Background: Health literacy involves individuals’ knowledge, personal skills, and confidence to take action to evaluate and appraise health-related information and improve their health or that of their community. Objective: This study aimed to analyze the association between health literacy and attitude toward vaccines, adjusted with other factors. Methods: We used the SLAVACO Wave 3, a survey conducted in December 2021 among a sample of 2022 individuals, representative of the French adult population. We investigated factors associated with the attitude toward vaccines using respondents’ different sociodemographic data, health literacy levels, and the health care system confidence levels using a multinomial logistic regression analysis. Results: Among the participants, 440.4 (21.8%) were classified as “distrustful of vaccines in general,” 729.2 (36.1%) were “selectively hesitant,” and 852.4 (42.2%) were “nonhesitant.” In our model, the level of health literacy was not statistically different between the “distrustful of vaccines in general” and the “selectively hesitant” (P=.48), but it was associated with being a “nonhesitant” (adjusted odds ratio [aOR] 1.86, 95% CI 1.25-2.76). The confidence in the health care system was a strong predictor for a “nonhesitant” attitude toward vaccines (aOR 12.4, 95% CI 7.97-19.2). We found a positive correlation of 0.34 (P<.001) between health literacy and confidence in the health care system, but the interaction term between health literacy and health care system confidence was not significant in our model. Conclusions: Health literacy was associated with a “nonhesitant” attitude toward vaccines. The findings demonstrated that health literacy and confidence in the health care system are modestly correlated. Therefore, to tackle the subject of vaccine hesitancy, the main focus should be on increasing the population’s confidence and on increasing their health literacy levels or providing vaccine information addressing the needs of less literate citizens.

In Denmark, 1.3 million buildings are currently registered as having asbestos-containing roofing. Studies have demonstrated that natural weathering of asbestos-containing materials can lead to the presence of airborne asbestos in the environment. The objective of this study was to measure the outdoor concentrations of airborne asbestos fibers in urban and residential areas of Denmark. We collected 192 outdoor air samples during June to September 2024 and March to May 2025 across four major cities: Copenhagen, Odense, Aarhus, and Aalborg. In each city, we conducted measurements at four sites in urban and residential areas, respectively. Additionally, we collected samples at four sites within each of two natural areas and four sites within each of two residential neighborhoods consisting exclusively of houses with asbestos-containing roofs. All samples were analyzed using phase-contrast optical microscopy (PCM) and scanning electron microscopy combined with energy-dispersive X-ray analysis (SEM-EDX). Asbestos-like fibers were detected in 108 (58 %) samples analyzed by PCM; however, the concentrations exceeded the limit of detection (LOD) of 300 f/m³ in only nine samples. The majority of these samples were collected in urban areas with concentration ranging 300-500 f/m³. Asbestos fibers were detected in 10 (5 %) samples analyzed by SEM-EDX; however, none exceeded the LOD of 100-160 f/m³. Asbestos fibers were detectable in a few samples from the urban and residential areas of Denmark. Concentrations were lower than the LOD, indicating a low asbestos exposure, also in areas with a high prevalence of buildings with asbestos-containing roofs.

Per- and polyfluoroalkyl substances (PFAS) are environmental contaminants associated with higher serum lipids, although primarily in cross-sectional studies, limiting causal inference. We aim to determine whether there is a causal relationship between PFAS and serum lipid levels by emulating a target trial of a hypothetical PFAS-reduction intervention using observational data. The target trial would enroll adults aged ≥20 years without prior cardiovascular, kidney, or liver disease, diabetes, or use of related medications. Participants would be randomly assigned to either PFAS-reduction counseling or no counseling, with adherence evaluated after 10 years, and then followed up after 10 years to assess effects on serum lipids. To emulate the target trial, we will use data from the Copenhagen City Heart Study on three successive clinical visits: baseline, follow-up, and outcome assessment visit, 10 years apart. Eligible participants meet the target trial criteria, have available blood samples for PFAS quantification at follow-up, and information on serum lipids at the outcome assessment. Intervention strategies will be evaluated based on observed reductions in PFAS concentrations between baseline and follow-up visit. Serum lipids are assessed at the outcome assessment visit. The emulation assumes exchangeability by adjusting for baseline and time-varying confounders using G-computation. This protocol explores applying the target trial emulation framework to improve causal inference in environmental epidemiology.

BACKGROUND Health literacy involves individuals’ knowledge, personal skills, and confidence to take action to evaluate and appraise health-related information and improve their health or that of their community. OBJECTIVE This study aimed to analyze the association between health literacy and attitude toward vaccines, adjusted with other factors. METHODS We used the SLAVACO Wave 3, a survey conducted in December 2021 among a sample of 2022 individuals, representative of the French adult population. We investigated factors associated with the attitude toward vaccines using respondents’ different sociodemographic data, health literacy levels, and the health care system confidence levels using a multinomial logistic regression analysis. RESULTS Among the participants, 440.4 (21.8%) were classified as “distrustful of vaccines in general,” 729.2 (36.1%) were “selectively hesitant,” and 852.4 (42.2%) were “nonhesitant.” In our model, the level of health literacy was not statistically different between the “distrustful of vaccines in general” and the “selectively hesitant” (P=.48), but it was associated with being a “nonhesitant” (adjusted odds ratio [aOR] 1.86, 95% CI 1.25-2.76). The confidence in the health care system was a strong predictor for a “nonhesitant” attitude toward vaccines (aOR 12.4, 95% CI 7.97-19.2). We found a positive correlation of 0.34 (P<.001) between health literacy and confidence in the health care system, but the interaction term between health literacy and health care system confidence was not significant in our model. CONCLUSIONS Health literacy was associated with a “nonhesitant” attitude toward vaccines. The findings demonstrated that health literacy and confidence in the health care system are modestly correlated. Therefore, to tackle the subject of vaccine hesitancy, the main focus should be on increasing the population’s confidence and on increasing their health literacy levels or providing vaccine information addressing the needs of less literate citizens.

Lower-chlorinated polychlorinated biphenyls (LC-PCBs) can evaporate from original materials in older buildings and be inhaled by inhabitants. Prenatal exposure to LC-PCBs may interfere with fetal lung development, with consequences for adult lung function. Determine the effect of prenatal LC-PCB exposure on adult lung function. We included 184 adult males whose mothers lived in two partially LC-PCB contaminated residential areas leading up to their pregnancy. Spirometry assessed forced expiratory volume in one second (FEV₁) and forced vital capacity (FVC). Z-scores standardized measurements. Associations were estimated using linear regression, with subsequent smoking stratification. Prenatally exposed individuals (n = 72) had 120 mL lower FEV₁ (95 % CI: -280, 30) and 120 mL lower FVC (95 % CI: -310, 70) compared to unexposed individuals. Responses were intensified in ever smokers, and absent in never smokers. Prenatal LC-PCBs exposure may reduce lung function in adult males, with later smoking potentially enhancing susceptibility.