Public Health最新文献

{"title":"Development and validation of the Malaysia adolescents e-cigarette survey (MY-ACES)","authors":"Siti Idayu Hasan ,&nbsp;Siti Nourul A'in Ruslan","doi":"10.1016/j.puhe.2026.106176","DOIUrl":"10.1016/j.puhe.2026.106176","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to develop and validate the Malaysia Adolescents E-Cigarette Survey that assess knowledge, beliefs, susceptibility, refusal self-efficacy, refusal skills techniques–intention, and refusal skills techniques–practice.</div></div><div><h3>Study design</h3><div>Multiphase content and construct validity.</div></div><div><h3>Methods</h3><div>The final 59-item My-ACES tool was developed based on an extensive literature review and expert panel review. The tool underwent content validation by an expert panel and was subsequently validated for construct validity and reliability in a sample of 367 Malaysian adolescents, aged 13–17 using a cross-sectional online survey from May to July 2025. Content validity was assessed by the Scale-level Content Validity Index. Construct validity and reliability were analyzed by Exploratory factor analysis, Cronbach's alpha, and Pearson correlations.</div></div><div><h3>Results</h3><div>The content validity showed that the Scale-level Content Validity Index ranged from 0.86 to 1.00 for consistency, representativeness, relevancy, and clarity, resulting in the final 59-item questionnaire. The construct validity of My-ACES, based on eigenvalues and factor loadings to confirm the six-factor structure (knowledge, beliefs, susceptibility, refusal self-efficacy, refusal skills techniques–intention, and refusal skills techniques–practice) with 70.3% total variance, was acceptable (Kaiser–Meyer–Olkin = 0.93; Bartlett's test of sphericity was significant, p &lt; 0.001). The internal consistency reliability of the six-factor structure was very good, with Cronbach's alpha values ranging from 0.87 to 0.96.</div></div><div><h3>Conclusion</h3><div>My-ACES is a psychometrically robust, theoretically grounded, and culturally relevant instrument specifically tailored for adolescent e-cigarette-related constructs in Malaysia. Its development provides a critical tool to strengthen public health surveillance, inform prevention and intervention strategies for support Malaysia's Tobacco Endgame 2040. However, causal inference and temporal stability could not be assessed due to the cross-sectional design, warranting future longitudinal and confirmatory validation studies to support its use in routine surveillance and policy monitoring.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"253 ","pages":"Article 106176"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146174776","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":"Representation of young mothers in Australian maternity and health care policy: A qualitative content analysis","authors":"Sally Hargreaves ,&nbsp;Jennifer Ayton ,&nbsp;Sarah Young ,&nbsp;Emily Hansen","doi":"10.1016/j.puhe.2026.106185","DOIUrl":"10.1016/j.puhe.2026.106185","url":null,"abstract":"<div><h3>Objectives</h3><div>Young mothers aged 15–24 years face complex maternity health needs, including higher risks of mental health issues, barriers to consistent and non-judgmental care, and increased social isolation and stigma. This study aims to examine how the health care needs of young mothers are represented in Australian maternity policies<strong>.</strong></div></div><div><h3>Study design</h3><div>A qualitative content analysis.</div></div><div><h3>Methods</h3><div>This qualitative content analysis used a Foucauldian approach to analyse seven Australian national and regional Tasmanian maternity and health care policy documents. Data was extracted and placed into predefined categories.</div></div><div><h3>Results</h3><div>The policy documents provided minimal evidence to guide and inform service provision for young mothers who live in regional, rural, and remote areas. The disconnect between global, national, and local policy relating to identified health issues and maternal health care for young mothers was evident.</div></div><div><h3>Conclusions</h3><div>The paucity of specific documented maternal health strategies and service provision for young mothers within national, statewide and local policy is apparent. This has led to poor policy development and guidance for young mothers. Further policy developments targeting service provision and maternal health care for young mothers living in regional, rural and remote areas needs to be addressed.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"253 ","pages":"Article 106185"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116717","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":"Comparison of musculoskeletal health in the general population between 2016/17 and 2022/3: A tapered matching study","authors":"Dahai Yu ,&nbsp;Emma Parry ,&nbsp;James Bailey ,&nbsp;Jonathan Hill ,&nbsp;Kelvin P. Jordan ,&nbsp;George Peat ,&nbsp;Ross Wilkie","doi":"10.1016/j.puhe.2026.106180","DOIUrl":"10.1016/j.puhe.2026.106180","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate changes in the prevalence of chronic pain (CP), high-impact chronic pain (HICP), and musculoskeletal health (MSK-HQ scores) before and after the COVID-19 pandemic.</div></div><div><h3>Study design</h3><div>Longitudinal cross-sectional study using data from two population-based surveys conducted in 2016/17 (PRELIM) and 2022/23 (MIDAS-POP).</div></div><div><h3>Methods</h3><div>Adults aged 35 and over registered with general practices in the West Midlands, UK, completed questionnaires including CP, HICP, and MSK-HQ. Entropy balancing was applied to match respondents across survey years on age, sex, deprivation, and ethnicity. Logistic and linear regressions estimated odds ratios (ORs) and mean differences. Subgroup analyses tested for interactions, and E-values were calculated to assess robustness to unmeasured confounding.</div></div><div><h3>Results</h3><div>CP prevalence increased from 35.6% in 2016/17 to 42.9% in 2022/23 (OR 1.36, 95% CI 1.22 to 1.51), and HICP from 15.5% to 22.4% (OR 1.57, 1.38 to 1.80). MSK-HQ scores among people with CP declined from 32.4 to 23.1, exceeding the minimal important change. Increases were more marked among women and people aged 35–54. Differences by deprivation and ethnicity were observed, although subgroup estimates for ethnicity should be interpreted cautiously due to small sample sizes. E-values suggested that the associations were moderately robust to unmeasured confounding.</div></div><div><h3>Conclusions</h3><div>Chronic pain prevalence and its burden have increased since the COVID-19 pandemic, alongside declines in musculoskeletal health. While some of this may reflect residual confounding, the findings underscore the need for targeted pain prevention and management strategies, particularly for working-age adults and underserved groups.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"253 ","pages":"Article 106180"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146175281","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":"Multimorbidity and associated factors among older adults with hypertension: Network analysis based on a cross-sectional study in rural China","authors":"Yifei Feng ,&nbsp;Guangying Li ,&nbsp;Saiyi Wang ,&nbsp;Xiaoman Wu ,&nbsp;Xiaoyu Jiao ,&nbsp;Yijing Zhang ,&nbsp;Clifford Silver Tarimo ,&nbsp;Nengguang Dai ,&nbsp;Rongmei Liu ,&nbsp;Qiuping Zhao ,&nbsp;Quanman Li ,&nbsp;Jian Wu ,&nbsp;Yinmei Yang","doi":"10.1016/j.puhe.2026.106191","DOIUrl":"10.1016/j.puhe.2026.106191","url":null,"abstract":"<div><h3>Objectives</h3><div>Multimorbidity has emerged as a growing public health challenge, particularly within the context of global population aging. Approximately over half of older adults with hypertension suffer from at least one additional chronic condition. This study aimed to assess the prevalence of multimorbidity, explore associated factors, and identify central diseases among older adults with hypertension in rural China.</div></div><div><h3>Study design</h3><div>A cross-sectional study.</div></div><div><h3>Methods</h3><div>A total of 16,953 older adults (aged ≥65 years) with hypertension were included. Multimorbidity was defined as hypertensive participants with one or more chronic diseases. The analysis included demographic and health behavior variables, as well as clinical attributes. Logistic regression analysis was performed to examine influencing factors of multimorbidity. A network analysis was used to identify core diseases and disease relationships.</div></div><div><h3>Results</h3><div>The prevalence of multimorbidity was 77.32% among older adults with hypertension. Increased age (aOR: 0.984, 95%CI: 0.977-0.991), healthy physical activity (aOR: 0.760, 95%CI: 0.696-0.829), healthy diet quality (aOR: 0.736, 95%CI: 0.616-0.879), healthy sleep duration (aOR: 0.768, 95%CI: 0.710-0.831) were protective factors of multimorbidity, while female (aOR: 1.418, 95%CI: 1.289-1.559), higher numbers of antihypertensive medicine (with no antihypertensive medication as the reference, aOR: 1.499, 95%CI: 1.327-1.693 for 1 medication; aOR: 1.894, 95%CI: 1.629-2.202 for ≥2 medications), duration of hypertension (aOR: 1.030, 95%CI: 1.025-1.035) and higher BMI (aOR: 1.140, 95%CI: 1.125-1.155) were risk factors of multimorbidity. Network analysis revealed that biliary disease (strength: 1.347), vision impairment (strength: 1.346), and arthritis or rheumatism (strength: 1.178) were central diseases. The correlation stability coefficient of the network model was 0.672, indicating excellent stability. The nodes of chronic kidney disease and liver disease were most strongly correlated (edge weight: 1.538), followed by the connection between arthritis or rheumatism and stomach or other digestive disease (edge weight: 1.050).</div></div><div><h3>Conclusions</h3><div>Multimorbidity in rural older adults with hypertension is associated not only with demographics but also with modifiable lifestyle factors and clinical characteristics. Network analysis reveals that chronic conditions co-occur non-randomly. These findings highlight the need for integrated care models that address these specific patterns, promote prudent prescribing, and support lifestyle modification as a key strategy in resource-limited settings.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"253 ","pages":"Article 106191"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146174774","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":"Medical issues of adult men residing in homeless shelters in Gdańsk, Poland","authors":"Piotr Glimasiński ,&nbsp;Iwona A. Bielska ,&nbsp;Małgorzata Lipińska ,&nbsp;Paweł Jaskulski ,&nbsp;Dawid Krefta ,&nbsp;Krzysztof Bartosz Klimiuk ,&nbsp;Oskar Bieńka ,&nbsp;Łukasz Balwicki","doi":"10.1016/j.puhe.2026.106181","DOIUrl":"10.1016/j.puhe.2026.106181","url":null,"abstract":"<div><h3>Objectives</h3><div>To describe sociodemographic characteristics, facility use and health conditions among adult men residing in homeless shelters in Gdańsk, Poland.</div></div><div><h3>Study design</h3><div>Retrospective, cross-sectional analysis of routinely collected non-governmental organization's operational records.</div></div><div><h3>Methods</h3><div>From 551 male shelter residents supported by the Saint Brother Albert's Aid Society in 2023, a random sample of 226 was selected. We summarized age, disability status, hospitalizations, diagnoses (ICD-10) and shelter use with descriptive statistics.</div></div><div><h3>Results</h3><div>Median age was 60 years; 42% had certified disability. In 2023, 31% were hospitalized at least once and 17 individuals had ≥3 admissions. Frequent diagnoses included essential hypertension (20%), epilepsy (11–12%) and heart failure (10%); alcohol dependence was documented in 40%. Infectious burdens were present, including tuberculosis (∼6%). Facility use concentrated in shelters with care services; night-shelter users had more admissions/removals and more fragmented stays.</div></div><div><h3>Conclusions</h3><div>Adult men experiencing homelessness in Gdańsk have substantial cardiovascular, neurological and infectious disease burdens with frequent hospital use. More studies based on medical registers and social services data should be conducted in the future.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"253 ","pages":"Article 106181"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146138113","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":"Digital exclusion, functional health literacy, and COVID-19 vaccination in later life: Evidence from 30,801 older adults across Europe","authors":"Clément Meier ,&nbsp;Jean Pierre Uwitonze ,&nbsp;Maud Wieczorek","doi":"10.1016/j.puhe.2026.106174","DOIUrl":"10.1016/j.puhe.2026.106174","url":null,"abstract":"<div><h3>Objectives</h3><div>Functional health literacy (HL), the ability to read and act on health information, is crucial for making informed decisions. Yet, few studies have specifically examined how it relates to COVID-19 vaccination behavior among older adults, particularly in conjunction with digital access. This study investigates the association between functional HL and COVID-19 vaccination uptake among older adults across Europe and explores whether this association is moderated by internet use.</div></div><div><h3>Study design</h3><div>Observational prospective study.</div></div><div><h3>Methods</h3><div>Data from 30,801 respondents aged 50 and older were drawn from Wave 8 (2019/2020) and the second COVID-19 questionnaire (2021) of SHARE, covering 27 countries. Functional HL was assessed using the Single-Item Literacy Screener. COVID-19 vaccination status and internet use were self-reported. Probit regression models, adjusted for individual- and country-level factors, tested the association and included HL × internet use interaction terms to assess moderation.</div></div><div><h3>Results</h3><div>Overall, 27 % of respondents reported at least sometimes needing help reading health information, 54 % reported using the internet, and 80 % were vaccinated against COVID-19. Lower HL was significantly associated with a lower likelihood of being vaccinated (AME = −0.02, p &lt; 0.001). A significant interaction between HL and internet use (p &lt; 0.001) indicated that the association between HL and vaccination was stronger among non-users of the internet.</div></div><div><h3>Conclusions</h3><div>Lower functional HL is associated with decreased COVID-19 vaccination uptake among older adults, particularly among those who do not use the internet. Public health interventions should address both HL and digital access to reduce inequalities in vaccination uptake among older populations.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"253 ","pages":"Article 106174"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146167726","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":"Association between dairy consumption and Parkinson's disease: A systematic review and meta-analysis","authors":"Gaurav Nepal ,&nbsp;Dan Yang ,&nbsp;Rajeev Ojha ,&nbsp;Zhilan Tu","doi":"10.1016/j.puhe.2026.106143","DOIUrl":"10.1016/j.puhe.2026.106143","url":null,"abstract":"<div><h3>Objectives</h3><div>Parkinson's disease (PD) is a progressive neurodegenerative disorder with no cure and rising global prevalence. Genetic, environmental, and dietary factors may influence risk. Dairy intake, may influence risk through gut microbiome changes and alpha-synuclein spread along the gut–brain axis, though epidemiological evidence is mixed. This meta-analysis examines the association between dairy consumption and PD risk in observational studies.</div></div><div><h3>Study design</h3><div>This study is a systematic review and meta-analysis of published literature.</div></div><div><h3>Methods</h3><div>PubMed and EMBASE were searched for original, peer-reviewed observational studies examining dairy intake and PD risk. Pooled risk estimates were calculated using fixed- or random-effects models depending on heterogeneity (I² threshold: 50 %). Subgroup analyses by dairy type and sex were conducted. This study adhered to PRISMA guidelines.</div></div><div><h3>Results</h3><div>Nine studies (eight cohort, one case-control) comprising diverse populations from the U.S., Europe, and Asia were included. A total of 15 results from 9 observational studies were analyzed. The combined cohort studies encompassed 634,327 participants with 4285 incident PD cases, while the case-control studies included 617 individuals (368 controls and 249 PD cases). High total dairy intake was significantly associated with increased PD risk (RR = 1.211; 95 % CI: 1.071–1.37; p = 0.002), with a stronger effect in males (RR = 1.282) than females (RR = 1.019). Milk consumption was also associated with increased PD risk (RR = 1.13; 95 % CI: 1.079–1.20; p &lt; 0.001), with consistent sex-specific results. No significant associations were found for yogurt/fermented milk, cheese, butter, or ice cream.</div></div><div><h3>Conclusions</h3><div>Higher consumption of total dairy and plain milk is associated with an increased risk of developing PD. Further studies involving diverse populations and ethnicities should explore this association, stratified by genetic and sporadic forms of PD.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106143"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980557","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":"Meteorological associations with out-of-hospital cardiac arrest: A national population-based time-series analysis","authors":"Ádám Pál-Jakab ,&nbsp;Patrik Pesti ,&nbsp;Zsuzsanna Horti-Maricza ,&nbsp;Bettina Nagy ,&nbsp;Boldizsár Kiss ,&nbsp;Botond Biebel ,&nbsp;György Pápai ,&nbsp;Gábor Csató ,&nbsp;Nora Boussoussou ,&nbsp;Béla Merkely ,&nbsp;András Gelencsér ,&nbsp;Péter Sótonyi ,&nbsp;Brigitta Szilágyi ,&nbsp;Endre Zima","doi":"10.1016/j.puhe.2026.106145","DOIUrl":"10.1016/j.puhe.2026.106145","url":null,"abstract":"<div><h3>Objectives</h3><div>Meteorological factors may influence cardiovascular emergency incidence, but comprehensive national evidence for out-of-hospital cardiac arrest (OHCA) associations remains limited. We investigated meteorological associations with OHCA occurrence using complete national population data.</div></div><div><h3>Study design</h3><div>Population-based time-series retrospective, non-interventional analysis.</div></div><div><h3>Methods</h3><div>We conducted a population-based time-series analysis using the Hungarian National Ambulance Service registry from November 2018 to December 2023. After excluding COVID-19 disruption period, 114830 OHCA cases across 1584 days were analysed. Meteorological parameters included temperature, wind speed, atmospheric pressure, humidity, and air quality. Associations were assessed using negative binomial regression models with temporal lag structures (0–3 days). We used a rolling 30-day z-score to detect outlier days with high OHCA cases and identified their unique weather conditions. Machine learning validation was performed with XGBoost and SHAP interpretation.</div></div><div><h3>Results</h3><div>Daily OHCA incidence averaged 60·9 ± 14·3 cases, peaking in winter (17·8 % higher than summer, p &lt; 0·001). Each 1 °C temperature decrease was associated with a 1·4 % increase in daily OHCA incidence (IRR 0·986). Wind speed demonstrated inverse association (7·9 % decrease in OHCA incidence per-IQR effect; IRR 0·928). The highest-incidence days saw 31·9 % more cases, equivalent to 19 additional cases daily, linked to adverse weather.</div></div><div><h3>Conclusion</h3><div>Meteorological factors demonstrate strong, predictable associations with OHCA incidence, with extreme weather increasing rates by nearly one-third. The 3-day lag patterns enable weather-based early warnings, supporting the integration of meteorological data into emergency response to reduce preventable deaths.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106145"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980463","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":"Persistent income-related inequalities in cancer screening utilisation in South Korea: Evidence from repeated cross-sectional data, 2013–2023","authors":"Soyun An ,&nbsp;Sunghyun Yi ,&nbsp;Jihyung Hong","doi":"10.1016/j.puhe.2026.106157","DOIUrl":"10.1016/j.puhe.2026.106157","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to examine trends in income-related inequalities in cancer screening from 2013 to 2023 and decompose these inequalities into contributing factors.</div></div><div><h3>Study design</h3><div>This is a repeated cross-sectional study.</div></div><div><h3>Methods</h3><div>Data were drawn from the 2013, 2018, and 2023 waves of the nationally representative cross-sectional Korea National Health and Nutrition Examination Survey. Screening uptake was defined as having received any cancer screening within the past two years, reflecting Korea's biennial check-up schedule. Income-related inequality was assessed using the Erreygers concentration index (ECI) and the horizontal inequity index (HIwv). The ECI was decomposed to identify contributing factors.</div></div><div><h3>Results</h3><div>Screening rates increased across all income groups, with overall participation rising from 63.7 % in 2013 to 71.8 % in 2023. However, a widening pro-rich inequality was observed over this period. The ECI rose from 0.127 (standard error [SE]: 0.018) in 2013 to 0.149 (SE: 0.016) in 2023, and the HIwv increased from 0.108 (SE: 0.019) to 0.146 (SE: 0.016). Income and private health insurance (PHI) made the largest contributions. Income's share of inequality nearly doubled from 38.2 % to 71.4 %, while PHI's declined from 35.8 % to 24.9 %.</div></div><div><h3>Conclusions</h3><div>Despite near-universal financial coverage, persistent pro-rich inequalities in cancer screening suggest that eliminating direct screening costs alone is insufficient to achieve equity. Broader strategies addressing structural and social barriers — including post-diagnosis financial concerns, time constraints, and gaps in education and health literacy — are required to ensure equitable access to preventive care.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106157"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145999524","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":"Antenatal lifestyle interventions to reduce gestational weight gain: Where should we start and how much will it cost?","authors":"Melanie Lloyd ,&nbsp;Yanan Hu ,&nbsp;Emily Callander ,&nbsp;Helena Teede ,&nbsp;Zanfina Ademi","doi":"10.1016/j.puhe.2026.106137","DOIUrl":"10.1016/j.puhe.2026.106137","url":null,"abstract":"<div><h3>Objectives</h3><div>Antenatal lifestyle interventions are effective in reducing negative outcomes associated with excess gestational weight gain. While strong cost-effectiveness has also been demonstrated, the cost of implementation is potentially a barrier to uptake. We aimed to estimate whether targeted implementation in high risk clinical groups (categorized by age, body mass index (BMI) and gravidity) returns greater health cost savings through a reduction in aggregate incidence of adverse pregnancy and birth outcomes.</div></div><div><h3>Study design</h3><div>Distributional budget impact analysis utilising population level linked data collections.</div></div><div><h3>Methods</h3><div>Total budget expenditure (cost of intervention minus cost savings from the associated reduction in adverse pregnancy outcomes) of implementing the lifestyle intervention in risk targeted population sub-groups was estimated, stratified by health system (public vs. private funding).</div></div><div><h3>Results</h3><div>Total annual budget expenditure if the intervention is routinely provided to 80 % of pregnant women in New South Wales and Queensland, Australia, is projected to be AU$11,654,857 for n = 94,539 public patients, and AU$6,527,434 for n = 33,516 private patients. If implemented in the BMI ≥30 kg/m² group only, expenditure is reduced to AU$643,339 for n = 10,298 public patients, and AU$579,003 for n = 5018 private patients, while for implementation in the Age ≥35 years group, it was AU$1,290,965 (n = 21,071 public) and AU$2,169,851 (n = 12,776 private). The number of adverse pregnancy outcomes averted per women was greatest in the BMI ≥30 kg/m² group.</div></div><div><h3>Conclusions</h3><div>Women in the highest BMI category should be prioritised for implementation of effective and cost-effective antenatal lifestyle intervention to reduce the aggregate budgetary impact of adverse pregnancy outcomes.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106137"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980560","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}