Background: The coronavirus disease 2019 (COVID‐19) poses special challenges for societies, as the disease causes millions of deaths. Although the direct prevention measures affect the prevalence and mortality the most, the other indirect factors, including natural environments and economics, could not be neglected. Evaluating the effect of natural land cover on COVID-19 health outcomes is an urgent and crucial public health topic. Methods: Here, we examine the relationships between natural land cover and the prevalence and mortality of COVID-19 in the United States. To probe the effects of long-term living with natural land cover, we extract county-level land cover data from 2001 to 2019. Based on statistically spatial tests, we employ the Spatial Simultaneous Autoregressive (SAC) Model to estimate natural land cover’s impact and monetary values on COVID-19 health outcomes. To examine the short-term effects of natural environments, we build a seasonal panel data set about the greenery index and COVID-19 health outcomes. The panel SAC model is used to detect the relationship between the greenery index and seasonal COVID-19 health outcomes. Results: A 1% increase in open water or deciduous forest is associated with a 0.004-death and 0.163-conformed-case, or 0.006-death and 0.099-confirmed-case decrease in every 1,000 people. Converting them into monetary value, for the mortality, a 1% increase in open water, deciduous forest, or evergreen forest in a county is equivalent to a 212-, 313-, or 219-USD increase in household income in the long term. Moreover, for the prevalence, a 1% change in open water, deciduous forest, or mixed forest is worth a 382-, 230-, or 650-USD increase in household income. Furthermore, a rational development intensity is also critical to reduce the risk of the COVID-19 pandemic. More greenery in the short term is also linked to lower prevalence and mortality. Conclusions: Our study underscores the importance of incorporating natural land cover as a means of mitigating the risks and negative consequences of future pandemics like COVID-19 and promoting overall public health.

Public health insurance (PHI) has been implemented with different levels of participation in many countries, from voluntary to mandatory. In Vietnam, a law amendment made PHI compulsory nationwide in 2015 with a tolerance phase allowing people a flexible time to enroll. This study aims to examine mechanisms under which the amendment affected the enrollment, healthcare utilization, and out-of-pocket (OOP) expenditures by middle- and low-income households in this transitioning process.Using the biennial Vietnam Household Living Standard Surveys, the study applied the doubly robust difference-in-differences approach to compare outcomes in the post-amendment period from the 2016 survey with those in the pre-amendment period from the 2014 survey. The approach inheriting advantages from its predecessors, i.e., the difference-in-differences and the augmented inverse-probability weighting methods, can mitigate possible biases in policy evaluations due to the changes within the group and between groups over time in the cross-section observational study.The results showed health insurance expansion with extensive subsidies in premiums and medical coverage for persons other than the full-time employed, young children or elderly members in the family, significantly increased enrollments in the middle- and low-income groups by 9% and 8%, respectively. The number of visits for PHI-eligible services also increased, approximately 0.5 more visit per person in the middle-income and 1 more visit per person in the low-income. The amendment, however, so far did not show any significant effect on reducing OOP payments, neither for the low nor the middle-income groups. To further expand PHI coverage and financial protections, policymakers should focus on improving public health facilities, contracting PHI to more accredited private health providers, and motivating the high-income group’s enrollments.

Background: In addition to high vaccination levels, COVID-19 control requires uptake and continued adherence to personal hygiene and social distancing behaviors. It is unclear whether residents of a city with successive experience in worldwide pandemics such as SARS, would quickly adopt and maintain preventive behaviors. Methods: A population-based, longitudinal telephone survey was conducted between in first local wave of the COVID-19 pandemic (April 2020) and third local wave (December 2020) (n = 403). The study examined factors associated with personal hygiene and social distancing behavior fatigue, as measured by reduced adherence. Results: Over 9 months, face mask use increased (96.5–100%, p < 0.001). Although habitual hand hygiene remained unchanged (92.0%), blue collar workers and non-working individuals showed higher risk of hand hygiene fatigue. There was a decline (p < 0.05) in avoidance of social gatherings (81.1 to 70.7%), avoidance of public places (52.9–27.5%) and avoidance of international travel (81.9–77.4%) even with rising caseloads. Lowered perception of COVID-19 disease severity was associated with decreased avoidance of social gatherings and public places while lower education was associated with decline in avoidance of social gatherings. Conclusion: Even in regions with past pandemic experience, maintaining social distancing behaviors during a protracted pandemic remains a major public health challenge.

Background: The lawsuit that led to the U.S. Master Settlement Agreement (MSA) exposed the cigarette industry’s deceptive marketing practices, which changed population perceptions about the cigarette industry and helped prevent cigarette smoking. The cigarette industry now owns many electronic cigarette (e-cigarette) companies and make their own e-cigarettes. Given that the MSA occurred in previous decades, many millennial and generation Z young adults may not know about the MSA and the cigarette industry’s marketing practices. It is unknown whether awareness about the MSA and cigarette industry practices may influence these young adults’ e-cigarette industry and e-cigarette health risk perceptions, which may inform e-cigarette prevention efforts. Methods: Cross-sectional data were collected from a U.S. sample of tobacco-naïve young adults, 18–30 years-old, susceptible to e-cigarette use (n = 1,329) through an online panel service in August 2021-January 2022. Participants reported their demographic characteristics, awareness of the MSA, awareness of cigarette industry practices, e-cigarette industry perceptions, and e-cigarette health risk perceptions. We examined the relationships between awareness of the MSA and cigarette industry practices with e-cigarette industry and e-cigarette health risk perceptions using multivariable linear regressions, adjusted for demographic characteristics. Results: Overall, 36.2%, 24.1%, and 39.3% of participants had heard of the MSA and knew a lot about it, had heard of the MSA, but did not know much about it, and did not hear of the MSA, respectively. On average, participants were aware of 5.2 (SD = 3.0) of the 11 cigarette industry practices included. Hearing about the MSA and knowing a lot about it and awareness of more cigarette industry practices were associated with less positive e-cigarette industry and higher e-cigarette health risk perceptions, whereas having heard of the MSA but not knowing much about it was associated with more positive e-cigarette industry and lower e-cigarette health risk perceptions. Conclusions: Findings suggest that increasing comprehensive awareness of the MSA and cigarette industry practices may influence young adults’ e-cigarette-related perceptions, and may importantly prevent detrimental information gaps about the cigarette industry. Future research should investigate the potential impact of increasing awareness of the MSA and cigarette industry practices in changing e-cigarette-related perceptions, which may help prevent e-cigarette use.

Background: Cardiovascular disease (CVD) is the leading cause of mortality worldwide and in Colombia. The analysis of CVD mortality has been mainly relied on individual factors and rates, but occurrence is also related to contextual conditions. Understanding the distribution of CVD in a region will contribute to implement more focused-preventive and care interventions. Methods: Using the national mortality register established by the Department of National Statistics, standardized rates and spatial distribution of CVD mortality were estimated for Cali, Colombia, between 2010–2017. Global and local spatial aggregation was assessed using the Geary’s C test and for each district standardized mortality ratios smoothed by the Bayesian empirical were estimated. Results: Over the period, CVD was the main cause of mortality with 28,804 deaths accounting for 23,8% of total deaths. The global CVD mortality rate varied from 235.9 to 257.4 per 100.000 habitants, with an average increase of 9.1% in the percentage change. The main cause of mortality were hypertensive diseases following by ischemic heart diseases and stroke. The standardized mortality ratios smoothed by the Bayesian empirical method showed that the districts 7, 13, 14, 15 and 16 located at the eastern area with the lowest socio-economic strata and the district 22 at the south of the city with the highest socio-economic strata had the high risks of CVD mortality. All these areas were at the boundary of the city. The the lowest risk was observed in districts 1 and 2 at the northwest area with the upper socio-economic strata. Over the study period, a spatial autocorrelation was found in the districts 1,9 10, 11, 12, 13, 14, 15, 19, and 21 by using the Geary’s C test. The highest significant spatial association was found in the districts 1 and 21. Conclusion: Of 22 districts in Cali, the highest risk of CVD mortality was found in three at the lowest and one in the upper socio-economic strata between 2013 and 2017. Over the period a global spatial aggregation was identified due mainly to districts peripherical located suggesting that there could be contextual conditions influencing the risk. Therefore, there is a need for considering local conditions to prevent CVD mortality.

Background: The growing number of patients with type 2 diabetes and prediabetes is a major public health concern. Physical activity is a cornerstone of diabetes management and may prevent its onset in prediabetes patients. Despite this, many patients with (pre)diabetes remain physically inactive. Primary care physicians are well-situated to deliver interventions to increase their patients' physical activity levels. However, effective and sustainable physical activity interventions for (pre)diabetes patients that can be translated into routine primary care are lacking. Methods: We describe the rationale and protocol for a 12-month pragmatic, multicentre, randomised, controlled trial assessing the effectiveness of an mHealth intervention delivered in general practice to increase physical activity and reduce sedentary behaviour of patients with prediabetes and type 2 diabetes (ENERGISED). Twenty-one general practices will recruit 340 patients with (pre)diabetes during routine health check-ups. Patients allocated to the active control arm will receive a Fitbit activity tracker to self-monitor their daily steps and try to achieve the recommended step goal. Patients allocated to the intervention arm will additionally receive the mHealth intervention, including the delivery of several text messages per week, with some of them delivered just in time, based on data continuously collected by the Fitbit tracker. The trial consists of two phases, each lasting six months: the lead-in phase, when the mHealth intervention will be supported with human phone counselling, and the maintenance phase, when the intervention will be fully automated. The primary outcome, average ambulatory activity (steps/day) measured by a wrist-worn accelerometer, will be assessed at the end of the maintenance phase at 12 months. Discussion: The trial has several strengths, such as the choice of active control to isolate the net effect of the intervention beyond simple self-monitoring with an activity tracker, broad eligibility criteria allowing for the inclusion of patients without a smartphone, procedures to minimise selection bias, and involvement of a relatively large number of general practices. These design choices contribute to the trial’s pragmatic character and ensure that the intervention, if effective, can be translated into routine primary care practice, allowing important public health benefits. Trial registration: ClinicalTrials.gov (NCT05351359, 28/04/2022).

Background: Pregnancy-related mortality in the United States is the greatest among all high-income countries, and Georgia has one of the highest maternal mortality rates—almost twice the national rate. Furthermore, inequities exist in rates of pregnancy-related deaths. In Georgia, non-Hispanic Black women are nearly 3 times more likely to die from pregnancy-related complications than non-Hispanic White women. Unlike health equity, a clear definition of maternal health equity is lacking, overall and in Georgia specifically, but is needed to reach consensus and align stakeholders for action. Therefore, we used a modified Delphi method to define maternal health equity in Georgia and to determine research priorities based on gaps in understanding of maternal health in Georgia. Methods: Thirteen expert members of the Georgia Maternal Health Research for Action Steering Committee (GMHRA-SC) participated in an iterative, consensus-driven, modified Delphi study comprised of 3 rounds of anonymous surveys. In round 1 (web-based survey), experts generated open-ended concepts of maternal health equity and listed research priorities. In rounds 2 (web-based meeting) and 3 (web-based survey), the definition and research priorities suggested during round 1 were categorized into concepts for ranking based on relevance, importance, and feasibility. Final concepts were subjected to a conventional content analysis to identify general themes. Results: The consensus definition of maternal health equity created after undergoing the Delphi method is: maternal health equity is the ultimate goal and ongoing process of ensuring optimal perinatal experiences and outcomes for everyone as the result of practices and policies free of interpersonal or structural bias that tackle current and historical injustices, including social, structural, and political determinants of health impacting the perinatal period and life course. This definition highlights addressing the current and historical injustices manifested in the social determinants of health, and the structural and political structures that impact the perinatal experience. Conclusion: The maternal health equity definition and identified research priorities will guide the GMHRA-SC and the broader maternal health community for research, practice, and advocacy in Georgia.

Background: One of the effective factors on BF (Breastfeeding) continuation is Breastfeeding self-efficacy (BFSE). This study was conducted to determine the relationship between Health Literacy (HL) and BFSE in lactating mothers referring to primary health care centers. Methods: This cross-sectional descriptive study was carried out on lactating mothers referring to primary health care centers in 2022. Multi-stage cluster sampling was done with 160 samples. The data were collected using demographic questionnaire, Persian shortened form of the BSES is a self-reported instrument for measuring a mother's Breastfeeding self-efficacy and Health Literacy for Iranian Adults (HELIA). Data were analyzed using ANOVA, independent t-test, correlation test and liner regression by SPSS version 16, with a significance level of 5%. Results: There was a significant positive correlation between the HL score and its four domains( Reading, Behaviour and decision making, Accessing, and Understanding) except for the appraisal domain with BFSE score. The variables of use of formula, HL, duration of breastfeeding, and education were considered predictors of BFSE. Conclusion: In general, the results indicate a possible relationship between BFSE and mothers' HL. Therefore, improving mother's HL can have a positive effect on promoting infants’ nutrition.

Disadvantaged areas experience higher levels of loneliness than advantaged areas, though studies rarely identify environmental determinants of neighbourhood inequity in loneliness. We studied the contribution of the quantity and quality of green space to neighbourhood inequity in loneliness in three buffer sizes (400 m, 800 m, 1600 m), using cross-sectional data from 3778 individuals aged 48–77 years old living in 200 neighbourhoods in Brisbane, Australia. Levels of loneliness were significantly higher in disadvantaged neighbourhoods, and these neighbourhoods had less green space and less access to quality green space. However, there was no evidence that neighbourhood disparities in green space contributed to the association between neighbourhood disadvantage and loneliness. Possible methodological and substantive reasons for this result are discussed.