Giulia Zamagni, Federica Concina, Paola Pani, Giuseppe Gorini, Federica Asta, Luisa Mastrobattista, Laura Timelli, Lorenzo Spizzichino, Claudia Carletti, Luca Ronfani, Valentina Minardi
{"title":"Use and susceptibility of youth aged 13-15 years to cigarettes, e-cigarettes and heated tobacco products: results of the Global Youth Tobacco Survey 2022 in eight Italian regions.","authors":"Giulia Zamagni, Federica Concina, Paola Pani, Giuseppe Gorini, Federica Asta, Luisa Mastrobattista, Laura Timelli, Lorenzo Spizzichino, Claudia Carletti, Luca Ronfani, Valentina Minardi","doi":"10.1093/eurpub/ckaf126","DOIUrl":"10.1093/eurpub/ckaf126","url":null,"abstract":"<p><p>Smoking is a leading risk factor for many preventable chronic diseases across the lifespan. Adolescence represents a critical period for the adoption of health-risk behaviours, including tobacco and nicotine products consumption. Evidence shows that adolescents who are susceptible to tobacco use are more likely to initiate and maintain smoking than their non-susceptible peers. This study examines factors associated with susceptibility to cigarettes, electronic cigarettes (e-cigs) and heated tobacco products (HTPs) in adolescents aged 13-15 years. Data were drawn from the 2022 Global Youth Tobacco Survey conducted in eight Italian regions. Susceptibility to tobacco products was measured through intentions to use tobacco and responses to hypothetical peer offers. Influencing factors (i.e. age, gender, having smoking friends or parents, exposure to tobacco advertising and to anti-smoking messages at school) were evaluated using a multivariable random intercept logistic regression to account for variability between macro-regions (North, Centre, South). The study included 17 713 participants from 738 schools and 1219 classes. Susceptibility to cigarettes was 27.8%, to e-cigs 36.6%, and to HTPs 29.5%. Regional differences emerged, with higher cigarette susceptibility in the South and higher e-cig susceptibility in the North. Having smoking friends was the strongest risk factor [cigarettes: odds ratio (OR) = 2.02, e-cigs: OR = 2.03, HTPs: OR = 2.22]. Anti-smoking messages at school were protective (cigarettes: OR = 0.92, e-cigarettes: OR = 0.91, HTPs: OR = 0.88). Individual factors had a stronger influence than geographical differences. The findings underscore the need for comprehensive tobacco control policies addressing the rising prevalence of poly-product use, stronger marketing regulations, and school-based and peer-led interventions.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":"930-937"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12529267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carlos Aniceto, Paula Braz, Ausenda Machado, Carlos Matias-Dias
{"title":"Mapping susceptibility to air pollution and its association with birth defects: a tool for public health intervention.","authors":"Carlos Aniceto, Paula Braz, Ausenda Machado, Carlos Matias-Dias","doi":"10.1093/eurpub/ckaf077","DOIUrl":"10.1093/eurpub/ckaf077","url":null,"abstract":"<p><p>Epidemiological studies evaluating the relation of environmental air pollution (AP) and birth defect (BD) are relevant to public health. Some limitations on these studies may derive from multiple factors contributing to the spatial variation of AP. This study aimed to integrate multifactorial AP indicators into an index and explore its application in a case-control study conducted in Portugal between 2016 and 2021. Spatial multicriteria analysis was employed to identify areas susceptible to AP. Variables included: (i) Euclidean distance to industrial units; (ii) kernel estimation of industrial units density; (iii) land occupation; (iv) Euclidean distance to main roads; and (v) areas conductive to radiation fog formation. Variables were classified into high, moderate, and low susceptibility. An AP susceptibility map was generated using the weighted linear combination method, with the analytic hierarchy process assigning weights to the variables. Georeferenced BD cases and controls were overlaid with environmental exposure variables and the AP index. Three AP susceptibility areas were identified: consolidated urban, peri-urban area, and a residential-industrial area. In areas of high susceptibility, 47 cases (29%) and 65 controls (31%) were observed; and in areas of low susceptibility 25 cases (15%) and 21 controls (10%) were observed. The development of the AP susceptibility map has been demonstrated to be a valuable tool for identifying patterns, generating hypotheses regarding the potential environmental exposure of NB to AP agents during pregnancy. When integrated into more complex analyses, these findings may contribute to assess the potential risk factors that play a major role in BD.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":"947-953"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12529273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ania Gorostiza, Jon Cacicedo, Itxaso Alayo, Andere Frias, Patricia Cobos Baena, Inés Gallego Camiña, Isabel Álvarez López, Marta Fernández Calleja, Alina Rigabert, Maria Victoria Alonso Martínez, Carolina Varela Rodríguez, Valentina Danesi, Andrea Roncadori, Mario Campone, Ane Fullaondo, Borja García-Lorenzo
{"title":"Basing healthcare decisions on value: patient-reported outcomes for patients diagnosed with breast cancer in a European cohort.","authors":"Ania Gorostiza, Jon Cacicedo, Itxaso Alayo, Andere Frias, Patricia Cobos Baena, Inés Gallego Camiña, Isabel Álvarez López, Marta Fernández Calleja, Alina Rigabert, Maria Victoria Alonso Martínez, Carolina Varela Rodríguez, Valentina Danesi, Andrea Roncadori, Mario Campone, Ane Fullaondo, Borja García-Lorenzo","doi":"10.1093/eurpub/ckaf064","DOIUrl":"10.1093/eurpub/ckaf064","url":null,"abstract":"<p><p>Improvements in breast cancer survival rate have been achieved through a variety of multimodal therapeutic approaches, which play a key role in the patients' healthcare pathway and their Patient-Reported Outcomes (PROs) from a Value-Based Healthcare (VBHC) perspective. This paper analyses differences in PROs of patients diagnosed with breast cancer according to their healthcare pathway. A cohort of 690 patients diagnosed with breast cancer between 2018 and 2020 at six European sites was used. PROs were assessed at baseline and 6 months using the International Consortium for Health Outcome Measures standard set. Archetypes defined by patient characteristics and treatment trajectories served as the basis for comparison. Multivariate linear regression models were used to analyse differences in PROs across archetypes. Functional scores generally worsened over 6 months, particularly in physical functioning, whereas emotional functioning improved. Archetypes undergoing mastectomy, with or without reconstruction, showed significant decreases in body image perception and satisfaction with breasts. Pain, fatigue, and peripheral symptoms were prevalent in most archetypes, with those receiving chemotherapy reporting the greatest symptom burden. Patients with in situ carcinoma and patients undergoing conservative surgery plus radiotherapy showed minimal deterioration. The use of PROs in a real-world setting enables the identification of differences across patient archetypes based on their therapeutic pathways. This information provides valuable insights for refining patient-centred care guiding VBHC strategies in oncology, developing of personalized care solutions, and facilitating Shared-Decision Making.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":"835-843"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12529264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eric Lucas, Nadya Dimitrova, Mariano Tomatis, Brian Sheridan, Marc Arbyn, Evelyne Heijnsdijk, Paola Armaroli, Patrick Martens, Veli-Matti Partanen, Arunah Chandran, Andre L Carvalho, Wendy Yared, Arianna Khatchadourian, Carlo Senore, Partha Basu
{"title":"Creating a data processing warehouse to support performance monitoring of cancer screening programmes in Europe using a common set of indicators.","authors":"Eric Lucas, Nadya Dimitrova, Mariano Tomatis, Brian Sheridan, Marc Arbyn, Evelyne Heijnsdijk, Paola Armaroli, Patrick Martens, Veli-Matti Partanen, Arunah Chandran, Andre L Carvalho, Wendy Yared, Arianna Khatchadourian, Carlo Senore, Partha Basu","doi":"10.1093/eurpub/ckaf119","DOIUrl":"10.1093/eurpub/ckaf119","url":null,"abstract":"<p><p>The CanScreen-ECIS project implemented by International Agency for Research on Cancer aimed to define indicators to monitor, breast, cervical, colorectal, and lung cancer screening and create a validated mechanism for the European screening programmes to be able to systematically collect and submit performance data for public dissemination through European Cancer Information System (ECIS). Indicators were developed through a stepwise process of literature review, Delphi survey followed by face-to-face interaction. A survey questionnaire to report policies, protocols, and organization of screening programmes and a data collection tool to estimate indicators across the screening continuum were designed. These were integrated into a data warehouse to permit programme managers to access the tools, undergo training, submit data, and estimate the indicators. The same warehouse would allow peer-reviewing of submitted information and data and will ultimately be connected to ECIS for data visualization. Functionalities of the tools and the warehouse were pilot tested through data collection from several European countries. Total 23 indicators were selected based on priority and feasibility. Programme managers from 23 European countries completed the surveys and submitted data from national/regional screening programmes. Data to estimate the indicators were obtained from 17, 13, and 15 breast, cervical, and colorectal cancer screening programmes, respectively. Major challenges identified by the participants included collecting data from opportunistic screening and data disaggregated by socio-economic status and other indicators of inequalities. The data warehouse will facilitate systematic data collection to report the status and performance of cancer screening programmes in the EU.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":"977-983"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12529281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Correction to: S08-3: Goals and realities in local governments' involvement in PA promotion for diverse populations subgroups - a comparative analysis of municipalities from 5 countries.","authors":"","doi":"10.1093/eurpub/ckaf134","DOIUrl":"10.1093/eurpub/ckaf134","url":null,"abstract":"","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":"1067"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12529259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eero Kekäläinen, Ossi Rahkonen, Ville Päivärinne, Henriikka Nurminen, Tea Lallukka
{"title":"Childhood and current socioeconomic position as determinants of sedentary time among young and early midlife employees.","authors":"Eero Kekäläinen, Ossi Rahkonen, Ville Päivärinne, Henriikka Nurminen, Tea Lallukka","doi":"10.1093/eurpub/ckaf152","DOIUrl":"10.1093/eurpub/ckaf152","url":null,"abstract":"<p><p>Socioeconomic position (SEP) is one of the primary determinants of sedentary behaviour. The study investigated the associations between life-course socioeconomic circumstances and sedentary time (ST) among young and early midlife municipal employees. We used data from the 2017 Helsinki Health Study (N = 4532), which targeted 19- to 39-year-old employees of the City of Helsinki. SEP was assessed through both childhood and current indicators: parental and own educational level, childhood and current economic difficulties, occupational class, income, and wealth. ST was self-reported in minutes per weekday across five behavioural domains. Linear regression models examined differences in STs between socioeconomic groups, with 95% confidence intervals (CIs). All SEP indicators except childhood economic difficulties were associated with total ST. Participants in the highest income quartile reported 76 min (95% CI 60-92) more ST per day than those in the lowest quartile. Similarly, participants with higher education sat 69 min (95% CI 55-84) longer than those with lower education. The largest differences were observed during working hours, with higher education and income associated with more ST. In contrast, lower SEP was associated with more ST spent at home in front of a television/computer and in vehicles. Although individuals with higher SEP often engage in more physical activity and have better health behaviours overall, they are also the most sedentary, especially during work hours. The association between SEP and ST varies across behavioural domains, emphasizing the importance of context-specific interventions.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":"916-924"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12529275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144946546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Social patterns of miscarriage reporting and risk: insights from survey data in France.","authors":"M C Compans, Heini Väisänen","doi":"10.1093/eurpub/ckaf099","DOIUrl":"10.1093/eurpub/ckaf099","url":null,"abstract":"<p><p>Miscarriages, which are spontaneous pregnancy losses before 20-28 weeks of gestation, affect approximately 15% of recognized pregnancies. Existing population-based evidence of social inequalities in miscarriage risk is inconsistent, partly due to a lack of data. Surveys can be representative of a national population but are subject to underreporting of miscarriages. We examine whether miscarriages are underreported in a French nationally representative survey, FECOND (2010-11), and analyse socioeconomic risk factors for miscarriage. First, we apply a model that estimates miscarriage underreporting. Second, we use multilevel multinomial logistic regressions to examine socio-demographic and epidemiological factors associated with miscarriage. We estimate that 92% of miscarriages were reported, and underreporting was slightly more pronounced among lower-educated women. The estimated prevalence of miscarriages (14% of all pregnancies) is unaffected by underreporting rates and only with small educational differences. Thus, investigating social disparities in miscarriage risk can be done without correcting for reporting bias. Advanced reproductive ages are associated with higher miscarriage risk. Unobserved time-consistent individual characteristics explain the association between miscarriage risk and prior reproductive history. Conversely, education and self-assessed financial conditions are not associated with miscarriage risk. Younger cohorts exhibit a higher miscarriage risk, suggesting an age effect on recall, a cohort effect on pregnancy recognition, or reduced stigma resulting in more reliable reporting of miscarriage. In sum, the miscarriage reporting rate in FECOND survey is relatively high and with only slight social disparities. No large socioeconomic differences were found in miscarriage risk.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":"954-959"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12529278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marion Bailhache, Sabine Plancoulaine, Fabienne El-Khoury, Olivier Leproux, Eloi Chazelas, Ramchandar Gomajee, Judith Van Der Waerden, Marie Aline Charles, Maria Melchior
{"title":"Intimate partner psychological violence and children's sleep difficulties up to 5 years of age: an ELFE birth cohort.","authors":"Marion Bailhache, Sabine Plancoulaine, Fabienne El-Khoury, Olivier Leproux, Eloi Chazelas, Ramchandar Gomajee, Judith Van Der Waerden, Marie Aline Charles, Maria Melchior","doi":"10.1093/eurpub/ckaf037","DOIUrl":"10.1093/eurpub/ckaf037","url":null,"abstract":"<p><p>To examine the association between intimate partner psychological violence (P-IPV) from before pregnancy to 2 years after the child's birth and child's sleep patterns, i.e. sleep onset difficulty (SOD), nighttime awakenings (NA), and nighttime sleep duration (NSD) between 2 and 5 years of child's age. Data come from the population-based French birth ELFE cohort launched in 2011. P-IPV was assessed before and during pregnancy, at 2 months and 2 years post-partum. Children's sleep patterns were measured at 2, 3, and 5 years of age. Group-based trajectory modelling was used to identify trajectories of P-IPV and each child's sleep patterns. Associations between P-IPV and children's sleep trajectories were assessed by weighted multivariate logistic regressions. Five P-IPV trajectories were identified: minimal (64%), prenatal (14%), decreasing (9%), increasing (8%), and persistent (5%). Two trajectories of SOD (few 65% and many 35%), three trajectories of NA (few 49%, decreasing 24%, and many 23%), and three trajectories of NSD (short 21%, medium 56%, and long 23%) were identified. About 9513, 9512, and 9499 children were included in comparative analyses, respectively, focused on SOD, NA, and NSD. Increasing and persistent P-IPV trajectories were both associated with the trajectory of many SODs [odds ratio (OR) = 1.53, 95% confident interval (CI) = 1.24-1.91; and OR = 1.71, 95% CI = 1.31-2.22, respectively] and the trajectory of many NA (OR = 1.66, 95% CI = 1.29-2.13); and (OR = 1.95, 95% CI = 1.42-2.69, respectively). Associations between persistent P-IPV and decreasing and many NA were significant among girls (OR = 1.76, 95% CI = 1.12-2.75 and OR = 2.27, 95% CI = 1.39-3.71, respectively), but not among boys. Family interventions in response to IPV should pay particular attention to sleep patterns of children exposed to IPV.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":"873-881"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12529263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Antonella d'Arminio Monforte, Gabriella d'Ettorre, Gioacchino Galardo, Enyal Lani, Eva Kagenaar, Susie Huntington, James Jarrett, Murad Ruf, Walter Ricciardi
{"title":"Estimating the potential health economic value of introducing universal opt-out testing for HIV in emergency departments in Italy.","authors":"Antonella d'Arminio Monforte, Gabriella d'Ettorre, Gioacchino Galardo, Enyal Lani, Eva Kagenaar, Susie Huntington, James Jarrett, Murad Ruf, Walter Ricciardi","doi":"10.1093/eurpub/ckaf057","DOIUrl":"10.1093/eurpub/ckaf057","url":null,"abstract":"<p><p>In Italy, an estimated 13 000-15 000 people have undiagnosed HIV, and in 2020, 60% of new diagnoses were late-stage (CD4 < 350 cells/mm3). In hospitals, including emergency departments (EDs), testing is largely limited to indicator-condition-guided testing (IC), with written consent universally required. We developed a closed-cohort hybrid decision tree-Markov model to compare health economic values of two HIV testing strategies in the ED: (1) universal opt-out and (2) IC (Italian standard of care). Data sources included healthcare costs and HIV public health data, obtained from national reports and published studies. A lifetime time horizon and a National Health Service perspective were used. Primary outcomes were life years, quality-adjusted life years (QALYs), and costs. Universal opt-out testing resulted in better health outcomes at higher costs. For every 10 000 individuals attending ED, opt-out testing resulted in 15.78 additional new HIV diagnoses and 14.47 more people linked to HIV care compared with IC. Prevalence threshold analysis demonstrated that opt-out testing was cost-effective compared to IC when the HIV prevalence was 0.25% or higher, assuming a willingness-to-pay threshold of €30 000/QALY. Universal opt-out HIV testing in the ED could be a cost-effective way to increase the number of new HIV diagnoses and improve HIV health outcomes in Italy. The model may underestimate the full benefits of this strategy as our model did not consider disengaged patients or transmissions averted. Further research using real-world data is needed to verify our findings.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":"999-1006"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12529270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sebastian Stannard, Simon D S Fraser, Rhiannon K Owen, Ann Berrington, Shantini Paranjothy, Nisreen A Alwan
{"title":"Exploring the relationship between education and academic ability in childhood with healthcare utilization in adulthood: findings from the Aberdeen Children of the 1950s (ACONF).","authors":"Sebastian Stannard, Simon D S Fraser, Rhiannon K Owen, Ann Berrington, Shantini Paranjothy, Nisreen A Alwan","doi":"10.1093/eurpub/ckaf120","DOIUrl":"10.1093/eurpub/ckaf120","url":null,"abstract":"<p><p>We explored the association between education and academic ability in childhood and both outpatient appointments and hospital admissions in adulthood, accounting for adult factors, including long-term conditions. The analytical sample consisted of 7183 participants in the Aberdeen Children of the 1950s. Three outcomes were measured using routine Scottish medical records over a five-year period (2004-2008): (1) ≥5 outpatient appointments, (2) ≥2 hospital admissions, or (3) ≥3 outpatient appointments plus ≥1 hospital admission. We constructed a childhood (age 6-11) education and academic ability domain and calculated predicted risk scores of the three outcomes for each cohort member. Nested logistic regression models investigate the association between domain predicted risk scores and odds of each of the three outcomes accounting for childhood confounders and self-reported adult mediators. Adjusting for childhood confounders, lower childhood education and academic ability were positively associated with ≥5 outpatient appointments (OR 1.03, 95% CI 1.01-1.05), ≥2 hospital admissions (OR 1.04, 95% CI 1.03-1.6), and ≥3 outpatient appointments plus ≥1 hospital admissions (OR 1.04, 95% CI 1.02-1.06). Accounting for adult mediators, associations remained statistically significant, but their effect sizes were reduced. When school leaving age was included in the model, the association between the exposure and all three outcomes were attenuated. Education and academic ability in early life may be related to the burden of multiple hospital admissions and outpatient appointments later in life. However, the age at which the participant left school seems to substantially mediate this relationship underscoring the positive impact of time spent in education.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":"903-909"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12529252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}