Piet Bracke

Background: Colorectal cancer (CRC) screening has contributed to reducing CRC incidence and mortality in Europe. However, inequalities in screening persist, with lower participation among individuals with lower educational attainment. It remains unclear whether screening programmes can mitigate these inequalities. This study examined the impact of mailed faecal immunochemical test (FIT) programmes on screening participation and related educational inequalities. Methods: We analysed repeated cross-sectional data from 202 976 respondents aged 50–74 in 24 European countries from the European Health Interview Survey (2014 and 2019), a nationally administered population-based survey. Outcomes were self-reported stool-based screening uptake (lifetime and past 2 years). Educational attainment was categorized into three levels (lower, middle, higher) based on ISCED-2011. We used a difference-in-differences design to compare changes in screening uptake between 2014 and 2019 in countries that implemented nationwide FIT programmes and countries that did not. Results: In countries that implemented FIT programmes, lifetime and past-2-year screening uptake increased by 28.3 (95% CI: 12.3–44.3) and 30.2 (95% CI: 13.8–46.6) percentage points (ppts), respectively, compared with countries without programmes. The increase was larger among individuals with middle than higher education, with an additional 8.9 (95% CI: 3.3–14.5) ppts for lifetime and 6.4 (95% CI: 1.5–11.2) ppts for past-2-year uptake, indicating a reduction in inequality between these groups. No reduction in inequality was observed between individuals with lower and higher education. Conclusion: Mailed FIT programmes increased stool-based screening uptake and reduced inequalities between individuals with middle and higher education. To further promote equity in CRC screening, future initiatives should prioritize individuals with lower educational attainment.

To explore the relationships between pain medication use and quality of life in individuals with chronic non-cancer pain (CNCP), with a focus on three domains: pain severity, well-being and psychosocial functioning, and stigma experiences. A secondary analysis was conducted using cross-sectional data from an online Belgian survey. The sample consisted of 332 participants with CNCP (M_age = 54 years; 82% women; 18% men). Participants were categorized into four groups: individuals taking (1) no medication, (2) non-opioids, (3) mild/weak opioids, or (4) strong opioids. Pain grades were assigned using the Graded Chronic Pain Scale. Distribution of frequencies and Spearman's correlation were calculated for pain severity, while (multivariate) analysis of variance was used for all psychosocial outcomes. Participants classified in higher pain grades were more likely to use stronger opioids. Significant differences emerged between medication groups in well-being and functioning, as well as stigma experiences. Specifically, individuals in the strongest opioid group reported the highest levels of pain interference, social isolation, enacted and internalized stigma, alongside the lowest levels of physical functioning and social participation. After controlling for pain severity, only differences between medication groups in pain interference and physical functioning remained significant. In contrast, pain severity showed significant main effects across all outcomes: pain interference, physical functioning, social participation, social isolation, depressive symptoms, anxiety, and overall stigma. This study emphasizes the need for a multidisciplinary treatment approach, given that both pain severity and opioid use were associated with poorer quality of life among individuals with CNCP.

Unemployment transitions in later life are associated with mental distress, yet their translation into mental health care utilisation remains underexamined. Adopting a medicalisation perspective, this study investigates associations between unemployment transitions and medication use for depression or anxiety among older adults, and whether these associations vary by educational attainment. We analysed six biennial SHARE waves (4-9), including 20,158 observations from 14,225 respondents aged 50-67 years across 27 countries. Weekly medication use for depression or anxiety was examined using three-level random-effects logistic regression, with waves nested within individuals and individuals within countries. Models adjusted sequentially for health complaints, depressive complaints, and doctor visits, and tested interactions with education. Transitioning into unemployment was associated with higher medication use, even after accounting for measured mental health complaints. Persistent unemployment was also associated with higher use, whereas re-employment showed no significant reduction. Interaction analyses indicated that persistent unemployment was most strongly associated with medication use among longer-educated adults. Findings suggest that late-career unemployment is linked to socially patterned pharmacological responses beyond measured need. They therefore support a stratified medicalisation perspective and underline the importance of addressing both unemployment-related distress and the educationally patterned ways it becomes pharmacologically managed.

The COVID-19 pandemic required substantive preventive measures to stop the spread of the SARS-CoV-2 virus. As the effectiveness of these measures highly depended on public adherence, understanding the determinants of compliance with preventive measures is crucial. While some influencing factors have been identified already, the role of social connection is not fully understood. Interestingly, social connection might be reciprocally affected by compliance with preventive measures in a way that poses a trade-off between social connection and compliance. Therefore, the aim of the current study was to evaluate the bidirectional relationship between social connection and compliance with preventive measures. This was done using longitudinal data from six waves (April 2020–March 2021) of the Belgian online COVID-19 Health Surveys, of a cohort of 11 974 adults. Random-intercept cross-lagged panel modelling was used to test whether social connection positively predicted subsequent compliance, and whether compliance negatively predicted subsequent social connection. Social support and social satisfaction served as social connection indicators. Compliance was modelled per separate preventive measure. The results showed that social support and social satisfaction were positively associated with subsequent compliance with several measures. Some effects were particularly pronounced in the most stringent waves. In the other direction, compliance with social restriction negatively predicted subsequent social satisfaction. Through its relation with compliance, social connection can be relevant for tackling public health crises that require public response. Vice versa, our results stress social connection as an area of concern in such crises. Thus, sustainably fostering social connection could benefit future pandemic preparedness.

This study examines the long-term impact of the COVID-19 pandemic on loneliness among adults aged 65 and over across 27 European countries, focusing on gender differences and the role of government-imposed containment measures. Using longitudinal data from four waves of the Survey of Health, Ageing and Retirement in Europe (SHARE), pre-pandemic (Wave 8), two SHARE Corona surveys (2020–2021), and post-pandemic (Wave 9), the analyses include 49,351 observations from 15,497 individuals. Logistic growth curve models (wave–individual–country) were estimated to assess changes in loneliness across pandemic periods and to explore how gender and policy stringency shaped these patterns. The results show that loneliness increased significantly during the second COVID-19 phases and remained elevated in the post-pandemic period compared with pre-pandemic levels, indicating a sustained rise in emotional vulnerability among older adults, especially for women. Higher policy stringency was associated with greater loneliness, following a curvilinear pattern: Loneliness rose with increasing restriction levels but leveled off and declined at the highest stringency levels. Interaction analyses showed that women were more sensitive to increases in policy stringency. The findings underscore the persistent and gendered effects of the COVID-19 pandemic on loneliness among Europe’s older population. Public health and social policy interventions should adopt gender-sensitive and context-aware approaches to reduce loneliness and enhance resilience during and after large-scale crises.

Social-scientific scholarship on vaccination has often stressed the importance of trust. Vaccine hesitancy has commonly been viewed as determined by the degree of trust that parents have in expert knowledge, health care authorities, and health care professionals (HCPs). Focusing primarily on parents as trustors, the bilateral nature of trust and HCPs’ trust in parents have seldom been considered. This article systematically explores these commonly overlooked aspects of trust-building. Drawing on a team ethnography in seven European countries consisting of 466 hours of observations, 167 in-depth interviews with vaccine-hesitant parents, and 171 in-depth interviews with HCPs, this article explores the levels, expressions, and outcomes of trust in the vaccination context. We suggest that trustful relationships are influenced by interpersonal and generalized trust and expressed through both the affective and cognitive dimensions. We further explore interactions where HCPs’ (dis)trust may mitigate vaccine hesitancy. We conclude by providing policy implications for education, campaigns, and interventions.