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Municipal recreation infrastructure is critical for enhancing people’s opportunities to be physically active during leisure time and reducing usage inequities. Yet, the literature on municipal equity-sensitive strategies is limited. To address this gap, we combined a socio-ecological framework with equity, diversity, and inclusion (EDI) and health equity lenses to examine intersecting social and structural determinants of municipal recreation (indoor and outdoor) infrastructure usage. We used data from 22 focus groups involving youth, adult regular users, and adult non-regular users. The intersecting factors influencing people’s utilization experiences were organized at intrapersonal, socio-cultural environment, organization, and built and natural environment levels. Policy and practice implications for municipal governments vis-à-vis EDI and health equity considerations are discussed. Recommendations include public transportation improvement, design of strategic communication plans, and linking activities with opportunities for socialization, among others. [ABSTRACT FROM AUTHOR]

Background: Social capital can be used as a conceptual framework to include social context as a predictor of human papillomavirus (HPV) vaccination and cervical cancer screening behaviours. However, the effectiveness of interventions that use social capital as a mechanism to improve uptake of immunization and screening remains elusive. Objective: To synthesize empirical evidence on the impact of social capital interventions on HPV immunization and cervical cancer screening and describe key characteristics of such interventions. Methods: Using a rapid review methodology, a search of literature published between 2012 and 2022 was conducted in four databases. Two researchers assessed the studies according to inclusion criteria in a three-step screening process. Studies were assessed for quality and data concerning social capital and equity components and intervention impact were extracted and analyzed using narrative synthesis. Results: Seven studies met the inclusion criteria. Studies found improved knowledge, beliefs and intentions regarding HPV immunization and cervical cancer screening. None of the studies improved uptake of immunization; however, three studies found postintervention improvements in uptake of cervical cancer screening. All studies either tailored their interventions to meet the needs of specific groups or described results for specific disadvantaged groups. Conclusion: Limited evidence suggests that interventions that consider and reflect local context through social capital may be more likely to increase the uptake of HPV immunization and cervical cancer screening. However, further research must be done to bridge the gap in translating improvements in knowledge and intention into HPV immunization and cervical cancer screening behaviours. [ABSTRACT FROM AUTHOR]

Abstract Background Population groups living in deprived areas are more exposed to several risk factors for diseases and injuries and die prematurely when compared with their better-off counterparts. The strength and patterning of the relationships between socioeconomic status and mortality differ depending on age, gender, and diseases or injuries. The objective of this study was to identify the magnitude of social differences in mortality among adult residents in a city of one million people in Southeastern Brazil in 2004-2008. Methods Forty-nine health care unit areas were classified into three homogeneous strata using 2000 Census small-area socioeconomic indicators. Mortality rates by age group, sex, and cause of death were calculated for each socioeconomic stratum. Mortality rate ratios (RR) and 95% confidence intervals were estimated for the low and middle socioeconomic strata compared with the high stratum. Results In general, age-specific mortality rates showed a social gradient of increasing risks of death with decreasing socioeconomic status. The highest mortality rate ratios between low and high strata were observed in the 30-39 age group for males (RR = 1.74, 95% CI 1.59-1.89), and females (RR = 1.90, 95% CI 1.65-2.15). Concerning specific diseases and injuries, the greatest inequalities between low and high strata were found for homicides (RR = 2.44, 95% CI 2.27-2.61) and traffic accidents (RR = 1.64, 95% CI 1.45-1.83) among males. For women, the highest inequalities between the low and high strata were for chronic respiratory diseases (RR = 2.19, 95% CI 1.94-2.45) and acute myocardial infarction (RR = 1.93, 95% CI 1.79-2.07). Only breast cancer showed a reversed social gradient (RR = 0.70, 95% CI 0.48-0.92). Inequalities in circulatory and respiratory diseases mortality were greater among females than among males. Conclusions Substandard living conditions are related to unhealthy behaviors, as well as difficulties in accessing health care. Therefore, the Brazilian Health System (SUS) must ensure greater access to primary and hospital care, and develop programs that promote healthier lifestyles among vulnerable groups to reduce social inequalities in mortality. Moreover, because deaths from external causes are concentrated in poor areas, cooperative and coordinated intersectoral actions should be taken to combat the deadly violence cycle.

Abstract Background Around the world the life expectancy at birth has risen steadily over time. However, this increase in life years is not equally distributed among different social segments of the population. Studies have demonstrated that social groups living in deprived areas have a shorter life expectancy at birth in comparison to affluent ones. The aim of this study was to evaluate inequalities in life expectancy by socioeconomic strata in a city with one million inhabitants in Southeastern Brazil, in 2000 and 2005. Methods Through an ecological approach, the 49 areas of health care units of the city were classified into three socioeconomic strata, defined according to variables of income and educational level of the heads of household obtained from the 2000 Census. Life tables were constructed by sex for each of the three socioeconomic strata in 2000 and 2005. Results The life expectancy at birth for men and women living in poor areas was 6.9 and 5.5 years lower in comparison to the affluent ones in 2000. Between 2000 and 2005, these social inequalities in life expectancy at birth reduced, since the groups with lower socioeconomic level had gained more life years. The increase in life expectancy at birth experienced by areas with worse living conditions was 3 times higher than the increment estimated for prosperous areas for both sexes. Males had the greatest gain in life years, leading to a narrowing of gender differentials in life expectancy between 2000 and 2005. Conclusions The reduction of social inequalities in life expectancy suggests that living and health conditions have improved over time, due to social and health policies. The expansion of both health care coverage and cash transfer policies could have had positive effects on mortality reduction and on the consequent increase in the life expectancy, especially for the poor population.

Human health and planetary health are influenced by city lifestyles, city leadership, and city development. For both, worrying trends are leading to increasing concern and it is imperative that human health and environmental impacts become core foci in urban policy. Changing trajectory will require concerted action; the journal Cities & Health is dedicated to supporting the flow of knowledge, in all directions, to help make this happen. We wish to foster communication between researchers, practitioners, policy-makers, communities, and decision-makers in cities. This is the purpose of the City Know-how section of the journal. 'Research for city practice' disseminates lessons from research by explaining key messages for city leaders, communities, and the professions involved in city policy and practice. 'City shorts' provide glimpses of what is being attempted or achieved 'on the ground' and 'case studies' are where you will find evaluations of interventions. Last, 'Commentary and debate' extends conversations we are having to develop and mobilize much needed new thinking. Join in these conversations. In order to strengthen the community of interest, we would like to include many and varied voices, including those from younger practitioners and researchers who are supporting health and health equity in everyday urban lives. [ABSTRACT FROM AUTHOR]

Free play, play controlled by the player(s), is an essential and positive determinant of children's social, physical, and emotional health. Ensuring opportunities for dynamic free play in rich physical and social environments is foundational to a child-friendly community. This paper discusses methodological lessons from a participatory mixed methods research partnership (multisite case study) that evaluated the impact of a municipal investment in an indoor play-based preschool recreation program and space on promoting free play. We reflect on the approach used to understand the differences between an innovative space, purposefully designed to promote free play, and conventional preschool recreation spaces with respect to child-friendly design. This study explored the multifaceted nature of children's play from the perspectives of parents, preschool instructors, and children relative to children's interaction with the physical and social attributes of three preschool environments. The use of a participatory mixed methods approach permitted a nuanced study of the conditions that support free play in municipal preschool recreation programs, which also can be used to study other community spaces. Rigorous methodology allowed for the careful investigation of purported child-friendly places to reveal findings that can provide policy-makers and community stakeholders with viable documentation for future investments in children's play. [ABSTRACT FROM AUTHOR]

Population ageing combined with physical inactivity has critical implications for the public health of communities in the twenty-first century. In the last decade, the World Health Organization launched the age-friendly cities agenda, aiming to address population ageing through whole-systems, rights-based, health equity-focused approaches. An important intervention for age-friendly communities is modifying built environments to support population-level physical activity. Physical activity can help mitigate impacts of chronic diseases and social isolation on older adults. Need for advocacy and action in this area raises questions of how to develop supportive environments for physical activity across age-friendly community types. In Canada, a substantial proportion of older adults live outside large urban municipalities, for which scant research exists on fostering age-friendly built environments. To this end, we conducted qualitative research involving semi-structured interviews with 21 municipal policy influencers in Alberta, Canada to gather perspectives on development and early implementation of an age-friendly policy framework in the small urban and rural context. Our findings are organised by three main themes providing key lessons for advocacy and action, namely pursuing comprehensive planning , promoting public engagement and prioritising the needs of older adults. This research informs advocacy and action priorities in promoting built environment modification for routine physical activity as part of an age-friendliness agenda for small urban and rural regions of Canada and other countries. [ABSTRACT FROM AUTHOR]

Background This study examined gender differences in healthy life expectancy (HLE) and unhealthy life expectancy (UHLE) among people aged 60 years or older living in a large Brazilian city. Methods Based on Chiang method, abridged life tables were constructed for men and for women. To calculate HLE, the Sullivan method was applied. Estimates of the prevalence of self-rated health and self-reported functional disability (global, mild/moderate, and severe) were obtained from a population-based household survey carried out in 2008, which involved noninstitutionalized individuals. Results Findings showed that women live longer and these extra years would be spent in good selfrated of health. For example, women aged 60 would live, on average, 4 more years in good health in comparison to men. In terms of global limitations and mild/moderate limitations, no gender differences were detected for HLE. However, UHLE was statistically higher among women than among men at all ages in the global limitations and mild/moderate limitations (except for the age 80). Women at age 60, for instance, could expect to live 3.1 years longer with mild/moderate limitations compared to the men. Gender differences were identified for severe limitations for either HLE or UHLE. In comparison to men, women at age 60, for example, would expect to live 2.5 and 2.0 more years without and with severe limitations. Conclusions By showing that the advantage of longer life expectancy among women is not necessarily accompanied by worse health conditions, these findings add some evidence to the debate about male-female health-survival paradox. Policy efforts are necessary to reduce gender differences in the quantity and quality of years to be lived, providing equal opportunities to women and men live longer with quality of life, autonomy, and independence. [ABSTRACT FROM AUTHOR]

Cytomegalovirus (CMV) infects 40–70% of women, but infection has been reported in >95% of breast cancer patients. We investigated the consequences of these observations by infecting mice with mCMV or a negative control medium for 4 days, 11 days or 10 weeks to establish active, intermediate or latent infections, respectively. Syngeneic 4T1 or E0771 breast cancer cells were then injected into a mammary fat pad of BALB/c or C57BL/6 mice, respectively. Infection did not affect tumor growth in these conditions, but latently infected BALB/c mice developed more lung metastases. The latent mCMV infection of MMTV-PyVT mice, which develop spontaneous breast tumors, also did not affect the number or sizes of breast tumors. However, there were more tumors that were multilobed with greater blood content, which had enhanced vasculature and decreased collagen content. Most significantly, mCMV infection also increased the number and size of lung metastases, which showed a higher cell proliferation. Viral DNA was detected in breast tumors and lung nodules although viral mRNA was not. These novel results have important clinical implications since an increased metastasis is prognostic of decreased survival. This work provides evidence that treating or preventing HCMV infections may increase the life expectancy of breast cancer patients by decreasing metastasis. [ABSTRACT FROM AUTHOR]

Objective: To identify effective policies and non-policy interventions preventing youth vaping behaviour initiation and assess their effectiveness by the level of intrusiveness and subpopulations., Design: This systematic rapid review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines., Data Sources: Searches on MEDLINE and APA-PsycINFO for studies published between January 2019 and November 2023., Eligibility Criteria: Observational, intervention or mixed-method studies and quantitative systematic reviews/meta-analyses measuring the impact of interventions on youth (6-18 years) who never vaped or who had experimentally vaped., Data Extraction and Synthesis: A predesigned form was used to extract data. To classify interventions by levels of intrusiveness, we used the PLACE Research Lab Intervention Ladder Policy Analysis Framework . We applied PROGRESS-Plus (Place of residence, Race/ethnicity/culture/language, Occupation,Gender/sex, Religion, Education, Socioeconomic status, Social capital, and additional context-specific factors) for an equity analysis. Methodological quality was assessed using the Effective Public Health Practice Project Quality Assessment Tool., Results: 20 studies were included: 45% were experiments or quasiexperiments, 85% reported data from the USA, 65% were non-policy interventions and 40% and 35% measured susceptibility and attitudes and behaviours related to vaping, respectively. Considering the level of intrusiveness, 45% of the studies provided information and 25% eliminated choices. Overall, the certainty of evidence was low. The effectiveness of interventions regarding their level of intrusiveness varied by each outcome. No clear pattern was found between the level of intrusiveness and intervention effectiveness, suggesting that overall, the studied interventions positively changed youth vaping behaviours. Some interventions had positive effects on multiple outcomes. Equity-related findings suggested that younger youth may be less responsive to the interventions. Recommendations for action are provided., Conclusions: We suggest that combining multiple interventions targeting different levels of intrusiveness and outcomes may be more effective in preventing youth vaping behaviours. Also important is to tailor programmes to younger youth to better meet their needs., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: Social capital can be used as a conceptual framework to include social context as a predictor of human papillomavirus (HPV) vaccination and cervical cancer screening behaviours. However, the effectiveness of interventions that use social capital as a mechanism to improve uptake of immunization and screening remains elusive., Objective: To synthesize empirical evidence on the impact of social capital interventions on HPV immunization and cervical cancer screening and describe key characteristics of such interventions., Methods: Using a rapid review methodology, a search of literature published between 2012 and 2022 was conducted in four databases. Two researchers assessed the studies according to inclusion criteria in a three-step screening process. Studies were assessed for quality and data concerning social capital and equity components and intervention impact were extracted and analyzed using narrative synthesis., Results: Seven studies met the inclusion criteria. Studies found improved knowledge, beliefs and intentions regarding HPV immunization and cervical cancer screening. None of the studies improved uptake of immunization; however, three studies found post-intervention improvements in uptake of cervical cancer screening. All studies either tailored their interventions to meet the needs of specific groups or described results for specific disadvantaged groups., Conclusion: Limited evidence suggests that interventions that consider and reflect local context through social capital may be more likely to increase the uptake of HPV immunization and cervical cancer screening. However, further research must be done to bridge the gap in translating improvements in knowledge and intention into HPV immunization and cervical cancer screening behaviours., Competing Interests: Competing interests None.

In order to describe trends in traffic accidents, mortality, vehicle types, fleet sizes, and victims' characteristics in Campinas, São Paulo State, Brazil, from 1995 to 2008, this study analyzed vehicle rates, traffic accident rates per inhabitant and per vehicle, case-fatality rates, proportional mortality, mortality rates, and rates ratios. The motorcycle fleet increased 241%. Although the case-fatality rate of motorcycle users from 2000 to 2008 decreased, in 2008 they accounted for 49.3% of fatal accidents on public byways in Campinas. Motorcycles were responsible for the highest run-over rate (66.7 pedestrians/1,000 accidents) and highest pedestrian fatality rate (4 deaths/1,000 accidents). Men showed much higher mortality rates than women. Pedestrian victims were mainly elderly; most vehicle occupants in traffic accidents were in the 15 to 29-year age bracket. From 2006 to 2008, nearly 80% of vehicle users 15 to 39 years of age were motorcyclists. Motorcycle accident prevention should be a priority, using multi-institutional measures.

This study investigated the impact of variation in mortality by age group and cause of death on gains in life expectancy at birth in the city of Campinas, São Paulo State, Brazil, in 1991, 2000, and 2005. Life tables were constructed. Pollard's method was used to estimate the contributions by age group and cause of death on gains in life expectancy. In 1991-2000, the age group that most contributed was 0-1 year (31.1% for males and 22.9% for females). In 2000-2005, 79% of the gain for males was the result of mortality improvements in the 15-44-year bracket. Cardiovascular diseases made the largest contribution in 1991-2000 (66.1% for males and 43.5% for females). A loss in longevity was seen in men (1.1 year) resulting from increased mortality from external causes. In 2000-2005, the substantial gain (2.3 year) in male life expectancy was due to a reduction in mortality from external causes. Neoplasms had a negative effect on the gain (0.11 year for males and 0.15 for females). These findings should help support public health policies to reduce mortality risks and increase life expectancy.

The aim of the study was to assess the prevalence of self-reported diabetes in the elderly, identifying associated factors, knowledge, and practices related to treatment options. This was a cross-sectional population-based study with stratified clustered two-stage sampling in six municipalities in the State of São Paulo, Brazil. Among the 1,949 elderly, 15.4% presented self-reported diabetes. Body mass index and exercising were statistically associated with diabetes. There was a significant difference between diabetics and non-diabetics in terms of self-rated health, hospitalization, self-reported illness in the previous two weeks, and report of the following diseases: hypertension, anemia, chronic kidney disease, and heart disease. In terms of per capita family income, there was no difference in regular medical visits, participation in discussion groups, and control practices. The findings show the need for behavior changes to prevent and control diabetes and its complications. Educational interventions are needed to expand the coverage of diabetes care.