Public Health最新文献

{"title":"Association between sexual violence and HIV among sexual and gender minorities in low-resource settings: A meta-analysis.","authors":"Hong Chen, Yunlan Jiang, Le Li, Yuelin Wang, Jing Wang, Senlin Wu, Mengjie Zhang, Xiaoyu Bai","doi":"10.1016/j.puhe.2026.106488","DOIUrl":"https://doi.org/10.1016/j.puhe.2026.106488","url":null,"abstract":"<p><strong>Objectives: </strong>Sexual violence has been reported to correlate with HIV infection among Sexual and gender minorities, yet evidence regarding the association between sexual violence and HIV infection within this population in low-resource settings remains limited. This meta-analysis aimed to quantify the pooled association and explore subgroup disparities.</p><p><strong>Study design: </strong>Systematic review and meta-analysis of observational studies following PRISMA 2020.</p><p><strong>Methods: </strong>Registered on PROSPERO (CRD420261398499). We searched eight databases up to April 7, 2026. Random-effects models were used to pool odds ratios; subgroup analyses, univariate meta-regression, sensitivity analyses, trim-and-fill, Egger's and Begg's tests were performed. The AHRQ/NOS tool was applied to assess study quality.</p><p><strong>Results: </strong>A total of 21 eligible observational studies were included. Only one small-sample study enrolled women who have sex with women (WSW), and the majority of evidence came from transgender women (TW) and cis-gender men who have sex with men (MSM).Sexual violence was significantly associated with elevated odds of HIV infection (pooled OR = 2.05, 95% CI: 1.71-2.47, I² = 57.4%). The magnitude of this observed association was stronger among TW (OR = 3.14) compared with cisgender MSM (OR = 1.84). Univariate meta-regression identified gender identity as the primary detectable source of between-study heterogeneity. Significant publication bias was detected; the trim-and-fill adjusted pooled OR was 1.73.</p><p><strong>Conclusions: </strong>We observed a significant association between sexual violence and elevated odds of HIV infection among Sexual and gender minorities in low-resource contexts, with TW showing the strongest association. These findings underscore the need for trauma-informed multi-level strategies targeting sexual violence and HIV-related health disparities in this population. Notably, evidence was predominantly generated from TW and cis-MSM, with only one small study among WSW; our findings cannot be generalized to WSW.</p>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"259 ","pages":"106488"},"PeriodicalIF":3.5,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898260","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":"Spatiotemporal analysis of influenza, pneumonia, and respiratory syncytial virus in association with environmental factors: A systematic review.","authors":"Md Momin Islam, Farha Musharrat Noor, Vishal Singh, Thuy Lam, Wenbiao Hu, Javier Cortes-Ramirez","doi":"10.1016/j.puhe.2026.106491","DOIUrl":"https://doi.org/10.1016/j.puhe.2026.106491","url":null,"abstract":"<p><strong>Objectives: </strong>Influenza, pneumonia, and respiratory syncytial virus are the leading causes of respiratory morbidity and mortality globally. Environmental factors influence the spread of these diseases, yet considerable variation remains in how these relationships are modelled across different climates and geographic scales. This systematic review evaluates the use of spatiotemporal frameworks to investigate the relationship between environmental factors and these diseases.</p><p><strong>Study design: </strong>Systematic review.</p><p><strong>Methods: </strong>A systematic search of PubMed, Embase, and Scopus identified peer-reviewed studies investigating the relationship between environmental factors and influenza, pneumonia, and respiratory syncytial virus using spatiotemporal modelling approaches. Methodological quality was assessed using the Spatial Methodology Appraisal of Research Tool. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and was registered with PROSPERO.</p><p><strong>Results: </strong>Twelve studies met the inclusion criteria. Temperature and humidity were the most identified environmental determinants. Bayesian hierarchical models were the leading analytical framework for handling spatial and temporal dependencies. The interaction between environmental factors and area-level socioeconomic conditions significantly influenced local infection risk. Overall, the findings indicate that these relationships are often nonlinear and vary across locations, with threshold effects and geographical heterogeneity frequently reported.</p><p><strong>Conclusions: </strong>Spatiotemporal modelling is a valuable tool for investigating the associations between environmental factors and respiratory infection risk. The reviewed evidence suggests that these relationships are often complex, delayed, and, in some cases, nonlinear. This study highlights temperature and humidity as the main environmental factors influencing respiratory infections, noting that local socioeconomic conditions strongly shape their impact. Effective public health surveillance should incorporate localised environmental characteristics and socioeconomic vulnerabilities to better address disease risk across diverse areas.</p>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"259 ","pages":"106491"},"PeriodicalIF":3.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892757","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":"Beyond Hub-and-Spoke: The territorial hub as a public health architecture for integrated care.","authors":"Fabrizio Bogliatto","doi":"10.1016/j.puhe.2026.106487","DOIUrl":"https://doi.org/10.1016/j.puhe.2026.106487","url":null,"abstract":"<p><strong>Objectives: </strong>The Hub-and-Spoke model has long provided a credible architecture for healthcare networks by concentrating high-complexity care within tertiary centers while organizing lower-intensity services around them. This article examines why its rigid interpretation is increasingly inadequate and proposes the Territorial Hub as the missing organizational layer between tertiary expertise and community-based care.</p><p><strong>Study design: </strong>Conceptual policy analysis.</p><p><strong>Methods: </strong>Hub-and-Spoke arrangements were critically examined alongside district and place-based systems, integrated delivery networks, accountable care organizations and primary-care-led models, focusing on clinical governance, territorial coordination, inter-hub relationships, public health functions, community participation, workforce capacity and transferability.</p><p><strong>Results: </strong>The Territorial Hub is defined as the organizational evolution of the first-level hospital. It assumes vertical responsibility for coordinating Community Houses, Community Hospitals, district services, home care, outpatient services and territorial professionals, while maintaining a horizontal, structured and bidirectional relationship with the Hospital Hub. The Hospital Hub concentrates on high-complexity care, research, education, innovation and the production and updating of clinical standards; the Territorial Hub translates these competencies into locally governed pathways, ensures continuity, manages complexity compatible with local resources and activates timely escalation towards advanced specialist care.</p><p><strong>Conclusions: </strong>The Hospital Hub-Territorial Hub architecture preserves necessary centralization while overcoming the passive notion of the spoke. Its implementation requires shared governance, explicit safety boundaries, adequate workforce capacity, community participation and evaluation through clinical, organizational and public health outcomes.</p>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"259 ","pages":"106487"},"PeriodicalIF":3.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892800","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":"Estimating the lifetime costs associated with maternal alcohol consumption during pregnancy.","authors":"Abdelrahman M Makram, Michel Wensing, Manuela Bombana","doi":"10.1016/j.puhe.2026.106464","DOIUrl":"https://doi.org/10.1016/j.puhe.2026.106464","url":null,"abstract":"<p><strong>Objectives: </strong>Maternal alcohol consumption during pregnancy is a major, yet preventable, risk factor for fetal alcohol spectrum disorders (FASD), which can lead to lifelong neurodevelopmental, educational, and social challenges. The economic burden of FASD in Germany remains poorly quantified. In this study, we aimed to estimate the direct and indirect lifetime costs associated with FASD in Germany.</p><p><strong>Study design: </strong>Static cohort-based cost-of-illness study.</p><p><strong>Methods: </strong>We conducted a cost-of-illness analysis from the perspectives of the German healthcare (e.g., psychiatric care) and social (e.g., alternative housing, special education) systems. Data from German and international studies were used to derive age-specific annual costs, which were applied to a modeled cohort of 12,600 and 13,500 individuals with FASD in Baden-Württemberg. Lifetime costs were calculated from birth to the German retirement age (67 years), adjusted to inflation in 2024, and discounted at 0%, 3%, and 5% per annum.</p><p><strong>Results: </strong>The estimated undiscounted lifetime cost per affected individual was EUR 3.9 million, corresponding to EUR 49.6-53.1 billion for a single birth cohort, depending on the assumed prevalence. Applying a 3% discount rate reduced the present value to EUR 1.5 million per individual and EUR 18.4-19.8 billion for the birth cohort, while a 5% discount rate further decreased these estimates to EUR 0.9 million per individual and EUR 11.1-11.9 billion.</p><p><strong>Conclusions: </strong>FASD represents a significant lifetime economic burden in Germany. Both undiscounted and discounted estimates underscore the importance of early preventive interventions, improved screening, and targeted support to reduce long-term costs for healthcare, social services, and society.</p>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"259 ","pages":"106464"},"PeriodicalIF":3.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892802","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":"Private health insurance and preventive care utilisation in Australia: A longitudinal study.","authors":"Chi M Nguyen, Lan P D Luc, Mai P Nguyen","doi":"10.1016/j.puhe.2026.106468","DOIUrl":"https://doi.org/10.1016/j.puhe.2026.106468","url":null,"abstract":"<p><strong>Objectives: </strong>To examine association of private health insurance (PHI) with preventive care utilisation, and the influences of chronic conditions in Australia.</p><p><strong>Study design: </strong>Longitudinal study.</p><p><strong>Methods: </strong>Data were drawn from three waves (2009, 2013 and 2017) of the Household, Income and Labour Dynamics in Australia Survey. Preventive healthcare utilisation was measured as the number of six reported preventive services: cervical screening, prostate screening, breast screening, bowel cancer screening, blood pressure checks and cholesterol testing. PHI coverage included extras PHI, hospital PHI, or combined hospital and extras PHI. Associations between PHI and preventive care were estimated using Poisson regression with augmented inverse probability weighting, adjusting for chronic conditions, demographic, and socioeconomic factors.</p><p><strong>Results: </strong>The cohort included 9674 individuals followed over three waves. Chronic conditions became more prevalent over time, particularly hypertension, arthritis/osteoporosis, depression or anxiety, cardiovascular disease and diabetes. Individuals with chronic conditions reported higher preventive service utilisation than those without such conditions. After adjustment, PHI was significantly associated with greater preventive care use compared with Medicare alone. Among women, hospital PHI and combined PHI were associated with a 14% higher utilisation rate (incidence rate ratio IRR 1.14, 95% confidence interval CI 1.09-1.18). Among men, hospital PHI was associated with a 12% higher rate (IRR 1.12, 95% CI 1.00-1.23), while combined PHI was associated with an 18% higher rate (IRR 1.18, 95% CI 1.11-1.25).</p><p><strong>Conclusions: </strong>PHI was associated with higher preventive care utilisation. Strengthening coordination between PHI and Medicare may improve preventive care delivery and chronic disease management in Australia.</p>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"259 ","pages":"106468"},"PeriodicalIF":3.5,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888763","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":"Health and behavioural risks for adverse pregnancy and offspring outcomes across peak male fertility: Prevalence in the Australian longitudinal study on male health.","authors":"Lauren M Francis, Elizabeth A Spry, Delyse Hutchinson, Milton Kotelchuck, Jacqueline A Boyle, Zac E Seidler, Craig A Olsson, Robert J Hancox, Samantha Teague, Michael J Wilson, Tim Moss, Tina Kretschmer, Karen Wynter, Ebony J Biden, Craig F Garfield, Sean Martin, Christopher J Greenwood, Richard Fletcher, Jacqui A Macdonald","doi":"10.1016/j.puhe.2026.106466","DOIUrl":"https://doi.org/10.1016/j.puhe.2026.106466","url":null,"abstract":"<p><strong>Objectives: </strong>Male preconception exposures are associated with adverse pregnancy and offspring outcomes, yet few studies have reported prevalence of these risk factors in men of reproductive age. We aimed to estimate preconception risk factor prevalence and concurrent risk counts, and to identify risk levels within population subgroups.</p><p><strong>Study design: </strong>Descriptive, cross-sectional analyses of a national cohort study.</p><p><strong>Methods: </strong>Data were from four waves across the Australian Longitudinal Study on Male Health (2012-2022). Included were fertile men aged 18-44 years at each wave (n_w1 = 8727; n_w2 = 5854; n_w3 = 3267; n_w4 = 2705). Eleven pre-established risk factors were assessed: eight were available at all waves and used to derive a concurrent risk score (harmful alcohol use, cigarette use, cannabis use, illicit drug use, occupational exposure to harmful substances, type 2 diabetes, depression, and high body mass); three were assessed at between one and three waves (anxiety, intimate partner violence perpetration, and low fruit or vegetable intake). Proportions were estimated at each wave and weighted to be population representative. Subgroup differences were examined in regression analyses.</p><p><strong>Results: </strong>82-84% of men had one or more preconception risk factors, 48-53% had two or more. The most common risk was low fruit or vegetable intake (76-77%). Relative to counterparts, men under financial stress reported 45-50% more risk factors, men with lower education reported 18-30% more, unemployed men 19-32% more, and men residing in regional or remote locations 12-22% more.</p><p><strong>Conclusions: </strong>Results present compelling evidence of high preconception health needs in men and underscore the importance of supporting men prior to reproduction.</p>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"259 ","pages":"106466"},"PeriodicalIF":3.5,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881629","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":"Assessing the public health impact of routinely collected electronic healthcare record data in NICE guidelines: A systematic review of CPRD research.","authors":"Alwin Paul, Ikenna Nwogu, Susan Hodgson, Eleanor Yelland, Shaun Rowark, Jennifer Quint, Hannah Whittaker","doi":"10.1016/j.puhe.2026.106467","DOIUrl":"https://doi.org/10.1016/j.puhe.2026.106467","url":null,"abstract":"<p><strong>Objectives: </strong>Evidence used in NICE guidance has traditionally prioritised randomised controlled trials, but increasing availability of electronic health record (EHR) data has expanded opportunities for real-world evidence. The Clinical Practice Research Datalink (CPRD) is a commonly used UK primary care EHR resource, yet the extent to which CPRD studies have informed NICE guidelines in the past decade is unclear.</p><p><strong>Study design: </strong>The systematic review was conducted in accordance with PRISMA guidelines.</p><p><strong>Methods: </strong>We conducted a systematic review of CPRD studies in PubMed, MEDLINE, and Embase published between 04/16-09/25. For each eligible CPRD study, targeted searches of NICE guidelines were performed to identify explicit citations in NICE guidelines. Two reviewers screened and extracted data independently, resolving disagreements by consensus or third reviewer. Guideline information, number of guidelines over time, type of guidelines, and disease area guidelines (using British National Formulary (BNF) chapters) were described.</p><p><strong>Results: </strong>7181 records were identified. After de-duplication, 2704 unique CPRD studies were screened against NICE guidelines. Of these, 92 CPRD-based studies met inclusion criteria and were cited across 67 NICE documents. The annual number of NICE guidelines citing CPRD studies increased between 2016 and 2025; 1.5% of identified guidelines published in 2016 and 27.7% in 2025. The guideline citing the most CPRD studies was cancer related. The most common types of guidelines included clinical guidelines (49.3%) and technology appraisals (32.8%). Guidelines made up 12 different BNF categories, most frequently central nervous system related (23.9%; n = 16).</p><p><strong>Conclusion: </strong>Observational CPRD studies are increasingly referenced in NICE guidelines across multiple disease areas, supporting the growing role of EHR data in national guideline development.</p>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"259 ","pages":"106467"},"PeriodicalIF":3.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876422","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":"Social care training for non-custodial staff in England working in prisons: A systematic scoping review to inform the training of 'Empowered Together' social workers.","authors":"Deborah Buck, Leila Sharda, Lee D Mulligan, Emily Egan, Matilda Minchin, Sanjana Buravalla, Kate Stalker, Clare Scollay, Adam O'Neill, Louise Robinson, Katrina Forsyth","doi":"10.1016/j.puhe.2026.106473","DOIUrl":"https://doi.org/10.1016/j.puhe.2026.106473","url":null,"abstract":"<p><strong>Objectives: </strong>To identify/map the nature and extent of the literature on training for non-custodial staff (social workers, healthcare staff and/or their equivalent) working in prisons in England, with a specific focus on social care, to inform the training of individuals delivering the Empowered Together (coordinated social care in prison) intervention.</p><p><strong>Study design: </strong>Systematic scoping review.</p><p><strong>Methods: </strong>We conducted systematic searches across eight electronic databases. Pairs of reviewers independently screened articles meeting pre-specified criteria. We extracted the following into Excel spreadsheets: study characteristics; training development, content/delivery, evaluation; author recommendations. We tabulated study characteristics and provided narrative summaries. We also considered the grey literature.</p><p><strong>Results: </strong>Of 512 records identified through database searches, two met our inclusion criteria. Both focused on training to support people living in prison with dementia. Each embraced stakeholder involvement as part of training development, targeted a range of staff (rather than solely social workers), and aimed to enhance knowledge among staff. However, only one covered practical skills and neither included evaluations of their training programmes. No relevant documents were found within the grey literature.</p><p><strong>Conclusions: </strong>This is the first systematic scoping review of social care training in prison. Findings suggest a paucity of evidence regarding training for social workers working in prisons across England. Future training should ideally be co-designed with key stakeholders including people living and working in prison, and future research should focus on robust evaluation of training initiatives not only in terms of knowledge but also the impacts this has on people living in prison.</p>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"259 ","pages":"106473"},"PeriodicalIF":3.5,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867521","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":"Multisectoral engagement in health emergency preparedness: A commentary on the WHO's universal health & preparedness review (UHPR).","authors":"Niluka Wijekoon Kannangarage, Jun Xing, Ludy Suryantoro, Luc Bertrand Tsachoua Choupe, Adam Tiliouine, Bo Jia","doi":"10.1016/j.puhe.2026.106465","DOIUrl":"https://doi.org/10.1016/j.puhe.2026.106465","url":null,"abstract":"<p><p>Despite the long-standing efforts to promote whole-of-government and whole-of-society models, health emergency preparedness is still challenged by siloed institutional or sectoral approaches. In practice, no unified mechanism has existed to systematically bring different sectors, communities, countries or regions to strengthen preparedness capacities. In response to these persistent gaps, World Health Organization (WHO) introduced the Universal Health and Preparedness Review (UHPR) as one of its Post COVID-19 initiatives. This commentary examines the place of UHPR in the sphere of health emergency preparedness in bringing sustained engagement between different sectors at the national level and facilitating cross-country and cross-regional peer learning at the global level.</p>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"259 ","pages":"106465"},"PeriodicalIF":3.5,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857804","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":"The impact of the universal choice of self-collection on cervical screening participation in Australia's National Cervical Screening Program: A population-based interrupted time series analysis.","authors":"Nicola S Creagh, Claire Nightingale, Julia Ml Brotherton, Jane S Hocking, Amalia Karahalios","doi":"10.1016/j.puhe.2026.106474","DOIUrl":"https://doi.org/10.1016/j.puhe.2026.106474","url":null,"abstract":"<p><strong>Objectives: </strong>In July 2022, Australia's National Cervical Screening Program introduced vaginal self-collection for human papillomavirus testing as a screening option. We evaluated the policy impact on cervical screening rates in Victoria, Australia, and compared use of clinician-versus self-collection by practice location.</p><p><strong>Study design: </strong>Interrupted time series.</p><p><strong>Methods: </strong>Using de-identified electronic medical records of age-eligible women (n = 267,127) from general practices (n = 69) contributing data to the Patron Primary Care Data repository. Interrupted time series analysis using segmented Poisson regression models estimated the slope change in monthly cervical screening rates per 100 women before (December 2017-June 2022) and after policy change (July 2022-June 2023). We described collection method by metropolitan versus regional/rural location.</p><p><strong>Results: </strong>Monthly screening rates per 100 women decreased before policy change (incident rate ratio [IRR]: 0.98; 95% confidence interval [CI]: 0.97, 0.98) and increased after policy change (IRR: 1.10; 95% CI: 1.08, 1.12). Self-collection screening per 100 women increased monthly after policy change (IRR: 1.22; 95% CI: 1.16, 1.29), compared to clinician-collection (IRR: 1.06; 95% CI: 1.08, 1.12). The use of self-collection after policy change was higher amongst regional/rural practices.</p><p><strong>Conclusions: </strong>Universal access to self-collection resulted in modest increases in cervical screening, though direct attribution to the policy cannot be confirmed. Ongoing implementation challenges may explain variation observed between metropolitan and regional/rural practices.</p>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"259 ","pages":"106474"},"PeriodicalIF":3.5,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857832","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}