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BACKGROUND: As prevalence of tobacco use falls, socioeconomic inequalities in tobacco use are increasing in many high-income countries. Evidence is lacking on the effect of preventive interventions on socioeconomic inequalities in smoking initiation among adolescents. We evaluated whether a multicomponent school-based prevention programme with parental involvement has differential effects on smoking initiation across socioeconomic groups and affects the magnitude of socioeconomic inequalities in smoking initiation.

METHODS: A secondary analysis of data from a 3-year cluster randomised controlled trial, the TOPAS study, conducted in Sweden from 2018 to 2021. Schools were randomised either to the full programme (Tobacco-Free Duo, T-DUO) or minimal intervention (EDU). The analysis was conducted according to intention to treat for the primary outcome, the probability of remaining a non-user of cigarettes at the end of compulsory school (ages 15-16). Parents' educational attainment was the socioeconomic variable. Differential effects were analysed by comparing adolescents exposed to T-DUO with those exposed to EDU within each socioeconomic group. The effect of the intervention on the magnitude of inequalities was analysed by comparing several measures of absolute and relative inequalities between T-DUO and EDU.

RESULTS: At the end of follow-up, the full programme had a similar, at most moderate effect on smoking initiation in all socioeconomic groups (relative risk 1.13 (95% CI 1.02 to 1.25) in the middle group). The programme did not significantly affect the magnitude of inequalities (Slope Index of Inequality difference 1.49 (95% CI -15.34 to 18.32)).

DISCUSSION: Socioeconomic inequalities in smoking initiation remain substantial. Our results indicate the absence of an effect of the programme T-DUO on these inequalities.

Aim: This study assessed the association between exposure to alcohol adverts on social media and alcohol use among university students in Uganda since alcohol consumption has severe effects, especially in countries with weak regulations for alcohol marketing.

Methods: In total, 996 undergraduate students at Makerere University responded to a questionnaire assessing exposure to alcohol advertising on social media (independent variable) and alcohol use (dependent variable). Adjusted multinomial logistic regression was used to analyse data.

Results: One in ten students reported hazardous drinking, while three in ten students were low-risk drinkers. Most students (70.1%) reported low exposure to alcohol adverts on social media, followed by high exposure (12.1%), and 17.8% reported no exposure. A key finding was that exposure to alcohol adverts on social media was significantly associated with alcohol use, especially the high exposure and hazardous drinking (odds ratio = 12.62, 95% confidence interval: 4.43-35.96). Students reporting high exposure to alcohol adverts on social media also had higher odds of low-risk drinking (odds ratio = 3.70, 95% confidence interval: 1.88-7.27) than those with low exposure (odds ratio = 1.77, 95% confidence interval: 1.09-2.87), in reference to no exposure.

Conclusion: Among Ugandan university students, exposure to alcohol adverts on social media is common and associated with alcohol use, in a dose-response manner. These findings suggest a need for a design and implementation of alcohol interventions for students using social media.

Background: Climate change is one of the most complex and important health threats of the 21st century. The knowledge of the impact of climate change on health is expanding rapidly. However, there has been no comprehensive assessment of the impact of climate change on the interlinked pregnancy, perinatal and infant periods. Hence, the objective of this study was to provide an overview of the effects of changing weather and climate hazards on maternal and infant health during pregnancy, the perinatal period and infancy.

Methods: We conducted a systematic review of peer-reviewed original articles and reviews found in PubMed, Web of Science, Embase, Cochrane, Global Health and WHO regional databases on the subject between January 2000 and May 2025. The included articles were in the English language, detailed exposure to climate change hazards during pregnancy, the perinatal period and up to 1 year of age in the child, with an outcome related to health.

Results: In total, 596 reviews and original articles were included in the analysis. Our findings demonstrate large differences in the number and types of studies for each climate-related hazard. Direct health effects from rising temperatures and extreme weather events, as well as indirect health effects such as infectious diseases, food insecurity, forced migration and socioeconomic changes due to climate change, have clear negative consequences for pregnant women and infants.

Conclusions: There is a large evidence base showcasing the harmful impact of climate change on pregnant women and infants through a variety of pathways. Action is urgently needed at all levels to address climate change and there is a need to implement large-scale mitigation and adaptation efforts that protect the health and well-being of pregnant women and infants everywhere.

Amid growing efforts to mitigate climate change in healthcare systems, there is a need to better understand the complex social and political processes by which a healthcare system can progress towards "net zero"goals. We aimed to gather stakeholders' perspectives to explain this process by applying a qualitative Theory of Change (ToC) co-creation methodology in the subnational healthcare system of Catalonia, Spain. Iterative virtual focus group interviews and written feedback rounds gathered the perspectives of 12 stakeholders, including researchers, government officials and healthcare professionals working in the Catalan healthcare system and/or climate action. Thematic and axial coding on focus group transcripts identified themes, categories and relationships. A ToC consisting of a sequence of nearly two hundred events envisioned by stakeholders to reach a long-term desired change of a "smart net zero"healthcare system was developed. The need for simultaneous top-down and bottom-up change was recognized, with identification of key stakeholder groups. Events were categorized into four "core change pathways"(policy, industry, healthcare institutions' and healthcare workers' pathways) and six "supporting processes"(governance, participation and collaboration, finance, digitalization, knowledge production and knowledge dissemination). The sequence of events in every pathway was further categorized into five stages of change: motivation, commitment, planning, implementation, and monitoring and evaluation. A ToC approach was useful to understand context-specific political, logistical, and social constraints and opportunities for different types of stakeholders to contribute to change towards a "net zero"healthcare system.

Integration of child-specific adaptation measures into health policies is imperative given children's heightened susceptibility to the health impacts of climate change. Using a document analysis method, we examined 160 national adaptation policies for inclusion of child-relevant measures and identified 19 child health-related adaptation domains. 44 (28%) of 160 countries' policies that were analysed failed to include any domains, 49 (31%) included at least one child-related domain, 62 (39%) included between two and six domains, and five (3%) included at least seven domains. Predominant domains among child-specific adaptation measures included education and awareness raising, followed by community engagement and nutrition. No country addressed children's direct needs in the domain of mental health. National adaptation policies tend towards overly simple conceptualisations of children across four major lenses: age, social role, gender, and agency. Limited inclusion of child-specific measures in national adaptation policies suggests insufficient recognition of and action on children's susceptibility to climate change effects.

To estimate the effect of a 3-year commitment to remain tobacco free on tobacco uptake among high school students in Sweden. The commitment is developed in the form of a contract between a child and a significant adult, constituting the core component of Tobacco-free Duo (T-Duo), a Swedish school-based tobacco prevention program. Secondary analysis of data from a cluster randomized controlled trial. Participants were 586 students in high schools assigned to the intervention arm of T-Duo. At inception, participants attended grade 7 (i.e., age 12–13). Only students who were tobacco naïve at baseline for the respective outcome and participated in all follow-ups were included. The exposure was defined as signing a 3-year contract with a significant adult, categorized as “stable contract” (3 years contract with the same contract partner), “unstable” (signed a contract sometime during follow-up but this was not sustained over time and/or with the same partner), and “no contract” at all during the intervention period. The primary outcome was having never tried cigarette smoking at the end of grade 9. Exposure and outcomes were self-reported in yearly questionnaires. Of 586 students, 321 (55%) held a stable contract, 204 (35%) an unstable contract, and 61 (10%) did not sign a contract at all. At the end of grade 9 (age 15–16), the relative risk (RR) to remain cigarette free was 1.11 (95% CI 1.00–1.22) (Number Needed to Treat = 10) among students in any type of contract compared to students that did not write a contract at all. The RRs for remaining tobacco free (secondary outcomes) ranged from 1.07 (0.98–1.16) for regular snus use to 1.16 (1.00–1.35) for any type of tobacco use. A commitment to remain tobacco free through a child–adult contract seems to exert a preventive effect on the uptake of tobacco use among Swedish adolescents over 3 school years. The current findings apply to a selected sample of both schools and students.

Registration: Current Controlled Trials ISRCTN52858080 Date: January 4, 2019, retrospectively registered.

Record-breaking temperatures were recorded across the globe in 2023. Without climate action, adverse climate-related health impacts are expected to worsen worldwide, affecting billions of people. Temperatures in Europe are warming at twice the rate of the global average, threatening the health of populations across the continent and leading to unnecessary loss of life. The Lancet Countdown in Europe was established in 2021, to assess the health profile of climate change aiming to stimulate European social and political will to implement rapid health-responsive climate mitigation and adaptation actions. In 2022, the collaboration published its indicator report, tracking progress on health and climate change via 33 indicators and across five domains.

This new report tracks 42 indicators highlighting the negative impacts of climate change on human health, the delayed climate action of European countries, and the missed opportunities to protect or improve health with health-responsive climate action. The methods behind indicators presented in the 2022 report have been improved, and nine new indicators have been added, covering leishmaniasis, ticks, food security, health-care emissions, production and consumption-based emissions, clean energy investment, and scientific, political, and media engagement with climate and health. Considering that negative climate-related health impacts and the responsibility for climate change are not equal at the regional and global levels, this report also endeavours to reflect on aspects of inequality and justice by highlighting at-risk groups within Europe and Europe's responsibility for the climate crisis.