{"title":"How is health equity considered in policy evaluations employing quasi-experimental methods? A scoping review and content analysis.","authors":"Kerstin Sell, Setareh Rabbani, Jacob Burns","doi":"10.1093/eurpub/ckae188","DOIUrl":"https://doi.org/10.1093/eurpub/ckae188","url":null,"abstract":"<p><p>Public health researchers employ quasi-experimental methods (QEM) to evaluate the effects of policies. Whilst some policies are designed to improve (health) equity, others may intentionally or unintentionally have detrimental effects on disadvantaged populations. We thus sought to investigate how health equity is addressed in policy evaluations which employ QEM. We conducted a content analysis on studies sourced from a scoping review. We drew a random sample of 350 records identified in systematic database searches in Medline, EMBASE, and EconLit (December 2022). Studies that employed QEM labels and examined public policies implemented in the WHO European region were included. We extracted data on study design, policies, and populations; assessed whether outcomes were examined in population sub-groups (as defined by PROGRESS-Plus criteria); and analysed discussion sections for equity-related conclusions. We included 59 studies, of which 39 (66.1%) studies considered health equity-albeit to variable depth. Twenty-five studies were focused exclusively on examining policy outcomes in a disadvantaged population (42.4%), of which 19 studies evaluated policies that targeted disadvantaged groups (e.g. minimum wage, social housing policies). Outcomes were stratified for one or more sub-populations in 22 studies (37.3%), most commonly for gender (n = 15, 25.4%) and a measure of socio-economic status (n = 13, 22%), particularly income and employment. Equity-related results and implications were discussed in 24 studies. While policy evaluations employing QEM have considerable value for informing decision-making in public health and other sectors that influence health, their potential to investigate equity impacts is currently not harnessed.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Roland Kraxner, Thomas E Dorner, Dominik Roth, Kathryn Hoffmann
{"title":"Access points to different levels of health care over 13 years. Utilization behaviour in a changing health care system. Results of a three-wave cross-sectional series in Austria.","authors":"Roland Kraxner, Thomas E Dorner, Dominik Roth, Kathryn Hoffmann","doi":"10.1093/eurpub/ckae180","DOIUrl":"https://doi.org/10.1093/eurpub/ckae180","url":null,"abstract":"<p><p>Providing health care is a balancing act among human resources, financial pressures and system-intrinsic factors. Understanding the utilization behaviour of primary and secondary care facilities [general practitioners (GPs) vs. specialists, as well as in- and outpatient hospital care] is crucial for a country like Austria, which has free access to all levels of care. The aim of this study was to reassess access point consultations in relation to sociodemographic variables over time. The databases used for this cross-sectional analysis were the Austrian Health Interview Surveys 2006/07, 2014, and 2019, with sample sizes of 15 474, 15 770, and 15 461 persons, respectively. Analyses included patterns of utilization behaviour, multivariable logistic regression models, and diff-in-diff analyses highlighting differences between the observation periods. GP and secondary care consultations increased from 2014 to 2019. While there were fewer GP visits in 2014 than in 2006/07, GP consultation rates grew by 3.2% between 2014 and 2019. Secondary care utilization increased by 5.4%-8.2% between 2006/07 and 2019, with the highest growth in older and less-educated persons. Secondary-level utilization without prior GP visits decreased again in 2019 after peaking in 2014. Utilization of all access points increased over the entire observation period, especially regarding secondary-level care. Higher GP visit rates do not seem to result in a drop in secondary-level consultations. These results emphasize the coordinator role of primary care in ongoing structural health reforms in European countries, such as Austria.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jin Zhao, Xiaolian Wen, Meijing Zheng, Liping Su, Xiaojing Guo
{"title":"Causal association of physical activity with lymphoma risk: a Mendelian randomization analysis.","authors":"Jin Zhao, Xiaolian Wen, Meijing Zheng, Liping Su, Xiaojing Guo","doi":"10.1093/eurpub/ckae172","DOIUrl":"https://doi.org/10.1093/eurpub/ckae172","url":null,"abstract":"<p><p>Controversial relationship of physical activity with lower lymphoma risk has been reported in observational studies. The purpose of this study was to explore the causal correlation of physical activity with lymphoma risk using two-sample Mendelian randomization (MR). Genetic variants associated with physical activity (moderate-to-vigorous physical activity (MVPA), average acceleration physical activity, number of days/week of moderate physical activity 10+ min, and number of days/week of vigorous physical activity 10+ min) and lymphoma [overall lymphoma, Hodgkin lymphoma, mature T/NK-cell lymphomas, diffuse large B-cell lymphoma (DLBCL), and follicular lymphoma] were obtained from published genome-wide association studies (GWAS) and the FinnGen database and used as instrumental variables. Primary results were based on inverse variance-weighted (IVW) analysis and were described as odds ratio (OR) and 95% confidence interval (CI). Higher levels of genetically predicted MVPA (OR = 0.079, 95% CI: 0.021-0.300, P = 0.0002) and number of days/week of vigorous physical activity 10+ min (OR = 0.237, 95% CI: 0.098-0.573, P = 0.0014) were negatively associated with Hodgkin lymphoma risk. There was a weak negative association between high levels of genetically predicted MVPA (OR = 0.114, 95% CI: 0.015-0.856, P = 0.0348) and average acceleration physical activity (OR = 0.830, 95% CI: 0.705-0.976, P = 0.0243) and risk of DLBCL. No causal relationship was observed between physical activity and the risk of overall lymphoma, mature T/NK-cell lymphomas, and follicular lymphoma (P > 0.05). This study supported the causal relationship between higher physical activity levels and lower risks of Hodgkin lymphoma and DLBCL.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Public health approaches to 'Leave No One Behind' in heatwave resilience: insights from the UK.","authors":"Ana Raquel Nunes","doi":"10.1093/eurpub/ckae187","DOIUrl":"https://doi.org/10.1093/eurpub/ckae187","url":null,"abstract":"<p><p>Heatwaves pose significant threats to vulnerable populations, making resilience efforts crucial. This study aims to explore stakeholders' perspectives on heatwave resilience from a public health perspective, with a specific focus on operationalising the commitment to 'Leave No One Behind' (LNOB) as outlined in the United Nations 2030 Agenda for Sustainable Development. In-depth qualitative interviews were conducted with key stakeholders from national and local government, industry and business, academia, and civil society organizations. Interviews examined stakeholders' understanding of the progress and challenges associated with fulfilling the commitment of LNOB in the context of heat resilience from a public health perspective, in England, UK. Content analysis of interview transcripts was undertaken. Stakeholders emphasize the importance of equity, inclusivity, and public health priorities in heatwave resilience efforts while specifically addressing the commitment to LNOB. Disparities in vulnerability due to socioeconomic factors, challenges in identifying and supporting vulnerable populations, progress made in addressing heatwave resilience, and the role of government and society in improving resilience efforts were emphasized. Stakeholders highlighted the need for targeted interventions, strengthened community support networks, and policy changes to address systemic inequalities and promote inclusivity in resilience strategies. Stakeholders' perspectives underscore the importance of aligning heatwave resilience efforts with global goals, particularly in promoting public health equity and inclusivity. By addressing the challenges identified and implementing the recommendations for improvement, policymakers and practitioners should work towards more equitable and inclusive resilience strategies to safeguard public health during heatwaves.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Philippe A Grenier, Maxence Arutkin, Anne Laure Brun, Anne-Cécile Métivier, Edouard Sage, Franck Haziza, Félix Ackermann, François Mellot, Alexandre Vallée
{"title":"Prevalent findings on low-dose CT scan lung cancer screening: a French prospective pilot study.","authors":"Philippe A Grenier, Maxence Arutkin, Anne Laure Brun, Anne-Cécile Métivier, Edouard Sage, Franck Haziza, Félix Ackermann, François Mellot, Alexandre Vallée","doi":"10.1093/eurpub/ckae183","DOIUrl":"https://doi.org/10.1093/eurpub/ckae183","url":null,"abstract":"<p><p>Despite significant therapeutic advances, lung cancer remains the biggest killer among cancers. In France, there is no national screening program against lung cancer. Thus, in this perspective, the Foch Hospital decided to implement a pilot and clinical low-dose CT screening program to evaluate the efficiency of such screening. The purpose of this study was to describe the prevalent findings of this low-dose CT screening program. Participants were recruited in the screening program through general practitioners (GPs), pharmacists, and specialists from June 2023 to June 2024. The inclusion criteria included male or female participants aged 50 to 80 years, current smokers or former smokers who had quit less than 15 years prior, with a smoking history of over 20 pack-years. Chest CT scans were conducted at Foch Hospital using a low-dose CT protocol based on volume mode with a multi-slice scanner (≥60 slices) without contrast injection. In total, 477 participants were recruited in the CT scan screening, 235 (49%) were males with a median age of 60 years [56-67] and 35 smoke pack-years [29-44] and 242 females (51%) with a median age of 60 years [55-60] and 30 smoke pack-years [25-40]. Eight participants showed positive nodules on CT scan, as a 1.7% rate. 66.7% of diagnosed cancers were in early stages (0-I). It is feasible to implement structured lung cancer screening using low-dose CT in a real-world setting among the general population. This approach successfully identifies most early-stage cancers that could be treated curatively.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Lessons learned from Taiwan's response to the COVID-19 pandemic: successes, challenges, and implications for future pandemics.","authors":"Vivian Chia-Rong Hsieh, Min-Hua Tsai, Hua-Chueh Chiang, Ming-Yi Weng","doi":"10.1093/eurpub/ckae185","DOIUrl":"https://doi.org/10.1093/eurpub/ckae185","url":null,"abstract":"<p><p>This study aims to provide an investigation of the containment and mitigation strategies encompassing the entirety of the pandemic in Taiwan. This descriptive, observational study used COVID-19 data from Taiwan, Japan, and South Korea, and analysed news releases from the Taiwanese health authority. Statistics provided evidence of outbreak severity through infection and mortality rates, while qualitative results from the document review offered insights on the actions taken by the government chronologically from 2 February 2020 to 31 December 2022. All three countries experienced significant infection peaks in 2022. Taiwan had two distinct peaks, one in late May and another in October. South Korea had a single, high peak in late March, while Japan experienced multiple smaller waves, the biggest wave in August. Similarly, weekly mortality rates peaked in 2022 for all three countries after a surge in their infected cases, with Taiwan (5.15/100 000) and South Korea (4.69/100 000) having higher rates than Japan (1.65/100 000). Results from qualitative analysis showed that Taiwan's early containment measures might have delayed the epidemic curve, allowing time for better preparation and proactive responses. However, the lack of a clear transition plan and the vulnerability of the elderly population contributed to higher mortality and infection rates. Despite ongoing challenges, Taiwan avoided nationwide lockdowns and relied on targeted restrictions to control transmission of the virus. Results of this article offer the narratives, reflections, and experiences from the case of Taiwan which may potentially present promising opportunities for impact in other settings and for future pandemics.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kaarina Korhonen, Agneta Cederström, Pekka Martikainen, Olof Östergren
{"title":"Intermarriage and mortality among Finnish migrants in Sweden: a prospective register study using binational data.","authors":"Kaarina Korhonen, Agneta Cederström, Pekka Martikainen, Olof Östergren","doi":"10.1093/eurpub/ckae179","DOIUrl":"https://doi.org/10.1093/eurpub/ckae179","url":null,"abstract":"<p><p>Conjugal ties may contribute to a convergence of health behaviours between migrants and natives, but the association between intermarriage and health outcomes remains understudied. We investigated mortality patterns among Finnish migrants in Sweden according to the spouse's country of birth and compared these patterns with those observed in the native populations of both Sweden and Finland. Leveraging register data from Sweden and Finland, we identified all married Finnish migrants aged 40-64 and their spouses in Sweden in 1999 and corresponding reference groups in both countries. We used a combination of direct matching and inverse probability weighting to adjust for sociodemographic differences between the groups. We followed individuals for all-cause, alcohol-related, smoking-related, and cardiovascular disease (CVD) mortality during 2000-17. Accounting for sociodemographic characteristics, Finnish migrant men married to Swedish-born as opposed to Finnish-born spouses showed lower all-cause [incidence rate ratio (IRR) 0.94, 95% confidence interval (CI) 0.90-0.98], and CVD mortality (IRR 0.88, 95% CI 0.81-0.95), levels more akin to native Swedes. Migrant women with Swedish-born spouses instead had higher smoking-related mortality (IRR 1.41, 95% CI 1.24-1.61) than those married to Finnish-born spouses, mirroring the higher smoking-related mortality of native Swedish women. Individual-level regression analysis on migrants further indicated lower alcohol-related mortality for intermarried men, adjusted for duration of marriage (IRR 0.74, 95% CI 0.56-0.98). These findings suggest that intermarriage with a native spouse can facilitate the convergence of health behaviours and behaviour-related mortality between migrants and natives.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Support for a ban on characterizing flavours in cigarettes in the UK: a longitudinal online survey.","authors":"Crawford Moodie, Catherine Best, Daniel Jones","doi":"10.1093/eurpub/ckae181","DOIUrl":"10.1093/eurpub/ckae181","url":null,"abstract":"<p><p>Most European countries have banned flavoured cigarettes. No study has explored whether support for such a ban changes post-implementation. In the UK, a menthol cigarette ban came into force in May 2020. A longitudinal survey in the UK with adult smokers and ex-smokers explored support for the ban in 2019 (N = 3175) and 2022 (N = 3047). Support increased from 2019 (pre-ban) to 2022 (post-ban) for all participants (18.1% to 35.0%), with increased support evident for flavour cigarette smokers (20.7% to 34.5%), non-flavour cigarette smokers (13.5% to 18.1%), and ex-smokers (24.4% to 50.8%). Increased support for tobacco-related policies helps regulators defend policy decisions.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Prospective relationship between family screen time rules, obesogenic behaviours, and childhood obesity.","authors":"Ladan Hashemi, Maryam Ghasemi, Deborah Schlichting, Maryam Pirouzi, Cameron Grant, Boyd Swinburn","doi":"10.1093/eurpub/ckae169","DOIUrl":"10.1093/eurpub/ckae169","url":null,"abstract":"<p><p>Family screen use rules (FSRs) could plausibly protect against the development of childhood obesity, although the mechanisms underlying these protective effects remain largely unexplored. This research aimed to investigate prospectively the associations between exposure to FSRs at age 24 months, obesogenic behaviours (excessive screen time and short sleep duration) at age 45 months, and obesity at age 54 months. Additionally, a model proposing the mediating role of obesogenic behaviours in the association between FSRs and childhood obesity was tested. Data were obtained from 5733 children and their mothers participating in the 'Growing Up in New Zealand' study. Logistic regressions examined the association between three FSRs (rules on quality, quantity and timing of screen time, and different numbers of FSRs), obesogenic behaviours, and childhood obesity. Structural equation modelling (SEM) was applied to assess the potential mediating roles of obesogenic behaviours in the association between FSRs and zBMI. Neither exposure to individual nor all three FSRs was significantly associated with lower odds of obesity. However, protective effects of FSRs were observed concerning obesogenic behaviours. Exposure to individual or all three FSRs correlated with reduced odds of not meeting screen time and sleep duration recommendations. SEM analysis indicated no direct association between FSRs and zBMI; nevertheless, a significant indirect association was identified through the mediation of obesogenic behaviours. These findings suggest the potential benefits of promoting the adoption of FSRs as a promising population-based strategy to enhance child health behaviours and mitigate the risk of childhood obesity.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andrea Huber Jezek, Ola Ekholm, Lau Caspar Thygesen, Anne Illemann Christensen
{"title":"The impact of reminders on representativeness and survey estimates among web-mode invited in the Danish National Health Survey.","authors":"Andrea Huber Jezek, Ola Ekholm, Lau Caspar Thygesen, Anne Illemann Christensen","doi":"10.1093/eurpub/ckae176","DOIUrl":"https://doi.org/10.1093/eurpub/ckae176","url":null,"abstract":"<p><p>Declining response proportions in health surveys may lead to increased non-response bias. Multiple reminders are often used to increase response proportions, and, thus, we aimed to determine if the use of reminders decreased the magnitude of non-response bias among web-mode invited in the Danish National Health Survey 2023. In the Danish National Health Survey 2023, a national random sample of 23 467 individuals (aged ≥16 years) with residence in Denmark were invited by a secure electronic mail service. Invited individuals received up to five inquiries: (i) web invitation, (ii) web reminder, (iii) paper invitation including a questionnaire and a prepaid return envelope, (iv) paper reminder, and (v) paper reminder including a questionnaire and a prepaid return envelope. The cumulative response proportions after first-, second-, third-, fourth-, and fifth inquiries were 19.1%, 28.9%, 37.2%, 39.3%, and 42.0%, respectively. In general, third, fourth, and fifth mailing respondents were more often men, at younger ages, with non-Western backgrounds, and unmarried compared to first mailing respondents. Furthermore, third, fourth, and fifth mailing respondents were in general found to have less favorable health behavior than first mailing respondents, but also a lower prevalence of fair or poor self-rated health and long-standing health problems. In conlusion, reminders are an effective way to increase the response proportion. Furthermore, the use of reminders was found to decrease the magnitude of non-response bias; however, the decrease was small due to the low number of individuals responding after fourth and fifth inquiries.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}