Background The coronavirus (COVID-19) pandemic has highlighted that individuals with behavioural risk factors commonly associated with non-communicable diseases (NCDs), such as smoking, harmful alcohol use, obesity, and physical inactivity, are more likely to experience severe symptoms from COVID-19. These risk factors have been shown to increase the risk of NCDs, but less is known about their broader influence on communicable diseases. Taking a wide focus on a range of common communicable diseases, this review aimed to synthesise research examining the impact of behavioural risk factors commonly associated with NCDs on risks of contracting, or having more severe outcomes from, communicable diseases. Methods Literature searches identified systematic reviews and meta-analyses that examined the association between behavioural risk factors (alcohol, smoking, illicit drug use, physical inactivity, obesity and poor diet) and the contraction/severity of common communicable diseases, including infection or associated pathogens. An a priori, prospectively registered protocol was followed (PROSPERO; registration number CRD42020223890). Results Fifty-three systematic reviews were included, of which 36 were also meta-analyses. Reviews focused on: tuberculosis, human immunodeficiency virus, hepatitis C virus, hepatitis B virus, invasive bacterial diseases, pneumonia, influenza, and COVID-19. Twenty-one reviews examined the association between behavioural risk factors and communicable disease contraction and 35 examined their association with communicable disease outcomes (three examined their association with both contraction and outcomes). Fifty out of 53 reviews (94%) concluded that at least one of the behavioural risk factors studied increased the risk of contracting or experiencing worse health outcomes from a communicable disease. Across all reviews, effect sizes, where calculated, ranged from 0.83 to 8.22. Conclusions Behavioural risk factors play a significant role in the risk of contracting and experiencing more severe outcomes from communicable diseases. Prevention of communicable diseases is likely to be most successful if it involves the prevention of behavioural risk factors commonly associated with NCDs. These findings are important for understanding risks associated with communicable disease, and timely, given the COVID-19 pandemic and the need for improvements in future pandemic preparedness. Addressing behavioural risk factors should be an important part of work to build resilience against any emerging and future epidemics and pandemics.

Background Interpersonal violence has devastating implications for individuals, families, and communities across the globe, placing a significant burden on health, justice, and social welfare systems. Smartphone technology may provide a platform for violence prevention interventions. However, evidence on the availability and user experience of smartphone applications aimed to prevent violence is underexplored. Methods Systematic searches of available smartphone applications marketed for personal safety and violence prevention on the Apple Store (IOS) and Google Play (Android) in the United Kingdom were run in May 2021. Relevant applications were downloaded, with data on user reviews and ratings extracted. Included applications were categorised according to their features and functions. Online user reviews were rated according to their sentiment (positive, negative, neutral) and thematically analysed. Results Of 503 applications, 86 apps met review criteria. Only 52 (61%) apps offered full functionality free of charge. Over half (52%) of apps were targeted towards the general population, with 16% targeting women and 13% targeting families. App functionality varied with 22% providing an alarm, 71% sending alerts to pre-designated contacts, 34% providing evidence capture and 26% offering educational information. Overall, 71% of applications had a user rating of four or above. For 61 apps a total of 3,820 user reviews were extracted. Over half (52.4%) of reviews were rated as having a positive sentiment, with 8.8% neutral and 38.8% negative. Key themes across user reviews included positive consequences of app use, technical and usage issues including app reliability, dissatisfaction with the financial cost of some app features and personal data and ethical issues. Conclusions Reviews suggest that users find apps for personal safety and violence prevention useful. However, individuals also report them being unreliable, not working as described and having features that others may exploit. Findings have implications for the development of policy on apps to improve personal safety, especially given recent national policy (e.g. UK) discussions about their utility. Without the regulation or accreditation of such technology for quality assurance and reliability, emphasis needs to be placed on ensuring user safety; otherwise vulnerable individuals may continue to place reliance on untested technology in potentially dangerous circumstances.

Background Unemployment has adverse consequences for families and can put children at risk of harm. This study presents a systematic review and meta-analysis of global evidence on associations between parental unemployment and adverse childhood experiences (ACEs). Methods Systematic literature searches across four databases identified cross-sectional, cohort or case–control studies measuring associations between parental employment and individual or cumulative ACEs in children. Available risk estimates were extracted and pooled odds ratios calculated using random-effects models. Results Of 60 included studies, 37 provided risk estimates suitable for pooling across seven ACE types. Paternal/any parental unemployment was associated with a 29% increased risk of sexual abuse, 54% increased risk of neglect, 60% increased risk of physical abuse and around 90% increased risk of child maltreatment and parental mental illness. No associations were found between maternal unemployment and ACEs. Pooling estimates from representative general population studies also identified increased risk of child maltreatment with paternal/any parental unemployment (82%) but not maternal unemployment. Conclusions Children who grow up with parental unemployment can be at increased risk of ACEs. A combination of socioeconomic measures to increase employment opportunities and parental support targeting fathers and mothers may help break multigenerational cycles of abuse and deprivation.