Global analysis of respiratory viral circulation and timing of epidemics in the pre-COVID-19 and COVID-19 pandemic eras, based on data from the Global Influenza Surveillance and Response System (GISRS).

OBJECTIVES: The COVID-19 pandemic significantly changed respiratory viruses' epidemiology due to non-pharmaceutical interventions and possible viral interactions. This study investigates whether the circulation patterns of respiratory viruses have returned to pre-pandemic norms by comparing their peak timing and duration during the first three SARS-CoV-2 seasons to pre-pandemic times. METHODS: Global Influenza Surveillance and Response System data from 194 countries (2014-2023) was analyzed for epidemic peak timing and duration, focusing on pre-pandemic and pandemic periods across both hemispheres and the intertropical belt. The analysis was restricted to countries meeting specific data thresholds to ensure robustness. RESULTS: In 2022/2023, the northern hemisphere experienced earlier influenza and respiratory syncytial virus (RSV) peaks by 1.9 months (P <0.001). The duration of influenza epidemics increased by 2.2 weeks (P <0.001), with RSV showing a similar trend. The southern hemisphere's influenza peak shift was not significant (P = 0.437). Intertropical regions presented no substantial change in peak timing but experienced a significant reduction in the duration for human metapneumovirus and adenovirus (7.2 and 6.5 weeks shorter, respectively, P <0.001). CONCLUSIONS: The pandemic altered the typical patterns of influenza and RSV, with earlier peaks in 2022 in temperate areas. These findings highlight the importance of robust surveillance data to inform public health strategies on evolving viral dynamics in the years to come.

Cadmium in biological samples and site-specific cancer risk and mortality: A systematic review of original articles and meta-analyses.

BACKGROUND: Cadmium (Cd) is classified as a class 1 carcinogen by the IARC, yet uncertainty persists regarding the total burden of cancer (incidence and mortality) caused by exposure to it, due to the still limited evidence with regard to its aetiological role in cancer at several body sites. OBJECTIVES AND METHODS: We searched PubMed and EMBASE for meta-analyses and original articles published by February 1st, 2024, that focused on the link between cadmium measured in biological samples (blood, urine, finger-/toe-nails, and hair) and site-specific cancer risk and mortality. RESULTS: We included 9 meta-analyses and 57 original articles (of these, the design was retrospective in 38 and prospective in 19, and Cd levels were quantified in blood, n=33, urine, n=19, both blood and urine, n=2, or finger-/toenail, n=3). Current data consistently suggest a causal role of exposure to cadmium in pancreas, lung, and bladder carcinogenesis. Total cancer risk and mortality are also positively correlated with Cd levels in biological samples. The evidence is weak or inconclusive for the remaining cancer sites (including breast and prostate), mostly due to the limited number of studies available to date and/or methodological limitations. DISCUSSION: Exposure to cadmium poses a risk for increased cancer incidence and mortality. Cadmium-related cancer burden might indeed be currently underestimated, as the amount of available evidence for most cancer sites and types is currently limited, and more research in the field is warranted. Continuing efforts to contain Cd pollution and mitigate associated health risk are also needed.

Health literacy and breast cancer screening adherence: results from the population of Tuscany, Italy.

Mammographic screening can reduce breast cancer (BC) mortality in women. In Italy, although attendance rates increased recently, they are still far from the recommended levels internationally. Inadequate health literacy (HL) may be a reason for poor awareness and/or knowledge about the importance of completing cancer screening. This study examined the relationship between HL, other sociodemographic determinants, and their influence on participation in both opportunistic and organized BC screenings among women aged 50-69 in Tuscany. The study analyzed 2017-2019 data from the Tuscan population subsample in the Italian Behavioral Risk Factor Surveillance System PASSI (Progressi delle Aziende Sanitarie per la Salute in Italia). HL was assessed using the Italian version of the six-item European Health Literacy Survey Questionnaire (HLS-EU-Q6). Among the 2250 interviewees, 75.3% underwent the organized BC screening and 9.4% on voluntary basis. Although to a different extent, HL was significantly associated to compliance rates with both opportunistic and organized screenings. Among sociodemographic factors, only occupational status was associated with opportunistic screening attendance rates. As expected, being invited by letter resulted to be strongly associated with participation to organized screening programs and the medical advice predicts for participating to both opportunistic and organized screening. This study highlights the relevant role that HL plays in BC, opportunistic and organized, screening adherence in a universal healthcare system. To increase BC screening participation rates, healthcare systems would benefit by implementing interventions for improved HL at population level or within healthcare organizations.

Prevalence and Contextual Factors of Juvenile Fibromyalgia in a Population-Based Italian Sample of Children and Adolescents.

Juvenile Fibromyalgia (JFM) is poorly known, leading to delay in the identification of the syndrome. On the other hand, early diagnosis in children is important to prevent the worsening of the disease. This study aims to estimate the prevalence of JFM in an Italian population-based convenience sample, using different criteria (2010 and 2016 ACR, Yunus and Masi), by involving family pediatricians. It also aims to assess the relationships between JFM and contextual factors of the children and their parents, as well as to raise awareness of JFM among pediatricians. Children's data were collected using an ad hoc electronic questionnaire. Overall, 7275 questionnaires were collected (48.5% females; mean age: 8.2 ± 3.6 years). Thirty-eight children (0.5%) met the 2010 ACR criteria, and 4 (0.1%) met the 2016 ACR criteria. The likelihood of meeting the 2010 ACR criteria was significantly higher for children older than 8 years (OR: 2.42), those who had injuries during the leisure time that caused persistent pain (OR: 6.49), whose parents (at least one) had a diagnosis of fibromyalgia (OR: 2.54) or diffuse pain (OR: 9.09). In conclusion, 2010 ACR criteria are confirmed as the more appropriate for children and adolescents and the analysis of contextual factors suggests the need for family pediatricians to pay particular attention to the most important predictors of JFM.

Role and challenges to digital technologies in community health promotion programs in Italy during the COVID-19 pandemic: a multiple embedded case study protocol.

BACKGROUND AND AIM: Due to the COVID-19 pandemics, The Italian League Against Cancer (LILT), a national federation of local associations promoting cancer prevention, had to face the challenge to find new ways and technologies to promote health in their territories. This study aims to explore how LILT associations led their health promotion interventions during the COVID-19 pandemic and to understand which interventions had a greater impact, for which population group, and why. METHODS: In this descriptive multiple embedded case study, each case will focus on the activities of a local LILT association and their collaborators on the perception and experience of the use of digital technology for health promotion and prevention, through interviews, observations, and a study of products and artifacts. A general overview of each case study will be provided, along with an introduction of the unit(s) of more in-depth analysis. The logical models that emerge from the analysis of each case will be described by using realist analysis, producing a list of possible CMO configurations (Context; Mechanisms; Outcomes). The final report will consist of a cross-case analysis (a comparison between the different case studies). DISCUSSION: This multiple case study will help generate a first "theory of the use of digital technology in health promotion in local LILT communities. The observation of what local LILT associations in Italy have done during COVID-19 will help identify new and useful health promotion strategies based on these technologies.

The clinical impact of continued smoking in patients with breast and other hormone-dependent cancer: A systematic literature review.

We conducted a systematic review of studies that investigated whether quitting smoking at or around diagnosis improves survival of patients with hormone-dependent cancers (HDC). Nine studies published in 2013-2022 were included. Studies were very diverse in terms of design, definition of quitters and continued smokers, and prevalence of prognostic factors other than smoking cessation (e.g. patients' demographics, tumour characteristic, and treatments). For breast, ovarian, and endometrial cancer, all included studies found that quitters had better overall, disease specific, and disease-free survival than continued smokers. For prostate cancer, there was no evidence of an association of smoking cessation with improved survival. This literature review provided suggestive evidence that female smokers diagnosed with cancer of the breast, ovary, or endometrium may improve their chances of surviving by stopping smoking. Smoking cessation counselling should become part of standard oncological care for these patients and integrated into breast cancer screening programs.

Use of digital technologies to support cancer screening in community health promotion interventions: scoping review.

The scoping review investigated how digital technologies have helped to increase cancer screening uptake in communities including adolescents, adults and elderly people during the COVID-19 outbreak between January 2020 and June 2021. Thirteen studies were identified as being relevant, mostly addressing underserved or minority communities with the purpose to increase screening uptake, delivering health education or investigating social and cultural barriers to cancer screening. The interventions effectively used digital technologies such as mobile apps and messengers mobile apps, messaging and Web platforms. The limitations imposed by COVID-19 on social interaction can be supported with digital solutions to ensure the continuity of cancer screening programs. However, more research is needed to clarify the exact nature of effectiveness, especially in large-scale interventions.

The Prognostic Impact of Quitting Smoking at or around Diagnosis on the Survival of Patients with Gastrointestinal Cancers: A Systematic Literature Review.

Cigarette smoking is a strong risk factor for the occurrence of gastrointestinal cancers, and a substantial proportion of newly diagnosed patients is made up of active smokers, yet the impact of smoking cessation at or around diagnosis on the clinical course of these cancers (whose prognosis is often unfavourable) has never been summarized to date. We reviewed studies published until 30 April 2022 that investigated whether smoking cessation at or around diagnosis favourably affects the clinical course of gastrointestinal cancers patients. Six studies were included for colorectal cancer patients, which provided limited yet suggestive evidence that quitters may have longer disease-specific survival compared to continued smokers. Only one study each focused on patients with gastric or HBV-positive liver cancer (both reporting a survival advantage for quitters vs. continued smokers), while we found no eligible studies for patients with cancer at other sites within the digestive system. More research is urgently needed to expand the evidence on the topic, given the potentially major clinical implications for these patients. Moreover, health professionals should provide the necessary smoking cessation support to any smoker who is undergoing diagnostic work-up or treatment for gastrointestinal cancer.

Prognostic Impact of Post-Diagnosis Smoking Cessation among Bladder Cancer Patients: A Systematic Literature Review and Meta-Analysis.

We reviewed the studies examining whether quitting smoking at or around diagnosis favourably affects the prognosis of bladder cancer (BC) patients, who are often active smokers at diagnosis. We found only nine eligible articles published until 31 January 2022, which encompassed around 5500 BC in total, the majority of which were nonmuscle invasive BC (only one paper included muscle-invasive BC). We used random effects meta-analysis to obtain a summary hazard ratio (SHR) and 95% confidence intervals (CI). The median proportion of smokers who quit at or around diagnosis was 29.8% (range 8.4-43.1%). For the overall, BC-specific, and progression-free survival, the studies were limited in number (n = 3) and provided conflicting results. At the same time, quitters did not appear to have a lower risk of recurrence than continued smokers (SHR 0.99, 95% CI 0.61-1.61). In conclusion, while the evidence is currently not sufficient to draw firm conclusions (especially for patients with muscle-invasive BC), physicians should not refrain from educating smoking BC patients about the benefits of smoking cessation and provide the necessary support.

Predictors of Influenza Vaccination Uptake and the Role of Health Literacy among Health and Social Care Volunteers in the Province of Prato (Italy).

Annual influenza vaccination is recommended for volunteers involved in primary health and social services. Little is known about the volunteers' adhesion to influenza vaccination recommendations. The aim of this study was to assess influenza vaccination determinants among a group of volunteers who provided essential activities during the first SARS-CoV-2 pandemic wave in the province of Prato, Tuscany (Italy) and to evaluate the role of health literacy in influencing vaccination determinants. METHOD: In this cross-sectional study, the predictors of influenza vaccination uptake were assessed through the administration of a questionnaire. Variables significantly associated with influenza vaccination uptake were included in five multivariate logistic regression models through a backward stepwise procedure. RESULTS: Among the 502 enrolled volunteers, 24.3% reported being vaccinated in the 2019-2020 season. Vaccination uptake was 48.8% in participants aged 65 years or older and 15.7% in those aged 64 years or younger. Considering the whole sample in the final model of multivariate logistic regression analysis, the predictors of influenza vaccination uptake were age (OR = 1.05; 95% CI = 1.03-1.07), presence of heart diseases (OR = 2.98; 95% CI = 1.24-7.19), pulmonary diseases (OR = 6.18; 95% CI = 2.01-19.04) and having undergone surgery under general anesthesia in the prior year (OR = 3.14; 95% CI = 1.23-8.06). In the multivariate model considering only participants with a sufficient level of health literacy (HL), none of these predictors resulted in significant associations with vaccination uptake, except for age (OR= 1.04; 95% CI = 1.02-1.07). CONCLUSIONS: Our findings revealed a very low influenza vaccination uptake among volunteers, suggesting the need to increase awareness in this at-risk group by means of a better communication approach.

Trends in Adolescent Health Risk Behaviors and Wellbeing: A 10 Year Observation from the EDIT Surveillance of Tuscany Region, Italy.

Background: The aim of this study was to evaluate the trends of prevalence of health risk behaviors (HRBs) and health conditions over a 10 year period (2008-2018) in a representative sample of adolescents of Tuscany Region, Italy. Methods: This was a repeated cross-sectional (four survey waves) study. The prevalence of 17 HRBs and health conditions were analyzed by age, sex, and socioeconomic status (SES). Results: A total of 21,943 students were surveyed. During the study period, decreases in smoking participation, cocaine use, driving under the influence of alcohol and drugs, and problem gambling were observed, while alcohol abuse and at-risk sexual behaviors remained unchanged or increased. Males resulted more frequently involved in most of the HRBs, while females more frequently reported physical inactivity, regular smoking, and not using a condom. Female participation in smoking and alcohol abuse behaviors, fruit and vegetable consumption, and bullying worsened over the study period. Smoking, poor dietary habits, physical inactivity, high distress level, and obesity were more frequently observed in low-SES students than in high-SES students. Conclusions: The findings showed different tendencies in adolescent participation in HRBs over the last decade; concerning trends in at-risk sexual behaviors and alcohol consumption and females' risk-taking behavior on the rise require careful monitoring.

[Mortality study in a cohort of entertainment workers]. / Studio di mortalità su una coorte di addetti al settore dello spettacolo.

SUMMARY: Introduction. Malignant mesotheliomas have been observed in entertainment workers in the last decades. They have been evaluated as occupationally exposed to asbestos contained in tools used for fireproof and sound-absorbing purposes. Aim of the study. To evaluate the mortality of workers engaged in a Florentine theatre where a large quantity of asbestos was found in the '80s, put in place 20 years earlier. Methods. It is a cohort study on entertainment workers with follow-up period ranged from 1-1-1970 till 31-12-2018. Standardized Mortality Ratios (SMRs) and their 95% Confidence Intervals (95% IC) were calculated by gender and job ("manual workers" and "all other jobs"), using age and sex specific mortality rates of Tuscan population. Results. The cohort includes 826 workers (389 manual workers and 437 engaged in other jobs) engaged by the Florentine theatre between 01/01/1937 and 31/12/1990. Excesses of mortality for all causes are observed in manual workers, either males (301 cases; SMR 304,0; 95% IC 271,5-340,3) or females (86 cases; SMR 429,8; 95% IC 348,0-531,0). The group of the other workers presents deficits of mortality by all causes, cancers and cardiovascular diseases in both genders. One death for pleural cancer is observed in a manual worker. Discussion. The results are in line with previous observations in similar occupations. In the examined Florentine theatre the asbestos exposures were important only for the manual workers who worked in the technical rooms characterized by the presence of friable asbestos sprinkled and in a bad state of maintenance.

COVID-19 and schools: what is the risk of contagion? Results of a rapid-antigen-test-based screening campaign in Florence, Italy.

INTRODUCTION: In the coronavirus disease 2019 era, debate around the risk of contagion in school is intense in Italy. The Department of Welfare and Health of Florence promoted a screening campaign with rapid antigen tests for all students and school personnel. The aim of this study was to assess the circulation of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in the school setting by means of mass screening in every primary and middle school in Florence. METHODS: All students and school personnel at primary and middle schools in Florence were asked to take part. The campaign started on 16 November 2020 and was completed on 12 February 2021. If a subject had a positive result on rapid antigen testing, a molecular test was performed to confirm the result. RESULTS: In total, 18,414 subjects were tested: 15,233 students (82.7%) and 3181 school personnel (17.3%). The rapid antigen test gave a positive result in 27 cases (0.15%). Of these, only 14 tests were confirmed to be positive on molecular testing. These results show a very low number of cases of SARS-CoV-2 among the study subjects (0.08%). CONCLUSIONS: These results show that the spread of SARS-CoV-2 in the school setting was low in Florence during the screening period.

Health Literacy as a Shared Capacity: Does the Health Literacy of a Country Influence the Health Disparities among Immigrants?

Health literacy (HL) is an individual ability as well as a distributed resource available within an individual's social network. We performed an explorative study assessing the role of HL as the country-level ecological variable in predicting the health disparities among immigrants. Country-level HL data were obtained from the publicly available first European Health Literacy Survey reports. Individual-level data on citizenship, perceived health status, body mass index, smoking habits, physical activity and attendance at breast and cervical cancer screening were extracted from the European Health Interview Survey of Eurostat. Data from both sources were obtained for Austria, Bulgaria, Greece, Poland and Spain. The country-specific odds ratio (OR) for the association between the participants' citizenship and other individual health-relevant characteristics was pooled into summary OR using random-effects models. Meta-regression was used to explore whether the HL of a country could explain part of the between-countries heterogeneity. Results: For the perceived health status, nutritional status and attendance at cervical cancer screening, the lower was the country-level HL (as ecological variable), the higher were the health inequalities relating to citizenship. The results of our exploratory research suggest that improving the population HL may help mitigate health inequalities between residents and migrants.

The epidemiology and severity of respiratory viral infections in a tropical country: Ecuador, 2009-2016.

BACKGROUND: Respiratory viral infections (RVI) are a leading cause of mortality worldwide. We compared the epidemiology and severity of RVI in Ecuador during 2009-2016. METHODS: Respiratory specimens collected within the national surveillance system were tested for influenza viruses, respiratory syncytial virus (RSV), adenovirus, parainfluenza virus, and human metapneumovirus. Overall and virus-specific positive detection rate (PDR) were calculated and compared the timing of epidemics caused by the different viruses. Logistic regression models were used to compare the age distribution and risk of death across respiratory viruses. RESULTS: A total of 41,172 specimens were analyzed: influenza (PDR=14.3%) and respiratory syncytial virus (RSV) (PDR=9.5%) were the most frequently detected viruses. Influenza epidemics typically peaked in December-January and RSV epidemics in March; seasonality was less evident for the other viruses. Compared to adults, children were more frequently infected with RSV, adenovirus, parainfluenza, and influenza B, while the elderly were less frequently infected with influenza A(H1N1)p. The age-adjusted risk of death was highest for A(H1N1)p (odds ratio [OR] 1.73, 95% confidence intervals [CI] 1.38-2.17), and lowest for RSV (OR 0.75, 95%CI 0.57-0.98). CONCLUSIONS: Whilst influenza and RSV were the most frequently detected pathogens, the risk of death differed by RVI, being highest for pandemic influenza and lowest for RSV.

Diagnosis-related differences in the quality of end-of-life care: A comparison between cancer and non-cancer patients.

BACKGROUND: Cancer, chronic heart failure (CHF), and chronic obstructive pulmonary disease (COPD) in the advanced stages have similar symptom burdens and survival rates. Despite these similarities, the majority of the attention directed to improving the quality of end-of-life (EOL) care has focused on cancer. AIM: To assess the extent to which the quality of EOL care received by cancer, CHF, and COPD patients in the last month of life is diagnosis-sensitive. METHODS: This is a retrospective observational study based on administrative data. The study population includes all Tuscany region residents aged 18 years or older who died with a clinical history of cancer, CHF, or COPD. Decedents were categorized into two mutually exclusive diagnosis categories: cancer (CA) and cardiopulmonary failure (CPF). Several EOL care quality outcome measures were adopted. Multivariable generalized linear model for each outcome were performed. RESULTS: The sample included 30,217 decedents. CPF patients were about 1.5 times more likely than cancer patients to die in an acute care hospital (RR 1.59, 95% C.I.: 1.54-1.63). CPF patients were more likely to be hospitalized or admitted to the emergency department (RR 1.09, 95% C.I.: 1.07-1.10; RR 1.15, 95% C.I.: 1.13-1.18, respectively) and less likely to use hospice services (RR 0.08, 95% C.I.: 0.07-0.09) than cancer patients in the last month of life. CPF patients had a four- and two-fold higher risk of intensive care unit admission or of undergoing life-sustaining treatments, respectively, than cancer patients (RR 3.71, 95% C.I.: 3.40-4.04; RR 2.43, 95% C.I.: 2.27-2.60, respectively). CONCLUSION: The study has highlighted the presence of significant differences in the quality of EOL care received in the last month of life by COPD and CHF compared with cancer patients. Further studies are needed to better elucidate the extent and the avoidability of these diagnosis-related differences in the quality of EOL care.

The Antecedents and Consequences of Health Literacy in an Ecological Perspective: Results from an Experimental Analysis.

This study analyses the relationship between the antecedents and consequences of health literacy (HL) at the ecological level among the nations involved in the European Health Literacy Survey (HLS-EU). The antecedents and consequences were investigated by means of proxy indicators. The HL was measured using the 47-item HLS-EU questionnaire (HLS-EUQ47) and the Newest Vital Sign (NVS). The two measures stood in significant correlation to the outcomes of the sub-discipline of the Euro Health Consumer Index (r = 0.790 for HLS-EUQ47; r = 0.789 for NVS). The HLS-EUQ47 also stood in correlation to the percentage of population with post-secondary education (r = 0.810), the reading performance for 15-year-old students (r = 0.905), the presence of a national screening program for breast (r = 0.732) or cervical cancer (r = 0.873). The NVS stood in correlation with the unemployment rate (r = −0.778), the Gross Domestic Product (r = 0.719), the Gini coefficient (r = −0.743), the rank of the Euro Patient Empowerment Index (r = −0.826), the expenditure on social protection (r = 0.814), the Consumer Empowerment Index (r = 0.898), the percentage of adults using the internet for seeking health information (r = 0.759), the prevalence of overweight individuals (r = −0.843), the health expenditure (r = 0.766), as well as the percentage of individuals using the internet for interacting with public authorities (r = 0.755). This study provides some preliminary considerations regarding alternative means by which to study HL and proposes new methods for experimentation. The methods and the results could offer a means by which the relationship between society and overall healthcare protection could be strengthened.

Focusing on the implementation of 21st century vaccines for adults.

Adult immunization is a priority for public health, particularly in countries where an aging population has become increasingly more numerous. Protection against diseases which typically affect adults (like flu, pneumococcal diseases and Herpes zoster), the shift of age of infections which originally affected children (like measles), the decreasing protection with time for infections which need periodical booster doses of vaccines (Tdap), the availability of vaccines which can also impact on adult health (HPV) are only some examples of the importance of implementing targeted vaccination strategies. The possibility to reach high coverage with immunizations that can guarantee a fundamental improvement of health for adults and the elderly can only be achieved through a coordinated effort where all stakeholders, under the coordination of public health, contribute to issue recommendations; create a functioning database for vaccine coverage registration; promote formative courses for healthcare workers and continuous information for the public; increase vaccines uptake among healthcare workers, who need to give the first testimony on the relevance of immunization.

Mortality after hip fracture in the elderly: The role of a multidisciplinary approach and time to surgery in a retrospective observational study on 23,973 patients.

BACKGROUND: Since most hip fractures occur in fragile patients, an important step forward in the treatment may be a co-managed, multidisciplinary treatment approach with orthopaedic surgeons and geriatricians. This multidisciplinary care model (MCM) is implemented in some Tuscan hospitals, while in hospitals with the usual care model (UCM) medical consultation is required only as deemed necessary by the admitting surgeon. The primary aim of this study was to assess the effect of the MCM on 30-day mortality, compared with the UCM. METHODS: A retrospective study was conducted on patients with main diagnosis of hip fracture, as reported in the hospital admission discharge reports, aged 65 years and older, who underwent surgery in Tuscan hospitals from 2010 to 2013. A multilevel logistic regression model was performed to assess the effect of the MCM vs the UCM. The Charlson Comorbidity Index (CCI) was used as a proxy for case mix complexity. RESULTS: 23,973 patients were included: 23% men and 77% women; the mean age was 83.5 years. The multilevel analysis showed that mortality was significantly higher in the UCM, after adjusting for gender, age, comorbidity and timing of surgery (OR=1.32; 95% CI 1.09-1.59; p=0.004). Surgical delay was not significantly associated with higher mortality rates. CONCLUSIONS: A co-managed approach to hip fracture, with orthopaedic surgeons and geriatricians, offers a multidisciplinary pathway for the elderly and leads to a reduction in mortality after hip fracture surgery.

Adherence to Mediterranean diet in a sample of Tuscan adolescents.

OBJECTIVE: The aim of this study was to estimate the level of adherence to the Mediterranean diet in a group of Italian high school students, in relation to their lifestyles and social and family contexts, and to compare the nutrition habits of the sample with other similar groups. METHODS: The KIDMED index and an ad hoc questionnaire were administered to 1127 students (mean age 16.8 ± 1.6 y) in the province of Florence. Any significant associations between the level of adherence to the Mediterranean diet and the aforementioned variables were assessed by the χ(2) test and by logistic regression analysis. RESULTS: The adherence to the Mediterranean diet was good in 16.5%, average in 60.5%, and poor in 23% of the students. The students attending technical high schools, those who played sports less than "almost every day", those who spent >3 h/d in sedentary activities, those who defined their school performance as worse than "more than sufficient," and those who referred to use of a car/moped as the most frequent mode of transportation, had significantly higher odds of poor rather than average or good adherence to Mediterranean diet. Moreover, being normal weight or overweight/obese, and referring to health workers as source of information on diet, seem to be protective factors against poor adherence to Mediterranean diet. CONCLUSIONS: Our sample presents a departure from the Mediterranean dietary pattern. It is certainly necessary to implement public health policies targeting teenagers to promote healthier lifestyle choices; the nutritional patterns of the Mediterranean diet should be among these choices.