread.
Background: There is sustained evidence of youth National Lottery participation in Ireland. Youth participation in gambling is associated with future problem gambling in adulthood.. Recent evidence suggests that National Lottery marketing materials in Ireland are overly child oriented. Objectives: This study explored child-oriented marketing practices associated with National Lottery draws in Ireland. Methods: Secondary analysis of data relating to National Lottery draw scheduling for 2023 and 2023 was examined to determine scheduling time and associated programming. Results: National Lottery draws in Ireland routinely take place at approximately 8.00pm on Saturdays and Wednesdays, long before the 9.00pm watershed in broadcasting. All of the associated programming with this time slot is 12/12A or younger (for a General audience [G], or Parental Guidance [PG]). Conclusions: These findings highlight longstanding child-oriented marketing practices associated with the National Lottery in Ireland. It is recommended that live National Lottery draws are moved to after the 9pm (21:00 Hrs) television broadcasting watershed. It is also suggested that current legislative separations are removed and the National Lottery becomes regulated under the more stringent Gambling Regulation Act, 2024. Finally, it is argued that a public health approach to all forms of gambling, including national lotteries, is adopted by the Office of the Regulator of the National Lottery (ORNL) and the Irish Government.
Background: The Dietary Intervention Study in Children (DISC) showed that a cholesterol-lowering dietary intervention can improve pediatric cardiovascular risk factors. Building on advances in longitudinal modeling, we re-analyzed DISC data to (1) reassess intervention effects using linear and spline mixed-effects models, (2) evaluate treatment effects within key subgroups, and (3) examine the impact of compliance on percent calories from fats. Methods: We conducted a secondary analysis of the randomized DISC trial, comparing a dietary intervention group with a usual care group. Linear mixed-effects and B-spline mixed-effects models characterized trajectories of LDL-cholesterol (LDL-C) and nutrient intake over time. We evaluated subgroup differences by sex and parental education and assessed compliance using session attendance and adherence to dietary goals for saturated fat, cholesterol, and total fat. Results: Compared with usual care, the intervention group showed a significant initial reduction in LDL-C and sustained decreases in total and saturated fat intake. B-spline models identified non-linear trends in LDL-C and dietary fat over follow-up. Higher attendance at intervention sessions was associated with reduced fat intake, with this effect less pronounced among girls. The intervention group also showed higher adherence to dietary goals, and higher parental education was related to better attendance. Conclusion: This reanalysis indicates that a family-based dietary intervention initiated in childhood can produce meaningful reductions in LDL-C and sustained improvements in dietary fat intake. The findings highlight the importance of adherence, parental involvement, and targeted support for specific subgroups in promoting long-term cardiovascular health in pediatric populations. Trial registration: NCT00000459.
Objectives: PFASs are synthetic chemicals that humans may be exposed to through workplace or the environment. Previous studies have suggested a carcinogenic effect. In our review, we investigated the association between PFAS exposure and risk of bladder and prostate cancer. Methods: We searched through IARC Monographs, ATSDR documents, and PubMed (up to January 2024) to find studies that examined the relationship between PFAS exposure and bladder and prostate cancer. Four reviewers independently screened studies, extracted data, and evaluated quality using a modified version of the Newcastle-Ottawa Scale (NOS). We conducted meta-analyses using random-effects models, stratified analyses, dose-response assessments, and evaluated publication bias. Results: We included 21 independent studies in our meta-analysis. The findings didn’t reveal an association between PFOA, PFOS, and PFAS exposure and bladder cancer, as well PFOA, PFNA and prostate cancer. However, we found an association between prostate cancer and total PFAS (RR = 1.12, 95% CI =1.06-1.18), based on two studies, and an association of borderline statistical significance with PFOS (RR = 1.04, 95% CI =0.98-1.11). There was no difference between outcome, region, year of publication, study design, quality score, and gender, exposure source and different levels of PFASs for both cancer types. Publication bias was excluded for prostate cancer studies (P = 0.71) and bladder cancer (P = 0.79). Conclusion: Our research did not find a link between different types of PFAS exposure and bladder cancer. However, it supports a potential association between PFOS exposure and prostate cancer. Bias and confounding cannot be excluded.
The Cox proportional hazards regression model is frequently used to develop clinical prediction models for time‐to‐event outcomes, allowing clinicians to estimate an individual's risk of experiencing the outcome within specified time horizons (e.g., estimate an individual's 10‐year risk of death). The Cox regression model models the association between covariates and the hazard of the outcome. A key assumption of the Cox model is the proportional hazards assumption: the ratio of the hazard function for any two individuals is constant over time, and the ratio is a function of only their covariates and the regression coefficients. Calibration is an important aspect of the validation of clinical prediction models. Calibration refers to the concordance between predicted and observed risk. The impact of the violation of the proportional hazards assumption on the calibration of clinical prediction models developed using the Cox model has not been examined. We conducted a set of Monte Carlo simulations to assess the impact of the magnitude of the violation of the proportional hazards assumption on the calibration of the Cox model. We compared the calibration of predictions obtained using a Cox regression model that ignored the violation of the proportional hazards assumption with those obtained using accelerated failure time (AFT) models, Royston and Parmar's spline‐based parametric survival models, and generalized linear models using pseudo‐observations. We found that violation of the proportional hazards assumption had negligible impact on the calibration of predictions obtained using a Cox model.
Introduction: Assessment of the applicability of primary studies to the review questions is an essential but often challenging aspect of systematic reviews of diagnostic test accuracy studies (DTA reviews). Objectives: To explore review authors’ applicability assessments for the QUADAS-2 reference standard domain within Cochrane DTA reviews, by highlighting applicability concerns, identifying potential issues with assessments. Using the findings to develop a framework for assessing the applicability of the target condition as defined by the reference standard. Methods: Methodological review. DTA reviews in the Cochrane Library that used QUADAS-2 and judged applicability for the reference standard domain as “high concern” for at least one study, were eligible. One reviewer extracted the rationale for the “high concern”, this was checked by a second reviewer. Two reviewers categorized the rationale inductively into themes, a third reviewer verified these. Discussions in the QUADAS development group (steering group and expert panel) regarding the extracted information informed framework development. Results: We identified 50 eligible reviews. We identified potential issues over half (n=28) of the included reviews. In 7, applicability assessments deviated from QUADAS-2 definitions and in 21 applicability concerns were insufficiently described. Five themes emerged in the remainder: study uses different reference standard threshold to define the target condition (6 reviews), misclassification by the reference standard in the study such that the target condition in the study does not match the review question (11 reviews), reference standard could not be applied to all participants resulting in a different target condition (5 reviews), misunderstanding QUADAS-2 applicability (7 reviews), and insufficient information (21 reviews). The Figure shows the framework that was informed by our findings and discussions. Our framework outlines four potential applicability concerns for the assessment of the target condition as defined by the reference standard: different sub-categories of the target condition, different threshold used to define the target condition, reference standard not applied to full study group, and misclassification of the target condition by the reference standard (Figure). Conclusion: Clear sources of applicability concerns are identifiable, but several Cochrane review authors struggle to adequately identify and report them. We have developed the first applicability framework to guide review authors in their assessment of applicability concerns for the QUADAS reference standard domain. The development of a framework for the QUADAS-2 domains Patient selection and Index Test are ongoing.
Alcohol remains a serious threat to the health and wellbeing of people across the island of Ireland. Ireland introduced legislation to introduce mandatory alcohol warning labels (AWLs) in 2026, although implementation is deferred until 2028. The cross-sectional survey research sought to explore support for AWLs across the island. The remainder of the survey then explored concerns people had with more graphic AWLs, as well as exploring what additional warnings or information people would like to see displayed in AWLs. Responses were gathered from 475 staff members and students at two universities, one located in Ireland and the other in Northern Ireland. A high level of support for the proposed Irish AWLs was noted (77.9%), with support for more graphic cigarette-style AWLs lower at 60.2%. The potential development of graphic AWLs evoked a considerable range of concerns thematically arranged as 1) Children; 2) Desensitisation; 3) Risks Over-played; 4) No Impact; 5) Unpleasant Viewing; 6) Addiction; 7) Trauma Trigger; 8) Stigmatisation; 9) Diverse Warnings. Although overall there is support for AWLs amongst the convenience sample, there remains confusion about the need and intent of AWLs. Further research is therefore recommended.
Background: Youth gambling in Ireland is of growing concern. Objectives: Thus, this study evaluated youth gambling protections in the Irish National Lottery’s online age verification system. Methods: A Tiger Team (Red Team) methodology was used. This involved using falsified National Lottery accounts (n = 56). Results: Over half (55.4%) of attempts were successfully verified, with successful verification significantly varying by gender. Conclusions: These findings highlight vulnerabilities in the National Lottery’s online age-verification system and underscore the urgent need for more robust safeguards to prevent underage access.
Introduction Unhealthy lifestyle behaviours are common modifiable risk factors for NCDs which cause a great decline for age group suffering from chronic diseases. The university years serve as a particularly crucial and formative stage for the overall development of lifelong behaviours that can either promote or seriously impair health outcomes. We aimed to assess health promoting lifestyle profile among university students and detect its determinants. Methodology Across-sectional study was conducted among 397 students (204 medical and 194 non-medical) using HPLP-II questionnaire. Results 75.82% of students were females and 96.22% were non-smokers. Less than half (43.3%) of students achieved total score of HPLP-II higher than 2.5. Medical students reported significant lower median total scores than non-medical ones (median:2.38 vs. 2.5 respectively). They also achieved significant lower median health responsibility (median 2 vs. 2.22) and nutrition (median 2.22 vs. 2.33) subscales compared to non-medical. Conclusion the higher burden that medical students face is responsible for the worse lifestyle scores they report. Intervention programs should be carried out to enhance lifestyle behaviours among the whole university students with special attention to medical ones.
