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The aim of this study was to build a detailed, integrative profile of the correlates of young adults' feelings of loneliness, in terms of their current health and functioning and their childhood experiences and circumstances. Data were drawn from the Environmental Risk Longitudinal Twin Study, a birth cohort of 2232 individuals born in England and Wales in 1994 and 1995. Loneliness was measured when participants were aged 18. Regression analyses were used to test concurrent associations between loneliness and health and functioning in young adulthood. Longitudinal analyses were conducted to examine childhood factors associated with young adult loneliness. Lonelier young adults were more likely to experience mental health problems, to engage in physical health risk behaviours, and to use more negative strategies to cope with stress. They were less confident in their employment prospects and were more likely to be out of work. Lonelier young adults were, as children, more likely to have had mental health difficulties and to have experienced bullying and social isolation. Loneliness was evenly distributed across genders and socioeconomic backgrounds. Young adults' experience of loneliness co-occurs with a diverse range of problems, with potential implications for health in later life. The findings underscore the importance of early intervention to prevent lonely young adults from being trapped in loneliness as they age.

Adverse childhood experiences (ACEs) have been associated with poor health status later in life. The objective of the present study was to examine the relationship between ACEs and health-related behaviors, chronic diseases, and mental health in adults. A cross-sectional study was performed with 1501 residents of Macheng, China. The ACE International Questionnaire (ACE-IQ) was used to assess ACEs, including psychological, physical, and sexual forms of abuse, as well as household dysfunction. The main outcome variables were lifetime drinking status, lifetime smoking status, chronic diseases, depression, and posttraumatic stress disorder. Multiple logistic regression models were used to examine the associations between overall ACE score and individual ACE component scores and risk behaviors/comorbidities in adulthood after controlling for potential confounders. A total of 66.2% of participants reported at least one ACE, and 5.93% reported four or more ACEs. Increased ACE scores were associated with increased risks of drinking (adjusted odds ratio [AOR] = 1.09, 95% confidence intervals [CI]: 1.00-1.09), chronic disease (AOR = 1.17, 95% CI: 1.06-1.28), depression (AOR = 1.37, 95% CI: 1.27-1.48), and posttraumatic stress disorder (AOR = 1.32, 95% CI: 1.23-1.42) in adulthood. After adjusting for confounding factors, the individual ACE components had different impacts on risk behavior and health, particularly on poor mental health outcomes in adulthood. ACEs during childhood were significantly associated with risk behaviors and poor health outcomes in adulthood, and different ACE components had different long-term effects on health outcomes in adulthood.

Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk–outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk–outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk–outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51–12·1) deaths (19·2% [16·9–21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12–9·31) deaths (15·4% [14·6–16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253–350) DALYs (11·6% [10·3–13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0–9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10–24 years, alcohol use for those aged 25–49 years, and high systolic blood pressure for those aged 50–74 years and 75 years and older. Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Bill & Melinda Gates Foundation.

More remains unknown than known about how to optimize multiple health behaviour change. After reviewing the prevalence and comorbidities among major chronic disease risk behaviours for adults and youth, we consider the origins and applicability of high-risk and population strategies to foster multiple health behaviour change. Findings indicate that health risk behaviours are prevalent, increase with age and co-occur as risk behaviour clusters or bundles. We conclude that both population and high-risk strategies for health behaviour intervention are warranted, potentially synergistic and need intervention design that accounts for substitute and complementary relationships among bundled health behaviours. To maximize positive public health impact, a pressing need exists for bodies of basic and translational science that explain health behaviour bundling. Also needed is applied science that elucidates the following: (1) the optimal number of behaviours to intervene upon; (2) how target behaviours are best selected (e.g. greatest health impact; patient preference or positive effect on bundled behaviours); (3) whether to increase healthy or decrease unhealthy behaviours; (4) whether to intervene on health behaviours simultaneously or sequentially and (5) how to achieve positive synergies across individual-, group- and population-level intervention approaches.

While the human immunodeficiency virus (HIV) incidence rate has remained steady in most groups, the overall incidence of HIV among men who have sex with men (MSM) has been steadily increasing in the United States. eHealth is a platform for health behavior change interventions and provides new opportunities for the delivery of HIV prevention messages. The purpose of this systematic review was to examine the use of eHealth interventions for HIV prevention in high-risk MSM. We systematically searched PubMed, OVID, ISI Web of Knowledge, Google Scholar, and Google for articles and grey literature reporting the original results of any studies related to HIV prevention in MSM and developed a standard data collection form to extract information on study characteristics and outcome data. In total, 13 articles met the inclusion criteria, of which five articles targeted HIV testing behaviors and eight focused on decreasing HIV risk behaviors. Interventions included Web-based education modules, text messaging (SMS, short message service), chat rooms, and social networking. The methodological quality of articles ranged from 49.4-94.6%. Wide variation in the interventions meant synthesis of the results using meta-analysis would not be appropriate. This review shows evidence that eHealth for HIV prevention in high-risk MSM has the potential to be effective in the short term for reducing HIV risk behaviors and increasing testing rates. Given that many of these studies were short term and had other limitations, but showed strong preliminary evidence of improving outcomes, additional work needs to rigorously assess the use of eHealth strategies for HIV prevention in high-risk MSM.

Abstract Although behavior change interventions are highly recommended in health care, their reach, a core dimension of the public health impact of interventions, is rarely evaluated. This study aimed to investigate whether an individualized, computer-based brief intervention to reduce co-occurring health risk behaviors (HRBs), namely tobacco smoking, at-risk alcohol use, insufficient physical activity, and unhealthy diet, can reach and retain a sufficiently large part of general hospital patients (>75%) and whether patients with high need, that is with more HRBs, low school education or current unemployment may be sufficiently reached and retained. Over 6 weeks in 2022, all 18–64-year-old patients admitted to 11 wards of five medical departments of a university hospital in Germany were asked to participate in a computer-based HRB screening and in a pre-post intervention study with three further assessments and individualized computer-generated feedback. To investigate associations between intervention reach and retention and patient characteristics, a logistic and a Poisson regression analysis were used. Screening reached 78.9% of all eligible patients (225/285). Of those eligible for the intervention study, 81.8% (175/214) participated in the intervention. Among these, 76.0% (133/175) participated at least once more after hospitalization. Patients’ lifestyle and socio-economic characteristics were not significantly associated with reach or retention, Ps ≥ .467. Proactive computer-based multiple-HRB change interventions may reach and retain a sufficiently large part of general hospital patients, including those most in need. When proven efficacious and adequately implemented, this is a promising approach concerning public health impact in the reduction non-communicable diseases. Trial registration:  ClinicalTrials.gov NCT05365269, 9 May 2022.

Until recently, population-based data for monitoring sexual minority health have been limited, making it difficult to document and address disparities by sexual orientation. The primary objective of this study was to examine differences by sexual orientation in an array of health outcomes and health risk factors using one of the nation’s largest health surveys. Data for this study came from 8290 adults who identified as lesbian, gay, or bisexual (LGB) and 300,256 adults who identified as heterosexual in the 2014–2015 Behavioral Risk Factor Surveillance System (BRFSS). Logistic regression models were used to compare physical and mental health outcomes, health condition diagnoses, and health risk factors by sexual orientation, controlling for demographic and socioeconomic status. Controlling for sociodemographic characteristics, gay and bisexual men reported higher odds of frequent mental distress [odds ratio (OR) 1.71, P = 0.001; OR 2.33, P < 0.001] and depression (OR 2.91, P < 0.001; OR 2.41, P < 0.001), compared with heterosexual men. Lesbian and bisexual women had higher odds of frequent mental distress (OR 1.53, P < 0.001; OR 2.08, P < 0.001) and depression (OR 1.93, P < 0.01; OR 3.15, P < 0.001), compared to heterosexual women. Sexual minorities also faced higher odds of poor physical health, activity limitations, chronic conditions, obesity, smoking, and binge drinking, although these risks differed by sexual orientation and gender. This study adds to the mounting evidence of health disparities by sexual orientation. Community health practitioners and policymakers should continue to collect data on sexual orientation in order to identify and address root causes of sexual orientation-based disparities, particularly at the community-level.

The present study examines links between civic engagement (voting, volunteering, and activism) during late adolescence and early adulthood, and socioeconomic status and mental and physical health in adulthood. Using nationally representative data from the National Longitudinal Study of Adolescent to Adult Health, a propensity score matching approach is used to rigorously estimate how civic engagement is associated with outcomes among 9,471 adolescents and young adults (baseline Mage = 15.9). All forms of civic engagement are positively associated with subsequent income and education level. Volunteering and voting are favorably associated with subsequent mental health and health behaviors, and activism is associated with more healthrisk behaviors and not associated with mental health. Civic engagement is not associated with physical health.

Scientific evidence reveals a high prevalence of health risk behaviour among university students. This calls for the creation of educational programmes that promote more knowledge about health. However, knowledge alone is not enough to change behaviours; other factors should be considered, including attitudes towards health. The objective of this cross-sectional study was to analyse the relationship between knowledge, attitudes and health risk behaviours among university students. For this, a previously validated self-report questionnaire was applied to a stratified sample of 840 students, by year of study (first- and third-year students) and their scientific area. In addition to sociodemographic issues, the questionnaire contains a health-related knowledge scale, an attitudes towards health scale, and questions about health risk behaviours. Students displayed poor knowledge about health, correctly answering 17.77 (SD = 4.59) questions out of a total of 36, and moderate scores concerning attitudes towards health (M = 2.61, SD = 0.48, range: 1–5). Students reported always engaging in, on average, 3.88 (SD = 1.45) of the seven behaviours subject to the analysis. Mediation analyses indicated that knowledge about health and attitudes towards health were statistically significant predictors of risky behaviours. Furthermore, it was indicated that attitudes towards health have a mediating effect between health knowledge and health risk behaviours. Findings from this study indicate that public health and education policies should promote healthy behaviours among university students, taking into account not only the level of knowledge but essentially the development of positive attitudes when facing behaviours which put health at risk.

Objectives To explore the relationship between cumulative ecological risk and individual risky behavior and multiple forms of aggregated behaviors among adolescents, and examine the gender differences. Methods A large-scale, nationally representative, and students-based investigation was conducted in rural and urban areas of eight provinces in China from October to December 2021. A total of 22 868 adolescents with an average age of 14.64 years completely standardized questionnaire in which the sociodemographic characteristics, socio-ecological risk factors and risky behaviors were used to analyze. Results Of included students, 48.4% encountered the high level of social-ecological risk. The prevalence of breakfast intake not daily, alcohol use (AU), smoking, physical inactivity, prolonged screen time (ST) on weekdays and weekends, suicidal ideation, suicidal plan, suicidal attempt, and non-suicidal self-injury (NSSI) was 41.0%, 11.9%, 3.4%, 61.9%, 15.1%, 51.1%, 27.7%, 13.9%, 6.5% and 27.0% respectively. 22.2% of participants engaged in high-risk behaviors. All were significantly influences of increased cumulative ecological risk on individual behavior and low-risk clustering behaviors separately. The odds ratio of breakfast intake not daily, AU, smoking, physical inactivity, prolonged ST in weekday and weekend, suicidal ideation, suicidal plan, suicidal attempt, and NSSI for the adjusted model in low versus high level of cumulative ecological risk was respectively significant in both boy and girls, and the ratio of odds ratios (ROR) was separately 0.95 ( p  = 0.228), 0.67 ( p  < 0.001), 0.44 ( p  < 0.001), 0.60 ( p  < 0.001), 0.78 ( p  = 0.001), 0.83 ( p  = 0.001), 0.80 ( p  = 0.001), 0.83 ( p  = 0.022), 0.71 ( p  = 0.005), 0.75 ( p  = 0.001). Girls encountering a high level of cumulative ecological risk were more likely to engage in multiple forms of clustering risky behaviors than boys (RORs: 0.77, p  = 0.001). Conclusions Research and effective inventions at the social-ecological environment, based on the view of cumulative risk, are needed to promote the healthy development of behaviors in adolescence, and pay more attention to decreasing the occurrence of risky behaviours in girls than boys.