Epidemiolgia (Basel, Switzerland)最新文献

{"title":"The Association Between Religiosity and Lifelong Cancer Incidence in an Israeli Male Cohort: A Competing Risk Survival Analysis.","authors":"Lipaz Varkel, Uri Goldbourt, Yariv Gerber","doi":"10.3390/epidemiologia7020038","DOIUrl":"10.3390/epidemiologia7020038","url":null,"abstract":"<p><strong>Background: </strong>While religious involvement has been linked to better health outcomes, its specific association with cancer incidence remains uncertain. The potential for confounding by lifestyle factors, such as physical activity, body weight, and smoking, complicates the interpretation of this relationship, necessitating further research in large, well-defined cohorts. This study aims to investigate the association between religiosity and cancer incidence in a large Israeli cohort while controlling for a comprehensive set of confounders and the competing risk of mortality.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 8746 male city-hall employees from the Israeli Ischemic Heart Disease (IIHD) cohort, enrolled in 1963. Cancer and mortality follow-up lasted through 2019. Religiosity was self-reported at baseline and categorized as secular, traditional, or religious. We employed a cause-specific Cox proportional hazards model with age as the time scale to analyze the risk of cancer incidence, treating death as a competing risk. The model was adjusted for a comprehensive set of baseline confounders, including socioeconomic status, smoking, physical activity, body mass index, systolic blood pressure, cholesterol, and diabetes.</p><p><strong>Results: </strong>During the follow-up period, cancer was diagnosed in 2692 participants. We observed a significant inverse association between religiosity and cancer incidence. Compared to secular participants, the religious group had a significantly lower risk of cancer (multivariable-adjusted hazard ratio [HR] = 0.80, 95% CI: 0.73-0.87; <i>p</i> < 0.001); the traditional group had a nonsignificantly lower risk (HR = 0.91, 95% CI: 0.82-1.02; <i>p</i> = 0.10). This association was specific to cancer incidence, as religiosity was not significantly associated with the competing risk of mortality.</p><p><strong>Conclusions: </strong>In this cohort study, a higher level of religiosity was associated with a significantly lower risk of lifelong cancer incidence, independent of a wide range of lifestyle, social, and clinical factors. These findings suggest that psychosocial and biobehavioral pathways associated with a religious lifestyle may play a protective role in cancer etiology.</p>","PeriodicalId":72944,"journal":{"name":"Epidemiolgia (Basel, Switzerland)","volume":"7 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505591","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":"Prevalence, Associated Factors, and Epidemiological Profile of Anemia Among Adults in a University Referral Hospital, Eastern Morocco.","authors":"Nawal Ouahbi, Khalid Serraj Andaloussi, Habiba Benneser Alaoui","doi":"10.3390/epidemiologia7020033","DOIUrl":"10.3390/epidemiologia7020033","url":null,"abstract":"<p><strong>Background/objectives: </strong>Anemia is a significant global public health problem that may signal a serious underlying health condition. However, its epidemiological profile among Moroccan adults of both sexes remains poorly documented. This study aims to determine the prevalence and associated factors, and to identify the profiles of observed anemia among hospitalized patients at the University Hospital Mohammed VI of Oujda.</p><p><strong>Methods: </strong>A prospective cross-sectional study was conducted among adult inpatients (≥18 years) admitted between February 2024 and April 2025. Sociodemographic, lifestyle, and clinical data were collected using structured questionnaires and hospital records. Statistical analyses were performed using SPSS version 21, applying the Mann-Whitney U test for quantitative variables and the Chi-square or Fisher's exact test for categorical variables.</p><p><strong>Results: </strong>A total of 446 adult patients were included in the study. The overall prevalence of anemia was 30.3%, affecting 31.9% of men and 28.4% of women. The highest prevalence (45.3%) was observed among participants aged 50 years and older. The services with the highest rates were the thoracic surgery, pneumology, and burns and reconstructive surgery departments. Significant associations with anemia were identified for age group (<i>p</i> = 0.004), hospital department (<i>p</i> = 0.028), presence of medical comorbidities (<i>p</i> < 0.001), and type of diagnosis at admission (<i>p</i> = 0.019). The predominant forms of anemia were mild anemia (62.2%), and normocytic normochromic anemia was the most frequent morphological type (55.6%).</p><p><strong>Conclusions: </strong>Anemia is a frequent comorbidity among hospitalized adults. Systematic screening upon admission and appropriate management during hospitalization are essential to reduce anemia-related complications and improve patient outcomes.</p>","PeriodicalId":72944,"journal":{"name":"Epidemiolgia (Basel, Switzerland)","volume":"7 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505593","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":"Environmental Determinants of Pediatric Obesity: An Epidemiological Review.","authors":"Doha Hassan, Mostafa Salama, Reham Ahmed, Seema Kumar","doi":"10.3390/epidemiologia7020036","DOIUrl":"10.3390/epidemiologia7020036","url":null,"abstract":"<p><p>Pediatric obesity represents an urgent public health concern, with rapidly increasing prevalence across all regions. While genetic susceptibility contributes significantly to interindividual variability in weight, the significant increase in obesity prevalence over the last 30 years is driven by shifts in environmental contributors. This narrative review will summarize evidence on the major environmental determinants of childhood obesity. Environmental contributors to obesity include the food environment, physical activity and built environments, socioeconomic and community context, home and family environments, digital exposures, early life and chemical obesogens and policy drivers. These environmental factors influence activity patterns, dietary habits, sleep, and stress. Additionally, many of these contributing factors cluster within communities that are disadvantaged, thereby increasing predisposition of specific racial, ethnic and socioeconomic groups to childhood obesity. We highlight research gaps and opportunities for multisectoral interventions aligned to impact the growing prevalence of childhood obesity.</p>","PeriodicalId":72944,"journal":{"name":"Epidemiolgia (Basel, Switzerland)","volume":"7 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505565","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":"Primary Hyperaldosteronism: Epidemiology, Diagnosis, and Clinical Associations.","authors":"Christos Savvidis, Charalampos Milionis, Argyro Pachi, Athanasios Tselebis, Ioannis Ilias","doi":"10.3390/epidemiologia7020032","DOIUrl":"10.3390/epidemiologia7020032","url":null,"abstract":"<p><strong>Background/objectives: </strong>Primary aldosteronism (PA), the leading cause of secondary hypertension, results from autonomous aldosterone hypersecretion. It is characterized by increased extracellular volume, elevated cardiac output, and greater arterial stiffness compared with essential hypertension, reflecting aldosterone-mediated hemodynamic dysregulation. The prevalence and morbidity of PA are increasingly acknowledged; however, PA continues to be underdiagnosed because of limited screening and diagnostic complexity.</p><p><strong>Methods: </strong>A narrative review was conducted using PubMed (2015-2025), with terms targeting PA epidemiology, excluding treatment-focused studies. From 971 articles, 133 relevant studies (original research studies, reviews, meta-analyses) were included, addressing prevalence, risk factors, comorbidities, genetics, and diagnostic issues.</p><p><strong>Results: </strong>PA prevalence in hypertensive populations is 5-10%, rising to 17.8% in young-onset and 20-30% in resistant hypertension. Screening indications include resistant/severe hypertension, hypokalemia, adrenal incidentaloma, young-onset disease, obstructive sleep apnea (59.8% comorbidity in hypertensive PA), and familial history, while a link may exist with papillary thyroid cancer. The aldosterone-renin ratio (ARR) is the primary screening tool, limited by assay variability and confounders (e.g., sodium intake). Confirmatory testing (such as with the saline infusion test) is often challenging to perform in routine practice. Adrenal venous sampling (AVS) is useful for subtyping unilateral (aldosterone-producing adenoma; APA; ~35-50%) vs. bilateral (idiopathic hyperaldosteronism; IHA) disease, despite technical challenges. Somatic mutations (e.g., KCNJ5, more frequent in Asians) and rare familial forms drive PA. Complications include cardiovascular events (Major Adverse Cardiovascular Events; MACE: 13.6% at 5.8 years), stroke, renal impairment (decreased eGFR, proteinuria), metabolic disorders (diabetes, obesity), and novel associations (vertebral fractures, renal stones, normal-tension glaucoma). Psychiatric comorbidities (depression/anxiety in 30-70% of patients) have been associated with central mineralocorticoid receptor effects, with sleep disturbances being prominent in females. Subclinical PA predicts hypertension and arterial stiffness.</p><p><strong>Conclusion: </strong>Improved screening protocols, standardized ARR cutoffs, and advanced imaging and genetic analyses are needed to enhance PA detection. Future research should validate cost-effective screening and clarify psychiatric-metabolic links for optimized management.</p>","PeriodicalId":72944,"journal":{"name":"Epidemiolgia (Basel, Switzerland)","volume":"7 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505559","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":"Comorbidities and Concomitant Medications in Middle-Aged Japanese People According to the Charlson Comorbidity Index and Age: Results of the NDB-K7Ps-Study-3.","authors":"Airi Sekine, Kei Nakajima","doi":"10.3390/epidemiologia7020034","DOIUrl":"10.3390/epidemiologia7020034","url":null,"abstract":"<p><p><b>Background/Objectives</b>: The Charlson Comorbidity Index (CCI), which focuses on 19 comorbid diseases and conditions, has been widely used as a valid predictor of mortality. This study aimed to comprehensively examine the prevalence of nearly all comorbidities and concomitant medications according to CCI classification (CCI = 0 and CCI ≥ 4) and age group (aged 40-44 and 70-74 years) in middle-aged Japanese adults. <b>Methods</b>: The present study included 9,182,226 individuals who underwent health checkups from April 2018 to March 2019. A total of 15,916 cases of diagnosed diseases and conditions, including communicable diseases; diseases of the eye, ear, skin, and musculoskeletal system; and psychiatric disorders, were investigated alongside 16,886 prescribed medications. <b>Results</b>: The prevalence of allergic rhinitis was ranked among the leading comorbidities in all age groups and CCI categories. Individuals with a CCI ≥ 4 in the 40-44 age group showed a higher prevalence of cardiometabolic diseases such as hypertension, diabetes, and dyslipidemia compared with individuals with a CCI = 0 in the 70-74 age group. Furthermore, individuals with a CCI ≥ 4 in the 40-44 age group also had a higher prevalence of communicable diseases, gastrointestinal symptoms, iron deficiency anemia, and psychiatric disorders compared with individuals with a CCI = 0 in the 70-74 age group. The ranking for prescribed medications was essentially the same between age groups, but was found to differ between CCI categories. <b>Conclusions</b>: This study identified overlooked comorbidities and concomitant medications that are not accounted for in the 19 conditions included in the CCI, which may be important prognostic factors in determining mortality. Although patients with more comorbidities were found to be more frequently diagnosed with cardiometabolic diseases regardless of their age, the presence of pharmacotherapy may be dependent on age.</p>","PeriodicalId":72944,"journal":{"name":"Epidemiolgia (Basel, Switzerland)","volume":"7 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505519","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":"Mortality Trends in Cancer of Unknown Primary Site in Serbia, 1990-2024: A Joinpoint Regression and Age-Period-Cohort Analysis.","authors":"Irena Ilic, Vladimir Jakovljevic, Milena Ilic","doi":"10.3390/epidemiologia7020037","DOIUrl":"10.3390/epidemiologia7020037","url":null,"abstract":"<p><strong>Background/objectives: </strong>Research on the mortality trends from cancer of unknown primary site in Serbia is scarce. This research sought to investigate temporal trends in mortality from cancer of unknown primary site in Serbia in the last few decades.</p><p><strong>Methods: </strong>This research was a population-based epidemiological descriptive study. Trends of age-standardized rates (ASRs) in mortality and average annual percent change (AAPC) were examined with joinpoint regression analysis. The age, period and cohort effects on mortality rates were evaluated using the age-period-cohort analysis.</p><p><strong>Results: </strong>From 1990 to 2024, 26,597 deaths from cancer of unknown primary site were registered in Serbia (14,944 in males and 11,613 in females). The trends for ASRs of mortality from cancer of unknown primary site in Serbia were stable for both males (AAPC = 0.2%, 95% CI = -0.4 to 0.7) and females (AAPC = 0.4%, 95% CI = -0.1 to 0.9) in all ages. Decreasing trends in mortality were observed in those under 55 years of age, while increasing trends were observed in older persons (55+), both in men and women. All estimated functions (period effect, cohort effect, the local drifts and net drift) for mortality in males in Serbia were significant (<i>p</i> < 0.05). For mortality in females, statistical significance was observed for cohort and period effects, along with the local drifts (<i>p</i> < 0.05 for all), while no statistical significance was observed for the net drift (<i>p</i> > 0.05).</p><p><strong>Conclusions: </strong>Mortality trends due to the cancer of unknown primary site were particularly unfavorable in elderly, suggesting that this burden of disease remains a public health issue in Serbia.</p>","PeriodicalId":72944,"journal":{"name":"Epidemiolgia (Basel, Switzerland)","volume":"7 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505628","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":"Infection and Vaccination-Induced Tick-Borne Encephalitis Virus IgG Antibody Prevalence in the Austrian Federal State of Upper Austria, a High-Risk Region for TBEV.","authors":"Gerhard Dobler, Susanne Süßner, Anne B Schindler, Philipp Girl, Johannes Borde","doi":"10.3390/epidemiologia7020035","DOIUrl":"10.3390/epidemiologia7020035","url":null,"abstract":"<p><strong>Background/objectives: </strong>Tick-borne encephalitis (TBE) is the most important tick-borne viral central nervous system (CNS) infection in Europe and Asia. Since the introduction of a vaccine in Austria in the late 1970s, sero-epidemiological studies on the true incidence of tick-borne encephalitis virus (TBEV) infection in the population have been difficult, because it was not possible to distinguish between vaccine- and infection-induced antibodies. The goal of our study has been to analyze the sero-epidemiology of TBEV infections, vaccination protection rate, and manifestation index of the disease in the region of interest.</p><p><strong>Methods: </strong>Applying a newly developed anti-TBEV-NS1-IgG assay and the neutralization test, the protection and infection rates in blood donors of the Austrian Federal State of Upper Austria.It is one of the first areas in Austria, where the TBEV vaccine had been rolled out and broadly used. Samples from blood donors of all districts of the Federal State of Upper Austria were screened for anti-TBEV-IgG. Positive sera were differentiated for infection- and vaccine-induced antibodies. The results were matched with donor age, gender, and geographical origin.</p><p><strong>Results: </strong>2162 samples were analyzed. A total of 87.0% of the blood donors tested showed anti-TBEV-IgG related to past TBEV vaccination. Within the unvaccinated group, a total of 13.3% of male and 9.9% of female blood donors exhibited anti-TBEV-NS1-IgG, indicating a past TBEV infection. The anti-TBE-NS1-IgG seroprevalence was determined at 74/100,000 for the whole population and at 594/100,000 in the non-vaccinated population. The manifestation index (MI) was calculated at 2.8%. The MI is defined as the probability or percentage of infected individuals who develop clinical symptoms of a disease.</p><p><strong>Conclusions: </strong>Our data provide evidence of a continuing high risk of TBEV infection in the Federal state of Upper Austria. The non-vaccinated population has an eightfold higher infection prevalence compared to the whole population. The MI of TBEV for severe infection seems lower as detailed in previous reports.</p>","PeriodicalId":72944,"journal":{"name":"Epidemiolgia (Basel, Switzerland)","volume":"7 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505551","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":"Correction: Myklebust et al. Sex Differences in Anxiety and Depression Among Coronary Heart Disease Patients During Cardiac Rehabilitation: A Quasi-Experimental Study. <i>Epidemiologia</i> 2025, <i>6</i>, 45.","authors":"Janne Grete Myklebust, Lotte Pannekoeke, Jon Arne Sandmæl, Harald Kåre Engan, Irene Lie, Christine Tørris","doi":"10.3390/epidemiologia7020031","DOIUrl":"10.3390/epidemiologia7020031","url":null,"abstract":"<p><p>Addition of Authors [...].</p>","PeriodicalId":72944,"journal":{"name":"Epidemiolgia (Basel, Switzerland)","volume":"7 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505435","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":"Ecologic and Sociodemographic Factors Associated with Seroprevalence of <i>Rickettsia</i> in Yucatan, Mexico.","authors":"Edgar Villarreal-Jimenez, Karla Dzul-Rosado, Fernando Puerto-Manzano, Jorge C Guillermo-Herrera, Henry Pech-Noh, Nina Mendez-Dominguez","doi":"10.3390/epidemiologia7020030","DOIUrl":"10.3390/epidemiologia7020030","url":null,"abstract":"<p><strong>Background: </strong>Rickettsioses disproportionately affect vulnerable populations and are frequently misdiagnosed as other febrile illnesses in Yucatan, the Mexican state with the greatest diversity of <i>Rickettsia</i> spp. Although significant seroprevalence has been reported in rural communities, the last population-based study was conducted over two decades ago, despite environmental and social changes that have likely increased transmission risk. This study aimed to estimate the seroprevalence of spotted fever group (SFG) and typhus group (TG) of <i>Rickettsia</i> in an endemic area of southeastern Mexico.</p><p><strong>Methods: </strong>A cross-sectional analytical study was conducted among 390 participants. Indirect immunofluorescence was used to detect IgG antibodies against SFG and TG of <i>Rickettsia</i>. Sociodemographic characteristics of participants, along with environmental and community-level variables from their regions of residence, were analyzed.</p><p><strong>Results: </strong>The overall seroprevalence of both <i>Rickettsia</i> groups was 31.2%. Higher maximum temperatures were associated with an increase in <i>Rickettsia</i> seroprevalence (PR = 4.18; 95% CI: 3.40-5.14), while higher population density was associated with a decrease in seroprevalence (PR = 0.97; 95% CI: 0.96-0.98).</p><p><strong>Conclusions: </strong><i>Rickettsia</i> seroprevalence in Yucatan remains high and is shaped by both environmental and demographic factors. These findings highlight the need to strengthen surveillance and prevention strategies that integrate ecological and social determinants within a One Health framework.</p>","PeriodicalId":72944,"journal":{"name":"Epidemiolgia (Basel, Switzerland)","volume":"7 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505507","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":"Systematic Review of Health Literacy and Health Behavior in Adolescents Research.","authors":"Saulius Sukys, Gerda Kuzmarskiene, Kristina Motiejunaite","doi":"10.3390/epidemiologia7010029","DOIUrl":"10.3390/epidemiologia7010029","url":null,"abstract":"<p><strong>Background/objectives: </strong>Despite the publication of several systematic reviews on adolescent health literacy, comprehensive evaluations of the relationship between health literacy and health-related behaviors are still limited. This systematic review sought to synthesize and critically appraise the available evidence on associations between health literacy and health behaviors among adolescents.</p><p><strong>Methods: </strong>A systematic search of three databases (Scopus, PubMed, and PsycINFO) was conducted in accordance with PRISMA guidelines. Thirty-seven eligible cross-sectional studies were selected for qualitative synthesis. Methodological quality was evaluated using the Newcastle-Ottawa Scale adapted for cross-sectional studies.</p><p><strong>Results: </strong>The 37 included studies encompassed 71,558 adolescents (mean age range 11.0-17.0 years) and were conducted primarily in Europe (n = 22), with additional studies from the USA (n = 5), Asia (n = 8), and cross-cultural settings (n = 2). Across studies, 11 HL instruments were used (including two eHealth literacy measures), most commonly the Health Literacy for School-aged Children scale (n = 14). Physical activity (n = 22), nutrition-related indicators (n = 26), and smoking/alcohol/drug outcomes (n = 16) were assessed using heterogeneous operationalisations. Overall, higher HL was more often associated with healthier behavioral profiles, with more consistent patterns for nutrition-related outcomes. Findings for physical activity and substance use were more heterogeneous and, in some cases, varied depending on the HL measurement approach (subjective vs. objective) and the behavioral reference period.</p><p><strong>Conclusions: </strong>Current evidence indicates that higher health literacy in adolescents is generally associated with more favorable health behaviors, particularly regarding nutrition-related indicators. However, study heterogeneity and the predominance of cross-sectional designs limit comparability and causal inference. Future research should prioritize standardized measurement tools and longitudinal designs to clarify directionality and underlying mechanisms.</p>","PeriodicalId":72944,"journal":{"name":"Epidemiolgia (Basel, Switzerland)","volume":"7 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12939913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147291951","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}