Background: Converging evidence indicates an adolescent mental health crisis in Western societies that has developed and exacerbated over the past decade. Proposed driving factors of this trend include more screen time, physical inactivity and social isolation but their causal influence on mental health is insufficiently understood. Objective: To test whether and based on which predictor variables the development of mental health in adolescents in the last decade can be predicted and to better understand the causal chain of factors at work. Methods: We implemented an interpretable machine learning pipeline with repeated cross-validation to assess the development of mental health throughout adolescence in members of two longitudinal cohort studies, the British Millenium cohort (MC, n = 8599) and the German KIGGS cohort (KIGGS, n = 1212). 144 (MC) and 102 (KIGGS) predictors assessed at the age of around 13.8 years (MC) and 11.6 years (KIGGS) were used to assess mental health at an age of around 16.7 years (MC) and 16.4 years (KIGGS). Based on these predictive models, we used permutation-based feature importance analyses to identify relevant predictors and predictor domains. Moreover, we performed partial dependence analyses in a causal inference framework to determine the direct effects of physical inactivity, screen time, and peer problems on the development of mental health. Results: The average cross-validated Pearson correlation between predicted and true mental health in late adolescence was r = 0.641 (MC) and 0.466 (KIGGS) using gradient boosting regression models. Feature importance analyses indicated a strong impact of pre-existing mental health and weaker impacts of sex (female as a risk factor), physical health (chronic disease as a risk factor), lifestyle, socioeconomic and family factors (e.g., low parental education, income and mental health as risk factors). Causal inference analyses suggested a strong proximate impact of peer relationships, but only a small impact of physical inactivity and a very small impact of screen time. Conclusions: Mental health development during adolescence can be assessed by a combination of variables from early adolescence. Peer problems represent an important proximal cause of mental health development and their deterioration may contribute to the current mental health crisis.

Background: Hepatitis B is an important public health challenge facing China, Understanding the long-term epidemiological trends and evolving spatial distribution patterns is critical for optimizing prevention strategies and achieving the WHO's 2030 hepatitis elimination targets. Objective: This study aimed to explore the epidemic trend and spatial distribution characteristics of hepatitis B in China from 2004 to 2020. Methods: This study used data on hepatitis B incidence from 2004 to 2020 from the China Public Health Science Data Center to analyze the time trend of hepatitis B incidence by joinpoint regression. The age-period-cohort model was used to analyze the age, period, and cohort effects of hepatitis B onset. Spatial autocorrelation analysis was used to explore the spatial distribution characteristics of hepatitis B in China. Results: From 2004 to 2020, China reported a total of 17,449,842 cases of hepatitis B, with an average annual incidence rate of 76.30/100,000. The incidence of hepatitis B in China showed an increasing trend from 2004 to 2007, with AAPC of 9.49 (95% CI: 2.12, 17.39), and a decreasing trend from 2007 to 2014, with AAPC of -3.77 (95% CI: -5.93, -1.55). The incidence of hepatitis B in China tended to be stable from 2014 to 2020, with an AAPC of -0.46 (95% CI: -2.86, 2.01). Age, period, and cohort effect significantly affect the incidence of hepatitis B. Age effect showed that the incidence rate of hepatitis B reached its peak at the age of 22, with an average incidence rate of 176.173/100,000; The period effect showed that the highest level during the study period occurred during 2004-2006; The cohort effect showed that the risk of hepatitis B increased first and then decreased with the turning point of 1924-1974. The incidence of hepatitis B varies significantly among regions. The incidence in the northeast and northwest regions has decreased, while that in the South and southwest regions has increased, while that in other regions has remained stable. Conclusions: China has achieved remarkable results in the prevention and control of hepatitis B, but there are still differences in the incidence rate among different age groups and regions. These results suggest the need to further strengthen the identification and screening of high-risk populations, and promote the supplementary vaccination of adult hepatitis B vaccine. Future intervention strategies should fully consider regional differences, implement precise intervention measures based on the epidemic trends and spatial distribution characteristics of each region, optimize resource allocation, and enhance the overall effectiveness of hepatitis B prevention and control.

Background: Social network data are essential and informative for public health research and implementation as they provide details on individuals and their social context. Objective: We aimed to generate a more complete sociocentric-like “fuzzy” network by harmonizing alternative sources of egocentric and digital network data to examine relationships between participants in the N2 cohort study. Further, we propose to examine network peer effects of status neutral HIV care continuum cascade. Methods: Data were collected from January 2018 to December 2019 in Chicago, Illinois, US from a community health center and via peer referral sampling as part of the Neighborhoods and Networks (N2) Cohort Study, comprised of Black sexually minoritized men and gender expansive populations. Participants provided sociodemographics, social networks, sexual networks, mobile phone contacts, and Facebook friend list data. Lab-based information about HIV care continuum cascade was also collected. We used an experimental approach to develop and test a fuzzy matching algorithm to construct a more complete network across confidant, sexual, Facebook, and phone networks using R and Excel. We calculated social network centrality measures for each of these networks and then described the HIV care continuum within the context of each network. We then used Spearman’s correlation and a network autocorrelation model to examine social network peer effects with HIV status and care engagement. Results: A total of 412 participants resulted in 2,054 network connection (ties) across all confidant, sexual, phone, and Facebook networks - reaching the entire study sample in one fully connected “fuzzy” network. Results from the network autocorrelation model suggest that participants who were proximate to network members who were engaged in care were significantly more likely to be engaged in care (significant at p<0.05). Conclusions: Using alternative sources of network data allowed us to fuzzy match a more complete network: fuzzy matching may identify hidden ties among participants which were missed by examining alternative sources of network data separately. Although sociocentric studies may be complex, more complete sociocentric-like networks may be generated using a fuzzy match approach that leverages peer referral, egocentric networks, and digital networks. Enriching offline networks with digital network data may provide insights into characteristics and norms that traditional egocentric approaches may not be able to capture.

Background: Unemployment is a risk factor for the development and perpetuation of psychological distress. Finding support for affected individuals can be particularly challenging, which causes a vicious cycle of psychological distress and unemployment. Objective: The aim of this systematic review is to assess and summarize existing evidence regarding interventions that address both mental health and re-employment, emphasizing accessibility through community or social care structures. Methods: A systematic literature search using PubMed and EBSCOhost and an additional search using reference list screening were conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In order to identify interventions for the mental health and re-employment of individuals experiencing psychological distress and unemployment, an inclusion process according to the PICO (population, intervention, comparison, and outcome) scheme and the study design was applied. Title and abstract screening and full-text screening for eligibility were performed independently by 2 reviewers. Quality assessments using the Cochrane Risk of Bias Tools for randomized and nonrandomized trials were conducted by 2 independent reviewers. Results: The initial systematic search yielded 4442 results, and 15 articles were additionally identified via reference list screening. Eventually, 74 articles were subjected to a thorough evaluation process by 2 independent reviewers. The interrater reliability was determined to be good, with a Cohen κ score of 0.770. After a multistep extraction process, 17 studies remained for inclusion, with each focusing on the improvement of mental health, re-employment, or both outcomes. A heterogeneous pattern of results emerged, with most interventions showing improvement in either mental health or re-employment. Most studies were assessed as having a moderate (n=7) or high (n=9) risk of bias. Conclusions: The results of the systematic research indicate that low-threshold services in close cooperation with institutions and exchange with other supportive stakeholders should be fostered. Derivable overarching themes and intervention content for integrative support measures can serve as guidelines for future interventions. Trial Registration: PROSPERO CRD42022378490; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022378490

Background: Publicly available public health tools such as the Area Deprivation Index (ADI), Child Opportunity Index (COI), and Social Vulnerability Index (SVI) are potential proxies for social determinants of health (SDOH), but evidence regarding their relationship with downstream health outcomes remains mixed. Objective: We sought to evaluate the relationship between emergency department utilization and inpatient encounters among pediatric brain or central nervous system (CNS) tumor patients by ADI, COI, and SVI. Methods: We conducted a retrospective cross-sectional study of pediatric brain and CNS tumor patients in Indiana from 2010 through 2020. We then fitted logistic, ordered logistic, and multilevel logistic regression models for emergency department (ED) visits and inpatient encounters to determine if there were associations between utilization and ADI, COI, or SVI. Finally, we overlaid index rankings onto maps to visually compare how indices characterized neighborhoods. Results: Out of 525 eligible patients, 264 (50.3%) had zero ED visits, 91 (17.3%) had one ED visit, and 170 (32.4%) had two or more ED visits. 73 (13.9%) patients had no hospitalizations, while 159 patients (30.3%) had one hospitalization, and 293 (55.8%) patients experienced multiple hospitalizations. Patients residing in moderate ADI neighborhoods experienced higher odds of any ED visits (aOR 2.42; 95% CI, 1.34–4.25) and multiple ED visits (aOR 2.02; 95% CI, 1.19–3.42). The COI and SVI were not associated with ED visits. Indices were not associated with inpatient visits. Additionally, we found that the ADI most likely to rank neighborhoods as very highly deprived. Conclusions: Indices provide useful context about the environment in which pediatric patients reside, but we found little evidence that indices are associated with health care utilization in our study population. Clinical Trial: null

Background: Colorectal cancer (CRC) and diabetes share many common lifestyle risk factors, such as obesity. However, it remains largely unknown how different factors interact to influence the risk of CRC among diabetes patients. Objective: This study aims to identify the interaction patterns among factors associated with the risk of CRC among diabetes patients. Methods: This is a retrospective cohort study conducted using electronic health records of Hong Kong. Patients who received diabetes care in general outpatient clinics between 2010 and 2019 without cancer history were included and followed up until December 2019. Conditional inference survival tree was applied to examine the interaction patterns among factors associated with the risk of CRC. Results: A total of 386,325 patients were included. During a median follow-up of 6.2 years, 4,199 patients developed CRC. Patients were first partitioned into four age groups by increased levels of CRC risk (≤54 vs 55 to 61 vs 62 to 73 vs >73 years). Among patients aged 54 years above, male sex was the dominant risk factor for CRC within each age stratum and the associations lessened with age. Abdominal obesity (waist-to-hip ratio >0.95) and longer duration of diabetes (median: 12 vs 4 years) were identified as key risk factor for CRC among males aged between 62 to 73 years and females aged 73 years above respectively. Conclusions: This study shows the interaction patterns among age, sex, waist-to-hip ratio, and duration of diabetes on the risk of CRC among diabetes patients. Findings of the study may help identify target groups for public health intervention strategies. Clinical Trial: NA

Background: HIV infections have caused severe public health and economic burdens to the world. Adolescents and young people continue to constitute a large proportion of newly diagnosed HIV cases. Digital health interventions have been increasingly used to prevent the rising HIV epidemic. Behavior change techniques (BCTs) are intervention components designed to modify the underlying processes that regulate behavior. The BCT taxonomy offers a systematic approach to identifying, extracting, and coding these components, providing valuable insights into effective intervention strategies. However, few reviews have comprehensively identified the use of BCTs in digital HIV interventions among adolescents and young people. Objective: This study aimed to synthesize existing evidence on the commonly used BCTs in effective digital HIV prevention programs targeting adolescents and young people. Methods: In total, 4 databases (PubMed, Embase, Cochrane Library, and APA PsycINFO) were searched, and studies from January 2008 to November 2024 were screened. Reference lists of relevant review studies were reviewed to identify any additional sources. Eligible randomized controlled trials with 1 of 3 HIV prevention outcomes (ie, HIV knowledge, condom-use self-efficacy, and condom use) were included. Basic study characteristics, intervention strategies, and study results were extracted and compared for data analysis. For the included interventions, BCTs were identified according to the BCT taxonomy proposed by Abraham and Michie in 2008, and the frequencies of BCTs used in these interventions were counted. Results: Searches yielded 383 studies after duplicates were removed, with 34 (8.9%) publications finally included in this review. The most frequently used BCTs included prompting intention formation (34/34, 100%), providing information about behavior-health link (33/34, 97%), providing information on consequences (33/34, 97%), and providing instruction (33/34, 97%). Interventions with significant improvements in HIV knowledge (11/34, 32%) more frequently used BCTs with a provision nature, such as providing information about behavior-health link (11/11, 100%), information on consequences (11/11, 100%), encouragement (10/11, 91%), and instruction (10/11, 91%). Those with significant increases in condom-use self-efficacy (7/34, 20%) used BCTs toward initiating actions, such as prompts for intention formation (7/7, 100%), barrier identification (7/7, 100%), and practice (5/7, 71%). In addition, studies showing significant improvements in condom use (14/34, 41%) included BCTs focused not only on provision and initiation but also on behavioral management and maintenance, such as use follow-up prompts (5/14, 36%), relapse prevention (4/14, 29%), prompt self-monitoring of behavior (3/14, 21%), and prompt review of behavioral goals (3/14, 21%). Conclusions: This is the first systematic review that examined the use of BCTs in digital HIV prevention interventions for adolescents and young adults. The identified BCTs offer important reference for developing more effective digital interventions, with implications for enhancing their HIV knowledge, condom-use self-efficacy, and condom use in youth.

Background: Early diagnosis and treatment initiation for tuberculosis (TB) not only improve individual patient outcomes, but also reduce circulation within communities. Active case-finding (ACF), a cornerstone of TB control programs, aims to achieve this by targeting symptom screening and laboratory testing to individuals at high risk of infection. However, its efficiency is dependent on its ability to accurately identify such high risk individuals and communities. The socio-economic determinants of TB include difficulties in accessing healthcare and high within-household contact rates. These two determinants are common in the poorest neighborhoods of sub-Saharan cities, where household crowding and lack of healthcare access often coincide with malnutrition and HIV infection, further contributing to the burden of tuberculosis. Objective: In this study we propose a new approach to enhance the efficacy of ACF with focused interventions that target subpopulations at high risk. In particular we focus on densely inhabited urban areas, where the proximity of individuals represents a proxy for poorer neighborhoods with enhanced contact rates. Methods: To this end, we used satellite imagery of the city of Kigali, Rwanda, to identify areas with a high density of small residential buildings. We subsequently screened 10,423 people living in these areas for TB exposure and symptoms and referred patients with a higher risk score for PCR testing. Results: We found autocorrelation in questionnaire scores for adjacent areas, up to 782 meters, suggesting that risk for TB can be associated with geographic areas. Out of 202 people with high questionnaire scores, 9 tested positive. Conclusions: Our results suggest that analyzing satellite imagery may allow the identification of urban areas where inhabitants are at higher risk of TB. Such results could be used to guide targeted active case-finding interventions. Clinical Trial: The protocol was approved by Rwanda National ethic Committee IRB 00001497 of IORG0001100 and Written informed consent obtained from each participant.

Background: Social norms provided a framework for understanding a variety of behaviors. Cultural tightness was introduced to measure the level of adherence to social norms and tolerance of deviant behavior. Objective: We aimed to explore the association between cultural tightness and COVID-19 vaccine hesitancy. Methods: A total of 44,339 participants aged over 18 years were enrolled from 28 different countries between 2020 and 2022. We used Vaccine Confidence Index (3 items related to evaluation of importance, effectiveness, and safety) with five-point Likert scale to collect COVID-19 vaccine confidence. Demographic information at the individual-level was obtained through the survey, while national-level data were sourced from the World Bank and Hofstede insights. Multilevel linear regressions with random effects for country were used to examine the association between cultural tightness and COVID-19 vaccine confidence. Results: Of the participants, 21,968 (50.2%) were male and 18,957 (43.3%) had an education level of university or above. Vietnam (Mean ± standard deviation (SD): 13.31±1.71) exhibited the highest level of confidence on COVID-19 vaccine and Slovakia (Mean ± SD: 9.52±0.14) had the lowest level. The higher levels of cultural tightness were positively linked to greater vaccine confidence (β: 1.936, 95% CI: 1.721, 2.151, P<0.001) after controlling individual- and national- level variables. Individuals who were younger in age, female, had lower levels of educational level, or belonged to minority religious groups demonstrated a positive association with lower vaccine confidence. Five Hofstede cultural dimensions were not significantly associated with vaccine confidence. The level of vaccine confidence in 2021 (β: -0.539, 95% CI: -0.670, -0.374, P<0.001) and 2022 (β: -0.234, 95% CI: -0.342, -0.101, P<0.001) was lower than that observed in 2020. Conclusions: Lower level of cultural tightness might be positively associated with low vaccine confidence. Our findings offered the insight for designing tailor interventions to vaccine hesitancy in different cultural tightness context.

Background: The AIDS epidemic among older people is becoming more serious. Evidence-based, acceptable and effective preventive interventions are urgently needed. Video-based intervention has become an innovative way to change healthy behaviors, and we have developed a brief video-based intervention named Sunset Without AIDS. Objective: In this study, we tested the effectiveness of a brief video-based intervention targeting older men's ability of AIDS prevention. Methods: A randomized controlled trial was conducted from June 20 to July 3, 2023. 100 older men were randomly divided into the intervention group (n=50) and the control group (n=50) by the envelope extraction method. The intervention group was given the Sunset Without AIDS video; the control group was received a normal AIDS education video. A questionnaire was used to measure the effect of the Sunset Without AIDS after two interventions. AIDS-related high-risk behaviors were followed up 1 and 3 months after the intervention. The difference was statistically significant at P≤0.05. Results: After two interventions, the total awareness rate (%) of AIDS-related knowledge in the intervention group and control group was 84% (42/50) and 66% (33/50), with P＝0.038. The stigma attitude scores of the two groups were 2.53 (SD 0.45) and 2.58 (SD 0.49), with P=0.549. But there was statistical difference in the first dimension (fear of infection) between the two groups (P<0.001). The positive scores of attitudes of AIDS-related high-risk behaviors of the two groups were 83.33 (SD 21.56) and 75.67 (SD 26.77), with P=0.58. 82% reported that they were satisfied with the educational content of the Sunset Without AIDS. At 1 and 3 months follow-up after the intervention, participants in two groups did not report AIDS-related high-risk behaviors. After watching the two videos, more people accepted and were satisfied with the Sunset without AIDS. Conclusions: Sunset without AIDS could improve the ability of AIDS prevention for older men in China and provide a certain basis for the innovation of AIDS education in the elderly population. Clinical Trial: Chinese Clinical Trial Registry ChiCTR2100045708; https://www.chictr.org.cn/showprojEN.html?proj=125478