Paiva Pessoa MR, Alves J, Duarte C
… +3 more, Reis C, Nunes A, Pereira J
Eur J Public Health
· 2026 Jun · PMID 42397976
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Depressive disorders represent the second leading cause of disability globally, and Portugal reports the second highest prevalence in Europe. Nevertheless, the role of socioeconomic factors, behavioural determinants, and...Depressive disorders represent the second leading cause of disability globally, and Portugal reports the second highest prevalence in Europe. Nevertheless, the role of socioeconomic factors, behavioural determinants, and potential differences in treatment remain underexplored. This study assessed socioeconomic inequalities in depression and inequity in mental healthcare utilization among Portuguese adults aged 25-65 years, and evaluated whether health behaviours mediate the socioeconomic status (SES) and depression association. We used microdata from the 2019 Portuguese National Health Interview Survey. Depression was measured through self-report and PHQ-8 (≥10, moderate and moderately-severe; ≥20, severe). Concentration curves and indices, standardized by sex and age, assessed SES-related inequality in depression; horizontal inequity in mental healthcare utilization was estimated by adjusting for morbidity. Logistic regression models estimated the SES-depression association, and mediation by health behaviours (smoking, alcohol, sedentary lifestyle, diet, BMI) was evaluated using attenuation analysis. Overall, 13.0% reported depression in the previous year and 6.8% met PHQ-8 criteria. Both were disproportionately concentrated among lower-income groups, with the strongest inequality observed for severe depression. Horizontal inequity was also observed: specialist consultations were disproportionately used by higher-income groups when adjusting for self-reported depression, whereas medication was more concentrated among lower-income individuals meeting PHQ-8 criteria. Sedentarism, BMI, and alcohol drinking partially mediated SES-depression association, reducing effect estimates by up to 23.9%. Marked socioeconomic inequalities exist in depression and mental healthcare utilization in Portugal. Strengthening equitable access to evidence-based mental healthcare and addressing upstream behavioural and socioeconomic determinants are critical to reducing the national mental health burden.
Chevalier C, Dumont R, Mechoullam S
… +3 more, Schrempft S, Guessous I, Nehme M
Eur J Public Health
· 2026 Jun · PMID 42394579
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A global decline in age at menarche has raised concerns about its long-term health and social consequences. This study investigates temporal trends in age at menarche in a Swiss population born between 1936 and 1989 and...A global decline in age at menarche has raised concerns about its long-term health and social consequences. This study investigates temporal trends in age at menarche in a Swiss population born between 1936 and 1989 and assesses associations with sociodemographic, metabolic, and reproductive health factors. Age at menarche was examined across birth cohorts to assess temporal trends. Using an outcome-wide analytical framework, adjusted for age, survey year, and education, logistic and linear regression models examined the associations between menarche timing and sociodemographic, metabolic, and reproductive health factors. The sample included 6462 women aged 34-75. Mean age at menarche was 13.1 years, decreasing from 14.1 (born in 1936) to 12.9 (born in 1989). Early menarche (<12 years) was associated with lower income (aOR = 0.79; 95% CI: 0.67-0.93), higher odds of hypertension (aOR 1.41; 1.18-1.67), diabetes (aOR 1.40; 1.05-1.83), hypercholesterolemia (aOR 1.27; 1.07-1.49), shorter stature (-2.12 cm), higher BMI, increased hysterectomy prevalence (aOR 1.69; 1.33-2.13), and longer reproductive lifespan (+1.59 years). Late menarche (>14 years) was associated with increased stillbirth (aOR 1.80; 1.12-2.84) and ectopic pregnancy risks (aOR 1.45; 1.04-2.00) (however to be seen as exploratory as not significant after FDR correction), different menstrual patterns, reduced reproductive lifespan (-3.12 years), and lower education (aOR 0.81; 0.71-0.93). Age at menarche has declined in Geneva and is associated with various health outcomes. Including menarche timing in clinical assessments could improve risk stratification and preventive care.
Li CX, Fan S, Feliu A
… +2 more, Laverty AA, Filippidis FT
Eur J Public Health
· 2026 Jun · PMID 42349935
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This study examined whether broader environmental orientations are associated with current e-cigarette use and disposable e-cigarette use in the European Union (EU). We analysed data from Special Eurobarometer 99.3 (2023...This study examined whether broader environmental orientations are associated with current e-cigarette use and disposable e-cigarette use in the European Union (EU). We analysed data from Special Eurobarometer 99.3 (2023) across 27 EU Member States (n = 26,353), measuring environmental orientations via climate concern and pro-environmental behaviours. Climate concern was associated with lower likelihood of e-cigarette use (Prevalence Ratio = 0.84, 95% CI, 0.72-0.99); pro-environmental behaviour was associated with a lower likelihood of disposable e-cigarette use (0.72,0.53-0.99). Both estimates were attenuated in sensitivity analyses; the latter relied on a small subgroup. Findings should be considered exploratory. Further research using product-specific environmental measures is warranted.
Pickett W, King N, Pagnotta VF
… +8 more, Donnelly PD, Harel-Fisch Y, Walsh SD, Ng K, Malinowska-Cieślik M, Várnai DE, Qirjako G, Molcho M
Eur J Public Health
· 2026 Jun · PMID 42341152
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Injuries are a leading public health priority within adolescent populations; however, few cross-national studies have examined their epidemiology over time. We described time trends in adolescent self-reported medically...Injuries are a leading public health priority within adolescent populations; however, few cross-national studies have examined their epidemiology over time. We described time trends in adolescent self-reported medically treated injury across 31 mainly European countries over 20 years, then explored whether observed temporal trends varied according to the prevalence of known behavioral risk factors. The data source included six cycles of the Health Behavior in School-aged Children study (2002-22; weighted n = 954 298, participants aged 11-15 years). Outcomes included self-reports of any and multiple medically treated injuries. Measures of behavioral risks included indicators of violence, substance use, and physical activity. Within countries reporting increases in injuries, variations in reported engagement in known behavioral risk factors were examined. Nearly half of adolescents reported at least one medically treated injury (47%-53% of boys; 38%-44% of girls) and nearly one quarter reported multiple injuries (23%-30% of boys; 16%-22% of girls). In the pooled analysis, temporal trends included increases in any medically treated injury for girls (all age groups) and boys (11 years only) and multiple injuries (boys and girls, all age groups). At the country-level, we observed more temporal increases than decreases. Increases in physical activity were observed coincident with observed injury trends. In one of the largest European analyses of its kind, we demonstrated the ongoing burden of adolescent injury. Persistently high rates of adolescent injuries are concerning, and the origins of temporal increases require an initial focus on sport and physical activity.
Päivärinne V, Kekäläinen E, Pietiläinen O
… +6 more, Valkonen J, Lahti J, Lahelma E, Kouvonen A, Rahkonen O, Lallukka T
Eur J Public Health
· 2026 Jun · PMID 42341151
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Longitudinal and domain-specific changes in sitting time (ST) across occupational classes are poorly understood. We examined changes in occupational class differences in total and domain-specific ST over a 5-year follow-...Longitudinal and domain-specific changes in sitting time (ST) across occupational classes are poorly understood. We examined changes in occupational class differences in total and domain-specific ST over a 5-year follow-up among young and early midlife employees. We used Helsinki Health Study survey data from 2017 to 2022 (n = 2762; 81% women; aged 19-39 years). Self-reported ST (min/day) was assessed across total ST and its five subdomains (work, leisure screen time, reading, transport, and other). Occupational class was categorized as manual and routine non-manual, semi-professional, and professional. Linear mixed models were used to estimate changes, with ST as the dependent variable and time, occupational class, and their interaction as the main independent variables. Analyses were stratified by gender and adjusted for sociodemographic and health-related factors. Total ST increased across occupational classes (+46 min/day, 95% CI: 37.6-54.4), driven by work-related ST (+24 min), and leisure screen ST (+21 min). Among women, manual and routine non-manual employees showed larger increases in total ST (+25 min vs. professionals) and leisure screen ST (+14 min), narrowing the total ST but widening screen time occupational class differences. Semi-professional women increased work ST (+21 min vs. professionals), narrowing occupational class differences in work ST. Among men, statistical significance of the associations could not be confirmed. ST increased across occupational classes, with domain-specific changes suggesting behavioural patterns. Increase in leisure screen time among manual and routine non-manual women employees may contribute to socioeconomic inequalities in health, highlighting the need for targeted, domain-specific interventions.
Sarli WM, Peri M, Canessa C
… +7 more, Lippi F, Lodi L, Menegazzo F, Puggelli F, Azzari C, Ricci S, FRAGI-le (Frontline Response Against Gaps in Immunisation) Group
Eur J Public Health
· 2026 Jun · PMID 42341150
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Fragile paediatric patients are at higher risk of vaccine-preventable diseases, yet coverage remains suboptimal. Hospitalisation offers an opportunity to review and update immunisation, but fragmented practices create in...Fragile paediatric patients are at higher risk of vaccine-preventable diseases, yet coverage remains suboptimal. Hospitalisation offers an opportunity to review and update immunisation, but fragmented practices create inequities, with access depending more on hospital context than clinical need. This study aimed to design, implement, and evaluate an in-hospital vaccination pathway for these patients. A mixed-methods approach was undertaken at Meyer Children's Hospital IRCCS, Florence, Italy. Baseline assessment included nine focus groups and an online questionnaire with healthcare professionals from units managing fragile patients, exploring practices, barriers, and needs. Findings informed the co-design of a pathway integrating documentation review, catch-up planning, and in-hospital delivery coordinated by the Immunology Unit. Administrative data on non-SARS-CoV-2 vaccinations in fragile patients (2022-2025) were analysed. Most respondents supported hospital-based vaccination (94.2%) but reported gaps in registry access, spaces, and training. Only 67.6% collected vaccination history systematically, 14.4% always mentioned vaccination in discharge letters, and 15.9% always recommended family immunisation. Despite acknowledging low influenza coverage (60.9% declared coverage <50%), 15.9% expressed hesitancy in administering non-live vaccines, mainly due to efficacy concerns (55.9%). After implementation, vaccine administrations increased from 361 in the 2022-2023 season to 752 in the 2024-2025 season (+108.3%; P < .0001). Increases were observed after staff sensitisation, with further growth following the creation of the hospital vaccination centre. A structured hospital-based vaccination pathway for fragile paediatric patients is feasible, well accepted, and associated with increased vaccine administrations within the hospital care pathway. Broader adoption could reduce inequities and strengthen vaccine access for high-risk children.
Eur J Public Health
· 2026 Jun · PMID 42333609
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AI chatbots such as ChatGPT, Gemini, and Claude are rapidly becoming part of adolescents' everyday lives. We argue that AI chatbots should be understood as emerging public health technologies and incorporated into govern...AI chatbots such as ChatGPT, Gemini, and Claude are rapidly becoming part of adolescents' everyday lives. We argue that AI chatbots should be understood as emerging public health technologies and incorporated into governance frameworks addressing adolescent health in digital environments.
Ben Halima MA, Aït Bouziad K, Louati N
… +2 more, Cousin-Renié MA, Dab W
Eur J Public Health
· 2026 Jun · PMID 42323880
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Disability pension represents a major public health challenge in France, with 843 000 beneficiaries and €8.5 billion expenditure in 2022. The transition from sickness absence to disability pension remains insufficiently...Disability pension represents a major public health challenge in France, with 843 000 beneficiaries and €8.5 billion expenditure in 2022. The transition from sickness absence to disability pension remains insufficiently documented in the French context. This study identifies risk factors for disability pension among French private-sector employees to inform targeted prevention strategies. We conducted a retrospective cohort study of 228 514 employees from a complementary health insurer (2018-23), encompassing 364 762 sickness absence episodes. Risk factors for transition to disability pension were analyzed using Kaplan-Meier survival and Cox proportional hazards models stratified by absence duration, adjusting for sociodemographic, employment, organizational, and health-related factors. Of all episodes, 6404 (1.8%) progressed to disability pension. Risk was particularly high among individuals aged ≥50 years and among those in higher-risk socio-professional groups, notably executives and individuals belonging to the "Other" category (including farmers, merchants, and business owners), compared with employees. Increased risk was also observed among workers in the lowest income quartile and among employees in large companies. Long-term sickness absence (>180 days) was associated with a higher risk of disability pension. Therapeutic part-time work reduced risk only for short absences. Most risk factors lost predictive power beyond 12 months, with declining effect sizes over time. This study identifies a critical 12-month intervention window. Early interventions should prioritize therapeutic part-time work and strengthen targeted support for older workers, executives, and large company employees to reduce disability pension transitions and curb rising costs.
Aston H, Bunk H, Henstock T
… +5 more, Madhukar A, Batrakova S, Memon A, Nafilyan V, Ayoubkhani D
Eur J Public Health
· 2026 Jun · PMID 42319976
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Poor health is strongly linked to reduced employment, lower earnings, and long-term labour market disengagement. While elective inpatient treatments may improve health, their broader economic impact is not well understoo...Poor health is strongly linked to reduced employment, lower earnings, and long-term labour market disengagement. While elective inpatient treatments may improve health, their broader economic impact is not well understood. This study aimed to estimate the long-term relationship between elective inpatient treatment and labour market outcomes across a wide range of specialties in England. We conducted a retrospective, longitudinal study using linked administrative data, combining Hospital Episode Statistics, the 2011 Census, death registrations, and HMRC Pay As You Earn records. Adults aged 25-64 who received elective inpatient care between April 2015 and March 2023 across 32 specialties were included. Monthly earnings and employment status were measured before and after treatment and standardized for age. Interrupted timeseries models with data-driven breakpoints were used to estimate counterfactual labour market trajectories had treatment not occurred. Treatment effects were calculated as the difference between observed and modelled outcomes. Among 4.9 million patients, elective treatment was associated with improved earnings and employment relative to a counterfactual of continued health deterioration. At 60 months after treatment, the largest effects were observed in haematology, oncology, and renal medicine. Across all specialties, cumulative 5-year treatment effects ranged from £47.2 billion to £73.7 billion in additional earnings and from 198 918 to 745 262 person-years of employment. Elective inpatient treatment is associated with substantial and sustained labour market benefits. Receiving treatment may improve individuals' ability to participate in work, with benefits persisting for many years after treatment, relative to the counterfactual.
Eur J Public Health
· 2026 Jun · PMID 42319975
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Little is known about the impact that older age and the cost-of-living crisis have on health and wellbeing in Scotland, a country with the lowest life expectancy in Western Europe. Using Scotland as a case study, we aim...Little is known about the impact that older age and the cost-of-living crisis have on health and wellbeing in Scotland, a country with the lowest life expectancy in Western Europe. Using Scotland as a case study, we aim to capture multidimensional poverty across adulthood and study the associations with health. Relying on the Joseph Rowntree Foundation's 2023 Poverty in Scotland Survey, we measured the odds of self-reported food, fuel, and financial insecurities across adulthood. We then assessed the association between these insecurities and self-reported physical, mental, and social domains of health. Overall, older adults (aged 65+) report less food, fuel, and financial insecurity. However, lower-income adults aged 35-74 reported significantly higher odds of fuel insecurity compared to younger, upper-income adults. All dimensions of insecurity are significantly associated with higher odds of poor health outcomes, especially among younger adults. Older adults paradoxically report largely fewer negative health impacts despite existing evidence of the group's health vulnerability to these insecurities. This study shows the importance of analysing poverty multi-dimensionally. It evidences that while pensions are associated with lower reported levels of food and financial insecurity, these associations do not maintain for fuel insecurity, especially among lower-income groups. The results support the reintroduction of non-means-tested winter heating benefits for older adults in Scotland. All three insecurities impact self-reported health, yet reports from older adults do not mirror health across the life course. This may be influenced by survey administration, question framing, understandings of health, problematization of insecurities and stigma.
Mas-Alòs S, Vandaele F, Farías E
… +14 more, Dorado V, Matas S, Puig-Ribera A, Aumatell E, De Clerck I, Codina-Nadal A, Adams E, Coenen P, Kayser B, Ryde G, Señé-Mir AM, Sjøgaard G, Väänänen I, HEPA Europe Network Collaborators
Eur J Public Health
· 2026 Jun · PMID 42315986
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Regular physical activity is essential for preventing noncommunicable diseases and benefits both employees and organizations. Although small- and medium-sized enterprises (SMEs) employ most of the European workforce, the...Regular physical activity is essential for preventing noncommunicable diseases and benefits both employees and organizations. Although small- and medium-sized enterprises (SMEs) employ most of the European workforce, they are often underrepresented in research on workplace health promotion. Most existing evidence from initiatives to promote health-enhancing physical activity (HEPA) focuses on large organizations and lacks insights into feasibility within SMEs. This study aimed to identify real-life HEPA initiatives perceived as most feasible for SMEs and to explore expert consensus on transferable features. We conducted a three-stage hybrid e-Delphi study including a grey literature review, an expert survey, and expert panel discussions, integrating both quantitative scoring and qualitative discussion. Experts independently rated the feasibility of workplace HEPA initiatives and participated in moderated sessions to interpret the findings and identify transferable elements. A total of 714 real-life HEPA initiatives were identified and categorized according to behaviour and intensity. Of these, 390 were evaluated by 17 international experts using predefined criteria, including feasibility by company size. No initiative-level consensus was reached across the WHO European Region. Panellists identified transferable features (most frequently in active-living and exercise/fitness domains) and emphasized adaptability, low-threshold approaches and enterprise size as an indicator. This study contributes a structured analysis of feasible workplace HEPA initiatives for SMEs, using a Delphi-based consensus process. The findings provide guidance for developing practical tools tailored to the needs and capacities of SMEs in the European context.
GBD 2023 Italy Interpersonal Violence Collaborators
, Capodici A, Zamagni G
… +13 more, Armocida B, Castelpietra G, Corso B, Damiani G, Golinelli D, La Vecchia C, Ronfani L, Sanmarchi F, Tedesco D, Traini E, Trisolino G, Violante F, Monasta L
Eur J Public Health
· 2026 Jun · PMID 42309801
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Interpersonal violence against children and adolescents constitutes a significant public health issue associated with substantial morbidity and long-term disability. This study utilizes Global Burden of Disease (GBD) 202...Interpersonal violence against children and adolescents constitutes a significant public health issue associated with substantial morbidity and long-term disability. This study utilizes Global Burden of Disease (GBD) 2023 estimates to quantify the burden of interpersonal violence injuries among the population <20 years of age across the 27 European Union countries (EU27). We analysed incidence and Years Lived with Disability (YLDs) for injury types and age groups (<5, 5-14, and 15-19 years). A 'Disability Drivers' analysis compared injury frequency against disability burden to identify priority areas. Long-term (1990-2023), mid-term (2010-2023), and short-term trends (2020-2023) were analysed to distinguish systemic risks from emerging threats. The analysis reveals geographical and temporal heterogeneity. In 2023, Hungary reported the highest incidence rate (1085.7 per 100 000; 95% UI: 917.6-1295.5), while Italy reported the lowest (131.9 per 100 000; 95% UI: 94.3-175.5). Despite low overall incidence, Italy exhibited short-term spikes (2020-2023) in severe trauma among children aged <5, with severe chest injuries rising by 79.1% (95% UI: 66.4%-92.3%). Long-term analysis identified systemic worsening in Eastern Europe, notably in Romania, where poisoning in children <5 years increased by 77.9% (95% UI: 55.5%-96.0%) since 1990. Violence-related injuries among children in the EU27 show a polarized pattern, with chronic burdens in Eastern Europe and emerging acute escalations in Southern Europe. Prevention strategies should consider both injury frequency and disability burden to effectively allocate resources.
Kam W, Guillaume E, Rollet Q
… +12 more, Petrova D, Fernández-Martínez NF, van Herck K, Carulla M, Pla C, Saladié F, Miracle C, Zadnik V, Tomšič S, Cowppli-Bony A, Launoy G, Backes C
Eur J Public Health
· 2026 Jun · PMID 42309527
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Organized breast cancer screening programmes are a cornerstone of cancer control policy across Europe. Population-based cancer registries (PBCRs) play a central role in monitoring screening performance, outcomes, and pro...Organized breast cancer screening programmes are a cornerstone of cancer control policy across Europe. Population-based cancer registries (PBCRs) play a central role in monitoring screening performance, outcomes, and programme quality. However, the extent and methodological approaches of registry-based evaluations across Europe have not been comprehensively synthesized. Following PRISMA-ScR guidelines, we conducted a scoping review of peer-reviewed studies evaluating organized breast cancer screening programmes in Europe using PBCR data. Studies were identified through systematic database searches and screened using predefined eligibility criteria. Data were extracted on study design, definitions of detection mode, outcome measures, and approaches to bias adjustment. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework guided the methodological analysis. Twenty-six studies were included, mainly from Western and Northern Europe, with most published before 2010. Screen-detected cancers consistently showed lower mortality, better survival, and more favourable tumour characteristics than interval or non-screened cancers. However, reporting of screening indicators was inconsistent. Definitions of detection modes, particularly interval cancers, and approaches to bias adjustment varied widely, limiting comparability. Few studies applied comprehensive bias correction or clearly reported registry-screening data linkage. Registry-based evaluations provide valuable evidence on the impact of breast cancer screening programmes, However, the evidence is limited by methodological heterogeneity and limited analytical standardization, reducing its comparability and policy relevance. Strengthening standardized definitions, improving transparency in analytical approaches, and better integrating programme monitoring with research could enhance the public health value of registry-based screening evaluation.
Chakraborty-Groot T, Almansa J, de Winter AF
… +3 more, Linares-Jimenez FG, Schuller AA, Reijneveld SA
Eur J Public Health
· 2026 Jun · PMID 42309526
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Multimorbidity may affect oral health, especially in individuals with limited health literacy (HL), or specific multimorbidity patterns; however, evidence remains scarce. Understanding these associations could improve ea...Multimorbidity may affect oral health, especially in individuals with limited health literacy (HL), or specific multimorbidity patterns; however, evidence remains scarce. Understanding these associations could improve early detection and prevention, both in clinical care and public health strategies. This study aimed to assess the association of multimorbidity and multimorbidity patterns with complete tooth loss, i.e. edentulism, and whether HL moderates this association. A total of 42 357 participants from the prospective multigenerational Dutch Lifelines Cohort Study were included. Multimorbidity was defined by ≥2 affected disease domains. Multimorbidity patterns were constructed with latent class analysis. Associations between multimorbidity (and patterns) with edentulism were assessed using logistic regression, with HL as a potential moderator. Models were adjusted for age, household income, and education. Edentulism prevalence was 9.5% and was higher among limited than adequate HL (14.5% vs. 7.9%) and among multimorbid vs. absent (19.5% vs. 7.7%). We identified five patterns: (1) Endocrinological + Psychiatry; (2) Cardiovascular + Endocrinological; (3) Neurological + Otorhinolaryngologic; (4) Endocrinological + Otorhinolaryngologic, and (5) Otorhinolaryngologic + Psychiatric. The odds of edentulism were 2.26 higher (95% CI: 2.06-2.47) in multimorbid. Pattern 2 (Cardiovascular + Endocrinological) had the highest odds ratio of edentulism (OR: 3.52, 95% CI: 3.03; 4.08) compared to multimorbidity absent. HL did not moderate the associations between multimorbidity and edentulism. Edentulism is more likely in the case of multimorbidity, especially if cardiovascular and endocrinological conditions co-occur, an explanation being the shared risk factors. This association remains the same across different HL levels. Our findings support collaborative medical and oral healthcare.