Air pollution is the fourth greatest overall risk factor for human health. Despite declining levels in Europe, air pollution still represents a major health and economic burden. We collected data from the Global Burden of Disease Study 2019 regarding overall, as well as ischemic heart disease (IHD), stroke, and tracheal, bronchus and lung cancer-specific disability adjusted life years (DALYs), years of life lost (YLL) and mortality attributable to air pollution for 43 European countries between 1990 and 2019. Concentrations of ambient particulate matter (aPM2.5), ozone, and household air pollution from solid fuels were obtained from State of Global Air 2020. We analysed changes in air pollution parameters, as well as DALYs, YLL, and mortality related to air pollution, also taking into account gross national income (GNI) and socio-demographic index (SDI). Using a novel calculation, aPM2.5 ratio (PMR) change and DALY rate ratio (DARR) change were used to assess each country’s ability to decrease its aPM2.5 pollution and DALYs to at least the extent of the European median decrease within the analysed period. Finally, we created a multiple regression model for reliably predicting YLL using aPM2.5 and household air pollution. The average annual population-weighted aPM2.5 exposure in Europe in 1990 was 20.8 μg/m3 (95% confidence interval (CI) 18.3–23.2), while in 2019 it was 33.7% lower at 13.8 μg/m3 (95% CI 12.0–15.6). There were in total 368 006 estimated deaths in Europe in 2019 attributable to air pollution, a 42.4% decrease compared to 639 052 in 1990. The majority (90.4%) of all deaths were associated with aPM2.5. IHD was the primary cause of death making up 44.6% of all deaths attributable to air pollution. The age-standardised DALY rate and YLL rate attributable to air pollution were more than 60% lower in 2019 compared to 1990. There was a strong positive correlation (r = 0.911) between YLL rate and aPM2.5 pollution in 2019 in Europe. Our multiple regression model predicts that for 10% increase in aPM2.5, YLL increases by 16.7%. Furthermore, 26 of 43 European countries had a positive DARR change. 31 of 43 European countries had a negative PMR change, thus not keeping up with the European median aPM2.5 concentration decrease. When categorising countries by SDI and GNI, countries in the higher brackets had significantly lower aPM2.5 concentration and DALY rate for IHD and stroke. Overall, air pollution levels, air pollution-related morbidity and mortality have decreased considerably in Europe in the last three decades. However, with the growing European population, air pollution remains an important public health and economic issue. Policies targeting air pollution reduction should continue to be strongly enforced to further reduce one of the greatest risk factors for human health.

ObjectivesTo evaluate the sleep patterns among young West Balkan adults during the third wave of the COVID-19 pandemic.Design and settingCross-sectional study conducted using an anonymous online questionnaire based on established sleep questionnaires Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) (February–August 2021).ParticipantsYoung adults of Bosnia and Herzegovina, Croatia and Serbia.ResultsOf 1058 subjects, mean age was 28.19±9.29 years; majority were women (81.4%) and students (61.9%). Compared with before the pandemic, 528 subjects (49.9%) reported a change in sleeping patterns during the pandemic, with 47.3% subjects reporting sleeping less. Mean sleeping duration during the COVID-19 pandemic was 7.71±2.14 hours with median sleep latency of 20 (10.0–30.0) min. Only 91 (8.6%) subjects reported consuming sleeping medications. Of all, 574 (54.2%) subjects had ISI score >7, with majority (71.2%) having subthreshold insomnia, and 618 (58.4%) PSQI score ≥5, thus indicating poor sleep quality. Of 656 (62.0%) tested subjects, 464 (43.9%) were COVID-19 positive (both symptomatic and asymptomatic) who were 48.8%, next to women (70%), more likely to have insomnia symptoms; and 66.9% were more likely to have poor sleep quality. Subjects using sleep medication were 44 times, and subjects being positive to ISI 15.36 times more likely to have poor sleep quality. In contrast, being a student was a negative independent predictor for both insomnia symptoms and poor sleep quality, and mental labour and not working were negative independent predictors for insomnia symptoms.ConclusionsDuring the third wave of the pandemic, sleep patterns were impaired in about half of young West Balkan adults, with COVID-19-positive subjects and being women as positive independent predictors and being a student as negative independent predictor of impaired sleep pattern. Due to its importance in long-term health outcomes, sleep quality in young adults, especially COVID-19-positive ones, should be thoroughly assessed.

Students, as a relatively health-informed population group, may still have limitations in health literacy, which is a concern as students take increasing responsibility for their health and make independent health decisions. The aim of this study was to evaluate the overall attitudes towards COVID vaccination among university students and to investigate various factors contributing to vaccination willingness among health and non-health studies students. A total of 752 students from the University of Split were included in this cross-sectional study and completed a questionnaire that consisted of three sections: socio-demographic data, health status information, and information on vaccination against COVID-19. Results show that the majority of students of health and natural sciences were willing to be vaccinated, but the majority of students of social sciences were not (p < 0.001). Students who used credible sources of information had a more significant proportion of those willing to be vaccinated and the majority of students who used less credible sources (79%) or did not think about it (68.8%) were unwilling to be vaccinated (p < 0.001). Multiple binary logistic regression modeling shows that female gender, younger age, studying social sciences, negative opinion about the need to reintroduce lockdown and the effectiveness of epidemiological measures, and usage of less credible sources of information were the most important factors contributing to increased vaccination hesitancy. Therefore, improving health literacy and restoring trust in relevant institutions can be critical in health promotion and COVID-19 prevention.