Extreme heat is an important public health risk. Climate change will likely increase the temperatures humans are exposed to through exacerbated heat wave intensity and frequency, possibly increasing ...health risks from heat. To prevent adverse effects on human health, heat prevention plans and climate change adaptation strategies are being implemented. But are these measures effectively reducing heat-related mortality and morbidity? This study assesses the evidence base in 2014.
We conducted a systematic review of peer-reviewed published literature. We applied a combined search strategy of automated search and journal content search using the electronic databases PubMed, Web of Knowledge, Biological Abstracts, CAB Abstracts and ProQuest Dissertation & Theses A&I. Quality appraisal was conducted using CASP checklists, and we identified recurrent themes in studies with content analysis methodology. We conducted sub-group analyses for two types of studies: survey and interview research on behavioral change and perception, and observational studies with regression.
30 articles were included in the review. The majority of studies (n = 17) assessed mortality or morbidity reductions with regression analysis. Overall, the assessments report a reduction of adverse effects during extreme heat in places where preventive measures have been implemented. Population perception and behavior change were assessed in five studies, none of which had carried out a pre-test. Two themes emerged from the review: methodological challenges are a major hindrance to rigorous evaluation, and what counts as proof of an effective reduction in adverse health outcomes is disputed.
Attributing health outcomes to heat adaptation remains a challenge. Recent study designs are less rigorous due to difficulties assigning the counterfactual. While sensitivity to heat is decreasing, the examined studies provide inconclusive evidence on individual planned adaptation measures.
Extreme temperature events and global climatic changes may put human health at risk. Urban centers are particularly vulnerable to adverse effects of climate change. Japan is a densely populated and ...highly urbanized island frequently exposed to natural hazards and heat episodes. Japanese governments and practitioners design heat adaptation strategies to protect health and reduce risks. Are these strategies implemented at the local level? How do policymakers and researchers perceive heat and climate change adaptation measures? How are these strategies evaluated? In short: what is happening in Japan “on the ground”? This critical review briefly outlines heat adaptation solutions and challenges from three Japanese prefectures. It draws attention to implementation and evaluation barriers, and highlights creative approaches to adaptation, such as involving civil society volunteers.
Taking into account the adverse impacts of climate change on human health, the importance of increasing knowledge and gaining essential skills is necessary to mitigate and adapt to its impacts and ...protect human health. Researchers and experts are urging for more research in the climate-health nexus, as well as calling for efforts that establish climate and health educational goals. They encourage the development of agreed upon, articulated science-based curricula and resources addressing climate-health issues. This review aims to map out the current state of integration of climate change education in school-based education across the world and identify the human health topics included. Furthermore, it aims to explore the extents to which levels of prevention and health co-benefits of climate mitigation and adaptation are covered within the framework of school-based climate change education. Five electronic databases will be searched for peer reviewed articles in English, from year 2000-to May 2022. The findings from the study will be useful to school curricula developers looking to expand climate change education. This review will also highlight potential research gaps in education on climate change-related health in schools. The scoping review was preregistered with the Open Science Framework registration DOI: https://doi.org/10.17605/OSF.IO/8U5GK.
Abstract
Background
Smoking cessation during pregnancy and the postpartum period by both women and their partners offers multiple health benefits. However, compared to pregnant/postpartum women, ...their partners are less likely to actively seek smoking cessation services. There is an increased recognition about the importance of tailored approaches to smoking cessation for expectant and new fathers. While Behavior Change Interventions (BCIs) are a promising approach for smoking cessation interventions, evidence on effectiveness exclusively among expectant and new fathers are fragmented and does not allow for many firm conclusions to be drawn.
Methods
We conducted a systematic review on effectiveness of BCIs on smoking cessation outcomes of expectant and new fathers both through individual and/or couple-based interventions. Peer reviewed articles were identified from eight databases without any date or language restriction.Two independent reviewers screened studies for relevance, assessed methodological quality of relevant studies, and extracted data from studies using a predeveloped data extraction sheet.
Results
We retrieved 1222 studies, of which 39 were considered for full text screening after reviewing the titles and abstracts. An additional eight studies were identified from reviewing the reference list of review articles picked up by the databases search. A total of nine Randomised Control Trials were included in the study. Six studies targeted expectant/new fathers, two targeted couples and one primarily targeted women with an intervention component to men. While the follow-up measurements for men varied across studies, the majority reported biochemically verified quit rates at 6 months. Most of the interventions showed positive effects on cessation outcomes. BCI were heterogenous across studies. Findings are suggestive of gender targeted interventions being more likely to have positive cessation outcomes.
Conclusions
This systematic review found limited evidence supporting the effectiveness of BCI among expectant and new fathers, although the majority of studies show positive effects of these interventions on smoking cessation outcomes. There remains a need for more research targeted at expectant and new fathers. Further, there is a need to identify how smoking cessation service delivery can better address the needs of (all) gender(s) during pregnancy.
In 2005, the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) entered into force. This treaty was developed in response to the global tobacco epidemic, and it includes ...measures to reduce both demand for and supply of tobacco. The measures related to demand reduction include raising tax, providing cessation services, promoting smoke free public places, banning advertising, and raising awareness. However, there are a limited number of measures for supply reduction, and these mainly include fighting illicit trade, banning sales to minors and providing alternatives to tobacco workers and growers. Unlike regulation of many other goods and services that have been subjected to retail restrictions, there is a lack of resources about restricting tobacco availability through regulation of tobacco retail environment. Considering the potential of retail environment regulations in reducing tobacco supply and consequently reducing tobacco use, this scoping review aims to identify relevant measures.
This review examines interventions, policies, and legislations to regulate tobacco retail environment to reduce tobacco availability. This was done by searching the WHO FCTC and its Conference of Parties decisions, a gray literature search including tobacco control databases, a scoping communication with the Focal Points of the 182 WHO FCTC Parties, and a databases search in PubMed, EMBASE, Cochrane Library, Global Health, and Web of Science.
Themes of policies were identified to reduce tobacco availability by regulating retail environment: four WHO FCTC and twelve non-WHO FCTC policies. The WHO FCTC policies included requiring a license to sell tobacco, banning tobacco sale via vending machines, promoting economically alternative activities to individual sellers, and banning ways of sale that constitute a way of advertising, promotion, and sponsorships. The Non-WHO FCTC policies included banning tobacco home delivery, tray sale, tobacco retail outlets in or within a minimum distance from specific facilities, sale in specific retail outlets, and sale of tobacco or one or more of its products, in addition to restricting tobacco retail outlets per density of population and per geographic area, capping the tobacco amount allowed per purchase, limiting the number of hours or days in which tobacco can be sold, requiring a minimum distance between tobacco retailers, reducing tobacco products availability and proximity within a retail outlet, and restricting sale to government controlled outlets.
Studies show the effects of regulation of the retail environment in influencing overall tobacco purchases, and there is evidence that having fewer retails reduces the level of impulse purchasing of cigarettes and tobacco goods. The measures covered by WHO FCTC are much more implemented than ones not covered by it. Although not all widely implemented, many themes of limiting tobacco availability by regulating tobacco retail environment are available. Further studies to explore such measures and the adoption of the effective ones under the WHO FCTC decisions, could possibly increase their implementation globally to reduce tobacco availability.
•Over thirty years of temperature-mortality data in Japan were analyzed to understand population adaptation to heat.•We examined if changes in adaptation are associated with air conditioning ...prevalence, healthcare, and socioeconomic profiles.•Excess heat mortality has declined over the past few decades in Japan, but the mortality impact of heat remains significant.•Socioeconomic developments over time positively influenced the reduction of heat-related mortality risk.•Future research should focus on the challenges of specific adaptation measures at the local context.
Excessive heat is a health risk, yet previous studies have observed a general decline in sensitivity to heat despite increasing temperatures. Conclusive evidence is lacking on whether long-term changes of this sensitivity can be attributed to specific adaptation measures, such as air conditioning, or should be linked to societal adaptation, such as improved healthcare systems or socioeconomic well-being. The aim of this study was to assess the variation of the association between heat and daily mortality during summer in Japan since the 1970s and to examine the influence of air conditioning (AC) prevalence, healthcare resources, and socioeconomic developments at the prefecture level on this variation.
We analyzed daily total, cardiovascular and respiratory disease mortality and temperature data from 1972 to 2010 for 47 prefectures. We used Poisson generalized linear model to estimate the effect of heat on mortality, random effects model to obtain the mean national effect estimates, and meta-regression to explore the impact of prefecture-level characteristics.
Average summer temperature has increased across Japan during the 39-year period. Excess mortality attributable to summer heat has decreased, with a national reduction of 20 (95%CI: 17, 22), 21 (95%CI: 18, 25), and 46 (95%CI: 36, 55) cases of total, cardiovascular, and respiratory deaths (per 1000 deaths). The increase of AC prevalence was not associated with a reduction of excess mortality over time. Prefectures and populations with improved economic status documented a larger decline of excess mortality. Healthcare resources were associated with fewer heat-related deaths in the 1970s, but the associations did not persist in the more recent period (i.e., 2006–2010).
Excess mortality due to heat has reduced in Japan, suggesting population adaptation. Yet, heat remains a significant health risk. Socioeconomic developments may play a role in heat adaptation. These findings may have implications for ensuring effective prevention of heat-related health impacts.
Human health and wellbeing and the health of the biosphere are inextricably linked. The state of Earth's life-support systems, including freshwater, oceans, land, biodiversity, atmosphere, and ...climate, affect human health. At the same time, human activities are adversely affecting natural systems. This review paper is the outcome of an interdisciplinary workshop under the auspices of the Future Earth Health Knowledge Action Network (Health KAN). It outlines a research agenda to address cross-cutting knowledge gaps to further understanding and management of the health risks of these global environmental changes through an expert consultation and review process. The research agenda has four main themes: (1) risk identification and management (including related to water, hygiene, sanitation, and waste management); food production and consumption; oceans; and extreme weather events and climate change. (2) Strengthening climate-resilient health systems; (3) Monitoring, surveillance, and evaluation; and (4) risk communication. Research approaches need to be transdisciplinary, multi-scalar, inclusive, equitable, and broadly communicated. Promoting resilient and sustainable development are critical for achieving human and planetary health.
ObjectiveThe aim of this study was to assess public acceptance of four possible healthcare policies supporting tobacco dependence treatment in line with the Framework Convention for Tobacco Control, ...Article 14 recommendations in Germany.DesignCross-sectional household survey.SettingData were drawn from the German population and collected through computer-assisted, face-to-face interviews.ParticipantsRepresentative random sample of 2087 people (>14 years) from the German population.Outcome measuresPublic acceptance was measured regarding (1) treatment cost reimbursement, (2) standard training for health professionals on offering cessation treatment, and making cessation treatment a standard part of care for smokers with (3) physical or (4) mental disorders. Association characteristics with smoking status and socio-economic status (SES) were assessed.ResultsSupport for all policies was high (50%–68%), even among smokers (48%–66%). Ex-smokers and never-smokers were more likely to support standard training on cessation for health professionals than current smokers (OR 1.43, 95% CI 1.07 to 1.92; OR 1.43; 95% CI 1.14 to 1.79, respectively). Ex-smokers were also more likely than current smokers to support cessation treatment for smokers with mental disorders (OR 1.39, 95% CI 1.11 to 1.73). Men were less likely than women to support cessation treatment for smokers with physical diseases (OR 0.74, 95% CI 0.60 to 0.91) and free provision of treatment (OR 0.80, 95% CI 0.66 to 0.97). Offering cessation treatment to smokers with physical disorders was generally more accepted than to those with mental health issues.ConclusionsThe majority of the German population supports healthcare policies to improve the availability and affordability of tobacco dependence treatment. Non-smokers were more supportive than current smokers of two of the four policies, but odds of support were only about 40% higher. SES characteristics were not consistently associated with public acceptance.Trial registration numberDRKS00011322.
Low- and middle-income countries (LMICs) are disproportionately impacted by interacting epidemics of tuberculosis (TB) and tobacco consumption. Research indicates behavioural support delivered by ...health workers effectively promotes tobacco cessation. There is, however, a paucity of training to support LMIC health workers deliver effective tobacco cessation behavioural support. The TB and Tobacco Consortium undertook research in South Asia to understand factors affecting TB health workers' delivery of tobacco cessation behavioural support, and subsequently developed a training package for LMICs.
Using the "capability, opportunity, and motivation as determinants of behaviour" (COM-B) framework to understand any issues facing health worker delivery of behaviour support, we analysed 25 semi-structured interviews and one focus group discussion with TB health workers, facility in-charges, and national tuberculosis control programme (NTP) staff members in each country. Results were integrated with findings of an adapted COM-B questionnaire on health worker confidence in tobacco cessation support delivery, administered to 36 TB health workers. Based on findings, we designed a guide and training programme on tobacco cessation support for health workers.
Qualitative results highlighted gaps in the majority of health workers' knowledge on tobacco cessation and TB and tobacco interaction, inadequate training on patient communication, insufficient resources and staff support, and NTPs' non-prioritization of tobacco cessation in all three countries. Questionnaire results reiterated the knowledge deficits and low confidence in patient communication. Participants suggested strengthening knowledge, skills, and competence through training and professional incentives. Based on findings, we developed an interactive two-day training and TB health worker guide adaptable for LMICs, focusing on evidence of best practice on TB and tobacco cessation support, communication, and rapport building with patients.
TB health workers are essential in addressing the dual burden of TB and tobacco faced by many LMICs. Factors affecting their delivery of tobacco cessation support can be identified using the COM-B framework, and include issues such as individuals' knowledge and skills, as well as structural barriers like professional support through monitoring and supervision. While structural changes are needed to tackle the latter, we have developed an adaptable and engaging health worker training package to address the former that can be delivered in routine TB care.
ISRCTN43811467 .
Self-management is crucial in mitigating the impacts of a growing non-communicable disease (NCD) burden, particularly in Low and Middle-Income countries. What influences self-management in these ...settings, however, is poorly understood. We aimed to identify the determinants of self-management in the high NCD region of South Asia and explore how they influence self-management. A systematic mixed-studies review was conducted. Key electronic databases MEDLINE (1946+), Embase (1974+), PsycInfo (1967+) and CINAHL (EBSCOhost) in March 2022 (and updated in April 2023) were searched for studies on the self-management of four high-burden NCD groups: cardiovascular diseases, type 2 diabetes, chronic respiratory diseases and depression. Study characteristics and quantitative data were extracted using a structured template, and qualitative information was extracted using NVivo. Quality appraisal was done using the Mixed Methods Assessment Tool (MMAT). Quantitative findings were organised using the Commission on Social Determinants of Health (CSDH) framework and synthesised narratively, supported by effect direction plots. Qualitative findings were thematically synthesised. Both were integrated in a mixed synthesis. Forty-four studies (26 quantitative, 16 qualitative and 2 mixed-methods studies) were included, the majority of which were conducted in urban settings and among individuals with diabetes and cardiovascular diseases. Higher age, education, and income (structural determinants), health-related knowledge, social support and self-efficacy (psychosocial determinants), longer illness duration and physical comorbidity (biologic determinants), and the affordability of medicine (health-system determinants) were key determinants of self-management. Qualitative themes highlighted the role of financial adversity and the social and physical environment in shaping self-management.A complex interplay of structural and intermediary social determinants shapes self-management in South Asian settings. Multi-component, whole-systems approaches could boost self-management in these settings. Key areas include empowerment and education of patients and wider community, design and delivery of bespoke behavioural interventions and a stronger emphasis on supporting self-management in healthcare settings.
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