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Thomas Rouyard and colleagues discuss use of the boosting approach as an alternative to nudging in developing non-coercive interventions to promote health

In October 2014, Chile implemented a tax modification on sugar-sweetened beverages (SSBs) called the Impuesto Adicional a las Bebidas Analcohólicas (IABA). The design of the tax was unique, increasing the tax on soft drinks above 6.25 grams of added sugar per 100 mL and decreasing the tax for those below this threshold. This study evaluates Chile's SSB tax, which was announced in March 2014 and implemented in October 2014. We used household-level grocery-purchasing data from 2011 to 2015 for 2,836 households living in cities representative of the urban population of Chile. We employed a fixed-effects econometric approach and estimated the before-after change in purchasing of SSBs controlling for seasonality, general time trend, temperature, and economic fluctuations as well as time-invariant household characteristics. Results showed significant changes in purchasing for the statistically preferred model: while there was a barely significant decrease in the volume of all soft drinks, there was a highly significant decrease in the monthly purchased volume of the higher-taxed, sugary soft drinks by 21.6%. The direction of this reduction was robust to different empirical modelling approaches, but the statistical significance and the magnitude of the changes varied considerably. The reduction in soft drink purchasing was most evident amongst higher socioeconomic groups and higher pretax purchasers of sugary soft drinks. There was no systematic, robust pattern in the estimates by household obesity status. After tax implementation, the purchase prices of soft drinks decreased for the items for which the tax rate was reduced, but they remained unchanged for sugary items, for which the tax was increased. However, the purchase prices increased for sugary soft drinks at the time of the policy announcement. The main limitations include a lack of a randomised design, limiting the extent of causal inference possible, and the focus on purchasing data rather than consumption or health outcomes. The results of subgroup analyses suggest that the policy may have been partially effective, though not necessarily in ways that are likely to reduce socioeconomic inequalities in diet-related health. It remains unclear whether the policy has had a major, overall population-level impact. Additionally, because the present study examined purchasing of soft drinks for only 1 year, a longer-term evaluation-ideally including an assessment of consumption and health impacts-should be conducted in future research. ClinicalTrials.gov Identifier: NCT02926001.

Cigarette prices in Japan are lower than those in most other high-income countries. A more striking fact is that cigarette tax revenues have been kept almost flat at just over two trillion JPY (Japanese yen; 18.2 billion US dollars) over more than three decades, despite steadily declining cigarette sales and seemingly weakening pressure from stakeholders with a vested interest in the tobacco industry. We attempted to examine trends and determinants of cigarette tax increases in Japan. In particular, we hypothesized that the Japanese finance ministry adjusts cigarette taxes to meet a revenue target. Under this hypothesis, we searched for the most plausible amount of the minimum target of tax revenue that corresponds to cigarette tax increases over the past 37 years (1985–2021) using public data on cigarette sales and taxes. The results revealed that two trillion JPY was the minimal revenue target that could plausibly explain the increase in cigarette tax. In addition, the timing and magnitude of cigarette tax increases have been successfully set to maintain stable tax revenues. A key determinant of cigarette tax increases in Japan has been hard revenue targets, rather than public health concerns.

The present work evaluates potential future typhoon and storm surges around the islands of Samar and Leyte in the Philippines taking into account monthly mean sea surface temperatures, atmospheric air temperature, and relative humidity (hereafter, SST, AAT, and RH) from MIROC5 according to four scenarios proposed by IPCC AR5. Super-typhoon Haiyan (2013), which caused catastrophic damage to coastal areas in the Philippines due to its high winds and storm surge, was used as the case study storm given that it was one of the tropical cyclones recorded in modern history. In this study, the Advanced Research Weather Research and Forecasting Model (ARW-WRF) is used to estimate the characteristics of both the present-day Haiyan and a typhoon with a similar return period under the climate condition of the year 2100. The unstructured, Finite Volume Community Ocean Model (FVCOM) was used to estimate both the present and potential future storm surges. The research has two main focuses. First, both the historical event and its storm surge are simulated and contrasted with field measurements of the storm surge height in order to prove the accuracy of the model. Second, the future typhoon and storm surge are estimated using the monthly mean value differences in SST, AAT, and RH from MIROC5 between 2011–2020 and 2091–2100 for the different scenarios. The characteristics of the simulated typhoon route and storm surge heights agree well with those of the best track data and field measurements. The numerical results of the future typhoon show that, if climate change is considered to only increase SST, its intensity and storm surge will be larger than under the present climate. The minimum sea-level pressure (hereafter, MSLP) of the future typhoon under scenario RCP 8.5 would be about 21 hPa lower and the storm surge 2.7 m higher than in the present climate. However, if SST, AAT, and RH are also taken into account, then the increase in typhoon intensity will not be as marked as if only SST is considered, with the MSLP under RCP 8.5 decreasing only by 13 hPa and the storm surge increasing by 0.7 m. The results of the present research thus suggest that while increases in SST can contribute to the intensification of future typhoons, increases in AAT and RH will somehow moderate this effect. Nevertheless, all scenarios considered point out to stronger typhoons and higher storm surges, clearly highlighting the perils posed by future climate change.

This study determined the structural factors affecting the shear creep characteristics of wood. The radial ( R ) distribution of shear creep characteristics within a stem of Japanese cedar was investigated under constant temperature and humidity conditions. The shear force was applied using an off-axis method. The investigated structural factors comprised the density of the wood and the width of the annual rings as macro-level factors and the microfibril angle (MFA) as a micro-level factor. The shear modulus [ G TL (0)] was found to be widely distributed in the R direction within the stem. Furthermore, a multiple regression analysis revealed that G TL (0) was strongly influenced by a positive correlation with both the MFA and density. The wide distribution of G TL (0) within the stem was satisfactorily explained by the MFA-dependent theory of orthotropic elasticity. Furthermore, the shear creep compliance curve demonstrated a tendency to increase logarithmically, regardless of the location within the stem. The MFA also exhibited a significant effect on (positive correlation with) the rate at which the shear creep compliance increased, while the effect of density was found to be minimal, although it had a significant effect on the shear modulus G TL (0).

Background This study aims to examine unmet healthcare needs and the burden of out-of-pocket (OOP) payments in Bangladesh among hypertensive adults using the most recent survey data. Methods A total of 5086 hypertensive patients aged 18 to 80 were recruited from 75 pharmacies in Bangladesh in 2023, 35 being located in urban areas and 40 in rural areas. Unmet healthcare needs was the primary outcome variable, while the incidence of catastrophic health expenditures (CHE) was the secondary outcome variable. A multilevel logistic regression model was performed to identify factors associated with unmet healthcare needs and CHE. A multilevel Tobit regression model was used to identify the determinants of OOP health expenditures. Results The study indicated that the prevalence of unmet healthcare needs among hypertensive adults was around 26% and incidence of CHE was 46% at 10% threshold of total consumption in Bangladesh. The most common reason for unmet healthcare needs was affordability, long waiting times, lack of availability, and transportation issues etc. Unmet healthcare needs were more prevalent among men, individuals with no education, divorced/separated, non-Muslims and poor population. Regression models suggested that older people, men, those with higher education, Muslim, married people, larger household, overweight and obese people, and rural residents were more likely to burden of OOP expenses. Conclusions High unmet needs and CHE prevalence in Bangladesh reveal inadequate health risk protection. Prioritizing affordability, addressing disparities, and strengthening financial risk protection can improve access and outcomes for hypertensive adults. Highlights In Bangladesh, 26% of hypertensive adults have unmet healthcare needs, mainly due to transportation problems and affordability issues. A high incidence of catastrophic health expenditures (46%) was observed, indicating a substantial financial burden on households due to healthcare costs. Unmet needs and out-of-pocket expenses are significantly affected by demographic factors like age, gender, education level, and marital status, emphasizing the need for targeted interventions.

In order to estimate the possible parameters of future extreme extratropical cyclones (ETCs), a pseudo-climate modelling study of three historical storms originating from the Atlantic Ocean and one from the Black Sea area was performed using multi-model approach considering IPCC emission scenarios RCP4.5 and RCP8.5 for the twenty-first century. Applying Weather Research and Forecasting atmosphere model (WRF), Finite Volume Community Ocean model (FVCOM-SWAVE) and the Simulating WAves Nearshore (SWAN) model, the changes in initial conditions in atmospheric air temperature, sea surface temperature and relative humidity were considered on the basis of 14 CMIP5 general circulation models ensemble. According to the future scenario results, no notable changes are expected in minimum atmospheric pressure within the ETCs of the future; however, the low pressure area was slightly larger and the strong wind zone was extending further south with greater peak wind speeds in the future (year 2081–2100) simulations. This, in turn, yielded a small surge height increase at Pärnu under RCP4.5 scenario; however, under RCP8.5 scenario the surge increase was up to 22–59 cm. Westerly approaching ETCs will bring more precipitation to the Baltic Sea area in the (warmer) future. In case of a southerly cyclone, the results were more mixed. An insignificant increase in wave heights during extreme storm conditions occurred. Although RCP8.5 future scenario is usually considered as unrealistic, the results of this study still suggest that the extreme ETCs may become more dangerous in the future, although probably not as certainly as tropical cyclones.

Lazertinib, a novel third‐generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR‐TKI), demonstrates marked efficacy in EGFR‐mutant lung cancer. However, resistance commonly develops, prompting consideration of therapeutic strategies to overcome initial drug resistance mechanisms. This study aimed to elucidate the adaptive resistance to lazertinib and advocate novel combination treatments that demonstrate efficacy in preventing resistance as a first‐line treatment for EGFR mutation‐positive NSCLC. We found that AXL knockdown significantly inhibited lung cancer cell viability in the presence of lazertinib, indicating that AXL activation contributes to lazertinib resistance. However, long‐term culture with a combination of lazertinib and AXL inhibitors led to residual cell proliferation and increased the MCL‐1 expression level, which was mediated by the nuclear translocation of the transcription factor YAP. Triple therapy with an MCL‐1 or YAP inhibitor in combination with lazertinib and an AXL inhibitor significantly reduced cell viability and increased the apoptosis rate. These results demonstrate that AXL and YAP/MCL‐1 signals contribute to adaptive lazertinib resistance in EGFR‐mutant lung cancer cells, suggesting that the initial dual inhibition of AXL and YAP/MCL‐1 might be a highly effective strategy in eliminating lazertinib‐resistant cells. This report demonstrates that AXL and YAP/MCL‐1 signals contribute to adaptive lazertinib resistance in EGFR‐mutant lung cancer cells, suggesting that the initial dual inhibition of AXL and YAP/MCL‐1 might be a highly effective strategy for eliminating lazertinib‐resistant cells.

Abnormal scar formation is a clinical challenge with limited therapeutic options. Mechanical stimulation is implicated in abnormal scarring. Accordingly, the present study investigated the role of LIMK2, a component of the Rho/ROCK/LIMK/cofilin pathway, in cell differentiation and apoptosis in response to mechanical stimulation and proliferation in human dermal fibroblasts (HDFs). In normal HDFs, expression of α-smooth muscle actin (α-SMA), a marker of differentiation into myofibroblasts, significantly increased with mechanical stimulation; however, this change was not observed when LIMK2 was inactivated. Mechanical stimulation increased expression of the anti-apoptotic protein Bcl-2 and decreased that of the pro-apoptotic protein BAX in controls, but these effects were not observed with LIMK2 inactivation. Moreover, fibroblast proliferation was inhibited with LIMK2 inactivation. These findings suggest that LIMK2 inactivation suppresses mechanical stimulation-induced myofibroblast differentiation and resistance to apoptosis, and also inhibits HDF proliferation, highlighting LIMK2 as a potential therapeutic target for the prevention and treatment of abnormal scars.

We implemented a clustered randomized controlled trial with 6,963 residents in six rural Ghana districts to estimate the causal impact of financial incentives on coronavirus disease 2019 (COVID-19) vaccination uptake. Villages randomly received one of four video treatment arms: a placebo, a standard health message, a high cash incentive (60 Ghana cedis) and a low cash incentive (20 Ghana cedis). For the first co-primary outcome—COVID-19 vaccination intentions—non-vaccinated participants assigned to the cash incentive treatments had an average rate of 81% (1,733 of 2,168) compared to 71% (1,895 of 2,669) for those in the placebo treatment arm. For the other co-primary outcome of self-reported vaccinations 2 months after the initial intervention, the average rate for participants in the cash treatment was 3.5% higher than for participants in the placebo treatment (95% confidence interval (CI): 0.001, 6.9; P  = 0.045): 40% (602 of 1,486) versus 36.3% (672 of 1,850). We also verified vaccination status of participants: in the cash treatment arm, 36.6% (355 of 1,058) of verified participants had at least one dose of the COVID-19 vaccine compared to 30.3% (439 of 1,544) for those in the placebo—a difference of 6.3% (95% CI: 2.4, 10.2; P  = 0.001). For the intention and the vaccination outcomes, the low cash incentive (20 Ghana cedis) had a larger positive effect on COVID-19 vaccine uptake than the high cash incentive (60 Ghana cedis). Trial identifier: AEARCTR-0008775 . A four-arm cluster-randomized trial testing the effects of a low cash incentive, a high cash incentive, a health message and a placebo on COVID-19 vaccine uptake in villages in rural Ghana demonstrated highest uptake with a low cash incentive.