Background: Higher levels of grip strength have been associated with greater bone health, but evidence is mostly in adolescence and early adulthood and often cross-sectional, so we aimed to evaluate the longitudinal relationship between grip strength and bone health in young children.
Methods: This study analysed data from the Southampton Women’s Survey, a population-based prospective birth cohort in the UK initiated in 1998. Handgrip strength (kg) was measured using a Jamar handgrip dynamometer and averaged over three attempts for each hand and a total body less head area-adjusted bone mineral content (aBMC) was assessed using dual-energy X-ray absorptiometry (DXA) at ages 4 (n = 990), 6 (n = 443), and 8 years (n = 972). Associations were examined using linear mixed-effects models for aBMC with an interaction term for grip strength (measured longitudinally) and age, and adjusted for sex, birthweight, and socio-economic status.
Results: Grip strength had a positive association with aBMC at baseline (4 years of age) such that those with 1kg higher grip strength had 2.6 g greater aBMC (CI (0.9, 4.3)). Additionally, higher grip strength was associated with a higher rate of growth of aBMC over time (interaction term 0.5 g, p-value < 0.001). That is, for every 1kg greater grip strength at any timepoint, the rate of growth of aBMC per year at that time was increased by 0.5 g/year. For example, those with grip strength at the 25th percentile had an increase of aBMC of 62.2 g/year, while those with grip strength at the 75th percentile had an increase of 65.5 g/year.
Conclusion: Grip strength was positively associated with baseline bone health and its growth throughout childhood across the follow-up period of this study, contributing to growing evidence supporting the potential benefits of muscle strength for bone health in childhood.

Background: Adolescence is a vital stage during which young people adopt various lifestyle behaviours that can impact their health. However, the broader determinants of these behaviours remain underexplored. This study investigated clustering patterns of lifestyle behaviours among adolescents, including physical activity, sedentary behaviour, and dietary habits, and examined their determinants at individual, community, and societal levels.
Methods: This study utilised nationally representative Global School-based Student Health Survey data from WHO. The lifestyle behaviours were categorised based on specific definitions, and the clustering patterns of multiple unhealthy behaviours were compared across various factors at personal, family, and country levels. Multilevel mixed effect logistic regression analysis was used to identify determinants of clustered unhealthy behaviours.
Results: The study included 293,770 adolescents from 73 countries and territories across five World Health Organization (WHO) regions. The overall prevalence of one, two, three, four, and five unhealthy behaviours was 6.9%, 29.9%, 36.5%, 21.5%, and 4.5%, respectively. The odds of multiple unhealthy behaviours (defined as ≥4) increase with age (AOR: 1.06, 95% CI: 1.05, 1.07) and are higher among female adolescents (AOR: 1.16, 95% CI: 1.14, 1.19). Adolescents from supportive families, peer environments, or food-secure households had lower odds [(AOR: 0.84, 95% CI: 0.82, 0.86); (AOR: 0.96, 95% CI: 0.94, 0.98); (AOR: 0.91, 95% CI: 0.87, 0.95)]. The odds of exhibiting multiple unhealthy behaviours were significantly higher among adolescents in countries with high (0.7–0.79) and very high (0.8–1.0) Human Development Indexes (HDI), compared to those in low (<0.55) HDI countries [(AOR: 1.84, 95% CI: 1.16, 2.94); (AOR: 3.00, 95% CI: 1.48, 6.08)].
Conclusion: The study findings reveal that multiple unhealthy lifestyle behaviours are globally prevalent among adolescents. These behaviours exhibit distinct clustering patterns associated with individual characteristics, family and peer environments, and broader socio-economic and societal contexts.
Keywords: lifestyle; dietary habit; physical activity; sedentary behaviour; adolescents

Background:
Oral health behaviours play a crucial role in one’s oral and overall health. There is evidence that area-level factors are closely associated with oral health behaviours. However, there is no definitive marker for identifying poor oral health behaviours and outcomes in adolescents. This study aimed to examine and compare the associations between area-level factors (remoteness and area deprivation) and oral health related behaviours in Australian adolescents.

Methods:
This study utilised data from the Longitudinal Study of Australian Children (LSAC). The sample consisted of 3,381 adolescents aged 12-13 years. The exposure measures were ‘area-level social disadvantage’ (measured by Socioeconomic Indexes for Areas (SEIFA)), and ‘remoteness’ from Wave 7 of the cohort. Outcome measures were participants-reported oral health behaviours such as visiting the dentist, toothbrushing, consumption of fruit juices, fast food and sugar-sweetened (SSBs). Associations between categories of each exposure and the oral health behaviours were tested by fitting multivariable logistic regression models generated using Stata 17.0.

Results:
Participants based in outer regional and remote regions had odds of 1.23 for failing to visit the dentists within a year, 1.07 for having a suboptimal tooth brushing frequency, 0.96 for consuming fruit juice, 0.91 for consuming fast food and 1.02 for consuming SSBs compared to those in the major cities. In the most deprived areas, adolescents had an odds ratio of 1.56 for failing to visit the dentists within a year, 1.43 for having a poor tooth brushing frequency, 1.30 for consuming fruit juice, 1.63 for consuming fast food and 1.59 for consuming SSBs compared to those in the least deprived regions.

Conclusion:
Remoteness is only associated with dental visit and fast-food consumption. Area deprivation is strongly associated with all the oral health behaviours included in this study. Therefore, public health policy makers ought to improve dental inequalities-based area level socio-economic status.

Objectives: The objective of this study was to investigate associations between self-reported maternal smoking and alcohol consumption and perinatal outcomes (low birthweight and preterm births) in Australia’s Northern Territory (NT). The NT is known to have a high prevalence of smoking and risky drinking behaviours. Monitoring these risks and their impact on births can help evaluate interventions aimed at improving birth outcomes.

Method: The study population included all NT resident mothers with a singleton livebirth from 1996–2022. Self-reported smoking and alcohol consumption status was collected during the first 20 weeks of pregnancy. Descriptive statistics were generated for demographic and obstetric factors to examine the distribution of the cohort according to smoking and alcohol consumption status. Logistic regression models were used to estimate the crude and adjusted odds ratios (OR) (with 95% confidence intervals (CI)) of the relationship of preterm and low birthweight births to maternal smoking and alcohol consumption.

Result: A total of 81 495 mothers and babies were included in the study. In the cohort, 73.0% of mothers self-reported not smoking or drinking alcohol, 19.9% reported smoking only, 4.6% reported both smoking and drinking and 2.5% reported drinking only during pregnancy. Compared to non-users, concurrent smoking and drinking alcohol in pregnancy had the highest risk of preterm birth (adjusted OR 1.32; 95% CI 1.18, 1.47) and low birthweight (adjusted OR 2.44; 95% CI 2.20, 2.71). Smoking significantly increased the risk of preterm (adjusted OR 1.28; 95% CI 1.20, 1.37) and low birthweight births (adjusted OR 1.92; 95% CI 1.79, 2.06).

Conclusion: Our findings reinforce existing advice that antenatal care should promote and support pregnant women to quit smoking and drinking. There is a clear need to strengthen prevention efforts among this cohort. The birth outcomes of NT mothers would improve with cessation of smoking and drinking alcohol during pregnancy.

Background: Ultra-processed foods (UPFs) are increasingly implicated in adverse health outcomes, including chronic respiratory diseases (CRDs). However, evidence linking UPF consumption to CRD mortality and the role of metabolic and inflammatory biomarkers (fasting glucose, hemoglobin [HbA1C], cholesterol, c-reactive protein [CRP]) and chemical exposures such as cadmium, lead, mercury and arsenic, neoformed contaminants and endocrine-disrupting chemicals [EDCs] as mediators is rarely examined.
Methods: Analysis of data from the National Health and Nutrition Examination Survey (NHANES) 2001–2018. Study participants were adults aged ≥20 years in the United States. Weighted Cox proportional hazard models were used. Generalized linear model was used to assess the relationship between UPF exposure and chemical exposures. Quantile g-computation was employed to evaluate the combined effects of multiple chemical exposures. Mediation analyses were conducted to quantify the contribution of body mass index, waist circumference (WC), fasting glucose, HbA1C, cholesterol, CRP, and blood concentrations of cadmium, lead, and mercury, to the UPF-mortality relationship.
Findings: A total of 40,276 participants (52% women) were included. Higher UPF consumption (% grams/day) was associated with increased CRD mortality risk (HR for quintile 5 vs. quintile 1: 1.63; 95% CI: 1.10– 2.41). Chemical contaminants such as lead, mercury, arsenic, acrylamide, glycideamide, 2,5-dimethylfuran, bisphenol A, and various phthalate metabolites were correlated with UPF intake and contributed to the observed mortality risks. Mediation analysis showed that CRP, HbA1C, and mercury explained a small proportion of the UPF-CRD mortality association, whereas BMI, WC, HbA1C, CRP, and mercury partially mediated the UPF-all-cause mortality association, with significant effect modification observed for BMI and HbA1C.
Conclusion: These findings suggest that UPF consumption is a significant risk factor for CRD mortality, potentially mediated in part by metabolic and inflammatory biomarkers, as well as chemical exposures. However, limited CRD events linked to specific chemicals prevented mediation analysis for neo-formed and
EDCs.

Background

Despite declining smoking rates and increasing cessation efforts, tobacco and nicotine use remains a leading cause of preventable death and disease. The World Health Organization Framework Convention on Tobacco Control (FCTC) has supported global tobacco control efforts, with some nations implementing strategies beyond the FCTC provisions to drive reductions. Retail licensing schemes are a key regulatory measure to help restrict and monitor product availability, regulate industry influence, and enhance enforcement. This study aims to assess tobacco and nicotine retail outlet characteristics in Queensland, Australia, to establish baseline data prior to the implementation of a licensing scheme.

Methods

Under Indigenous leadership and guidance, a survey was developed to assess product availability, visibility, pricing, signage and in-store accessibility. Retailers were identified through field exploration in selected regions stratified by socioeconomic status and remoteness. Trained fieldworkers systematically observed stores where tobacco, e-cigarettes, herbal and nicotine pouches were sold using a standardised methodology. Descriptive analysis was performed to characterise tobacco and nicotine retail practices and environments.

Results

Tobacco was available (100%) in all stores (100%, n=423) consisting of petrol stations (n=127, 30%), tobacconists (n=117, 27.7%), supermarkets (n=107, 25.3%), liquor stores (n=41, 9.7%) and other retailers (n=31, 7.3%). E-cigarettes and nicotine pouches were commonly found in tobacconists and areas of socioeconomic advantage. Liquor stores exhibited high accessibility (n=21/41, 51.2%), while tobacconists had the greatest product visibility (n=24/117, 20.5%). Quitline signage was prevalent (95%), but other cessation supports were rare (<1%). Retailers in remote locations exclusively sold tobacco products and had minimal product accessibility and visibility (<5%).

Conclusion

In a dynamic policy landscape, characterised by increased enforcement and industry-driven product expansion, this study is among the first to comprehensively document retail features in Australia. These findings show smoking products are highly accessible and marketed to some extent with a lack of other cessation supports in-store.

Background & aims: Dietary patterns and cadmium intake have been found to be associated with chronic kidney disease in China. However, the link between ultra-processed food (UPF), dietary arsenic intake and CKD has been understudied in China. This study examines the relationship between UPF intake, arsenic exposure, and CKD risk in Chinese adults.
Method: Data were analysed from 6760 adults in the China Health and Nutrition Survey who participated in at least three waves of survey in 1997, 2000, 2004, 2006, and 2009. Dietary intake was evaluated through a 3-day 24-hour dietary recall at each survey wave. UPF consumption was classified according to NOVA Group 4. Arsenic intake was estimated using food composition tables from published literature in China. Kidney function was assessed in 2009 using estimated glomerular filtration rate (eGFR) with CKD defined as eGFR <60 mL/min/1.73 m².
Results: There were 518 (7.7%) cases of CKD in the analytical sample. Cumulative mean UPF intake was inversely associated with arsenic intake. Compared with non-consumers of UPF, the adjusted odds ratios (OR) (95% CI) for CKD among those with mean UPF consumption of 1-19 g/day, 20-49 g/day, and ≥50 g/day were 0.83 (0.64-1.08), 0.65 (0.47-0.90) and 0.60 (0.40-0.89), respectively (p for trend 0.002). Higher arsenic intake was positively associated with CKD, with an OR 3.29 (95%CI 2.33-4.66) when comparing extreme quartiles. The association between UPF intake and CKD was partly mediated by arsenic intake.
Conclusion : Higher UPF intake was inversely associated with CKD risk, which may be partly explained by its inverse association with arsenic intake. In contrast, a high intake of arsenic was related to increased odds of CKD.

Background
Doctors have a legal and professional responsibility to provide patients with safe care. When unable to do so because of a mental or physical illness, disability, or substance use disorder, doctors may become impaired. We sought to determine which doctors are at increased risk of being reported to a medical regulator due to a health condition which may place the public at risk.
Methods
Administrative data provided by the Australian Health Practitioner Regulation Agency (AHPRA) were used to link registration data with health impairment reports from 2012 to 2022 on all doctors in Australia. We excluded 52,590 doctors in NSW as AHPRA has limited oversight over notifications made in NSW, and five doctors residing outside of Australia during the study period. We performed multivariate logistic regression analysis at the doctor-year level to identify factors (profession, age, sex, country of training) associated with health impairment reports. Generalised linear models with Poisson distribution and the log link function were used to estimate incident risk ratios for predictors of health impairment reports over time.
Results
Across the ten-year study period, 112,677 doctors were registered on average for 6.9 ± 3.5 years. 1,258 of 112,677 doctors (1.1%) received a health impairment report. Risks were higher for men than women (IRR 1.45, CI 1.26–1.66) and those ≥70-years than 30 to 39-years (IRR 2.94, CI 2.32–3.73). Compared with physicians, psychiatrists (IRR 2.27, CI 1.61–3.21) had twice the risk of health impairment reports; and anaesthetists (IRR 2.8, CI 1.66–4.82) were the specialty at greatest risk of substance use reports. A quarter of reports (23.5%) resulted in practice suspensions or restrictions.
Conclusions
Health impairment reports are rare but have serious consequences. Understanding risk factors may assist efforts to support doctors’ health and protect patients.

Background: Raising awareness about stroke symptoms, risk factors, and management may reduce its burden. This study examined the association between the Stroke Riskometer™ mobile phone application and stroke awareness between intervention group (IG) with the app and usual care group (UCG) without the app.
Methods: This was a phase III, prospective, double-blinded endpoint, 2-arm randomised controlled trial in Australia and New Zealand. Participants were aged 35-75 years with ≥2 stroke modifiable risk factors, but no history of stroke/myocardial infarction/cognitive impairment/terminal illness recruited via social media and primary health organisations from August 2021-November 2023. Stroke awareness was measured at baseline, 3- and 6-months post-randomisation using six validated questions summed to a total score from 0 (low awareness) to 19 (high awareness). Linear mixed-effects modelling assessed changes in stroke awareness between IG and UCG over time, using intention-to-treat (ITT) with multiple imputation to replace missing data. Interactions tested effect modification by sex, age, level of education, socioeconomic status, site of recruitment and ethnicity.
Results: Among 862 randomised participants (IG n=429; UCG n=433) with a mean age 58 (SD 11) years; 63% female; 62% tertiary educated; and 15% most disadvantaged area-level socioeconomic status. IG stroke awareness scores improved from baseline (n= 429, mean [SD] 13.43 [3.59]) to 3-months (n=395, mean 14.27 [3.35]) and 6-months (n= 416, mean 14.59 [3.27]) compared to UCG participants' scores at baseline (n= 433, mean 13.16 [3.61]) to 3-months (n= 412, mean 14.01 [3.38]) and 6-months (n= 425, mean 13.97 [3.49]). The time-IG interaction showed a significantly increased stroke awareness (β = 0.52, 95%CI: 0.04, 1.00) compared to UCG. The interaction analysis revealed a significantly higher intervention effect in non-European and non-Indigenous ethnic group, and the least disadvantaged area-level socioeconomic status.
Conclusions: The Stroke Riskometer™ mobile phone application significantly improved stroke awareness at 6-months post-randomisation compared to UCG.