Eur J Public Health
· 2026 Jun · PMID 42301953
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Following the introduction of comprehensive bans on tobacco advertising, promotion, and sponsorship (TAPS), little is known about how the tobacco industry (TI) adapts its marketing strategies in low- and middle-income co...Following the introduction of comprehensive bans on tobacco advertising, promotion, and sponsorship (TAPS), little is known about how the tobacco industry (TI) adapts its marketing strategies in low- and middle-income countries at point of sale (POS). This study examined post-ban TI marketing practices in Armenia after the 2022 comprehensive TAPS and display ban, focusing on youth exposure. We conducted a qualitative study using structured observations at 132 POS near educational facilities in Yerevan (capital city) and the Kotayk region, in-depth interviews with store owners/workers (n = 8), and focus group discussions with youth aged 15-20 (n = 28). Thematic analysis was applied with triangulation across data sources. Despite the ban, tobacco products remained widely available and visible near educational facilities. Cigarettes, e-cigarettes, and heated tobacco products were prominently displayed using power walls, illuminated fixtures, and placement near youth-appealing items. Advertising persisted through covert, legally ambiguous tactics such as illuminated displays, integrated signage, colour schemes, flavours, and loyalty-based promotions, coupled with misleading messages, often not recognized as advertising by youth or retailers. Retailer incentive schemes, such as financial rewards, gifts, and staff engagement, were used to secure product prominence and drive sales. Youth access restrictions were weakly enforced, with poor visibility of age-of-sale signage, inconsistent ID checks, and reports of informal access routes. Comprehensive TAPS and POS display bans alone are insufficient to eliminate youth exposure to tobacco marketing. Stronger enforcement, regulation of indirect and retailer-focused marketing, and sustained monitoring of POS environments are essential to protect youth from ongoing TI influence.
Eur J Public Health
· 2026 Jun · PMID 42301952
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Attained socioeconomic position is associated with drug-related deaths, but whether social characteristics in childhood predict drug-related mortality remains unclear. We estimated differences in drug-related mortality b...Attained socioeconomic position is associated with drug-related deaths, but whether social characteristics in childhood predict drug-related mortality remains unclear. We estimated differences in drug-related mortality between ages 16 and 41 by parental education, household income, and household type. We used administrative data on all Finnish residents born 1982-2004 (N = 1 446 548). Underlying and contributory causes of drug-related mortality (1997-2023) were drawn from Causes of Death Register records and parental education, household income and household type (age 15) were derived from administrative records. Differences in drug-related mortality by childhood social characteristics and their co-occurrence were estimated using sex-stratified Cox regression. Birth cohort differences were estimated using Kaplan-Meier failure curves. The drug-related mortality rate per 100 000 person-years for men (21.9, 95% CI: 21.1-22.8) was over 3× higher than that of women (5.7, 5.3-6.2). Among both men and women, respectively, lower parental education (basic: HR 1.86, 1.63-2.11; HR 1.78, 1.37-2.32) and non-nuclear household type (single-parent households: HR 2.10, 1.89-2.33; HR 3.06, 2.46-3.79) independently predicted higher mortality hazards net of all predictors, whereas the estimates for household income greatly attenuated. Interaction analyses between parental education and household type suggested larger relative increases in mortality hazards by lower parental education among individuals from non-nuclear families. Mortality differences were consistently observed across birth cohorts. Childhood household type and parental education independently predicted subsequent drug-related mortality among men and women. Children of lower educated parents from non-nuclear families had the highest excess risk.
Autellet A, Lacroix C, Batisse A
… +6 more, Micallef J, Fouilhe N, Le Boisselier R, Peyrière H, Eiden C, French Addictovigilance Network
Eur J Public Health
· 2026 Jun · PMID 42301951
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New psychoactive substances (NPS) represent a growing public health challenge in Europe. Their rapid emergence, chemical diversity and unpredictable toxicity complicate prevention, clinical management and regulatory resp...New psychoactive substances (NPS) represent a growing public health challenge in Europe. Their rapid emergence, chemical diversity and unpredictable toxicity complicate prevention, clinical management and regulatory responses. This study provides an updated overview of NPS-related harms in France using national addictovigilance data. Data were extracted from three complementary surveillance systems: (i) the NotS program of spontaneous reports of NPS-related adverse events (2009-24), (ii) the OPPIDUM survey conducted among users attending addiction care centers (2016-24), and (iii) the DRAMES registry of toxicologically confirmed drug-related deaths (2012-23). Substances were classified by chemical family and clinical effects were coded using MedDRA terminology. In addition to descriptive analyses, regression models were used to assess temporal trends. A total of 3468 NotS involving at least one NPS were recorded, increasing from 5 cases in 2009 to 726 in 2024. Synthetic cathinones and synthetic cannabinoids accounted for nearly 90% of notifications. Trend analyses confirmed a significant increase in NPS notifications and reported use over time. In OPPIDUM, the proportion of NPS users increased from 0.3% in 2016 to 1.7% in 2024. In DRAMES, 136 NPS-related deaths were identified between 2012 and 2023, with no significant overall increase in mortality during the study period. Synthetic cathinones and synthetic cannabinoids dominate the French NPS landscape. The integration of multiple addictovigilance data sources provides a robust framework for early signal detection and supports public health decision-making.
Lace B, Inashkina I, Dan D
… +9 more, Weinman A, Adam P, Kvlividze O, Tumiene B, Isidro A, Pereira CA, Teixeira G, Crowley RK, ERDERA UC Stakeholder Panel
Eur J Public Health
· 2026 Jun · PMID 42290236
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The European Joint Programme on Rare Diseases successfully advanced rare disease research and also revealed challenges for underrepresented countries, those less frequently holding or leading grants. This study aimed to...The European Joint Programme on Rare Diseases successfully advanced rare disease research and also revealed challenges for underrepresented countries, those less frequently holding or leading grants. This study aimed to survey Rare Disease researchers in these countries, identify barriers to participation in research, and propose solutions. A modified Delphi approach without formal consensus thresholds of 186 respondents highlighted fragmented or outdated policies and heterogeneous funding. Nearly all participants prioritized the need for EU-wide policies defining minimum quality standards for Rare Disease care. Key priorities include access to genetic testing and essential services to support uniform care and shared research capacity.
Eur J Public Health
· 2026 Jun · PMID 42289904
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Children's exposure to parental violence increases the risk of adverse health outcomes. We aimed to examine how combinations of maternal and paternal violent disciplinary practices at ages 7 and 13 years shape adolescent...Children's exposure to parental violence increases the risk of adverse health outcomes. We aimed to examine how combinations of maternal and paternal violent disciplinary practices at ages 7 and 13 years shape adolescents' health-related behaviors and depressive symptoms. This cohort study included 4,610 participants from the Portuguese Generation XXI birth cohort, enrolled at birth (2005-2006) and followed up at ages 7 and 13 years. Maternal and paternal disciplinary tactics were reported using the Parent-Child Conflict Tactics Scale, assessing psychological aggression, corporal punishment, and severe physical assault. Outcomes at age 13 years included health-related behaviors (fighting and substance use) and depressive symptoms. Combined effects of maternal and paternal discipline were assessed using multiplicative and additive interaction models. Mothers used corporal punishment and severe physical assault more frequently with boys, whereas fathers used all types of violent discipline more often with boys than with girls. The use of either corporal punishment or psychological aggression by both mothers and fathers was associated with a multiplicative effect on adolescent substance use. Psychological aggression by both parents also showed an additive effect on risky health-related behaviors and depressive symptoms. The use of severe physical violence by both parents was associated with an additive interaction on health-related bahaviors and depressive symptoms. The combined use of violent discipline by fathers and mothers was associated with a multiplicative increase in the likelihood of adolescent negative health-related behaviors and depressive symptoms, suggesting a synergistic effect with significant implications for early interventions and prevention strategies.
Beike JE, Rösler U, Skwarek A
… +2 more, Wendsche J, Pfeffer-Hoffmann C
Eur J Public Health
· 2026 Jun · PMID 42289903
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Despite the vital role migrant live-in care workers play in elder care across Europe, they often confront precarious employment conditions with limited legal protections and low visibility. Quantitative evidence on their...Despite the vital role migrant live-in care workers play in elder care across Europe, they often confront precarious employment conditions with limited legal protections and low visibility. Quantitative evidence on their work and health has been scarce. This study (i) describes live-in care workers' sociodemographic characteristics and job conditions in German homecare; (ii) compares their job demands, resources and motivational, and health-related outcomes with those of geriatric nurses and the German general working population; and (iii) analyses the extent to which their demands and resources are linked to motivational and health outcomes. The Copenhagen Psychosocial Questionnaire was used to assess the psychosocial working conditions, health-related and motivational outcomes of the participating live-in care workers. The sample comprised 429 migrant live-in care workers, of whom 93% were women and 77% were older than 49 years. Most live-ins originated from Poland (50%), followed by Bulgaria (30%), Croatia (13%), and Romania (4%). Nearly half lack formal contracts. Compared to geriatric nurses and all occupations, they experience higher work-privacy conflicts (d = 0.66; d = 0.93) and emotional demands but lower quantitative and physical demands. They report lower job satisfaction, higher burnout, greater presenteeism, and stronger turnover intentions (d = 0.71; d = 0.81). Job demands and resources are significant predictors of health and motivational outcomes. Our study highlights the importance of work-privacy conflict as a central occupational stressor for live-ins. Policy actions and interventions must improve their working conditions, strengthen job resources and protect their health and well-being.
Eur J Public Health
· 2026 Jun · PMID 42285582
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Attending work despite illness (sickness presenteeism) is common in many workplaces. While most research has focused on individual and workplace determinants, less is known about country-level factors. This study examine...Attending work despite illness (sickness presenteeism) is common in many workplaces. While most research has focused on individual and workplace determinants, less is known about country-level factors. This study examines (i) the association between national sick pay policies and presenteeism, (ii) the extent to which these policies contribute to cross-country variation in presenteeism, and (iii) whether associations differ by sociodemographic and occupational characteristics. We used data on 19 657 employees in 35 countries from the 2015 European Working Conditions Survey combined with country-level information on sick pay regulations. Countries were classified as offering 'generous' sick pay if they compensated from the first day of illness with ≥80% wage replacement for at least 2 weeks (43% of the countries met this criterion). Presenteeism was measured by the fraction of days worked while ill out of all illness days in the past 12 months (presenteeism propensity). We estimated multilevel models that controlled for individual characteristics (sociodemographics, job characteristics, health) and country features (unemployment, gross domestic product, and population density). Generous sick pay was associated with an 8-percentage-point lower presenteeism propensity (average marginal effect: -0.08; SE: 0.04; P < .05), explaining 12.4% of the between-country variance in presenteeism propensity. The association appeared more pronounced among older workers, low-income employees, routine occupations, and those in industry or public administration. National sick pay regulations may shape presenteeism, particularly among groups where financial motives are central. Adequate sick pay may help prevent workers from engaging in presenteeism and mitigate its consequences.
Eur J Public Health
· 2026 Jun · PMID 42281494
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The current collapse in development assistance, including development assistance for health, is anchored in budgetary efficiency, geopolitical reorientation, or the need for national prioritization. However, it is produc...The current collapse in development assistance, including development assistance for health, is anchored in budgetary efficiency, geopolitical reorientation, or the need for national prioritization. However, it is producing one of the largest self-inflicted efficiency losses in modern global health policy by ignoring essential concepts of development economics and health. In contexts of high inequality and with the inherent market failures in these areas, equity is not the opposite of efficiency but rather a necessary condition for achieving it.
Eur J Public Health
· 2026 Jun · PMID 42277327
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Persisting social disadvantage is associated with poor health and higher mortality. Increasing social mobility is, therefore, a major policy goal in the United Kingdom and other Western nations. However, the extent to wh...Persisting social disadvantage is associated with poor health and higher mortality. Increasing social mobility is, therefore, a major policy goal in the United Kingdom and other Western nations. However, the extent to which mortality is attenuated by upward social mobility is unclear, evidence from lifecourse studies suggests the persisting effects of early disadvantage. We sought to examine the relationship between intercensal social mobility and all-cause mortality. Census returns from three waves of the Northern Ireland Longitudinal Study (1991 n = 439 553; 2001 n = 446 573; 2011 n = 480 031) linked with mortality data. Using census data on 'educational attainment', 'occupational social class', 'housing tenure', and 'household car access' we derived an index of individual and household-level disadvantage and examined intercensal social mobility and all-cause mortality between 1991-2001 and 2001-2011. At each census point, all-cause mortality was positively associated with increasing social disadvantage. Relative to the least disadvantaged at each census, populations in the most disadvantaged areas recorded (hazard ratios = 3.23 (95% CI 2.49, 4.19); HR = 5.09 (4.21, 6.17), and HR = 5.30 (4.56, 6.16)) for 1991, 2001, and 2011, respectively. Compared with the socially static groups, those with generally downward social mobility showed an excess mortality, while mortality in the upwardly social mobility groups was generally lower than (or similar to) those in more socially static groups. Perhaps predictably, all-cause mortality was strongly associated with downward social mobility across time periods. Of greater concern, the Hazards associated with downward mobility appear to intensify over time. Moreover, increased social mobility appears to have little positive impact on mortality.
Kalima ML, Lallukka T, Roos E
… +2 more, Valkonen J, Svärd AC
Eur J Public Health
· 2026 Jun · PMID 42267719
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Overweight/obesity and psychological distress often co-exist and are associated with sickness absence (SA). The objective of this study was to examine joint contribution of overweight/obesity and psychological distress o...Overweight/obesity and psychological distress often co-exist and are associated with sickness absence (SA). The objective of this study was to examine joint contribution of overweight/obesity and psychological distress on short and long SA periods, and to explore potential synergistic interactions between these factors. The Helsinki Health Study survey collected in 2017 among 19-39-year-old Finnish municipal employees was linked to employer's SA registers (1-7 days for short and 8+ days for long SA periods), including participants consenting to linkage (n = 3966, 80% women). The mean follow-up time was 2.1 years. We calculated body mass index (BMI) from weight and height and evaluated psychological distress using the emotional wellbeing subscale of RAND-36 health-related quality of life survey. Rate ratios (RRs) and their 95% confidence intervals (CIs) were calculated for SA periods using negative binomial regression models. Interaction between overweight/obesity and psychological distress was examined using the Synergy Index (S). Most participants (85%) had at least one short and over one-fourth (29%) one long SA period. Overweight/obesity (42%) and psychological distress (23%) jointly contributed to short (RR, 1.62; 95% CI, 1.44-1.82) and long (RR, 2.48; 95% CI, 2.09-2.95) SA periods, compared to those with healthy weight and no psychological distress. The interaction between overweight/obesity and psychological distress was additive for short (S = 1.11), and synergistic for long SA periods (S = 1.40). Sociodemographic factors, working conditions, and health behaviors only slightly attenuated these associations. It is important to consider co-occurrence of overweight/obesity and psychological distress in prevention of SA.
Eur J Public Health
· 2026 Jun · PMID 42267718
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Falls are a significant cause of disability, hospitalization, and loss of autonomy in older adults. Although unmet care needs are known to worsen health outcomes (e.g. reduced quality of life, disability), their associat...Falls are a significant cause of disability, hospitalization, and loss of autonomy in older adults. Although unmet care needs are known to worsen health outcomes (e.g. reduced quality of life, disability), their association with fall risk among frail community-dwelling older adults remains unclear. This study examines this relationship. We used panel data from waves 6-9 (2015-22) of the Survey of Health, Ageing and Retirement in Europe for adults aged 50+. The analytic sample included 872 non-frail individuals (3001 observations) and 1061 frail individuals (3552 observations). We examined the association between unmet needs for assistance with activities of daily living and falls among frail and non-frail individuals. Two-way fixed effects models with lagged exposures were estimated to account for time-invariant individual heterogeneity and reduce reverse causality. Analyses distinguished between unmet formal and informal care needs. Among frail individuals, unmet needs (compared to met needs) for formal care were associated to 18.8 percentage point increase in fall risk (95% CI, 0.1-37.6; P = .049), while unmet needs for informal care raised the risk by 22 percentage points (95% CI, 0.1-45.1; P = .049). No significant associations were found among non-frail individuals. Effects were particularly pronounced among women, those living alone, and adults aged 70+. Unmet care needs significantly increase the risk of falls among frail older adults. Targeted public health strategies are essential to prevent falls, preserve autonomy, and limit long-term care burdens in the frail population.
Wu ER, Joki A, Venäläinen MS
… +3 more, Suojanen LU, Pietiläinen KH, Ahola AJ
Eur J Public Health
· 2026 Apr · PMID 42154894
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To investigate associations between alcohol consumption, smoking, and weight loss outcomes over a 12-month digital lifestyle intervention, the Healthy Weight Coaching. Weight, height, and waist circumference were self-re...To investigate associations between alcohol consumption, smoking, and weight loss outcomes over a 12-month digital lifestyle intervention, the Healthy Weight Coaching. Weight, height, and waist circumference were self-reported at baseline, followed by weekly weight and quarterly waist circumference reporting. Interpolated weights were used to calculate body mass index at 3, 6, 9, and 12 months. At these timepoints, relative changes from baseline in weight and waist circumference were calculated. On web-based questionnaires, participants reported alcohol consumption (frequency, single-session dose) and smoking (status, daily dose, start age, end year). Participants were categorized as abstinent, low-risk drinkers, and risky drinkers (men: >14 units/week or >6 units/occasion; women: >7 units/week or >5 units/occasion), and as current, former and non-smokers. At baseline, of the 1719 participants (83.3% women, median age 51 years, body mass index 39.1 kg/m2), 20.9% reported abstinence and 16.2% risky drinking, while 12.1% and 22.3% were current and former smokers, respectively. Alcohol consumption decreased over the program, driven by reductions among baseline risky drinkers. Among baseline non-drinkers, increased alcohol intake over 12 months was linked to smaller waist circumference reduction (weekly dose, B = 0.762, P = 0.005; single-session dose, B = 1.168, P = 0.020). Instead, among baseline risky drinkers, cutting alcohol intake was linked to greater weight loss (weekly dose, B = 0.062, P = 0.034; single-session dose, B = 0.321, P < 0.001), and larger waist circumference reduction (single-session dose, B = 0.381, P = 0.031). Higher number of pack-years was associated with attenuated waist circumference reduction (B = 0.059, P = 0.002). Addressing alcohol consumption and smoking may improve weight loss outcomes in digital lifestyle interventions. The trial is registered at clinicaltrials.gov (Clinical Trials Identifier NCT04019249).