Vaccination programs are cost-effective for preventing communicable diseases, yet vaccine events caused vaccine crises among parents nationwide, which has created challenges for current and future vaccination programs. This study aimed to investigate parents’ emotional reactions (i.e., anger and anxiety) toward the 2018 vaccine event in China and explore the associations between parental emotional reactions and vaccine decision-making. A cross-sectional survey was conducted among 1,135 parents in 2018. Five-point Likert scales were provided for respondents to rank their anger and anxiety toward the event, and their vaccine-related trust and intentions before and after the event. Multiple logistic regression analyses were employed to explore the associations. Regarding the vaccine event, 576 (50.8%) and 402 (35.4%) respondents felt very angry and angry, and 310 (27.4%) and 516 (45.5%) respondents felt very anxious and anxious, respectively. Altogether, 797 (70.3%) respondents reported a lower trust in domestically produced vaccines after the event, and 704 (62.3%) respondents reported declines in intention to choose domestically produced vaccines for their children. Multiple logistic regression analyses revealed that anxiety was a predictor of lower trust and intention after the event (p < .001), anger was a predictor of lower trust (p = .005), and both were risk factors for declines in trust and intention (p < .01). This study confirmed that negative emotional reactions toward a vaccine event were important contributors for parental vaccine decisions. Health authorities and facilities are encouraged to act in a timely manner to reduce the public’s negative emotions by providing rapid crisis responses.

Background: Inappropriate antibiotic use behaviours have been widely reported across the world, exacerbating the development of antimicrobial resistance (AMR). In this study, we aimed to systematically identify and collate studies exploring factors influencing healthcare consumers’ antibiotic misuse globally, in order to inform future interventions to improve antibiotic use practices. Methods: We systematically searched PubMed, EMBASE, PsycINFO, Cochrane, and reference lists for potentially relevant studies published before June 2020. Original and empirical studies that identified factors for healthcare consumers’ antibiotic misuse were eligible for inclusion. The Social Ecological Framework and Health Belief Model were employed for data extraction and synthesis. We did random-effects meta-analyses to pool the odds ratios of risk factors for antibiotic misuse. Findings: We included 68 articles for systematic review and analysis: 51 quantitative, nine qualitative, and eight mixed-methods studies. Prevalent antibiotic misuses were reported globally, especially in low-to-middle income countries. Knowledge had mixed effects on antibiotic use behaviours. Barriers to healthcare – wait time, transportation, stigmatization – influenced people’s antibiotic use practices. Meta-analyses identified pro-attitudes towards self-medication with antibiotics (SMA), relatives having medical backgrounds, older age, living in rural areas, and storing antibiotics at home to be risk factors for SMA; relatives having a medical background and prior experience of antibiotic use were risk factors for storing antibiotics at home. Interpretation: Antibiotic misuse in the community is alarmingly prevalent, and is identified to be affected by non-biomedical factors. Future AMR strategies should incorporate a multifaceted community-based design that addresses drivers of antibiotic misuse tailored to local contexts. Funding Statement: This work was supported by the UK Foreign, Commonwealth and Development Office and Wellcome [215373/A/19/Z]. Declaration of Interests: The authors declare that there is no conflict of interest

Objectives: To examine the relationship between uncertainty stress and oral health-related quality of life (OHRQoL) among junior high school students in Zhejiang Province, China, and to identify the sociodemographic factors that may influence this association. Design: Cross-sectional survey using multistage cluster sampling. Setting: Junior high schools in two cities (Ningbo and Jinhua) in Zhejiang Province, China, between April and July 2024. Participants: 1348 eighth-grade students aged 13–16 years were included. Inclusion criteria: voluntary participation with guardian consent, absence of mental illness or physical disabilities and adequate literacy to complete questionnaires. Exclusion criteria: intellectual disability or incomplete responses. Outcome measures: OHRQoL was dichotomised based on the Child Perceptions Questionnaire for 11- to 14-year-olds (CPQ11-14) median score (≤20=good OHRQoL and >20=poor OHRQoL). Uncertainty stress was measured via a validated 5-point Likert scale (≤12=low and ≥13=high). Results: High uncertainty stress was significantly associated with poor OHRQoL (χ²=41.34, p<0.001). Multivariable logistic regression adjusting for gender and maternal education showed students with high uncertainty stress had 4.7-fold increased odds of poor OHRQoL (adjusted OR (aOR)=4.72, 95% CI: 2.81 to 7.93, p<0.001). Female gender was independently associated with poor OHRQoL (aOR=1.30, 95% CI: 1.05 to 1.62, p<0.05). Higher maternal education had a protective association with a maternal bachelor’s degree associated with 57% reduced odds of poor OHRQoL (aOR=0.43, 95% CI: 0.25 to 0.75, p<0.01). Conclusions: Junior high school students experiencing high uncertainty stress have a significantly increased risk of poor OHRQoL. Female students and those with less educated mothers were particularly vulnerable. School-based interventions should integrate psychological support with oral health promotion. Future longitudinal studies are needed to establish causal relationships.

Preconception health behaviors significantly influence pregnancy outcomes, yet patterns of these behaviors and their determinants have received limited attention, particularly among men. Understanding behavioral profiles is essential for developing targeted interventions to improve paternal reproductive health. We conducted a cross-sectional study examining over 20 guideline-recommended preconception health behaviors among 952 Chinese men. Latent profile analysis was utilized to identify different behavioral profiles. Multinomial logistic regressions assessed associations of profile membership with sociodemographic and medical history characteristics. Four distinct preconception health behavioral profiles were identified: a “Moderate” profile (44.0%) with scores near or slightly above the overall mean on most behaviors; a “Vulnerable” profile (4.5%) showing markedly negative scores across multiple behaviors; and two intermediate profiles “Unmotivated” (33.2%) and “At-Risk” (18.3%) with scores closer to average on some behaviors but notably lower on others (e.g., planning, avoidance of environmental hazards and domestic violence, treating existing diseases). Several behaviors received low scores across all profiles, including preconception check-ups, genetic screening, receiving professional preconception education, physical activity, and immunization. Lower education and unplanned pregnancy were consistently associated with at-risk behavioral profiles. Interventions must combine universal campaigns to elevate systematically neglected behaviors with targeted strategies addressing profile-specific needs. Pregnancy planning emerges as a keystone intervention opportunity. National programs require rebranding to emphasize paternal participation, while all strategies must address underlying social determinants rather than focusing solely on individual behavior change.

Purpose: To evaluate the pathways through which preconception health knowledge relates to preconception health behaviors via behavioral skills among Chinese reproductive-aged individuals and couples using the Information–Motivation–Behavioral Skills model, and to assess dyadic partner effects. Design: Cross-sectional study with individual-level mediation and dyadic path models. Setting: Population-based survey in Zhejiang Province, China (July–September 2023). Sample: 1991 individuals (1086 women; 905 men), including 458 heterosexual couples. Measures: Preconception health behavior score (0-100) summing >20 guideline-recommended behaviors; preconception health knowledge; behavioral skills; sociodemographics. Analysis: Individual-level mediation estimated with Sobel–Goodman tests; dyadic effects estimated using Actor–Partner Interdependence Model extended to Mediation (APIMeM) via path analysis; two-sided tests with P < 0.05. Results: Mean behavior scores: women 71.27 ± 9.03; men 71.12 ± 9.96. Women: total effect of knowledge on behaviors 0.896 ( P = 0.001); direct 0.785 ( P = 0.003); indirect via skills 0.111 ( P = 0.033). Men: total 1.731 ( P < 0.001); direct 1.313 ( P < 0.001); indirect 0.418 ( P < 0.001). Dyadic analyses showed partner skill-to-behavior effects: women’s skills → men’s behaviors β = 0.127 ( P = 0.003); men’s skills → women’s behaviors β = 0.153 ( P = 0.001). Conclusion: Preconception knowledge and behavioral skills are linked to healthier preconception behaviors, with meaningful partner interdependence. Couple-centered, skill-building interventions may improve preconception health and pregnancy outcomes. Cross-sectional design limits causal inference; self-reported behaviors may introduce bias; findings from one province may limit generalizability.