Preconception health improvement is vital for maternal and child health, yet societal perceptions about who holds responsibility for this remain underexplored. We conducted a hybrid workshop at the 2024 UK Preconception Early-Mid Career Researcher (EMCR) Network conference, attended by academics, health professionals and members of the public (N = 60). Small-group discussions on responsibility for preconception health improvement were audio-recorded and transcribed alongside notes from online whiteboards and paper-based flipcharts. Using framework analysis, we applied a deductive coding framework derived from the workshop questions. Attendees felt a disproportionate burden of responsibility for preconception health improvement was placed on women, reflecting deeply entrenched gendered norms within research, healthcare and broader societal structures. Attendees’ recommendations centred around (i) society, community and culture, (ii) education and early awareness, (iii) considerations for future research, and (iv) systems-level and policy solutions. These findings provide valuable insights for developing equitable public health strategies and research agendas relating to preconception health. Being healthy before pregnancy and parenthood is important. It affects pregnancy outcomes and lifelong wellbeing. But there are mixed views on who should be responsible for improving health before pregnancy. We held a workshop with 60 people, including health workers, researchers, and members of the public. We asked who is responsible for health before pregnancy and how this shows up in different contexts. We also asked for suggestions for how to make sure this responsibility is shared evenly. Attendees felt that women carry most of the burden. This happens in health care, research, and everyday life. Men are often left out of conversations about health around pregnancy. Current approaches to improving health before pregnancy focus on women’s choices and actions such as diet and smoking rather than wider issues like poverty, education, and health care access. Attendees felt that health before pregnancy should be a shared responsibility between partners, health workers, government, and society. They suggested including men equally in health care, research, and campaigns around health before pregnancy. They also said that education about this should start early, in schools. They called for changes in communities to support health before pregnancy, so that people don’t need to do this alone. These suggestions can help create fairer approaches to improving health before pregnancy and parenthood that support everyone. They reflect that this requires support from the whole of society.

Individual-level behaviors account for a majority of global emission levels, but motivating people to adopt more pro-environmental behaviors (PEB) remains a critical challenge. Research shows that brief, behavioral nudges can encourage PEBs. However, limited research has tested the efficacy of multi-dimensional framing. Through an online experiment (N = 1,535), we tested the effects of multi-dimensional message frames, or the combination of norms-based feedback (social comparisons, collective impact, or individual impact) paired with analogical framing (emissions in tons or gallons of gasoline), compared to a control condition. We test how these interventions change their willingness, likelihood, ability, and commitment to modifying their most frequent environmentally harmful behavior. Feedback that compared an individual's environmental behavior to the norm (“typical Americans”), or shared the collective emissions impact, when combined with equivalency framing, increased the likelihood and commitment to shift toward pro-environmental behaviors. All other combination frames had non-significant effects. We find that the intervention effects are fully mediated by a theory of planned behavior-like funnel, with social norms and interventions influencing willingness, likelihood, and commitment to behavior change. When individuals felt stronger control over the future of the environment, multi-dimensional frames more strongly motivated change across several treatment conditions. Otherwise, we find evidence of income as a moderator, with some numeric multi-dimensional frames backfiring for higher-income participants. This research offers insights into the efficacy, segmentation potential, and psychological limitations of multidimensional frames in sustainable decision-making. Leveraging these nuances could improve low-cost, scalable environmental framing strategies for policy, environmental advocacy, and other climate efforts.

Background: Systematic reviews suggest preconception health interventions may be effective in improving maternal and infant outcomes. However, few studies have explored women's views on the types of support required for preconception health improvement, nor when and to whom this support should be provided. Methods: We purposively sampled women aged 18-48 years in the West of England from respondents to a survey, and conducted semi-structured in-depth interviews to explore their views on support needs in the preconception period and target populations for this support. We analyzed the data using a data-driven framework analysis. Results: The women we interviewed (N = 20) broadly supported promoting greater awareness of preconception health and felt the limited focus on health before pregnancy downplays its importance relative to antenatal health. Some women opposed support services and structural interventions to improve preconception health, due to concerns these are less impactful than encouraging individual responsibility for health. Women who supported structural interventions highlighted broader determinants of health and socioeconomic barriers to preconception health improvement. Men were considered a key target population for preconception support, to help share the burden for preconception health improvement. Women broadly supported 'age-appropriate', school-based preconception health education, highlighting young women as an under-served group in need of additional preconception education. Conclusion: Our findings indicate a need to deliver early preventive support ahead of first pregnancy through services, interventions and policies co-produced with women and women's partners. Future research should explore how to increase public understanding of the socioeconomic, environmental and commercial determinants of preconception health.

Objective: To examine the prospective association between psychological well-being related measures and severe obesity development in young and middle-aged UK adults.Design: A longitudinal analysis of two cohort studies.Methods: We used data from the National Child and Development Study (NCDS) and the British Cohort Study (BCS) to examine the association between baseline psychological well-being related measures (depressive symptoms, life satisfaction, and self-efficacy) and severe obesity development (defined as body mass index – BMI ≥35) and residualised BMI change scores at follow-up. We analysed repeated measures of baseline and follow-up pairs with 6- to 7-year follow-up on average (n = 22,390 and 23,811 observations in NCDS and BCS, respectively) using panel data analysis and controlling for sociodemographic factors. We conducted additional analyses using analytical sample sizes with longer follow-up (16-17 years). Results: Although a range of sociodemographic factors (e.g., being female, non-married) were associated with increased risk of severe obesity development, we found limited evidence that psychological well-being related measures were associated with severe obesity development across cohorts and pooled analyses. Depressive symptoms, life satisfaction, and self-efficacy were however associated with relatively small changes in continuous BMI change across analyses and this tended to be limited to participants without obesity (BMI 18.5 – <30) and not those already living with obesity (BMI 30 – <35) at baseline.Conclusions: Although poorer psychological well-being is associated with modest changes in body weight in individuals without obesity, there is limited evidence that psychological well-being related measures prospectively predict the development of severe obesity.

Background: We examined the role of psychosocial factors in overweight and obesity development. Methods: UK Millennium Cohort Study data of children with normal weight were analysed. Weight changes were determined from baselines at ages 11 (n=7,979) and 14 (n=6,906) to follow-up at age 17. Baseline individual psychosocial factors were combined into two distinct indexes (caregiver-reported child mental health, child-reported psychosocial well-being). Regression models examined the associations between baseline indexes and individual psychosocial factors and overweight and obesity development (vs. no) and body mass index (BMI) z-score changes. Results: Worse child mental health, but not psychosocial well-being, at age 11 was associated with overweight and obesity development (OR=1.14;95%CI=1.02,1.27) and increased BMI z-scores (β=0.08;95%CI=0.04,0.12) to age 17. No psychosocial indexes at age 14 predicted the outcomes. Further analyses showed that child mental health at ages 11 vs. 14 was more likely to predict the outcomes. Based on individual factors, externalising symptoms and experiencing peer bullying at age 11 may be important contributors to overweight and obesity development. Conclusions: Poor child mental health at age 11 is associated with overweight and obesity development by age 17. Late childhood/early adolescence may be a sensitive period in which psychosocial factors determine body weight trajectories.

Background: Limited research has examined whether accumulation of discrimination over time is associated with worse mental health and whether such experiences are related to socioeconomic status (SES). Methods: A sample of UK adults with self-reported discrimination experiences (n = 3863) was taken from three waves of the UK Household Longitudinal Study (2015-2020). Multinomial logistic regression assessed associations between SES (income, education, occupation) and cumulative discrimination (number of timepoints discrimination was reported). Logistic regression models assessed prospective associations between cumulative discrimination and probable mental health problems (GHQ-12; 4+ threshold). Results: Those with lower income were more likely to report discrimination at one timepoint (vs. none). No SES measures were associated with experiencing discrimination at multiple timepoints. Participants who reported one timepoint of discrimination (vs. no experiences) were significantly more likely to report probable mental health problems (OR = 1.47, p < .001, 95% CI 1.20-1.80). Moreover, compared to those experiencing one timepoint, participants reporting multiple timepoints of discrimination were significantly more likely to report probable mental health problems (OR = 1.46, p = .002, 95% CI 1.15-1.86), indicating a cumulative association between discrimination and mental health. There was limited evidence that SES moderated this cumulative association. Limitations: Mental health measures were based on self-report questionnaires and not a clinical diagnosis. Conclusions: Amongst a sample of UK adults, perceiving discrimination at multiple timepoints increased the likelihood of experiencing probable mental health problems. There was limited evidence that this cumulative association differed by SES. National measures designed to reduce discrimination may benefit mental health.

Summary Background There is limited evidence on how changes in obesity from childhood to adolescence are associated with adolescent mental health. We examined the associations between childhood obesity trajectories, obesity episodes, and mental health at age 17. Methods Data were from the UK Millennium Cohort Study. Obesity trajectory groups at ages 7 and 17 ( n = 8306) and previous obesity episodes (number of sweeps with obesity) at ages 7, 11 and 14 ( n = 7246) were examined. Caregiver and self‐reported internalising and externalising symptoms at age 17 were used to measure mental health. Linear regression models were used. Results Relative to never developing obesity, obesity development ( β = 1.01; 95% CI = 0.71, 1.32) and persistence ( β = 1.18; 95% CI = 0.74, 1.61) were associated with higher internalising symptoms at age 17 and worsening (increase in scores) of these symptoms between ages 7 and 17 ( β = 0.87; 95% CI = 0.57, 1.17 and β = 0.86; 95% CI = 0.56, 1.26 for development and persistence, respectively). Obesity development was associated with higher externalising symptoms at age 17 ( β = 0.52; 95% CI = 0.25, 0.80) and worsening of these symptoms over time ( β = 0.30; 95% CI = 0.07, 0.53). Having multiple past obesity episodes was not associated with worsening mental health independent of follow‐up weight status. There were no differences in mental health outcomes between children who reversed versus never developed obesity. Conclusions Obesity development or persistence from ages 7 to 17 are associated with worsening mental health. If childhood obesity is reversed, there appears to be no evidence of a negative association between previous obesity and mental health at age 17.

We examined the prospective associations between psychological well-being related factors (depressive symptoms, life satisfaction, self-efficacy) and transitioning from overweight and obesity to normal body weight (vs persistence of overweight and obesity) and change in body mass index (BMI). We used multiple baselines and follow-ups from the National Child and Development Study (NCDS; 8513 observations) and the British Cohort Study (BCS; 11,113 observations). A proportion (8%–9%) of participants with overweight and obesity (BMI ≥25) at baseline transitioned into normal weight (BMI 18.5–<25) by follow-ups. There was no evidence of better psychological well-being related factors (e.g. lower depressive symptoms) being significantly associated with a transition from overweight and obesity to normal weight or reduced BMI in each cohort and pooled cohort analyses. However, age and gender were associated with transition. At population level, better psychological well-being may not be associated with likelihood of weight loss once obesity is developed in adulthood.

Life satisfaction and physical pain are key aspects of human well-being. Yet, evidence on the direction of their association and potential explanatory factors is relatively scarce. We address these questions across two studies. In Study 1, we explore the cross-lagged association between life satisfaction and physical pain using 22 waves from Australian longitudinal data (Household, Income and Labour Dynamics of Australia; N = 233,854), individual fixed effects regressions, and Random Intercept Cross-Lagged Panel Models. We found a bidirectional relationship between life satisfaction and pain, which is virtually identical across both methods. In Study 2, we use data from the 1970 British Cohort Study ( N = 4,002) and Ordinary Least Squares regressions with a wide set of covariates. We found that people who reported greater life satisfaction at age 26 (vs. lower) reported lower physical pain at age 46. We document factors that partially explain this link, including psychological distress and past unemployment.

OBJECTIVE:While work provides a crucial source of income and purpose, pain can be a significant limiting factor. Yet robust empirical evidence on the factors underlying the link between pain and being out of work remains scarce. We explore the longitudinal association between pain and being out of work and potential explanatory factors. METHODS:We used nationally representative longitudinal data from the Household, Income and Labour Dynamics of Australia Survey (n=25 973, number of observations=233 989, 2002-2022). We conducted individual fixed effects regressions with a wide range of covariates. RESULTS:We found that pain in a given year was significantly positively associated with the likelihood of being out of work the year after. Pain interference with work explained this link. This association was moderated by job control: participants who reported very severe pain and low job control were more likely (10.6%) to lose their job next year than those who reported very severe pain and high job control (6.7%). CONCLUSIONS:Pain was associated with being out of work, with job control moderating that link. Having the autonomy to flexibly adapt the nature of work tasks to accommodate pain may protect against being out of work.

Objective: To examine the prospective association between psychological well-being and overweight and obesity reversal.Methods: We analysed data of UK children with overweight or obesity at ages 11 (n=4,556), 14 (n=3,791) (baselines), and 17 (follow-up). Psychological well-being related measures were characterised into indexes of caregiver-reported child mental health and child-reported psychosocial well-being (a higher score indicated better mental health or psychosocial well-being). Weight changes were presented as reversal vs. persistence of overweight or obesity and residualised change body mass index (BMI) z-scores. Data were analysed using regression analysis.Results: Better child mental health and psychosocial well-being at age 11 were independently associated with increased odds of reversal vs. persistence (OR=1.16; 95%CI=1.03,1.29; and OR=1.29; 95%CI=1.15,1.44; respectively) and decreased BMI z-scores (β=-0.08, 95%CI=-0.13,-0.03; and β=-0.07, 95%CI=-0.11,-0.03; respectively) to age 17. However, neither were associated with weight changes when measured at age 14. Analyses between psychological well-being related measures and timing of measures indicated that psychological well-being related measures were more likely to prospectively predict weight changes when measured at age 11 versus age 14.Conclusions: Better psychological well-being at age 11 is a prognostic factor that may be associated with an increased likelihood of reversing childhood overweight and obesity by age 17.

Male infertility is a global health concern. The effectiveness of interventions developed to improve males' knowledge of fertility regulation and fertility-related risk factors remains unclear. This systematic review aimed to synthesize and evaluate the evidence for these interventions. Four databases were searched from inception to June 2023. Eligible studies examined interventions to increase fertility knowledge among presumed fertile males aged >= 16 years of age. Conference abstracts, protocols and studies without sex-disaggregated results for males were excluded. A narrative synthesis without meta-analysis was performed. A total of 4884 records were identified. Five studies (reported in six publications), all conducted in high-income countries, were included. Two were randomized control trials, and three were experimental studies. Interventions were delivered in person by a health professional (n = 3), online and via a mobile app. All studies showed a significant improvement in knowledge of fertility or fertility-related risk factors from baseline to follow-up. The largest improvement was observed for secondary and vocational students. A moderate, long-term retainment of knowledge was observed at two-year follow-up in one study. Available evidence suggests interventions to improve males' fertility knowledge are effective, particularly for younger, less educated males.

PurposeThis study investigated the effects of early shared reading and access to books on reading vocabulary in middle childhood and the pathways associated with later reading success.MethodPath analysis of data from four waves of a national longitudinal study of children (N = 7,751) was used to investigate direct and indirect effects of early home literacy practices at age 3 on reading attainment at age 9, controlling for demographic and family characteristics. Children were aged 3, 5, 7, and 9 years at each respective wave of data collection, and 49.1% of the sample were girls. The majority of caregivers in the study were White (94.3%).ResultsEarly shared reading and availability of books predicted higher reading scores at age 9, controlling for covariates at age 3. Sixty-four percent of the association between early shared reading and reading attainment in middle childhood was explained by several paths incorporating language and literacy variables at age 5 and reading for pleasure at age 7. The association between books at age 3 and vocabulary at age 9 was fully accounted for through an increase in the number of books at age 5 and greater likelihood of reading for pleasure at age 7.ConclusionBoth early shared reading and availability of books predicted reading attainment in middle childhood though through different pathways. The findings support reading interventions that provide books and shared reading opportunities in early childhood.

Background: We examined how obesity trajectories and time living with obesity during childhood predict mental health at age 17. Methods: Data were from the UK Millennium Cohort Study. Obesity trajectory groups between ages 7 and 17 (n=8,306) and previous obesity episodes from ages 7, 11, and 14 (n=7,246) were examined. Caregiver-reported internalising and externalising symptoms at age 17 were assessed. Linear regression models were used.Results: Obesity development and persistence (vs. never developing obesity) were associated with worse internalising symptoms at age 17, and worsening trajectory of these symptoms between age 7 and 17. Evidence of worse externalising symptoms at age 17 and a worsening trajectory of these symptoms over time only appeared for obesity development (vs. never developing obesity). Obesity reversal (vs. never developing obesity) by age 17 was not associated with worsening mental health. Having multiple episodes of obesity in the past was not associated with worsening mental health in individuals with and without current obesity at age 17.Conclusions: Development and persistence of obesity from ages 7-17 are associated with worsening mental health. If childhood obesity is reversed, there appears to be no evidence of a negative effect of previous obesity on mental health at age 17.

Background:Significant social and political changes occurred in the UK between 2015 and 2020. Few studies have examined population level trends in experiencing discrimination and mental health problems during this period. Aims:To determine prevalence trends in perceived discrimination and probable mental health problems amongst UK adults during 2015-2020. Method:Repeated cross-sectional data from the UK Household Longitudinal Study was used to estimate nationally representative trends in perceived discrimination and probable mental health problems (GHQ-12; 4+ threshold) among adults between 2015/2016-2019/2020 (25,756 observations). Weighted logistic regression models with post-estimation margins commands determined changes between survey waves controlling for sociodemographic characteristics. Mediation models explored whether changes in perceived discrimination prevalence trends explained trends in probable mental health problems. Results:From 2015/2016 to 2019/2020 perceived discrimination and probable mental health problems increased significantly by 6·1% (95% CI: 3·4-8·8, p <·001) and 4·5% (95% CI: 1·3-7·7, p = ·006), respectively. These changes did not tend to reliably differ by sociodemographic grouping. Increased prevalence of probable mental health problems from 2015/2016 to 2019/2020 was partially explained (15·2% of association mediated) by the increase in perceived discrimination observed during the same time period. Conclusions:Amongst UK adults, the prevalence of perceived discrimination and probable mental health problems increased between 2015/2016 to 2019/2020. Increases in perceived discrimination partially explained increases in probable mental health problems. National measures designed to reduce both discrimination and mental health problems have potential to make substantial improvements to public health and should be prioritised in the UK.

Background: This study examined the role of psychological well-being measures in explaining the associations between obesity and risk of non-communicable diseases (NCDs: hypertension, heart disease, stroke, diabetes, arthritis, cancer, and memory-related disease) in older adults. Methods: Data were from the English Longitudinal Study of Ageing (ELSA), UK (baseline: Wave 4 – 2008/2009; n = 8,127) and the Health and Retirement Study (HRS), US (baseline: Waves 9 and 10 – 2008/2010; n = 12,477) with up to 10-year follow-up period in each study. Objective body mass index was used to define obesity. A range of well-being related psychological measures (e.g., depressive symptoms, life satisfaction) was available in ELSA (n = 7) and HRS (n = 15), and an index of overall psychological distress was developed separately in each study by combining select psychological measures. Health outcomes or NCDs were from a self-reported doctor diagnosis and/or other assessments (e.g., biomarker data) in both studies; and in ELSA, NCDs from linked hospital admissions data were examined. Longitudinal associations between obesity status, psychological measures, and NCDs were examined using Cox proportional hazard models (individual NCDs) and Poisson regression (a cumulative number of NCDs). Mediation by psychological measures was assessed using causal mediation analysis. Results: Obesity was consistently associated with an increased prospective risk of hypertension, heart disease, diabetes, arthritis, and a cumulative number of NCDs in both ELSA and HRS. Overall greater psychological distress and some individual psychological measures were associated with an increased prospective risk of heart disease, stroke, arthritis, memory-related disease, and a cumulative number of NCDs across studies. Findings from mediation analyses showed that neither the index of psychological distress nor any individual psychological measures explained (mediated) why obesity increased the risk of developing NCDs in both studies. Conclusion: Obesity and impaired psychological well-being independently and additively increase the risk of developing NCDs.

AbstractIntroductionWe examined the psychological burden associated with metabolic syndrome (MetSyn).MethodsWe used comparable longitudinal data of older adults (≥50 years) from the UK (English Longitudinal Study of Aging) and the US (Health and Retirement Study). We defined MetSyn based on biomarker assessments (e.g., blood pressure, impaired glycemic control). Using regression models, we tested a range of individual psychological outcomes (e.g., depressive symptoms) associated with MetSyn. We also examined whether these psychological outcomes may explain or moderate the link between MetSyn and non‐communicable diseases (NCDs).FindingsMetSyn was associated cross‐sectionally with a range of psychological outcomes, including depression, anxiety, loneliness, hopelessness, cynical hostility, social strain, negative affect and decreased positive affect, social support and purpose in life. There was no convincing evidence that psychological factors interacted with or explained (mediated) the relationship between MetSyn and increased risk of developing NCD over 10‐year follow‐ups.ConclusionsMetSyn and the psychological burden outcomes examined may have independent effects on NCD risk.

Physical pain has trended upward globally over the last decade. Here, we explore whether the COVID-19 pandemic modified this alarming trend. We used data from 146 countries worldwide (510,247 respondents) to examine whether pain levels changed during the COVID-19 pandemic. Adjusted regressions across countries revealed that 33.3% of people were in pain in 2019, 32.8% in 2020, 32.5% in 2021, and 34.1% in 2022. The change in pain from 2019 to each of the pandemic years was not statistically significant. This suggests that, on average, there was no significant change in pain during the pandemic. However, from 2019 to 2020 there was a significant decline in pain among individuals over 55 years of age, those who were widowed, and those without children in the household. On a global scale, the COVID-19 pandemic was not associated with a significant change in pain levels. The concerning pre-pandemic elevation in global pain continued during this challenging period.

BackgroundSystematic review evidence suggests preconception health interventions may be effective in improving a range of outcomes. However, few studies have explored women’s views on potential content and delivery methods for these interventions.MethodsParticipants were purposively sampled from respondents (n = 313) of a survey. Semi-structured, in-depth interviews were conducted to explore their views on seven candidate delivery methods for preconception health interventions: general practitioners (GPs), nurse practitioners, pharmacists, social media, personal texts and emails, pregnancy tests, and health education in schools. Data were analyzed using a data-driven framework analysis.ResultsTwenty women were interviewed. Women wanted interventions to be easily accessible but allow them to conceal their pregnancy plans. They preferred to choose to receive preconception interventions but were receptive to health professionals raising preconception health during ‘relevant’ appointments such as contraceptive counseling and cervical smear tests. They wanted intervention content to provide trustworthy and positively framed information that highlights the benefits of good preconception health and avoids stigmatizing women for their weight and preconception actions. The inclusion of support for preconception mental health and the use of visual media, personalization, simple information, and interesting and unfamiliar facts were viewed favorably.ConclusionInterventions to improve preconception health should reflect the sensitivities of pregnancy intentions, be easy to access in a way that enables discretion, and be designed to seek consent to receive the intervention. These interventions should ideally be tailored to their target populations and provide trustworthy information from reputable sources. The potential for unintended harmful effects should be explored.

Abstract Purpose: Loneliness may have been exacerbated during the COVID-19 pandemic. The objective of this study was to assess i) correlates of loneliness among Irish adults during the first implementation of social distancing measures in the COVID-19 pandemic, ii) trajectories of loneliness during the first year of the COVID-19 pandemic, and iii) predictors of changes in loneliness during this time. Methods: Longitudinal nationally representative panel data were gathered from 1041 participants aged 18-80 across four timepoints during 2020, the first collected from 31st March 2020. Latent growth models in a structural equation modelling framework were used to evaluate change in loneliness over time. Results: Participants were on average moderately lonely at the onset of the pandemic (intercept estimate = 1.91). Higher baseline loneliness was associated with being younger, not being in a relationship, being employed in the healthcare sector, lower levels of neighbourhood belongingness, and higher levels of depression. On average, loneliness levels were highly stable throughout 2020. Those working in the healthcare sector experienced a decline in loneliness over time, as did those with higher baseline levels of depressive symptomatology. Conclusions: We describe correlates of loneliness at the beginning of the COVID-19 pandemic in Ireland in 2020, as well as predictors of changes in loneliness across the first year of the pandemic. Those working in the healthcare sector had high initial loneliness which then declined, potentially reflecting adaptation to the demands of the pandemic. Results are discussed in the context of potentially informative theoretical frameworks of loneliness.