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Copyright of Public Health Forum is the property of De Gruyter and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: Mobile health interventions are promising behavior change tools. However, there is a concern that they may benefit some populations less than others and thus widen inequalities in health. This systematic review investigated differences in uptake of, engagement with, and effectiveness of mobile interventions for weight‐related behaviors (i.e., diet, physical activity, and sedentary behavior) based on a range of inequality indicators including age, gender, race/ethnicity, and socioeconomic status. The protocol was registered on PROSPERO (CRD42020192473). Six databases (CINAHL, EMBASE, ProQuest, PsycINFO, Pubmed, and Web of Science) were searched from inception to July 2021. Publications were eligible for inclusion if they reported the results of an exclusively mobile intervention and examined outcomes by at least one inequality indicator. Sixteen publications reporting on 13 studies were included with most reporting on multiple behaviors and inequality indicators. Uptake was investigated in one study with no differences reported by the inequality indicators studied. Studies investigating engagement (n = 7) reported differences by age (n = 1), gender (n = 3), ethnicity (n = 2), and education (n = 2), while those investigating effectiveness (n = 9) reported differences by age (n = 3), gender (n = 5), education (n = 2), occupation (n = 1), and geographical location (n = 1). Given the limited number of studies and their inconsistent findings, evidence of the presence of a digital divide in mobile interventions targeting weight‐related behaviors is inconclusive. Therefore, we recommend that inequality indicators are specifically addressed, analyzed, and reported when evaluating mobile interventions. [ABSTRACT FROM AUTHOR]

Background Students are a vulnerable group for the indirect impact of the COVID-19 pandemic, particularly their mental health. This paper examined the cross-national variation in students' depressive symptoms and whether this can be related to the various protective measures implemented in response to the initial stage of the COVID-19 outbreak. Methods Student data stem from the COVID-19 International Student Well-being Study, covering 26 countries during the first wave of the COVID-19 pandemic. Country-level data on government responses to the COVID-19 pandemic were retrieved from the Oxford COVID-19 Tracker. Multilevel analyses were performed to estimate the impact of the containment and economic support measures on students' depressive symptoms (n  =   78 312). Results School and workplace closures, and stay-at-home restrictions were positively related to students' depressive symptoms during the COVID-19 pandemic, while none of the economic support measures significantly related to depressive symptoms. Countries' scores on the index of these containment measures explained 1.5% of the cross-national variation in students' depressive symptoms (5.3%). This containment index's effect was stable, even when controlling for the economic support index, students' characteristics, and countries' epidemiological context and economic conditions. Conclusions Our findings raise concerns about the potential adverse effects of existing containment measures (especially the closure of schools and workplaces and stay-at-home restrictions) on students' mental health. [ABSTRACT FROM AUTHOR]

Background: Previous findings suggest that university students are at an elevated risk to experience financial hardship and to suffer from depressive symptoms. This vulnerability may have substantially increased during the coronavirus disease 19 (COVID-19) pandemic which might have affected students' socio-economic situation but possibly also their mental well-being. We examined whether the financial situation changed during the COVID-19 pandemic among German university students, and whether changes were associated with mental well-being. Methods: We conducted a cross-sectional online survey in May and July 2020 at five German universities. Participants were asked, if they had sufficient financial resources to cover monthly expenses before and during the pandemic. The answer options were dichotomized into worsened and no change/better financial situation compared to before the COVID-19 pandemic. Depressive symptoms were assessed using the CES-D 8 scale. For examining associations between sociodemographic, study-related, and financial factors and "worsened financial situation," we ran a generalized linear mixed model. To assess associations between depressive symptoms and worsened financial situation, we performed a linear mixed model. Results: We included 7,199 participants in the analyses (69% female, 30% male, 1% diverse, mean age: 24 years, standard deviation: 4.7). Overall, 25% of the participants reported to have a worsened financial situation at the time of the survey than in the time before COVID-19. Factors associated with a worsened financial situation were migration background, parents not being academics, not being able to borrow money, and payment of tuition fee by student and loan [odds ratios (OR) ranging from 1.20 to 2.35]. Factors associated with lower odds were: being single, living with others, studying a health-related field, being enrolled in a doctoral/Ph.D. or state exam program, and publicly funded tuition/tuition paid with a scholarship (OR ranging from 0.42 to 0.80). A worsened financial situation was associated with 1.02 points more on the CES-D 8 scale (95% CI: 0.80–1.24). Conclusion: Our results suggest that the pandemic put a number of students under financial strain with detrimental consequences for their mental well-being. Renewed attention must be paid to this vulnerable group to prevent the potentially damaging effects on their mental health. [ABSTRACT FROM AUTHOR]

Objective: To systematically review systematic reviews of school-based sexual-health and relationship Education (SHRE) programmes and, thereby, identify interventions and intervention components that promote reductions in risky sexual behaviour among young people. Methods: Electronic bibliographies were searched systematically to identify systematic reviews of school-based interventions targeting sexual-health. Results were summarised using a narrative synthesis. Results: Thirty-seven systematic reviews (summarising 224 primary randomised controlled trials) met our inclusion and quality assessment criteria. In general, these reviews analysed distinct sets of primary studies, and no comprehensive review of available primary studies was identified. Interventions were categorised into five types that segment this review literature. Unfortunately, many reviews reported weak and inconsistent evidence of behaviour change. Nonetheless, integration of review findings generated a list of 32 design, content and implementation characteristics that may enhance effectiveness of school-based, sexual-health interventions. Abstinence-only interventions were found to be ineffective in promoting positive changes in sexual behaviour. By contrast, comprehensive interventions, those specifically targeting HIV prevention, and school-based clinics were found to be effective in improving knowledge and changing attitudes, behaviours and health-relevant outcomes. Conclusions: School-based interventions targeting risky sexual behaviour can be effective. Particular design, content and implementation characteristics appear to be associated with greater effectiveness. We recommend consideration of these characteristics by designers of school-based sexual-health interventions. [ABSTRACT FROM PUBLISHER]

Objective: To undertake a systematic review and meta-analysis to establish the effectiveness of handwashing in reducing absence and/or the spread of respiratory tract (RT) and/or gastrointestinal (GI) infection among school-aged children and/or staff in educational settings.Design: Randomised-controlled trials (RCTs).Setting: Schools and other settings with a formal educational component in any country.Patients: Children aged 3-11 years, and/or staff working with them.Intervention: Interventions with a hand hygiene component.Main Outcome Measures: Incidence of RT or GI infections or symptoms related to such infections; absenteeism; laboratory results of RT and/or GI infections.Results: Eighteen cluster RCTs were identified; 13 school-based, 5 in child day care facilities or preschools. Studies were heterogeneous and had significant quality issues including small numbers of clusters and participants and inadequate randomisation. Individual study results suggest interventions may reduce children's absence, RT infection incidence and symptoms, and laboratory confirmed influenza-like illness. Evidence of impact on GI infection or symptoms was equivocal.Conclusions: Studies are generally not well executed or reported. Despite updating existing systematic reviews and identifying new studies, evidence of the effect of hand hygiene interventions on infection incidence in educational settings is mostly equivocal but they may decrease RT infection among children. These results update and add to knowledge about this crucial public health issue in key settings with a vulnerable population. More robust, well reported cluster RCTs which learn from existing studies, are required. [ABSTRACT FROM AUTHOR]

Given the long duration of the COVID-19 pandemic, monitoring mental health remains important. This study aimed to determine (1) the prevalence of anxiety and depressive symptoms among university students 20 months after the first COVID-19 restrictions and (2) which factors were associated with these outcomes. The cross-sectional COVID-19 German Student Well-being Study (C19 GSWS) collected data of 7025 students at five German universities. Associations between anxiety and depressive symptoms with sociodemographic and other factors were analysed using multivariable logistic regression models. The mean age of the participants was 23.9 years (SD = 4.9), 67 % were female and 31 % male. The prevalence for depressive symptoms was 29 % (PHQ-2) and 12 % (CES-D 8) and 32 % for anxiety. A complicated relationship status, the lack of a trusted person, and financial difficulties were associated with anxiety and depressive symptoms. University students who were worried about (re-) infection with COVID-19 had a 1.37-times higher chance for reporting anxiety (GAD-2: OR, 95 % CI: 1.09–1.71). Those with pre-existing cardiovascular health conditions had an up to 3.21-times higher chance for reporting depressive symptoms (OR, CESD-D 8, 95 % CI: 1.44–7.14). The study design is cross-sectional and uses self-reported outcomes. Concepts for prevention and counselling to tackle mental health problems in students are needed and programmes should take specific stressors related to the pandemic into account. • The prevalence for depressive symptoms among university students is 12 % to 29 %. • The prevalence for anxiety is 32 %. • Financial difficulties were associated with anxiety and depressive symptoms. • Worrying about (re-) infection with COVID-19 was associated with anxiety. [ABSTRACT FROM AUTHOR]