Global Transitions最新文献

{"title":"Time series analysis of the impact of ambient temperature influence on healthcare service utilization by diabetes patients in the Special Capital Region of Jakarta, Indonesia: A study using Indonesian National Health Insurance data","authors":"Helen Andriani ,&nbsp;Chairina Suci Andhisa ,&nbsp;Paul LC. Chua ,&nbsp;Miftahul Arsyi","doi":"10.1016/j.glt.2025.09.004","DOIUrl":"10.1016/j.glt.2025.09.004","url":null,"abstract":"<div><h3>Background</h3><div>The rising global incidence of diabetes poses a major health challenge, with growing evidence linking diabetes mellitus (DM) and ambient temperature. Due to compromised heat stress responses, people with diabetes are more vulnerable to extreme weather, common comorbidities, insulin resistance, and chronic inflammation. This study examines the impact of ambient temperature on healthcare utilization among diabetes patients in Jakarta, Indonesia, using data from the National Health Insurance program.</div></div><div><h3>Method</h3><div>The study used 2015–2023 sample data from Indonesia's Healthcare and Social Security Agency (BPJS Health), comprising 2,407,300 participants diagnosed with DM. Claims data were stratified by residence, DM type, and healthcare facility type (primary vs. referral care). These were linked with daily, weekly, and monthly temperature records obtained from the Indonesian Agency for Meteorology, Climatology, and Geophysics (BMKG). Negative binomial regression model were applied to assess associations between temperature and DM-related healthcare visits, as the data indicated overdispersion in the count outcomes.</div></div><div><h3>Results</h3><div>Higher daily average temperatures were associated with increased healthcare visits, particularly in primary care. A 1 °C increase in the 7-day average temperature was associated with a 3 % rise in patient visits, while a 14-day average increase was linked to a 4 % rise. Lag structures reduced daily variability, highlighting consistent associations. Utilization patterns also showed peaks on Mondays and declines on weekends and public holidays.</div></div><div><h3>Conclusions</h3><div>Diabetic patients are vulnerable to elevated temperatures, potentially due to impaired thermoregulation and medication effects. As climate change exacerbates extreme temperatures, Jakarta's healthcare system may face increased demand. Interventions such as access to cool public spaces, enhanced patient monitoring, and resilient healthcare infrastructure are recommended.</div></div>","PeriodicalId":33615,"journal":{"name":"Global Transitions","volume":"8 1","pages":"Pages 64-73"},"PeriodicalIF":3.1,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145220722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Green finance, innovation, and environment: Testing the EKC in ASEAN-4 with MMQR approach","authors":"Md.Sazib Miyan ,&nbsp;Calvin W.H. Cheong ,&nbsp;Arshian Sharif ,&nbsp;Sahar Afshan","doi":"10.1016/j.glt.2025.09.001","DOIUrl":"10.1016/j.glt.2025.09.001","url":null,"abstract":"<div><div>Rising carbon emissions and environmental degradation in ASEAN-4 economies underscore the urgent need for sustainable financial mechanisms and innovative technologies to address climate challenges. Despite growing interest in green initiatives, limited research exists on their distributional impacts and causal links with environmental outcomes in this regional context. This study examines the nexus between green finance (GFIN), green innovation (GTI), and environmental sustainability within the Environmental Kuznets Curve (EKC) framework across Indonesia, Malaysia, the Philippines, and Thailand from 2000 to 2020. Employing advanced panel econometric techniques, Method of Moments Quantile Regression (MMQR), Bootstrap Quantile Regression (BSQR), and Dumitrescu-Hurlin Granger causality tests, the analysis reveals that both GFIN and GTI significantly reduce CO₂ emissions, with stronger effects at lower quantiles, indicating greater efficacy at early stages of environmental degradation. The EKC hypothesis is validated, as economic growth initially raises emissions but reduces them at higher income levels. Renewable energy (REN) consistently mitigates emissions, while non-renewable energy (NRE) worsens them across all quantiles, reinforcing the need for energy transition. Causality tests reveal a bidirectional relationship between CO₂ and NRE, and unidirectional causality from CO₂ to REN and GTI. These findings underscore critical policy imperatives: scaling up green finance, accelerating clean innovation, phasing out fossil fuel subsidies, and strengthening regional cooperation to decouple growth from emissions and advance Sustainable Development Goals (SDGs).</div></div>","PeriodicalId":33615,"journal":{"name":"Global Transitions","volume":"8 1","pages":"Pages 74-88"},"PeriodicalIF":3.1,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145266683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the impact of digitalization transition of Senegal and its implication on human health and wellbeing","authors":"Madior Ndiaye,&nbsp;Raafat George Saade,&nbsp;Hao Liu","doi":"10.1016/j.glt.2025.09.002","DOIUrl":"10.1016/j.glt.2025.09.002","url":null,"abstract":"<div><div>Digitalization has become ubiquitous; however, stakeholders have varying degrees of integration globally. Within the context of this study, a digitalization strategy has the potential for economic growth, enhanced health services, and ensuring national stability, thereby improving social well-being and facilitating a country's emergence as a developing nation. This study seeks to examine Senegal's digital landscape, with a particular focus on its impact on health and well-being, which are pivotal in the nation's progression towards becoming an emerging country. This study identifies key themes and factors contributing to Senegal's digital transformation and its potential to enhance overall quality of life. A systematic literature review (SLR) revealed a paucity of relevant research specific to the Senegalese context. Through thematic analysis, we identified research gaps (themes) that could assist Senegal in achieving its digitalization objectives: incremental transitioning facilitated by broadband improvements; digitalization of the economic, political, and human resources sectors; influence of trust and perceived risk on the adoption of emerging technologies; and integration of emerging technologies across all facets of life. Moreover, we conducted a pilot survey based on the Unified Theory of Acceptance and Use of Technology to obtain additional insights into digital healthcare adoption.</div></div>","PeriodicalId":33615,"journal":{"name":"Global Transitions","volume":"8 1","pages":"Pages 37-55"},"PeriodicalIF":3.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145220721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping the divide: Early development of global cancer drugs and its mismatch with cancer burden","authors":"Jie Wang ,&nbsp;Minmin Wang ,&nbsp;Minghui Ren ,&nbsp;Yinzi Jin","doi":"10.1016/j.glt.2025.09.003","DOIUrl":"10.1016/j.glt.2025.09.003","url":null,"abstract":"<div><h3>Background</h3><div>The misalignment between cancer burden and drug innovation poses significant challenges for global health. However, the global scope, temporal trends, and underlying factors contributing to this mismatch remain underexplored. We aim to evaluate the extent, trends, and driving forces behind the disparity between early drug development and cancer burden.</div></div><div><h3>Methods</h3><div>This retrospective cohort study encompasses a total of 9473 early phase cancer drug trials from 1990 to 2023. Concentration curves and concentration indices (CIs) were employed to measure and track the mismatch over time. Residual analysis derived from a regression model identified cancers that may be either overlooked or overly focused upon. Decomposition of CIs was applied to ascertain the contributors to this mismatch and its evolution.</div></div><div><h3>Results</h3><div>The CI between early drug development and cancer burden exhibited an upward trend over time, rising from 0.105 (95 % CI: 0.015 to 0.225) in the 1990s to 0.208 (95 % CI: 0.092 to 0.326) in the 2020s. Early drug development activities had disproportionately favored high-burden cancers. Demand-side factors, such as disease burden (average contribution: 53.35 %) and market size (average contribution: 25.16 %), were the primary drivers of both the mismatch and its growth.</div></div><div><h3>Conclusions</h3><div>The primary drivers of early drug development are medical and market demands, which lead to disproportionate focus on more prevalent or commercially attractive cancers. To address these disparities, targeted initiatives and policy reforms are necessary to ensure that drug development aligns more closely with global health needs, especially for cancers that receive insufficient attention.</div></div>","PeriodicalId":33615,"journal":{"name":"Global Transitions","volume":"8 1","pages":"Pages 56-63"},"PeriodicalIF":3.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145220720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating climate change, food security, and innovative agriculture in Newfoundland and Labrador (NL): A Water-Energy-Food (WEF) nexus approach","authors":"Abdul-Latif Alhassan ,&nbsp;Mery Angeles Perez ,&nbsp;Lakshman W. Galagedara","doi":"10.1016/j.glt.2025.08.002","DOIUrl":"10.1016/j.glt.2025.08.002","url":null,"abstract":"<div><div>This study examines the intersection of climate change, agricultural innovation, and food security in Newfoundland and Labrador (NL), a province characterized by a short growing season, poor and acidic soils, and a small agriculture sector highly vulnerable to climate change. Despite being one of Canada's most food-insecure provinces, there is a significant lack of comprehensive studies on the Water-Energy-Food-Climate Change (WEF-CC) nexus and agricultural innovation in NL. The study aimed to (1) inventory innovative agricultural practices that promote food security and climate resilience, (2) identify key stakeholders in agricultural innovation, (3) explore factors influencing innovation in the province, and (4) assess the use of by-products in agriculture. Data were collected through semi-structured interviews and analyzed using NVivo content analysis. The findings revealed two primary types of relevant agricultural innovation in NL: practice-based and technology-based. Six key stakeholders in agricultural innovation were identified. However, the lack of an independent third-party innovation enabler or connector was perceived as a barrier to progress. To address this gap, the study proposes the establishment of the Newfoundland and Labrador Agricultural Innovation Centre (NLAIC), a collaborative body designed to support agricultural innovation. Additionally, opportunities for utilizing agricultural and industrial by-products, including plant-based and animal-based innovations, were identified as emerging in the province. Tackling innovation barriers and promoting nexus thinking and collaboration among stakeholders and sectors could enhance climate resilience and food security in NL.</div></div>","PeriodicalId":33615,"journal":{"name":"Global Transitions","volume":"8 1","pages":"Pages 22-36"},"PeriodicalIF":3.1,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145027278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urban-rural disparities in self-reported dengue infection: A comprehensive analysis of the 2023 Indonesian health survey","authors":"Mara Ipa ,&nbsp;Asep Hermawan ,&nbsp;Rais Yunarko ,&nbsp;Tri Ramadhani ,&nbsp;Muhammad Choirul Hidajat ,&nbsp;Harimat Hendarwan ,&nbsp;Triwibowo Ambar Garjito ,&nbsp;Aneta Afelt ,&nbsp;Supriyati Supriyati ,&nbsp;Tri Wibawa","doi":"10.1016/j.glt.2025.08.003","DOIUrl":"10.1016/j.glt.2025.08.003","url":null,"abstract":"<div><h3>Background</h3><div>Dengue Virus (DENV) infection remains a significant public health issue in Indonesia, with incidence rates differing between urban and rural areas. This study aimed to identify individual and household factors driving self-reported dengue infections in these settings.</div></div><div><h3>Methods</h3><div>A secondary analysis of the 2023 Indonesian Health Survey (SKI) included 877,531 respondents from urban (n = 469,549) and rural (n = 407,982) areas. The study focused on individuals of all ages who had been diagnosed with dengue fever by a physician within the past year. Disparities in self-reported dengue infection were assessed using standardized questionnaires that covered individual factors (age, sex, education, occupation, and preventive measures) and household factors (health facility awareness, travel time, transport affordability, wealth, water source, and preventive behavior). Data collected from August to October 2023 were analyzed using weighted logistic regression models in STATA 17.0 MP to account for the complex sampling design.</div></div><div><h3>Results</h3><div>Self-reported dengue incidence was higher in urban areas (0.73 %) than rural areas (0.52 %). In urban settings, higher odds of dengue infection were associated with having school-aged children, living in crowded households, belonging to the wealthiest quintile, using bottled water, and neglecting regular cleaning of water storage containers. In rural areas, adults using refill water had increased odds of infection, while those working in the informal sector and practicing mosquito bite prevention showed reduced odds.</div></div><div><h3>Conclusions</h3><div>Our study highlights social determinants of dengue infection in Indonesia, emphasizing the need for targeted public health interventions that address educational disparities, economical access to healthcare, and effective preventive practices.</div></div>","PeriodicalId":33615,"journal":{"name":"Global Transitions","volume":"8 1","pages":"Pages 10-21"},"PeriodicalIF":3.1,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145019979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial disparities in the association of epigenetic age acceleration with the transition between normal cognition, mild cognitive impairment and dementia","authors":"Guangwen Liu ,&nbsp;Chenlu Hong ,&nbsp;Yujie Huang ,&nbsp;Boyuan Guan ,&nbsp;Yating Liu ,&nbsp;Zhaorui Liu ,&nbsp;Yanan Luo","doi":"10.1016/j.glt.2025.08.001","DOIUrl":"10.1016/j.glt.2025.08.001","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;This study aimed to explore the association between epigenetic age acceleration and the transition between different cognitive status during dementia process. We also verified the racial disparities in the above relationships.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Data was from the US Health and Retirement Study, involving 3593 participants (50+) with a 4-year follow-up. Normal cognition (NC), mild cognitive impairment (MCI) and dementia was evaluated by the modified Telephone Interview for Cognitive Status. Epigenetic age was determined by epigenetic clocks based on DNA methylation patterns and dichotomized into acceleration and deceleration according to residual from the regression of epigenetic age on chronological age. Cox regression models were conducted to examine the association between epigenetic age acceleration and risk of transition between NC, MCI and dementia. Subgroup analysis was conducted to verify racial disparities.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among those with NC at baseline (n = 2671), 1053 (39.42 %) were male, 1618 (60.58 %) were female, 2057 (77.01 %) were Whites, and 614 (22.99 %) were Non-Whites. A total of 278 participants developed the transition from NC to MCI and 42 participants developed the transition from NC to dementia during the median follow-up of 3.92 years (interquartile range: 1.17–4.83 years). Accelerated epigenetic aging measured by GrimAge clock was associated with higher risk of MCI incidence (HR = 1.56, 95 % CI: 1.15–2.11) whereas epigenetic age acceleration measured by all the seven epigenetic clocks and the risk of transition from NC to dementia was not associated. Among those with MCI at baseline (n = 922), 408 (44.25 %) were male, 514 (55.75 %) were female, 633 (68.66 %) were Whites, and 289 (31.34 %) were Non-Whites. A total of 132 participants experienced transition from MCI to dementia during the median follow-up of 3.58 years (interquartile range: 1.17–4.67 years). Participants with age acceleration measured by Horvath's skin&amp;blood clock had a higher risk of transition from MCI to dementia (HR = 1.62, 95 % CI: 1.09–2.40). Heterogeneity of race was found in the relationship of epigenetic aging with transition between cognitive status and the observed associations only existed among non-Whites. Specifically, associations between GrimAge AccelAge and higher risk of transition from NC to MCI (HR = 2.04, 95 % CI: 1.10–3.79, &lt;em&gt;P&lt;/em&gt; for interaction = 0.039) as well as transition from NC to dementia (HR = 3.71, 95 % CI: 1.03–13.34, &lt;em&gt;P&lt;/em&gt; for interaction = 0.040) were only found among Non-White participants. In addition, significant association between epigenetic age acceleration measured by Hannum (HR = 2.16, 95 % CI: 1.10–4.24, &lt;em&gt;P&lt;/em&gt; for interaction = 0.048), Horvath's skin&amp;blood (HR = 4.33, 95 % CI: 2.04–9.20, &lt;em&gt;P&lt;/em&gt; for interaction = 0.046), and Zhang's clock (HR = 1.94, 95 % CI: 1.07–3.51, &lt;em&gt;P&lt;/em&gt; for interaction = 0.046), and the higher","PeriodicalId":33615,"journal":{"name":"Global Transitions","volume":"8 1","pages":"Pages 1-9"},"PeriodicalIF":3.1,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144902428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Environmental science, policy, and industry nexus: Integrating Frameworks for better transport sustainability","authors":"Nahed Bahman ,&nbsp;Naser Naser ,&nbsp;Ezzat Khan ,&nbsp;Tariq Mahmood","doi":"10.1016/j.glt.2024.12.001","DOIUrl":"10.1016/j.glt.2024.12.001","url":null,"abstract":"<div><div>The transport sector is one of the primary contributors to climate change since greenhouse gas (GHG) emissions have grown by about 80 % from 1990 to 2019. Energy use by this sector has increased over the years, now accounting for up to one-fifth of global energy use. This research, based on the necessity to improve sustainability in the transport sector in terms of increasing environmental impacts, and limitations in frameworks developed, seeks to integrate better and more effective assessments with mitigation measures. Despite the advances made in environmental sustainability, both scientists and policymakers recognize significant gaps in existing methods for measuring and reducing transport emissions. This study presents an integrated framework combining elements of Integrated Environmental Assessment (IEA) with Life Cycle Assessment (LCA) data, thus enhancing policy effectiveness in the sector. The study relies on sound data from LCAs in guiding the formulation of Policy Instruments and Policy Mixes. The methodology involves statistical analysis of surveys and LCA data within a policy context, focusing on sustainability assessment of transport systems. Important findings in key results show that embedding LCA into policy frameworks effectively helps minimize impacts on the environment and enhances sustainability within transport systems. Such important implications have been seen as valuable to policymakers and industries by proposing integration of LCA into environmental policies as a way of minimizing further burdens on the environment in addition to propelling climate change mitigation efforts.</div></div>","PeriodicalId":33615,"journal":{"name":"Global Transitions","volume":"7 ","pages":"Pages 29-40"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143130066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selecting E-bikes using a multi-criteria integrated analytic hierarchy approach for sustainable transportation option","authors":"Rohit Bansal ,&nbsp;Yasmeen Ansari ,&nbsp;Neha Gupta ,&nbsp;Manika Sharma","doi":"10.1016/j.glt.2025.02.006","DOIUrl":"10.1016/j.glt.2025.02.006","url":null,"abstract":"<div><div>Electric bikes play a crucial role in reducing greenhouse gas emissions, mitigating the problem of global warming, and contributing to sustainable development. Also, it helps to reduce crude imports, save foreign currency, and strengthen the balance of payments. This study aims to create a multi-criteria approach based on an integrated analytic hierarchy process (AHP) and multi-attributes border approximation area comparison (MABAC) that considers the various aspects of an Electric-bike’s (E-bike) performance and characteristics. The study results reveal that the AHP method performs best when making informed decisions regarding E-bikes. The eight criteria that were selected were the most desirable. Findings demonstrate buyers prioritized E-bikes' driving range (24 %) and battery capacity (21 %). The findings of this study support the idea of developing comprehensive selection criteria that consider the various features of an E-bike’s performance and characteristics. This study can be useful for low-performing electric scooter manufacturers to assess their benchmarks. The government should also facilitate adding more charging stations and battery-swapping facilities and tie up with petrol pumps, CNG stations, and other options. Based on the eight parameters in our study, Simple One ranked one, followed by Ola Pro and TVS iQube. The findings will be useful for manufacturers and policymakers to formulate and implement strategies to boost EV market penetration.</div></div>","PeriodicalId":33615,"journal":{"name":"Global Transitions","volume":"7 ","pages":"Pages 94-108"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143552999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining the association between tobacco and its substitutes use with psychosocial symptoms among 187,329 adolescents: A comparative analysis across 47 countries with varied universal health coverage index","authors":"Zichen Ye ,&nbsp;Manman Chen ,&nbsp;Xijie Wang ,&nbsp;Zhilan Xie ,&nbsp;Daqian Zhang ,&nbsp;Dandan Wu ,&nbsp;Yuankai Zhao ,&nbsp;Yimin Qu ,&nbsp;Yu Jiang","doi":"10.1016/j.glt.2025.02.007","DOIUrl":"10.1016/j.glt.2025.02.007","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to analyze the association between tobacco and its substitutes use and psychosocial symptoms among adolescents, and to investigate whether these associations varied based on the Universal Health Coverage (UHC) index.</div></div><div><h3>Methods</h3><div>A pooled cross-sectional analysis was conducted using data from the Global School-based Student Health Survey from 2013 to the most recent available year, covering 47 countries and involving 187,329 adolescents aged 12–17 years. Log-binomial regression models were applied to analyze the association between current tobacco and substitutes use and psychosocial symptoms including suicide ideation, being lonely, and worrying. Further stratified analysis was performed with log-binomial regression models to analyze whether the associations differed under different national UHC index.</div></div><div><h3>Results</h3><div>The prevalence of psychosocial symptoms, including suicide ideation, being lonely, and worrying, were 14.1 %, 12.8 %, and 10.3 %, respectively. The prevalence of tobacco and its substitutes use was significantly higher among boys (20.9 % vs. 10.7 %; <em>P</em> &lt; 0.001). Tobacco and its substitutes use was associated with greater risk of suicide ideation (boys: OR = 1.89, 95%CI 1.82–1.97; girls: OR = 2.33, 95%CI 2.26–2.40), being lonely (boys: OR = 1.58, 95%CI 1.51–1.64; girls: OR = 1.68, 95%CI 1.63,1.73), and worrying (boys: OR = 1.78, 95%CI 1.70,1.87; girls: OR = 1.82, 95%CI 1.76,1.89). The differences were also significant in all sex-stratified subgroup analyses (<em>P</em> &lt; 0.001). These associations were greater in countries with lower UHC index, particularly tobacco-related risk of suicide ideation among girls.</div></div><div><h3>Conclusion</h3><div>Tobacco and its substitutes use is associated with increased risks of various psychosocial symptoms, including feelings of suicide ideation, being lonely, and worrying, in adolescents, particularly among girls and in countries with lower UHC index.</div></div>","PeriodicalId":33615,"journal":{"name":"Global Transitions","volume":"7 ","pages":"Pages 128-135"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143563592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}