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We aimed to develop a core outcome set (COS) for systems-wide public health interventions seeking to promote early life health and wellbeing. Research was embedded within the existing systems-based intervention research programme ‘ActEarly’, located in two different areas with high rates of child poverty, Bradford (West Yorkshire) and the Borough of Tower Hamlets (London). 168 potential outcomes were derived from five local government outcome frameworks, a community-led survey and an ActEarly consortium workshop. Two rounds of a Delphi study (Round 1: 37 participants; Round 2: 56 participants) reduced the number of outcomes to 64. 199 members of the community then took part in consultations across ActEarly sites, resulting in a final COS for systems-based public health interventions of 40 outcomes. These were grouped into the domains of: Development & education (N = 6); Physical health & health behaviors (N = 6); Mental health (N = 5); Social environment (N = 4); Physical environment (N = 7); and Poverty & inequality (N = 7). This process has led to a COS with outcomes prioritized from the perspectives of local communities. It provides the means to increase standardization and guide the selection of outcome measures for systems-based evaluation of public health programmes and supports evaluation of individual interventions within system change approaches.

In recent years, reports of lead contamination have dramatically increased in Georgia. Given concerns about the exposure of children to lead (Pb), the National Multiple Indicator Cluster Survey (MICS-2018) included a blood sampling component. The results showed that 41% of the children that participated had blood Pb levels (BLL) ≥ 5 µg/dL and that BLL in children living in Western Georgia were higher than those in Eastern regions. In response to these findings, NCDC implemented written and verbal advice to the families of children who participated in the MICS-2018 on how to reduce Pb exposure. From August 2019 onwards, the state program of clinical follow-up was implemented. The design of this study was a longitudinal study. The intervention of interest was the public health advice and medical follow-up, and the outcome was defined as the difference in BLL between the MICS-2018 survey and the state program follow-up. We observed a significant overall reduction in median BLL between MICS-2018 and state program follow-up in both August 2019 and the latest results (until December 2019). However, we did not observe any significant further reduction between August and the most recent BLL results. In the Georgian setting, written and verbal communication targeting individual households, alongside home visits to the most exposed, effectively reduced BLL in children.

Ensuring the sustainability of school-based public health intervention activities remains a challenge. The Young and Active (Y&amp, A) intervention used peer-led workshops to promote movement and strengthen students’ sense of community in 16 Danish high schools. Peer mentors inspired first-year students to implement movement activities. To support sustainability, we applied a three-year stepwise implementation strategy using university students as peer mentors in year 1 and senior high school students in the following two years. This study explores the sustainability potential of Y&amp, A, focusing on school coordinators’ reflections on the intervention’s fit to their schools and the student-driven approach, and we assess the three-step implementation strategy. The study is based on telephone interviews with coordinators (n = 7) from schools that participated in all three years and participant observations of four workshops (a total of approximately 250 participating students). Results were generated through an abductive analysis. Seven schools continued the intervention throughout the three years and adapted it to fit their priorities. The student-driven approach was perceived to be valuable, but few student-driven activities were initiated. Teacher support seemed crucial to support students in starting up activities and acting as peer mentors in workshops. The three-step implementation strategy proved valuable due to the peer-approach and the possibility of gradual adaptation. In future similar initiatives, it is important to address how the adequate staff support of students can be facilitated.

To address existing gaps in public health practice, we used data from a 2014 internet panel survey of 954 Los Angeles County adults to investigate the relationships between psychosocial community characteristics (PCCs) and two key chronic disease-related dietary behaviors: fruit and vegetable (F+V) and soda consumption. Negative binomial regression models estimated the associations between ‘neighborhood risks and resources’ and ‘sense of community’ factors for each dietary outcome of interest. While high perceived neighborhood violence (p &lt, 0.001) and perceived community-level collective efficacy (p &lt, 0.001) were associated with higher F+V consumption, no PCCs were directly associated with soda consumption overall. However, moderation analyses by race/ethnicity showed a more varied pattern. High perceived violence was associated with lower F+V consumption among White and Asian/Native Hawaiian/Other Pacific Islander (ANHOPI) groups (p &lt, 0.01). Inadequate park access and walking as the primary mode of transportation to the grocery store were associated with higher soda consumption among the ANHOPI group only (p &lt, 0.05). Study findings suggest that current and future chronic disease prevention efforts should consider how social and psychological dynamics of communities influence dietary behaviors, especially among racially/ethnically diverse groups in urban settings. Intervention design and implementation planning could benefit from and be optimized based on these considerations.

A total of 475,214 COVID-19 cases, including 13,659 deaths, had been recorded in Canada as of 15 December 2020. The daily reports of confirmed cases and deaths in Canada prior to 15 December 2020 were obtained from publicly available sources and used to examine regional variations in case fatality rate (CFR). Based on a factor of underestimation and the duration of time from symptom onset to death, the time-delay adjusted CFR for COVID-19 was estimated in the four most affected provinces (Quebec, Ontario, Alberta, and British Columbia) and nationwide. The model-based adjusted CFR was higher than the crude CFR throughout the pandemic, primarily owing to the incorporation in our estimation of the delay between case reports and deaths. The adjusted CFR in Canada was estimated to be 3.36% nationwide. At the provincial level, the adjusted CFR was the highest in Quebec (5.13%)—where the proportion of deaths among older individuals was also the highest among the four provinces—followed by Ontario (3.17%), British Columbia (1.97%), and Alberta (1.13%). Provincial-level variations in CFR were considerable, suggesting that public health interventions focused on densely populated areas and elderly individuals can ameliorate the mortality burden of the COVID-19 pandemic.

There is growing evidence that the food environment can influence diets. The present study aimed to assess the relative availability and prominence of healthy foods (HF) versus unhealthy products (UP) in supermarkets in Buenos Aires, Argentina and to explore differences by retail characteristics and neighborhood income level. We conducted store audits in 32 randomly selected food retails. Food availability (presence/absence, ratio of cumulative linear shelf length for HF vs. UP) and prominence inside the store (location visibility) were measured based on the International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) protocol. On average, for every 1 m of shelf length for UP, there was about 25 cm of shelf length for HF (HF/UP ratio: 0.255, SD 0.130). UP were more frequently available in high-prominence store areas (31/32 retails) than HF (9/32 retails). Shelf length ratio differed across commercial chains (p = 0.0268), but not by store size or type. Retails in the lower-income neighborhoods had a lower HF/UP ratio than those in the higher-income neighborhoods (p = 0.0329). Availability of the selected HF was overcome largely by the UP, particularly in high prominence areas, and in neighborhoods with lower income level, which may pose an opportunity for public health interventions.

The novel coronavirus (SARS-CoV-2) has spread globally and has been declared a pandemic by the World Health Organization. While influenza virus shows seasonality, it is unknown if COVID-19 has any weather-related affect. In this work, we analyze the patterns in local weather of all the regions affected by COVID-19 globally. Our results indicate that approximately 85% of the COVID-19 reported cases until 1 May 2020, making approximately 3 million reported cases (out of approximately 29 million tests performed) have occurred in regions with temperature between 3 and 17 &deg, C and absolute humidity between 1 and 9 g/m3. Similarly, hot and humid regions outside these ranges have only reported around 15% or approximately 0.5 million cases (out of approximately 7 million tests performed). This suggests that weather might be playing a role in COVID-19 spread across the world. However, this role could be limited in US and European cities (above 45 N), as mean temperature and absolute humidity levels do not reach these ranges even during the peak summer months. For hot and humid countries, most of them have already been experiencing temperatures &gt, 35 &deg, C and absolute humidity &gt, 9 g/m3 since the beginning of March, and therefore the effect of weather, however little it is, has already been accounted for in the COVID-19 spread in those regions, and they must take strict social distancing measures to stop the further spread of COVID-19. Our analysis showed that the effect of weather may have only resulted in comparatively slower spread of COVID-19, but not halted it. We found that cases in warm and humid countries have consistently increased, accounting for approximately 500,000 cases in regions with absolute humidity &gt, 9 g/m3, therefore effective public health interventions must be implemented to stop the spread of COVID-19. This also means that &lsquo, summer&rsquo, would not alone stop the spread of COVID-19 in any part of the world.

Background: Monitoring trends and perceptions of new nicotine salt-based electronic cigarettes (ECs), like JUUL, is important to identify associations with product experimentation and use. Understanding harm perceptions of these new devices will inform prevention and intervention efforts. The current study assesses perceptions of the absolute harmfulness of JUUL use in addition to comparing it to other tobacco products. Methods: Participants (N = 839, 52% male) reporting ever use of JUUL were recruited from Amazon&rsquo, s Mechanical Turk from January to March 2018. Respondents completed questionnaire items assessing demographics, co-use of non-JUUL products, JUUL use status (i.e., daily users (10.8%), non-daily users (29.4%), and triers (59.9%)), and JUUL and other tobacco products absolute harm perceptions. Results: Overall, participants rated JUUL as significantly less harmful than all other tobacco products (p &lt, 0.001), except other ECs. Daily JUUL users rated JUUL as less harmful compared to non-daily JUUL users and JUUL triers (p &lt, 0.05). JUUL was rated as more harmful by women compared to men (p &lt, 0.05). Conclusions: Increased frequency of JUUL use was associated with decreased harm perceptions. JUUL was associated with reduced perceptions of absolute harm compared to most other tobacco products, except other ECs. Public health practitioners should develop public health interventions that increase harm perceptions of ECs.

Despite substantially higher skin cancer risks, little research has investigated men’s attitudes about skin cancer and how those attitudes relate to their risks of developing skin cancer. This study aims to close the gap in research, regarding men’s perceptions and behaviors about skin cancer, sun exposure, and tanning. This study utilized a cross-sectional survey of 705 men recruited from Amazon Mechanical Turk (MTurk), reporting attitudes and behaviors towards sun exposure, tanning, and sun protection. While the majority of men reported large daily outdoor activities, that their skin frequently burns with sun exposure, and riskier perceptions of tanning, only a minority reported daily use of sunscreen or most other sun protective behaviors. More sun protection methods were associated with more frequent use of sunscreen and less positive tanning perceptions. Men consistently engaged in high-risk behaviors for developing skin cancer, but they did not engage highly in protective behaviors to mitigate their risk. The findings can help improve clinical and public health interventions to lower men’s risk of skin cancer with strong messages about sunscreen use and sun protective methods.

Chronic kidney disease is one of the major health challenges in India. Cuttack district of the Odisha state of India is regarded as a hotspot for chronic kidney disease (CKD). However, there is limited information on true prevalence. This study estimates the prevalence of CKD in the Narsinghpur block of Cuttack district, Odisha. A cross-sectional study was conducted among population members aged 20&ndash, 60 years. Using a multi-stage cluster sampling. 24 villages were randomly selected for mass screening for CKD. Blood samples were collected and glomerulus filtration rates were calculated. It was found that among the 2978 people screened, 14.3% were diagnosed with CKD and 10.8% were diagnosed with CKD without either diabetes or hypertension. In one-third of the sampled villages, about 20% population was diagnosed with CKD. The prevalence was higher among males (57%), in the population below 50 years of age (54%), lower socioeconomic groups (70%), and agricultural occupational groups (48%). Groundwater tube wells (49%) and wells (41%) were the main drinking water sources for CKD patients. This study highlights the need for detection of unknown etiologies of CKD and public health interventions for the prevention of CKD in India.

We conducted a cross-sectional study to provide an overview primary school children food environment in two urban settings in Kenya. Six schools, catering to children from low-, medium- and high-income households in the cities of Nairobi and Kisumu in Kenya, participated in the study. Data on types of food places and foods offered were collected and healthy and unhealthy food availability scores calculated for each place. We utilized prevalence ratio analysis to examine associations between food availability, food place characteristics and neighborhood income levels. Altogether, 508 food places, located within 1 km of the schools and the school children’s neighborhoods were observed. Open-air market sellers and kiosks were most common. The proportion of food places with high healthy food availability was 2.2 times greater among food places in Nairobi compared to Kisumu, 1.9 times greater in food places with multiple cashpoints, 1.7 times greater in medium/large sized food places and 1.4 times greater in food places located in high income neighborhoods. These findings highlight differences in availability of healthy foods and unhealthy foods across types of food places and neighborhood income levels and inform public health interventions aimed at promoting healthy food environments in Kenya.

Artificial Intelligence (AI) and Machine Learning (ML) have expanded their utilization in different fields of medicine. During the SARS-CoV-2 outbreak, AI and ML were also applied for the evaluation and/or implementation of public health interventions aimed to flatten the epidemiological curve. This systematic review aims to evaluate the effectiveness of the use of AI and ML when applied to public health interventions to contain the spread of SARS-CoV-2. Our findings showed that quarantine should be the best strategy for containing COVID-19. Nationwide lockdown also showed positive impact, whereas social distancing should be considered to be effective only in combination with other interventions including the closure of schools and commercial activities and the limitation of public transportation. Our findings also showed that all the interventions should be initiated early in the pandemic and continued for a sustained period. Despite the study limitation, we concluded that AI and ML could be of help for policy makers to define the strategies for containing the COVID-19 pandemic. ispartof: International Journal Of Environmental Research And Public Health vol:18 issue:9 ispartof: location:Switzerland status: Published online

Schools are an ideal setting to deliver public health interventions, yet there are competing obligations that could limit their implementation. This study aimed to examine the decision making process and explore what evidence informs prioritisation of public health interventions in this setting. Semi-structured interviews were conducted with 14 staff in seven UK schools between November 2017 and March 2018. Participants were recruited from schools participating in The Birmingham Daily Mile trial and comprised leadership staff, teachers, and pastoral staff. Analyses used a constant comparison approach to explore the prioritisation process and schools&rsquo, use of economic evidence. Teachers felt that they had little decision making influence in regard to public health interventions, with this falling on leadership staff. Participants perceived tension between delivering academic subjects and public health initiatives and thought proven impact was important to justify the opportunity cost. Evidence did not appear to be routinely used, and participants were unaware of cost-effectiveness analyses, but thought it could be a useful tool. This study shows that schools face challenges in balancing the academic, health, and wellbeing needs of children. There is a need for targeted evidence that includes appropriate costs and outcomes and meets school decision makers&rsquo, needs.

Following an extreme heat event in 2009, a Heat Alert and Response System (HARS) was implemented for the greater Vancouver area of British Columbia (BC), Canada. This system has provided a framework for guiding public health interventions and assessing population response and adaptation to extreme heat in greater Vancouver, but no other parts of BC were covered by HARS. The objective of this study was to identify evidence-based heat alert thresholds for the Southwest, Southeast, Northwest, and Northeast regions to facilitate the introduction of HARS across BC. This was done based on a national approach that considers high temperatures on two consecutive days and the intervening overnight low, referred to as the high-low-high approach. Daily forecast and observed air temperatures and daily mortality counts for May through September of 2004 through 2016 were obtained. For each date (dayt), dayt&minus, 2 forecasts were used to assign high temperatures for dayt and dayt+1 and the overnight low. A range of high-low-high threshold combinations was assessed for each region by finding associations with daily mortality using time-series models and other considerations. The following thresholds were established: 29-16-29 &deg, C in the Southwest, 35-18-35 &deg, C in the Southeast, 28-13-28 &deg, C in the Northwest, and 29-14-29 &deg, C in the Northeast. Heat alert thresholds for all regions in BC provide health authorities with information on dangerously hot temperature conditions and inform the activation of protective public health interventions.

Mothers' instigation of complementary feeding before their infant reaches 6 months old risks shortening their breastfeeding duration, and high morbidity and mortality for their child. Complementary feeding practices require further investigation in Saudi Arabia. The present study aims to evaluate complementary feeding practices, and to establish which factors are associated with the early introduction of complementary feeding in the Saudi Arabian context. Cross-sectional research was conducted with 632 mothers of infants aged between 4 and 24 months attending five primary health care centers (PHCCs) between July and December 2015 in Saudi Arabia. Data on participants' socio-demographic characteristics and complementary feeding practices were collected via structured questionnaires. A regression analysis identified the factors associated with the early introduction of solid foods, defined as before 17 weeks. 62.5% of the study's infants received solid foods before reaching 17 weeks old. The maternal factors at higher risk of early introduction of solids were: younger age; Saudi nationality; shorter education; employment within 6 months post-birth; caesareans; not breastfeeding fully for six weeks post-birth, and living in low-income households. Complementary feeding prior to 6 months postpartum was common in Saudi Arabia. Public health interventions are needed to reduce early complementary feeding, focusing on mothers at highest risk of giving solids too early.

Physical activity (PA) patterns track from childhood through to adulthood. The study aimed to determine the levels and correlates of sedentary time (ST), total PA (TPA), and moderate-to-vigorous PA (MVPA) in preschool-aged children. We conducted cross-sectional analyses of 1052 children aged three-to-four-years-old from six studies included in the International Children’s Accelerometry Database. Multilevel linear regression models adjusting for age, gender, season, minutes of wear time, and study clustering effects were used to estimate associations between age, gender, country, season, ethnicity, parental education, day of the week, time of sunrise, time of sunset, and hours of daylight and the daily minutes spent in ST, TPA, and MVPA. Across the UK, Switzerland, Belgium, and the USA, children in our analysis sample spent 490 min in ST per day and 30.0% and 21.2% of children did not engage in recommended daily TPA (≥180 min) and MVPA (≥60 min) guidelines. There was evidence for an association between all 10 potential correlates analyzed and at least one of the outcome variables; average daily minutes spent in ST, TPA and/or MVPA. These correlates can inform the design of public health interventions internationally to decrease ST and increase PA in preschoolers.

Background: Physical activity is an important contributor to reducing the risk for a variety of diseases. Understanding why people are physically active contributes to evidence-based planning of public health interventions because successful actions will target factors known to be related to physical activity (PA). Therefore the aim of this study is to identify the most meaningful correlates of PA in children and adolescents using a large, representative data set. Methods: Among n = 3539 (1801 boys) 6 to 17-year-old participants of the German representative Motorik-Modul baseline study (2003–2006) a total of 1154 different demographic, psychological, behavioral, biological, social and environmental factors were ranked according to their power of predicting PA using least absolute shrinkage and selection operator (LASSO) regressions. Results: A total of 18 (in girls) and 19 (in boys) important PA predictors from different, personal, social and environmental factors have been identified and ranked by LASSO. Peer modeling and physical self-concept were identified as the strongest correlates of PA in both boys and girls. Conclusions: The results confirm that PA interventions must target changes in different categories of PA correlates, but we suggest to focus particularly on the social environment and physical self-concept for interventions targeting children and adolescents in Germany nowadays. We also strongly recommend to repeatedly track correlates of PA, at least every 10 years, from representative samples in order to tailor contemporary PA interventions.