Aditi Bunker

Background: Food systems strongly affect human and environmental health. Across Europe, they often generate negative public health and environmental outcomes and contribute to inequalities in access to healthy, sustainable food. Addressing these challenges requires understanding the complex dynamics of the interaction of individual behavior within food systems, which involves a combination of internal mechanisms and external influences. Objective: This study, part of the FEAST project (Food Systems That Support Transitions to Healthy and Sustainable Diets), aims to increase understanding of how micro-, meso-, and macro-level factors shape Europeans’ food preferences, purchasing, and consumption behaviors. It also explores differences across European regions and population subgroups. Methods: A cross-sectional survey was conducted among 27,000 adults in 27 European countries across the 5 FEAST food regions (Anglo-Saxon, Central European, Scandinavian, Southern European, and Eastern European). In addition to the vulnerable groups (older adults; low-income or low-education people and those with health or disability conditions; families with minors, women, gender-diverse people, etc) that could be captured in the main survey, an additional sample of 400 vulnerable individuals from the Down syndrome (DS) community (including carers of people with DS) was expected to be involved in 5 European countries (Ireland, Italy, Portugal, Romania, and Scotland). To achieve the target of 1000 participants per country, the general population was recruited through a market-insights platform with extensive European coverage. Individuals with DS and their caregivers were recruited through national DS associations. Data were collected using an 88-item questionnaire covering dietary patterns, food-purchasing behavior, drivers and barriers to healthy and sustainable eating, perceived dietary sustainability, opinions on food policy options, and sociodemographic characteristics. The same questionnaire was administered to caregivers, whereas individuals with DS completed an adapted version addressing eating habits, food appearance, and food neophobia in an accessible format. Statistical analyses are being conducted to identify determinants of healthy and sustainable diets. Results: A total of 27,417 questionnaires were collected from the general population across 27 countries, together with 82 questionnaires from people with DS and 242 from caregivers. Expected findings will describe Europeans’ food consumption habits, preferences, and purchasing behaviors, including those of vulnerable groups, and assess their alignment with planetary health diet principles. The study will also identify key barriers and facilitators to adopting healthier and more sustainable diets, as well as sources of nutritional information and attitudes toward food-related policies. Conclusions: The findings will support our understanding of individual dietary habits and the development of multilevel strategies to promote healthier and more sustainable diets in these population subgroups across Europe. They will also provide insights into interactions between consumers and the food system, highlighting barriers and facilitators that influence dietary choices.

Human-induced climate change significantly impacts human health, with children being particularly susceptible to its impacts. National Adaptation Plans serve as the main framework for countries to establish targets and strategies to tackle the health impacts of climate change. However, child health remains largely neglected in national adaptation planning globally. This study seeks to identify facilitators for the inclusion of child health in adaptation policies through in-depth interviews with researchers and policymakers. We interviewed 18 stakeholders (across 11 countries in 5 continents), representing different geographic locations and income levels, involved in writing National Adaptation Plans. We analyzed verbatim transcripts thematically. In instances where child health components were incorporated, or respondents felt that headway on child inclusion was imminent, three themes most pointedly emerged related to child health inclusion in climate change policies, namely an ability to: Attract Allies (across government sectors and geographic boundaries), Beware Biases (to overcome hesitation about legitimate child needs), and Collaborate with Children. As countries are set to increase their level of ambition and need to both update and create National Adaptation Plans, we hope the ABC framework can guide efforts on how to best incorporate children’s health needs into responsive climate change adaptation policies.

The West Nile virus vector Culex pipiens and invasive species Aedes albopictus are abundant in Attica, Greece, which deploys an integrated vector management program for targeted vector control. The objective of our study is to evaluate the effects of this program on mosquito vector populations. Using mosquito surveillance and intervention occurrence data, we assessed the effects of mosquito control interventions on vector populations using a two-stage interrupted time series (ITS) approach. First, we fitted ITS models to 16 weeks of data centered on the week of each unique species-specific intervention. Second, we pooled the estimated coefficients in a meta-regression model. Following vector control interventions at the targeted intervention sites, we observed an overall 34% reduction (RR 0.66; 95% CI 0.50-0.89) in Culex pipiens counts and a nonsignificant 5% increase (RR 1.05; 95% CI 0.81-1.35) in Aedes albopictus counts, compared to the pre-intervention period. These results support the implementation in reducing Culex pipiens populations in Attica as part of an integrated public health plan to mitigate West Nile virus risk. However, the limited impact on Ae. albopictus suggests the need for complementary strategies beyond conventional biocides. Overall, this study could serve a model for evaluating IVM programs in diverse settings.

BACKGROUND Chronic obstructive pulmonary disease (COPD) and mental health conditions represent intersecting public health challenges, especially in resource-limited rural China. Existing care models often neglect the psychosocial needs of populations at high risk for COPD, resulting in limited effectiveness of prevention and management strategies. This study evaluates an integrated intervention designed to improve both mental and physical health outcomes among high-COPD-risk individuals with mental health symptoms, using a population medicine framework. OBJECTIVE This study aims to evaluate the effect of an integrated, population medicine–based multimorbidity intervention package among high-COPD-risk individuals with mental health symptoms in Xishui County, Guizhou Province, China. METHODS We are conducting a 12-month, 2-arm cluster randomized controlled trial across 26 townships in Xishui County, Guizhou, China. A total of 44,000 residents aged ≥35 years were screened using the Chronic Obstructive Pulmonary Disease Screening Questionnaire, identifying 10,000 individuals at high risk of COPD. Among them, 3807 individuals with Warwick-Edinburgh Mental Well-Being Scale scores below 45 were enrolled as participants. Intervention components include digital cognitive behavioral therapy–based mental health support, community screening, chronic disease management, patient education, digital follow-up, and team-based care. The primary outcomes are depressive symptoms (9-item Patient Health Questionnaire), anxiety symptoms (7-item General Anxiety Disorder), and mental well-being (Warwick-Edinburgh Mental Well-Being Scale). Secondary outcomes are control of chronic diseases, physiological and functional indicators such as lung function, health-related quality of life, mental and behavioral health, health care utilization, knowledge of COPD and asthma, productivity loss, and care cascade indicators for chronic conditions. RESULTS Data collection for the POPMIX-MH trial began in June 2024. Baseline, 3-month, and 6-month assessments have been completed, and the 12-month follow-up assessments are planned to be completed in March 2026. CONCLUSIONS This study is the first to integrate psychological support, chronic disease management, and community-based screening into a single scalable intervention package targeting multimorbidity in China. It tests the feasibility of applying population medicine principles, emphasizing integrated, preventive, and population-level care, within primary care systems in low-resource settings. By targeting both mental and physical health, it redefines chronic care beyond traditional organ-specific approaches. CLINICALTRIAL ClinicalTrials.gov NCT06458218; https://clinicaltrials.gov/ct2/show/NCT06458218 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/85853

BACKGROUND Tobacco-related noncommunicable diseases (NCDs) present a major public health challenge in China, requiring population-level management. Chronic obstructive pulmonary disease (COPD) is the most common and prevalent chronic respiratory disease associated with tobacco use. In addition, COPD shares risk factors with other NCDs that frequently co-occur, leading to multimorbidity. This study focuses on the early detection and integrated management of COPD and related multimorbidity among high-risk populations. Population medicine, an emerging and evolving concept aimed at maximizing population health and well-being, provides a promising framework for shifting interventions against COPD from an individual patient focus to a population-level approach. OBJECTIVE This study aims to evaluate the effectiveness of a population medicine–based multimorbidity intervention package among individuals at high risk for COPD. METHODS We are conducting a 2-arm, population-based, stratified cluster randomized controlled trial (cRCT). The intervention integrates community screening, chronic disease management, patient education, digital follow-up, and team-based care. The trial is being implemented in Xishui County, Guizhou Province, a low-resource county in Southwestern China. Each of the 26 townships in Xishui County was considered a cluster and stratified into large and small townships based on population size. An equal number of residents from each township stratum (large and small) were randomized to undergo the COPD Screening Questionnaire. Individuals identified as being at high risk for COPD were considered study participants and were subsequently enrolled in either the intervention or control arm. The target sample size was approximately 2850 individuals. RESULTS Data collection for the POPMIX-COPD trial began in June 2024. Baseline, 3-month, and 6-month assessments have been completed, and 12-month follow-up assessments are planned to be completed in March 2026. All participants in the intervention arm are being followed for 1 year, with 1 telephone follow-up at month 3 and in-person follow-ups at months 6 and 12. Primary outcomes for each participant include the number of chronic conditions controlled, receipt of lung function testing, and forced expiratory volume in 1 second. In addition, secondary outcomes were health-related quality of life, mental and behavioral health status, health care utilization, knowledge of COPD and asthma, and care cascade indicators for chronic conditions. CONCLUSIONS This cRCT is the first multimorbidity intervention study designed within the population medicine framework to target populations at high risk for COPD. It was featured as a case study in the report of the Lancet Commission on Investing in Health. The results of the trial are expected to inform the next generation of multimorbidity management and population medicine practices among global health authorities and practitioners. CLINICALTRIAL ClinicalTrials.gov NCT06456996; https://clinicaltrials.gov/ct2/show/NCT06456996 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/85597

Background: Structural passive cooling interventions such as cool roofs are used to reduce indoor ambient temperature. However, it is unknown how acceptable and desirable cool roof technology is in rural low-income settings in sub-Saharan Africa, where home occupants are exposed to rising indoor temperatures. Methods: We engaged 48 participants in four focus group discussions to explore the factors influencing the acceptability of “cool roofs” in Nouna, Burkina Faso. We analysed the data using reflexive thematic analysis. We structured our findings using the acceptability framework developed by Sekhon, Cartwright and Francis (2017), which comprises seven components: affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, and self-efficacy. Results: Our participants described an environment of extreme heat and the need for adaptation strategies to reduce the temperature within their homes. The cool roofs would be deemed acceptable if they were affordable, effective in reducing heat, and aligned with values around self-efficacy, particularly in relation to local production and ownership. Conclusion: Providing communities with technical information regarding how the cool roof functions and can be maintained may support uptake via acceptability. Desirability of the roof may be achieved via a combination of highlighting the indoor cooling of the roof as reported by users, sharing of results with the community so that they have an insight into the effects of the roof, and feedback regarding the products useability and durability.

Rising temperatures in Africa present an increasing threat to agricultural productivity and public health, particularly among subsistence farming communities reliant on rain-fed agriculture. Heat exposure can impair farmers' work capacity, disrupt harvests, and heighten health risks, especially for young children vulnerable to undernutrition. The Heat to Harvest (H2H) study investigates how environmental heat exposure influences farmers' physiological and behavioral responses, and how these in turn affect harvest yields and child nutrition. It also examines differences in labor performance and recovery between households with and without cool roof coatings, although this intervention is not the central focus. H2H is designed as a prospective cohort study nested within two Health and Demographic Surveillance Systems (HDSS) in Nouna, Burkina Faso, and Siaya, Kenya. The study integrates environmental monitoring (temperature and humidity sensors used to compute Wet Bulb Globe Temperature), biometric data (via wearables tracking heart rate, temperature, physical activity, energy expenditure, and sleep), and GPS tracking (capturing spatial mobility and labor duration). The study is embedded within a larger cluster-randomized controlled trial, facilitating comparative analysis under varying thermal conditions. Findings will provide evidence-based insights into how climate-related heat stress affects health and agricultural outcomes, supporting the development of targeted adaptation strategies to enhance resilience, health, and food security in vulnerable farming communities.

Constructed with used plastic bottles, the eco-cooler has been widely adopted in resource-poor communities in Bangladesh and other countries. We tested the eco-cooler under controlled conditions using a scientific wind tunnel in a climatic chamber. In our tests, we used seven eco-cooler designs in 27 climate conditions typical of Bangladesh (temperatures of 40 °C, 35 °C, and 30 °C; humidity levels of 70%, 60%, and 40%; and wind speeds of 4.0 m s⁻¹, 2.0 m s⁻¹, and 0.2 m s⁻¹) in 92 experiments (N = 7686 measurements in 87 short experiments and N = 23,428 measurements in five long experiments). We found no significant temperature reductions with eco-cooler use, except at low wind speeds, where temperature reduced by up to 0.2 °C. In theoretical calculations extending our empirical findings, the greatest temperature drop was 0.85 °C at 4.0 m s⁻¹ with a 40 °C static air inflow temperature. However, this temperature drop did not extend beyond the nozzles of the bottles in the eco-cooler. The eco-cooler did not work effectively as an indoor air cooler.

Objectives This study aims to assess both socioeconomic and climatic factors of cholera morbidity in Mozambique considering both spatial and temporal dimensions. Design An ecological longitudinal retrospective study using monthly provincial cholera cases from Mozambican Ministry of Health between 2000 and 2018. The cholera cases were linked to socioeconomic data from Mozambique Demographic and Health Surveys conducted in the period 2000–2018 and climatic data; relative humidity (RH), mean temperature, precipitation and Normalised Difference Vegetation Index (NDVI). A negative binomial regression model in a Bayesian framework was used to model cholera incidence while adjusting for the spatiotemporal covariance, lagged effect of environmental factors and the socioeconomic indicators. Setting Eleven provinces in Mozambique. Results Over the 19-year period, a total of 153 941 cholera cases were notified to the surveillance system in Mozambique. Risk of cholera increased with higher monthly mean temperatures above 24°C in comparison to the reference mean temperature of 23°C. At mean temperature of 19°C, cholera risk was higher at a lag of 5–6 months. At a shorter lag of 1 month, precipitation of 223.3 mm resulted in an 57% increase in cholera risk (relative risk, RR 1.57 (95% CI 1.06 to 2.31)). Cholera risk was greatest at 3 lag months with monthly NDVI of 0.137 (RR 1.220 (95% CI 1.042 to 1.430)), compared with the reference value of 0.2. At an RH of 54%, cholera RR was increased by 62% (RR 1.620 (95% CI 1.124 to 2.342)) at a lag of 4 months. We found that ownership of radio RR 0.29, (95% CI 0.109 to 0.776) and mobile phones RR 0.262 (95% CI 0.097 to 0.711) were significantly associated with low cholera risk. Conclusion The derived lagged patterns can provide appropriate lead times in a climate-driven cholera early warning system that could contribute to the prevention and management of outbreaks.