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STUDY QUESTIONHow are educational level, labor market attachment and income associated with receiving a first ART treatment in either the public or private healthcare sector among women in Denmark?SUMMARY ANSWERHigher educational level and income as well as labor market attachment were associated with higher probability of initiating ART treatment at public and private fertility clinics among women in Denmark.WHAT IS KNOWN ALREADYInfertility is common in populations worldwide, and the approach to this issue differs between societies and healthcare systems. In the public Danish healthcare system, ART treatment is free of charge, and the direct cost for patients is therefore low. In the private healthcare sector in Denmark, ART treatment is self-financed. There is limited knowledge about the association between socioeconomic factors and seeking ART treatment, although previous studies have indicated that higher socioeconomic status is associated with seeking ART treatment.STUDY DESIGN, SIZE, DURATIONWomen undergoing ART treatment during 1994–2016 registered in the Danish IVF register were individually linked with data from sociodemographic population registers using the Danish Personal Identification number. The study population consisted of 69 018 women treated with ART and 670 713 age-matched comparison women from the background population with no previous history of ART treatment.PARTICIPANTS/MATERIALS, SETTING, METHODSThe women included in the analyses were aged 18–45 years. The associations between attained educational level, labor market attachment and income and receiving a first ART treatment attempt were investigated for women either initiating treatment in the public sector or in the private sector, respectively. Information on age and origin was included as potential confounders, and odds ratios (ORs) were estimated in logistic regression models. In addition, analyses were stratified by age group to investigate potential differences across the age span.MAIN RESULTS AND THE ROLE OF CHANCEAdjusted results showed increased odds of receiving a first ART treatment in either the public or private sector among women with a higher educational level. Furthermore, women in employment were more likely to receive a first ART treatment in the public or private sector compared to women outside the workforce. The odds of receiving a first ART treatment increased with increasing income level. Surprisingly, income level had a greater impact on the odds of receiving a first ART treatment in the public sector than in the private sector. Women in the highest income group had 10 times higher odds of receiving a first ART treatment in the public sector (OR: 10.53 95% CI: 10.13, 10.95) compared to women in the lowest income group. Sub-analyses in different age groups showed significant associations between ART treatment and income level and labor market attachment in all age groups.LIMITATIONS, REASONS FOR CAUTIONOur study does not include non-ART treatments, as the national IVF register did not register these types of fertility treatments before 2007.WIDER IMPLICATIONS OF THE FINDINGSIn Denmark, there is equal access to medically assisted reproduction treatment in the publicly funded healthcare system, and since there is no social inequality in the prevalence of infertility, social inequality in the use of ART treatment would not be expected as such. However, our results show that social inequality is found for a first ART treatment attempt across publicly and privately funded ART treatment across the socioeconomic indicators, educational level, labor market attachment and income.STUDY FUNDING/COMPETING INTEREST(S)The funding for the establishment of the Danish National ART-Couple II Cohort (DANAC II Cohort) was obtained from the Rosa Ebba Hansen Foundation. The authors have no conflict of interest to declare.TRIAL REGISTRATION NUMBERN/A.

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.

Objective: The Healthy High school study aimed to promote wellbeing at high schools in Denmark. While the study was still running, the funding body encouraged the project group to test the applicability of one of the high school-based intervention components, i.e. the Young and Active (Y&A) intervention component, to a Vocational Education and Training (VET) school setting. Y&A comprised a peer-led innovation workshop aimed at inspiring first-year students to develop and implement activities at school which promote sense of community and movement during the school day. Students could apply for a start-up grant to establish new activities and facilities. This research note reports on the systematic process of adapting this intervention component to a VET school setting: 1) needs assessment, 2) preliminary adaptation design, 3) preliminary adaptation testing, and 4) adaptation refinement. Results: Based on the needs assessment, the following adaptions were made to the original intervention component; 1) A narrowed objective and focus i.e. promoting active breaks during the school day, 2) The addition of activity props to support the implementation of active breaks, and 3) Changes to the target group. As part of the further adaptation process, this preliminarily adapted version will be pilot-tested among students at VET schools using mixed methods.