International Journal of Environmental Research and Public Health

27 pages, 1443 KiB

Open AccessReview

Governance in Crisis: A Mixed-Methods Analysis of Global Health Governance During COVID-19

by Kadria Ali Abdel-Motaal and Sungsoo Chun

Int. J. Environ. Res. Public Health 2025, 22(8), 1305; https://doi.org/10.3390/ijerph22081305 (registering DOI) - 20 Aug 2025

Abstract

Background: The COVID-19 pandemic exposed major structural deficiencies in global health governance, including stark inequities in vaccine access, intervention timing, and mortality outcomes. While economic resources played a role, the influence of governance performance remains insufficiently examined. This study addresses a significant gap [...] Read more.

Background: The COVID-19 pandemic exposed major structural deficiencies in global health governance, including stark inequities in vaccine access, intervention timing, and mortality outcomes. While economic resources played a role, the influence of governance performance remains insufficiently examined. This study addresses a significant gap by integrating governance metrics with pandemic response data to assess how governance quality, independent of income level, affected national outcomes. Although the Oxford COVID-19 Government Response Tracker (OxCGRT) dataset has been widely used to document policy responses, this study offers a novel contribution by linking these policy interventions with governance performance and evaluating their joint effect on health outcomes and vaccine equity. Methods: This mixed-methods study combines quantitative analysis of global datasets with a qualitative literature review. Quantitative data were mainly obtained from the Oxford COVID-19 Government Response Tracker (OxCGRT), the World Bank’s Worldwide Governance Indicators (WGIs), and World Bank/WHO databases. A governance performance index was constructed using two WGI components: Government Effectiveness and Regulatory Quality. Countries were grouped into high, medium, or low governance categories. Statistical tests included ANOVA, Kaplan Meier survival analysis, and multivariable OLS regression. The qualitative component reviewed 45 academic and institutional sources on governance performance during COVID-19. Results: Countries with high governance performance had earlier public health interventions, lower mortality, and broader vaccine coverage, independent of income level. Kaplan Meier analysis revealed faster school closures in these countries (p < 0.01). Multivariable regression showed governance remained a significant predictor after adjusting for income and health spending. Qualitative findings highlighted recurring weaknesses in legal enforceability, intergovernmental coordination, and global financing mechanisms. Conclusion: Governance performance had a decisive impact on pandemic outcomes. The COVID-19 crisis revealed the need for robust governance systems capable of responding to complex emergencies that extend beyond the health sector into institutional, economic, and social spheres. Full article

(This article belongs to the Special Issue Advancing Health Equity: Challenges and Opportunities)

18 pages, 293 KiB

Open AccessArticle

Cultural Adaptation of the Mothers and Babies Online Course: A Delphi Study for Black Mothers with Preterm Infants

by Kobi V. Ajayi, Robin Page, Kelly Wilson, Carly McCord and Whitney Garney

Int. J. Environ. Res. Public Health 2025, 22(8), 1304; https://doi.org/10.3390/ijerph22081304 (registering DOI) - 20 Aug 2025

Abstract

With persistent racial inequities, cultural adaptations of health programs can promote equitable maternal mental health. Despite the intersecting identities of Black mothers with preterm birth combined with racial discrimination, previous mental health programs in the neonatal intensive care unit (NICU) are void of [...] Read more.

With persistent racial inequities, cultural adaptations of health programs can promote equitable maternal mental health. Despite the intersecting identities of Black mothers with preterm birth combined with racial discrimination, previous mental health programs in the neonatal intensive care unit (NICU) are void of the sociocultural context that perpetuates racially motivated care. This study uses a two-round Delphi process to gather knowledge on the cultural appropriateness and content validity of the adapted Mothers and Babies Online Course, a United States Prevention Service Task Force-recommended intervention for managing mental health symptoms in pregnant and new mothers for Black mothers with preterm birth. The Black feminist theory and cultural adaptation strategies were used to conceptualize the adaptation process. Opinions were solicited from Black mothers and professionals based on predetermined criteria. Eleven participants, comprising eight mothers and three professionals, participated in Round One. Of these, only one professional did not participate in Round Two, totaling 10 participants who participated in Round Two. The participants rated the adapted program—eMB 4 Blackmamas, positively, and four themes emerged, substantiating the importance of culturally responsive mental health. The themes also offered additional feedback related to improving the program delivery. Including diverse stakeholders in mental health research offers unique and balanced insights into designing culturally appropriate programs to promote and protect Black maternal mental health in the NICU. Full article

16 pages, 293 KiB

Open AccessArticle

Using a Community-Based Participatory Research Approach to Study the Mental Health of Older Adults with a Refugee Life Experience

by Rochelle L. Frounfelker, Puja Thapa and Tej Mishra

Int. J. Environ. Res. Public Health 2025, 22(8), 1303; https://doi.org/10.3390/ijerph22081303 (registering DOI) - 20 Aug 2025

Abstract

Older adults with a refugee life experience have a disproportionate burden of mental health problems compared to non-refugee aging populations. Community-based participatory research (CBPR) is a promising approach to identify the challenges and strengths of older refugee adults and identify solutions to mental [...] Read more.

Older adults with a refugee life experience have a disproportionate burden of mental health problems compared to non-refugee aging populations. Community-based participatory research (CBPR) is a promising approach to identify the challenges and strengths of older refugee adults and identify solutions to mental health disparities. We present a case study of one such CBPR program of research with older ethnic Nepali Bhutanese adults resettled in North America, Project Bhalakushari. We highlight the many opportunities to integrate older adults and members of the broader Bhutanese community in activities throughout the research process, starting with forming academic–community partnerships, identifying the needs and strengths of the community, conducting research, and sharing study findings with a broad audience of community members, health practitioners, policy-makers, and academics. Our case study emphasizes that a successful, culturally informed partnership should consider the involvement of the entire community, regardless of age, in the initiative to secure buy-in and support and maximize the positive impact of the work. We identify concrete strategies to overcome challenges specific to conducting research, with a focus on recruitment, outreach, and data collection. Full article

(This article belongs to the Special Issue Global Migrants and Refugees: Recent Trends, Health Inequities and Aging)

20 pages, 380 KiB

Open AccessArticle

Predictors of COVID-19 Pandemic-Related Pregnancy Stress: Prenatal and Postpartum Experiences in Canada

by Sigourney Shaw-Churchill and Karen P. Phillips

Int. J. Environ. Res. Public Health 2025, 22(8), 1302; https://doi.org/10.3390/ijerph22081302 (registering DOI) - 20 Aug 2025

Abstract

The COVID-19 pandemic and related public health and hospital restrictions directly influenced Canadian perinatal healthcare. This study aimed to evaluate predictors of pandemic-related pregnancy and postpartum stress in Canada. A sample of 398 women with Canadian pandemic pregnancy experiences completed an online cross-sectional [...] Read more.

The COVID-19 pandemic and related public health and hospital restrictions directly influenced Canadian perinatal healthcare. This study aimed to evaluate predictors of pandemic-related pregnancy and postpartum stress in Canada. A sample of 398 women with Canadian pandemic pregnancy experiences completed an online cross-sectional survey between September 2021 and February 2022. Demographic factors, perinatal healthcare characteristics, and psychometric measures including Oslo Social Support Scale (OSSS-3) and Brief COPE were analyzed by independent hierarchical generalized linear models (GLM) to identify predictive variables associated with prenatal and postpartum pandemic-related pregnancy stress scales (PREPS). Respondents reported low social support, low–moderate Problem-Focused and Emotion-Focused Coping scores, with low Avoidant Coping. Middle income and canceled prenatal care appointments were associated with prenatal PREPS-Preparedness Stress, with provider satisfaction negatively associated. Avoidant Coping was positively associated with both prenatal and postpartum Preparedness Stress and Infection Stress scores, whereas Problem-Focused Coping was associated with both prenatal and postpartum Positive Appraisal. High COVID-19 rates and region of healthcare were associated with prenatal and postpartum Infection Stress. Our findings that perinatal healthcare characteristics and psychometric measures, rather than demographic characteristics, were greater predictors of pandemic-related stress reflect the broad societal disruptions that shaped Canadian pregnancy experiences in our sample of mostly high income, well-educated, non-racialized women. Full article

11 pages, 246 KiB

Open AccessArticle

Assessing Public Health Capacity for Infectious Disease Modeling: A Qualitative Study of State and Local Agencies

by Skyler J. Crouch, Katie S. Allen, Delaney Thornton, Joel Hartsell, Elizabeth H. Weybright, Julia E. Szymczak and Kimberley I. Shoaf

Int. J. Environ. Res. Public Health 2025, 22(8), 1301; https://doi.org/10.3390/ijerph22081301 (registering DOI) - 20 Aug 2025

Abstract

Infectious disease modeling and forecasting tools are crucial for outbreak management. However, variability exists in the capacity of state and local health departments to effectively utilize these tools, influenced by factors such as infrastructure, funding, staff capacity, and data access. This study aims [...] Read more.

Infectious disease modeling and forecasting tools are crucial for outbreak management. However, variability exists in the capacity of state and local health departments to effectively utilize these tools, influenced by factors such as infrastructure, funding, staff capacity, and data access. This study aims to identify the current priorities, needs, and capacities of state and local public health departments regarding infectious disease modeling and forecasting tools. Key informant interviews were conducted with epidemiologists, informaticists, and leadership across state and local health departments from Montana, Utah, and Washington. Thematic coding and axial coding were used for thematic analysis. Three themes emerged: (1) models and tools must be adaptable based on the jurisdiction type (rural, urban, state); (2) building trust in models and tools is an important precursor to adoption; and (3) there are concerns about the availability and quality of data. This study highlights the need for adaptable modeling tools that are tailored to specific public health jurisdictions. Building trust in modeling and forecasting tools and addressing data quality issues are essential for successful tool implementation and adoption across diverse public health settings. Full article

10 pages, 241 KiB

Open AccessProtocol

Pre-Exposure Prophylaxis Uptake, Implementation and Barriers in Africa: A Scoping Review Protocol

by Silingene Joyce Ngcobo and Tracy Zhandire

Int. J. Environ. Res. Public Health 2025, 22(8), 1300; https://doi.org/10.3390/ijerph22081300 (registering DOI) - 20 Aug 2025

Abstract

Background: Despite significant advancements in HIV prevention, Africa continues to bear a disproportionately high burden of new infections. Pre-exposure prophylaxis (PrEP) has demonstrated over 90% efficacy in preventing HIV acquisition when taken consistently; however, its implementation and uptake across African countries remain suboptimal. [...] Read more.

Background: Despite significant advancements in HIV prevention, Africa continues to bear a disproportionately high burden of new infections. Pre-exposure prophylaxis (PrEP) has demonstrated over 90% efficacy in preventing HIV acquisition when taken consistently; however, its implementation and uptake across African countries remain suboptimal. Objective: This scoping review aims to systematically map existing literature on PrEP uptake and implementation in Africa, identify key barriers and facilitators influencing access and adherence, examine targeted population groups, and explore policy and programmatic approaches to PrEP delivery across diverse African contexts. Methods: The review will follow the methodological framework proposed by Arksey and O’Malley, refined by Levac et al., and will include comprehensive searches of electronic databases, grey literature, and official reports. Data will be thematically synthesized to identify research trends, gaps, and contextual variations. Expected Outcomes: The findings will provide a comprehensive overview of the current landscape of PrEP implementation in Africa, highlighting research trends, contextual variations across countries, and gaps in service delivery and policy frameworks. This will inform future implementation strategies, guide evidence-based approaches to enhance PrEP uptake, and support policymaking to scale up effective interventions across diverse African settings, ultimately contributing to HIV prevention efforts on the continent. Full article

(This article belongs to the Section Infectious Diseases, Chronic Diseases, and Disease Prevention)

31 pages, 2422 KiB

Open AccessReview

Chemical Hazards in Products of Animal Origin in Cambodia from 2000 to 2023: A Systematic Review and Meta-Analysis

by Shwe Phue San, Linda Nicolaides, Delia Grace, Tumnoon Charaslertrangsi, Chhoun Chamnan, Shetty Seetharama Thombathu, Ra Thorng, Leab Kong, Sreymom Noeurn, Kuok Fidero, Che Ratana, Nazanin Zand and Rortana Chea

Int. J. Environ. Res. Public Health 2025, 22(8), 1299; https://doi.org/10.3390/ijerph22081299 - 19 Aug 2025

Abstract

Chemical hazards in food present a significant health risk. The objective of our review is to understand health risks associated with chemical contaminants in products of animal origin (POAO) in Cambodia, where there is no known published study. We followed the “Preferred Reporting [...] Read more.

Chemical hazards in food present a significant health risk. The objective of our review is to understand health risks associated with chemical contaminants in products of animal origin (POAO) in Cambodia, where there is no known published study. We followed the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines. A total of 23 reports were included for review. The findings are presented according to the PRISMA guidelines. The studies mostly focused on fishery products, with arsenic and mercury being the most frequently studied hazards. The evidence of banned substances such as chloramphenicol and certain organochlorine pesticides (OCPs), including chlordane and Mirex, was reported in fish and meat. Additionally, mercury levels were measured in beef, pork, viscera, and eggs, but the average concentration remained significantly below the hazard index. The average concentration of polycyclic aromatic hydrocarbons (PAH) in smoked fish exceeded the EU limits, ranging from 0.034 to 17.2 mg/kg, with an average mean concentration of 1.92 mg/kg. The pooled geometric means of arsenic and mercury in fish were 0.40 mg/kg (95% CI: 0.25–0.66) and ~0.14 mg/kg (95% CI: 0.087 to 0.223), respectively. The health risk of mercury contamination in fishery products needs the attention of the risk managers. However, industrial contaminants such as polybrominated diphenyl ethers (PBDEs) and butyl tin in marine fishes were lower than those reported elsewhere, such as Japan. We discuss the implications of the findings for human health and national food control systems (NFCS), the capacity of different agencies to undertake chemical risk assessment, the utility of systematic literature reviews (SLRs) for risk assessment and communication in low- and middle-income countries (LMICs), and the need for further research. Full article

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32 pages, 1073 KiB

Open AccessArticle

Beyond Storytime: Oklahoma Public Libraries’ Comprehensive Approach to the Resilience of Refugee Children and Their Families Support

by Salma Akter and Suchismita Bhattacharjee

Int. J. Environ. Res. Public Health 2025, 22(8), 1298; https://doi.org/10.3390/ijerph22081298 - 19 Aug 2025

Abstract

Public libraries serve as vital community hubs that foster engagement, empowerment, and education, particularly for vulnerable populations, including refugee children and families. This study examines how Oklahoma’s public libraries contribute to refugee resilience and identifies challenges they face in providing these essential services. [...] Read more.

Public libraries serve as vital community hubs that foster engagement, empowerment, and education, particularly for vulnerable populations, including refugee children and families. This study examines how Oklahoma’s public libraries contribute to refugee resilience and identifies challenges they face in providing these essential services. Using a qualitative method approach, including 20 semi-structured interviews with library staff, questionnaire surveys, and observations conducted across three Oklahoma library systems (Metropolitan, Pioneer, and Tulsa City-County) the study explored programs, services, and strategies that support refugee adaptation and integration. Findings reveal that libraries excel in three key areas: cognitive services (language literacy, digital access, educational resources), socio-cultural services (community building, cultural exchange), and physiological services (safe spaces, welcoming environments). These services contribute to building human, social, and economic capital, with human capital consistently ranked as most crucial for refugee resilience. However, libraries face significant challenges, with language barriers, program gaps, and outreach limitations being the most prevalent obstacles. Additional barriers include facility constraints, transportation difficulties, resource limitations, and privacy concerns. The study proposes nine comprehensive guidelines for creating sustainable pathways to refugee resilience through enhanced library services, emphasizing proactive community engagement, staff training, multilingual resources, advocacy, strategic partnerships, tailored programming, transportation solutions, cultural competence, and welcoming environments. This study contributes to understanding how public libraries can function as inclusive institutions that support refugee children’s successful integration and development in their new communities. Full article

(This article belongs to the Special Issue Refugee Health and Well-Being: Psychological, Behavioral and Biochemical Insights)

19 pages, 4882 KiB

Open AccessArticle

“Slowly but Steadily, You’re Running Out of Steam”: Aging Parents’ Caregiving Experiences Through Photovoice

by Martin Nagl-Cupal, Marlene Werner, Daniela Haselmayer and Thomas Falkenstein

Int. J. Environ. Res. Public Health 2025, 22(8), 1297; https://doi.org/10.3390/ijerph22081297 - 19 Aug 2025

Abstract

Aging parents caring for adult children with disabilities or other care needs face significant challenges and health-related issues over extended periods. The aim of this study was to explore the experiences of aging parents with caregiving responsibilities. This qualitative participatory study followed the [...] Read more.

Aging parents caring for adult children with disabilities or other care needs face significant challenges and health-related issues over extended periods. The aim of this study was to explore the experiences of aging parents with caregiving responsibilities. This qualitative participatory study followed the research process of a photovoice study. Thirteen parents, aged 51 to 76 years, of adult children with care needs, aged 20 to 49 years, participated in this study. The parents captured photographs depicting their daily lives which were contextualized and coded during group discussions. The data were analyzed using thematic analysis and reviewed collaboratively with the participants. Six key themes emerged in the data analysis. 1. mastering complexity, 2. being an expert and advocate, 3. balancing autonomy and care, 4. care as a lifelong journey, 5. standing on the margins of society, and 6. worrying about the future. This study underscores the urgent need for comprehensive and coordinated support systems that ensure the well-being of aging caregivers while addressing the evolving needs of their adult children. Full article

(This article belongs to the Special Issue Family Caregiving of Older Adults)

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22 pages, 3489 KiB

Open AccessArticle

Assessing Annoyance and Sleep Disturbance Related to Changing Aircraft Noise Context: Evidence from Tan Son Nhat Airport

by Thulan Nguyen, Tran Thi Hong Nhung Nguyen, Makoto Morinaga, Yasuhiro Hiraguri and Takashi Morihara

Int. J. Environ. Res. Public Health 2025, 22(8), 1296; https://doi.org/10.3390/ijerph22081296 - 19 Aug 2025

Abstract

This study examines the impact of aircraft noise on annoyance and sleep disturbances among residents near Tan Son Nhat Airport in Ho Chi Minh City, Vietnam, from 2019 to 2023. It aims to assess the specific effects of aircraft noise exposure on sleep [...] Read more.

This study examines the impact of aircraft noise on annoyance and sleep disturbances among residents near Tan Son Nhat Airport in Ho Chi Minh City, Vietnam, from 2019 to 2023. It aims to assess the specific effects of aircraft noise exposure on sleep quality, as well as changes in exposure due to reduced air traffic during the COVID-19 pandemic. Surveys conducted before and during the pandemic revealed that, despite lower noise levels, residents continued to report high levels of annoyance, indicating a complex exposure-response relationship. This study evaluates both the impact of aircraft noise levels and the role of non-acoustic factors in mitigating sleep disturbances and shaping residents’ responses over time. The study’s findings support the applicability of WHO guidelines in this context and emphasize the importance of considering both noise reduction and community engagement in noise management strategies. Full article

(This article belongs to the Special Issue Community Response to Environmental Noise)

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14 pages, 632 KiB

Open AccessArticle

“If You Haven’t Slept a Lot (…) You Don’t Want to Go Out for a Run, You Don’t Want to Ride a Bike, You Just Kind of Sit and You Just (…) Do Nothing”—Perceptions of 24-Hour Movement Behaviours Among Adolescents Living with Type 1 Diabetes

by Mhairi Patience, Alison Kirk, Xanne Janssen, James Sanders and Megan Crawford

Int. J. Environ. Res. Public Health 2025, 22(8), 1295; https://doi.org/10.3390/ijerph22081295 - 19 Aug 2025

Abstract

The importance of physical activity, sedentary behaviour, and sleep behaviour in adolescents with type 1 diabetes (T1D) has been explored in isolation. However, adolescents experience health benefits when these behaviours are balanced appropriately throughout the day, and are considered to be interconnected rather [...] Read more.

The importance of physical activity, sedentary behaviour, and sleep behaviour in adolescents with type 1 diabetes (T1D) has been explored in isolation. However, adolescents experience health benefits when these behaviours are balanced appropriately throughout the day, and are considered to be interconnected rather than isolated. The aim of this study was to investigate the perspectives of adolescents living with T1D towards these behaviours collectively. The participants were 15 adolescents (aged 11–18 years) with T1D, recruited using online methods and word of mouth. Online semi-structured interviews were transcribed using intelligent verbatim and analysed using thematic analysis. We identified the following four central themes and five subthemes: (1) sleep and physical activity are understood and valued above sedentary behaviour; (2) recognition of movement behaviours’ interconnection; (3) movement behaviours’ interaction with health outcomes (mood, glycaemic control, and glycaemic control as a barrier to movement behaviours); and (4) movement behaviours within the environmental context of the adolescent (school and caregivers). Adolescents with T1D are aware of the interconnectedness of each movement behaviour and the positive influence a balanced approach can have on mood and T1D management. The findings provide important information for future holistic interventions promoting healthy behaviours that target the adolescent, their school environment, and their caregivers. Full article

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15 pages, 706 KiB

Open AccessArticle

Using Functional Near-Infrared Spectroscopy to Elucidate Neurophysiological Mechanism of Action of Equine-Assisted Services: Proof-of-Concept Study

by Beth A. Lanning, Cory M. Smith, Cierra Ugale, Elena Nazarenko and William R. Marchand

Int. J. Environ. Res. Public Health 2025, 22(8), 1294; https://doi.org/10.3390/ijerph22081294 - 19 Aug 2025

Abstract

Equine-assisted services (EAS) are used for civilian and military trauma survivors to reduce depression and posttraumatic stress symptoms. While early scientific evidence supports the benefits of EAS, the neurophysiological mechanisms underlying these benefits are unknown. The specific aims of this exploratory study were [...] Read more.

Equine-assisted services (EAS) are used for civilian and military trauma survivors to reduce depression and posttraumatic stress symptoms. While early scientific evidence supports the benefits of EAS, the neurophysiological mechanisms underlying these benefits are unknown. The specific aims of this exploratory study were to determine (1) whether functional near-infrared spectroscopy (fNIRS) neuroimaging can be used to explore neural responses of EAS veteran participants and (2) the correlation between neural responses and psychological outcomes of the participants interacting with equines. Fifteen veterans participated in a 2-day EAS program consisting of four randomized activities. An fNIRS sensor cap was used to measure the oxygenated (O₂Hb), deoxygenated (hHb), and total hemoglobin (tHb) of the participants during each activity. The results indicated no significant differences for O₂Hb and tHb across the visits or activities, however, a significant difference in hHb was observed. There was an increase in hHb during the activities that included an equine, which indicated a greater cognitive load and attention. Further, data from pre-/post-psychometric assessments showed a significant improvement in participants’ trait anxiety, psychological flexibility, and positive and negative affect after interacting with the horse. Preliminary data revealed a potential association between the cognitive attention and psychological health of participants during an EAS session. Full article

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13 pages, 516 KiB

Open AccessArticle

Perception of Concern and Associated Factors During the COVID-19 Pandemic: An Epidemiological Survey in a Brazilian Municipality

by Adriano Pires Barbosa and Marília Jesus Batista

Int. J. Environ. Res. Public Health 2025, 22(8), 1293; https://doi.org/10.3390/ijerph22081293 - 19 Aug 2025

Abstract

The COVID-19 pandemic impacted mental health. This cross-sectional study analyzed the perception of concern related to the pandemic in Jundiaí-SP, June 2020. Participants consisted of residents of households selected by probability sampling and individuals with respiratory symptoms who sought Basic Health Units (UBS). [...] Read more.

The COVID-19 pandemic impacted mental health. This cross-sectional study analyzed the perception of concern related to the pandemic in Jundiaí-SP, June 2020. Participants consisted of residents of households selected by probability sampling and individuals with respiratory symptoms who sought Basic Health Units (UBS). The participants underwent rapid testing for SARS-CoV-2 and answered a questionnaire. The outcome was the perception of concern about pandemic and the independent variables were socioeconomic characteristics, behavioral variables, signs and symptoms, and rapid test results. Bivariate analysis was performed and variables with p < 0.20 were included in a binary logistic regression model (p < 0.05) using SPSS 20.0. A total of 2432 individuals participated in the study, including 1181 from UBS and 1251 from households. Females (OR: 1.42; CI: 1.18–1.71), black and mixed race participants (OR: 1.40; CI: 1.15–1.71), participants with an income up to 3 minimum wages (MW) (up to 1 MW: OR: 2.58; CI: 1.80–3.70; 1 to 3 MW: OR: 1.64; CI: 1.35–1.98), and younger participants (18–39 years: OR: 3.07; CI: 2.39–3.94; 40–59 years: OR: 2.42; CI: 1.89–3.10) were more concerned. Greater concern was perceived by more vulnerable individuals, regardless of testing positive for COVID-19 which is important to subsidize public mental health policies and crisis interventions, focusing on reducing race, gender and socioeconomic inequalities. Full article

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14 pages, 394 KiB

Open AccessArticle

Self-Reported Oral Health Among Elderly Immigrants Residing in Norway: A Cross-Sectional Study

by Wegdan Hasha, Stein Atle Lie, Anne N. Åstrøm and Manal Mustafa

Int. J. Environ. Res. Public Health 2025, 22(8), 1292; https://doi.org/10.3390/ijerph22081292 - 18 Aug 2025

Abstract

Immigrants represent 20.8% of Norway’s population, with 22.2% aged 50+. This study aimed to assess oral health-related behaviors and perceived oral health in relation to sociodemographic factors among elderly immigrants aged 50+. Methods: 174 participants (94% response rate). Data on sociodemographic, oral hygiene, [...] Read more.

Immigrants represent 20.8% of Norway’s population, with 22.2% aged 50+. This study aimed to assess oral health-related behaviors and perceived oral health in relation to sociodemographic factors among elderly immigrants aged 50+. Methods: 174 participants (94% response rate). Data on sociodemographic, oral hygiene, diet, snus use, xerostomia, and halitosis were collected using the self-reported questionnaire. p-value < 0.05 indicates statistical significance. Results: Participants’ mean age was 60.7, with 60% reporting poor self-perceived oral health, and over 64% had missing teeth. Participants reported poor oral hygiene habits (35.1%, n = 61), frequent sugar consumption (51.1%, n = 89), and smoking (16.1%, n = 28). Poor oral health was more common in those aged 60 and over (OR = 2.5, CI: 1.1–5.8) and with a narrow social network (OR = 3.8, CI: 1.7–8.5). Women had lower odds of sugar consumption (OR = 0.38, CI: 0.18–0.8) and smoking (OR = 0.27, CI: 0.09–0.7), but living in Norway for less than 3 years increased smoking odds (OR = 4.5, CI: 1.2–15.8). Moreover, being unmarried (OR = 5.5, p = 0.008), recent immigration (OR = 24.3, p < 001), and a narrow social network (OR = 4.7, p = 0.004) were associated with higher odds of missing teeth. Conclusions: Elderly immigrants in Norway reported poor oral health, tooth loss, and unhealthy dietary and hygiene habits, highlighting the need for targeted interventions. Full article

(This article belongs to the Section Global Health)

11 pages, 257 KiB

Open AccessArticle

Prevalence and Factors Associated with HIV Testing Among Men Aged 15–54 Years in Kenya—Evidence from the 2022 Demographic and Health Survey

by Ipeleng Caroline Victoria Melato, Alfred Musekiwa and Siphesihle Robin Nxele

Int. J. Environ. Res. Public Health 2025, 22(8), 1291; https://doi.org/10.3390/ijerph22081291 - 18 Aug 2025

Abstract

Sub-Saharan Africa bears the heaviest burden of HIV/AIDS. Kenya alone has an estimated 1.4 million people living with HIV. Therefore, this study determined HIV testing prevalence and associated factors among men aged 15–54 years in Kenya. The study is a secondary data analysis [...] Read more.

Sub-Saharan Africa bears the heaviest burden of HIV/AIDS. Kenya alone has an estimated 1.4 million people living with HIV. Therefore, this study determined HIV testing prevalence and associated factors among men aged 15–54 years in Kenya. The study is a secondary data analysis of the 2022 Kenya Demographic and Health Survey, a nationally representative population-based cross-sectional survey. A multivariable logistic regression model was used to determine factors associated with HIV testing. Survey weights were used to adjust analyses for unequal sampling probabilities. Out of 14,453 men included in the study, the prevalence of self-reported HIV testing was 73.5%, which was higher among men aged 30–34 years old compared to the 15–19 years (90.2% vs. 33.3%), married or living with a partner (89.1% vs. 55.5%), residing in urban areas (82.5% vs. 67.8%), with higher education (90.6% vs. 58.4%), employed (80.5% vs. 43.1%), richest (83.8% vs. 60.4%), and those with three or more sexual partners (81.7% vs. 68.0%) groups. Targeted interventions to encourage more men to participate in regular HIV testing are needed. This can be achieved by bringing HIV testing sites closer to males through HIV self-testing and community testing, particularly home-based testing. Full article

(This article belongs to the Special Issue Progress Toward the UNAIDS 95-95-95 Targets for HIV Care Cascade)

13 pages, 1704 KiB

Open AccessArticle

Socioeconomic Disparities and Risk of Papillary Thyroid Cancer Associated with Environmental Exposure to Per- and Polyfluoroalkyl Substances (PFAS) in Florida

by Laura E. Wild, Nicholas DiStefano, Garrett Forman, Bianca I. Arocha, Ming S. Lee, Peter A. Borowsky, Elizabeth Franzmann, Natasha Solle, Alberto J. Caban-Martinez and Erin Kobetz

Int. J. Environ. Res. Public Health 2025, 22(8), 1290; https://doi.org/10.3390/ijerph22081290 - 18 Aug 2025

Abstract

The existing literature suggests that exposure to Per- and Polyfluoroalkyl Substances (PFAS) can increase Papillary Thyroid Cancer (PTC) risk by interfering with thyroid hormone signaling, leading to hormonal imbalances that promote carcinogenesis. In addition, significant disparities exist in environmental exposure. However, ecological evidence [...] Read more.

The existing literature suggests that exposure to Per- and Polyfluoroalkyl Substances (PFAS) can increase Papillary Thyroid Cancer (PTC) risk by interfering with thyroid hormone signaling, leading to hormonal imbalances that promote carcinogenesis. In addition, significant disparities exist in environmental exposure. However, ecological evidence of these associations has not been established within a statewide database of cancer outcomes. Therefore, this study investigated the relationship between socioeconomic conditions, environmental PFAS exposure, and PTC incidence in Florida using the state’s cancer registry. Data on facilities potentially releasing PFAS and ZIP codes with known PFAS drinking water contamination were retrieved from the EPA’s PFAS Analytic Tool. Proximity to PFAS sites and age-adjusted incidence by patient race/ethnicity were calculated by census tract. Lower socioeconomic status was associated with greater exposure to environmental PFAS. Census tracts with closer proximity to PFAS sites were more likely to have public water systems with PFAS contamination. Lastly, residential proximity to PFAS sites was positively associated with age-adjusted PTC incidence in Non-Hispanic Whites and Hispanics. These results demonstrate disparities in environmental exposure and suggest that exposure to PFAS may be an important factor for PTC risk at the population level and should be considered in the development of public health policies. Full article

(This article belongs to the Special Issue Environmental Epidemiology and Spatial Analysis)

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11 pages, 335 KiB

Open AccessArticle

Out-of-Pocket Expenditure (OOPE) Among COVID-19 Patients by Insurance Status in a Quaternary Hospital in Karnataka, India

by Rajesh Kamath, Chris Sebastian, Varshini R. Jayapriya, Siddhartha Sankar Acharya, Ashok Kamat, Helmut Brand, Reshma Maria Cocess D’Souza, Prajwal Salins, Aswin Sugunan, Sagarika Kamath, Sangita G. Kamath and Sanjay B. Kini

Int. J. Environ. Res. Public Health 2025, 22(8), 1289; https://doi.org/10.3390/ijerph22081289 - 18 Aug 2025

Abstract

Out-of-pocket expenditure (OOPE) comprises 62% of national health expenditure in India. This heavy reliance on direct payments has engendered economic vulnerability and catastrophic financial pressures (typically defined as out-of-pocket spending exceeding a certain threshold of household income, leading to financial hardship) on households [...] Read more.

Out-of-pocket expenditure (OOPE) comprises 62% of national health expenditure in India. This heavy reliance on direct payments has engendered economic vulnerability and catastrophic financial pressures (typically defined as out-of-pocket spending exceeding a certain threshold of household income, leading to financial hardship) on households in a country where public health spending remains below targeted levels. The onset of the COVID-19 pandemic intensified these financial hardships further, as both total healthcare spending and OOPE experienced significant escalations due to the increased need for emergency care, vaccination efforts, and expanded health infrastructure. A retrospective, single-center study was conducted using data from COVID-19 patients admitted between June 2020 and June 2022. Patient data were collected from the Medical Records, IT, and Finance departments. A validated proforma was used for data extraction. Descriptive statistics were calculated, and the Shapiro–Wilk test was applied to assess normality of billing and OOPE data. Patients were stratified into three groups based on their insurance status, allowing for comparative analysis of OOPE percentages and absolute expenditures. The 2715 COVID-19 patients were categorized into three groups according to their health financing: those covered under AB-PMJAY (42.76%), private health insurance (22.16%), and the uninsured (35%). While the median billing amounts were comparable across these groups (ranging between INR 85,000 and INR 90,000), a substantial disparity was observed in terms of financial burden. All patients covered under AB-PMJAY incurred no OOPE, whereas privately insured patients had a median OOPE that constituted approximately 21% of their total billing amounts, with significant variability among different insurers. The uninsured group represented 35% of the cases and experienced the highest median OOPE, indicating substantial financial risk. The COVID-19 pandemic has revealed critical gaps in India’s health financing framework. This study emphasizes the strong financial protection provided by AB-PMJAY, while also exposing the limitations of private health insurance in shielding patients from substantial healthcare costs. As the country progresses toward universal health coverage, there is a pressing need to expand public health insurance schemes that are inclusive, equitable, and effectively implemented. Additionally, strengthening regulation and accountability in the private insurance sector is essential. The study findings reinforce that AB-PMJAY has been highly successful in reducing OOPE and enhancing financial risk protection. Although private insurance reduced OOPE, patients still faced considerable expenses. The stark difference in OOPE of 100% for uninsured patients, 21.16% for privately insured, and 0% for AB-PMJAY beneficiaries underscores the importance of further expanding AB-PMJAY to reach more vulnerable populations. Full article

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11 pages, 755 KiB

Open AccessArticle

Acute Glycemic and Hemodynamic Responses to Single- and Multi-Joint Resistance Exercises in Individuals with Type 2 Diabetes: A Pilot Randomized Crossover Study

by Rodrigo Sudatti Delevatti, Fábio Duarte da Silva, Filipe De Lucca Braga, Lucineia Orsolin Pfeifer and Maria Eduarda de Moraes Sirydakis

Int. J. Environ. Res. Public Health 2025, 22(8), 1288; https://doi.org/10.3390/ijerph22081288 - 18 Aug 2025

Abstract

Introduction: There is a lack of knowledge regarding the acute glycemic and blood pressure responses to resistance exercises that involve different amounts of muscle mass. Objective: To analyze the acute effects of single- and multi-joint resistance exercises on glycemic control and blood pressure [...] Read more.

Introduction: There is a lack of knowledge regarding the acute glycemic and blood pressure responses to resistance exercises that involve different amounts of muscle mass. Objective: To analyze the acute effects of single- and multi-joint resistance exercises on glycemic control and blood pressure in individuals with type 2 diabetes (T2DM). Methods: This is a pilot randomized crossover trial, including adults with T2DM of both genders. The participants performed three sessions (two experimental sessions: one with single-joint exercises (SIN) and the other with multi-joint exercises (MULTI); and a control session (CON)) in a randomized order, with outcomes being evaluated pre-exercise, immediately, 15 and 30 min after the sessions. Both sessions consisted of five exercises performed in three sets of 10 to 12 maximum repetitions. Analyses were performed by generalized estimation equations. Results: Fifteen adults (including eleven women) participated in this study. Both experimental sessions showed glycemic reductions immediately after the sessions (MULTI: −17 mg/dL; SIN: −29 mg/dL; p < 0.001), and these values were kept similar up to 30 min after the session. The control session presented a glycemic reduction immediately after the session (−18 mg/dL), which increased 15 min later (−29 mg/dL), stabilizing up to 30 min after the session. Systolic blood pressure was increased immediately after both experimental sessions, retuning to baseline values 15 min post-session. Diastolic blood pressure increased in the control session with time, without any alterations in the experimental sessions. Conclusions: Similar glycemic reductions were found in the experimental sessions, without superiority over the control session. Minimal changes were found in blood pressure. Full article

(This article belongs to the Special Issue New Advances in Diabetes)

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9 pages, 243 KiB

Open AccessArticle

Association of Financial Distress and Monthly Income with Smoking During the COVID-19 Pandemic Recession in Thailand: A Nationwide Cross-Sectional Study

by Chutarat Sathirapanya, Wit Wichaidit, Vijj Kasemsup, Vasin Pipattanachat and Rassamee Chotipanvithayakul

Int. J. Environ. Res. Public Health 2025, 22(8), 1287; https://doi.org/10.3390/ijerph22081287 - 18 Aug 2025

Abstract

(1) Background: Psychological distress causes increased smoking frequency. Thus, financial distress (FD), a type of psychological distress, during the COVID-19 pandemic recession is possibly associated with increased smoking frequency. We studied the association between disrupted employment or earnings-associated FD and the number of [...] Read more.

(1) Background: Psychological distress causes increased smoking frequency. Thus, financial distress (FD), a type of psychological distress, during the COVID-19 pandemic recession is possibly associated with increased smoking frequency. We studied the association between disrupted employment or earnings-associated FD and the number of cigarettes smoked daily, as well as the effects of pre-pandemic regular monthly incomes on the association. (2) Methods: We retrieved the collected data from a former nationwide and community-based study regarding the psycho-socio-economic characteristics of Thai people during the third wave of the COVID-19 pandemic in Thailand in 2021. The participants for this study were current smokers aged ≥ 18 years. General demographics, perceived FD, and pre-pandemic regular monthly incomes were analyzed. Descriptive statistics and multivariate logistic regression with sampling weight adjustments were the analyses used (p < 0.05). (3) Results: 849 current smokers were suitable for statistical analyses. We found that 664 (12.9%) of participants experienced FD, but it did not significantly affect smoking frequency. However, those who had FD and regularly earning ≥ THB 10,000 ($271.11 US) per month was significantly associated with increased daily cigarette use, after adjusting for age and sex (adjusted OR = 2.74; 95% CI = 1.18, 6.37, p = 0.020). (4) Conclusion: FD alone did not affect daily smoking frequency. Understanding the psycho-socio-economic factors is necessary for smoking control during the COVID-19 economic recession. Full article

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