International Journal of Environmental Research and Public Health

18 pages, 824 KB

Open AccessFeature PaperArticle

Emotional and Physical Symptoms Following Intimate Partner Violence Victimization in the United States: Implications for Law and Public Health Policy

by Gia Elise Barboza-Salerno, Karla Shockley McCarthy, Taylor Harrington and Amy Watson-Grace

Int. J. Environ. Res. Public Health 2025, 22(12), 1829; https://doi.org/10.3390/ijerph22121829 - 5 Dec 2025

Abstract

Intimate partner violence (IPV) is a public health issue that produces significant psychological and physiological consequences. This exploratory descriptive study examines whether sustaining a serious injury increases the likelihood that IPV survivors experience emotional and physical symptoms. We analyzed nonfatal violence by an [...] Read more.

Intimate partner violence (IPV) is a public health issue that produces significant psychological and physiological consequences. This exploratory descriptive study examines whether sustaining a serious injury increases the likelihood that IPV survivors experience emotional and physical symptoms. We analyzed nonfatal violence by an intimate partner reported in the U.S. National Crime Victimization Survey (2009–2023) and applied survey-adjusted logistic regression models. We assessed two dichotomous outcomes: (1) whether respondents reported at least one emotional symptom (e.g., vulnerable, violated, distrustful, or unsafe) and (2) whether they reported at least one physical symptom (e.g., headaches, fatigue, or muscle tension). We define serious injury as broken bones, gunshot wounds, internal injuries, or loss of consciousness. We included demographic characteristics (age, race, sex, and educational attainment) as control variables. The results show that IPV survivors who sustained serious injuries had significantly higher odds of reporting both emotional and physical symptoms than those who did not sustain such injuries. These findings underscore how serious injury compounds the burden of IPV and emphasize the need for comprehensive medical, legal, and psychosocial interventions to address its lasting health impacts. Full article

(This article belongs to the Special Issue Public Health Advances in the Recognition and Response to Gender-Based Violence, Sexual Assault, and Domestic Violence)

15 pages, 2980 KB

Open AccessArticle

Impact of the COVID-19 Pandemic on Violence-Related Emergency Visits: Trend, Seasonality, and Interrupted Time-Series Analysis in Peru, 2015–2024

by Claudia Veralucia Saldaña Diaz, Juan Carlos Ezequiel Roque Quezada, Diana Karolina Urbano Sánchez, Víctor Llacsa Saravia and Alberto Gonzales Guzmán

Int. J. Environ. Res. Public Health 2025, 22(12), 1828; https://doi.org/10.3390/ijerph22121828 - 5 Dec 2025

Abstract

Violence is a major public health concern, but long-term hospital-based analyses in Latin America remain scarce. This study examined trends, structural breaks, and seasonality of violence-related emergency visits at the José Casimiro Ulloa Emergency Hospital in Lima, Peru, between 2015 and 2024. A [...] Read more.

Violence is a major public health concern, but long-term hospital-based analyses in Latin America remain scarce. This study examined trends, structural breaks, and seasonality of violence-related emergency visits at the José Casimiro Ulloa Emergency Hospital in Lima, Peru, between 2015 and 2024. A retrospective analysis of 14,570 visits was performed, classifying cases according to the World Health Organization typology into self-inflicted, interpersonal community, and interpersonal family violence. Descriptive statistics were stratified by sex, life stage, migratory status, and pandemic period: pre-pandemic (2015–2019), pandemic (2020–2021), and post-pandemic (2022–2024). Time-series analyses included segmented regression and seasonal-trend decomposition. Males (78.3%), youth, and adults were the most affected groups. Interpersonal community violence accounted for 94.2% of cases and closely mirrored the overall series, peaking at 327 visits in July 2019 and falling to 28 in April 2020. Segmented regression showed significant immediate decreases at the onset of the pandemic (−71.6 visits, p < 0.001) and partial rebounds after 2022. Family violence remained consistently low and stable, while self-inflicted violence displayed a pre-pandemic upward trend, a sharp decline in 2020, and higher post-pandemic levels. Seasonality was evident before 2020, disappeared during the pandemic, and re-emerged with reduced amplitude thereafter. The COVID-19 pandemic caused abrupt but heterogeneous disruptions in violence-related emergency visits in Lima. Full article

(This article belongs to the Section Global Health)

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14 pages, 312 KB

Open AccessArticle

Health and Functioning of Community-Dwelling Older Adults in Urban and Rural Areas of Portugal—What Are the Implications for Physiotherapy Care?

by Magda Reis, Sara Ferreira, Monserrat Conde and Anabela Correia Martins

Int. J. Environ. Res. Public Health 2025, 22(12), 1827; https://doi.org/10.3390/ijerph22121827 - 5 Dec 2025

Abstract

Background: Ageing leads to physical, cognitive, and social changes that affect people’s functioning and social participation. Health literacy, sociodemographic, and environmental factors influence health outcomes and access to care. This study aimed to characterize the health and functioning of Portuguese adults aged 65 [...] Read more.

Background: Ageing leads to physical, cognitive, and social changes that affect people’s functioning and social participation. Health literacy, sociodemographic, and environmental factors influence health outcomes and access to care. This study aimed to characterize the health and functioning of Portuguese adults aged 65 and over, focusing on sociodemographic factors, health status, lifestyle, fall risk, functional capacity, and social participation, and on comparing rural and urban populations. Materials and Methods: An exploratory, cross-sectional study was conducted using data from older adults who completed the FallSensing screening protocol. Participants were classified by residence type (rural vs. urban), and group comparisons were made. Results: The sample (n = 474) was predominantly female (66.5%) with a mean age of 74.62 (±6.49) years. Rural participants were older (76.87 ± 6.89 vs. 73.50 ± 5.87) and had higher body mass index (BMI) (28.32 ± 4.31 vs. 27.51 ± 4.12), lower educational attainment—for example, 22.9% had no formal education compared to 7.0% of urban participants—and a higher prevalence of hypertension (72.6% vs. 55.4%), whereas urban participants experienced higher rates of osteoporosis (24.4% vs. 14.3%), hearing loss (41.9% vs. 26.9%), and alcohol consumption (12.7% vs. 2.3%) (p ≤ 0.05). Rural residents also demonstrated significantly poorer results for grip strength (21.03 ± 7.36 vs. 23.73 ± 8.61), gait speed (1.17 ± 0.44 vs. 1.45 ± 0.39), and the Timed Up and Go (TUG) test (13.4 ± 10.40 vs. 9.62 ± 4.43), as well as lower exercise self-efficacy (12.83 ± 4.97 vs. 14.28 ± 4.40) (p < 0.001), and more pronounced moderate-to-severe restrictions in social participation (28.0% vs. 15.7%) (p = 0.013). They reported greater use of assistive devices and more severe limitations in social participation. Although falls were reported more often in urban areas, rural residents experienced greater fall frequency. Conclusions: These findings suggest that rural living is associated with lower functional capacity and poorer health, underscoring the need for targeted physiotherapy and primary care strategies in rural settings. Full article

(This article belongs to the Special Issue Health Equity and Universal Health Coverage)

4 pages, 210 KB

Open AccessEditorial

Supporting Family Caregivers in an Aging Society: The Need for Comprehensive, Evidence-Based Interventions

by Hanne Konradsen and Zarina Nahar Kabir

Int. J. Environ. Res. Public Health 2025, 22(12), 1826; https://doi.org/10.3390/ijerph22121826 - 5 Dec 2025

Abstract

Globally, the population is aging, representing one of the most significant societal transformations of our time [...] Full article

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

12 pages, 261 KB

Open AccessArticle

Stakeholder Attitudes Toward the Implementation of School-Based, Universal, Mental Health Screening: Student, Caregiver, and Teacher Perspectives

by Ronald M. Rapee, Rebecca-Lee Kuhnert, Ian Bowsher, John Burns, Julie Dixon, Catherine Lourey, Lauren F. McLellan, Traci Prendergast and Viviana Wuthrich

Int. J. Environ. Res. Public Health 2025, 22(12), 1825; https://doi.org/10.3390/ijerph22121825 - 5 Dec 2025

Abstract

This paper reports on data from two trials about stakeholders’ attitudes to school-based mental health screening. Study 1 reports data from 6228 students from grades 4 to 12 while Study 2 reports data from 267 caregivers and 34 educators from a larger trial. [...] Read more.

This paper reports on data from two trials about stakeholders’ attitudes to school-based mental health screening. Study 1 reports data from 6228 students from grades 4 to 12 while Study 2 reports data from 267 caregivers and 34 educators from a larger trial. All three groups of stakeholders reported broadly positive attitudes toward school-based screening. Few students reported distress from questions and most agreed that schools should screen. Caregivers and educators reported positive attitudes toward the use and implementation of screening and reported few concerns about harms. Educators who conducted screening reported mostly positive experiences, although they noted high resource burden and false positives and negatives. Full article

(This article belongs to the Special Issue Mental Health Screening in Schools: Current Methods, Perspectives, and Challenges)

13 pages, 586 KB

Open AccessArticle

Segmental Trunk Control in Sitting Between Full-Term and Preterm Infants Raised in the Orphanage Setting

by Nurul Fauziah Arifin, Wantana Siritaratiwat, Ponlapat Yonglitthipagon, Lugkana Mato, Thiwaphon Chatprem and Noppharath Sangkarit

Int. J. Environ. Res. Public Health 2025, 22(12), 1824; https://doi.org/10.3390/ijerph22121824 - 5 Dec 2025

Abstract

Background: Postural control is vital for independent sitting in infants. Those in orphanages face environmental limitations and biological factors that affect trunk control. This study aimed to compare segmental trunk control between full-term and preterm/low-birth-weight infants and examine the correlations with daily [...] Read more.

Background: Postural control is vital for independent sitting in infants. Those in orphanages face environmental limitations and biological factors that affect trunk control. This study aimed to compare segmental trunk control between full-term and preterm/low-birth-weight infants and examine the correlations with daily activities. Methods: Thirty-three infants (16 full-term, 17 preterm/low birth weight) were assessed using the Segmental Assessment of Trunk Control (SATCo), and 27 were observed with the Daily Activity of Infant Scale (DAIS) over three weekdays and two weekends. Results: A slight significant difference (p < 0.05) in SATCo scores was found, with full-term infants scoring higher. Results found that both prenatal exposure and environmental factors could influence trunk control. A significant correlation (r_s = 0.771, p < 0.001) between trunk control and daily activities underscores the importance of upright and antigravity activities for postural development. A small-to-medium effect size suggested limited practical significance due to being conducted in a single orphanage with a homogeneous sample. Conclusions: The findings emphasize enhancing the orphanage environment and child-rearing practices to support trunk control development through upright posture, movement exploration, and high-quality caregiver interactions. Full article

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18 pages, 2586 KB

Open AccessArticle

Household Clustering of High-Risk Contacts in Smear-Positive TB Patient Families: Evidence for Hotspot Households and Risk Stratification in Rural Eastern Cape

by Hloniphani Guma, Ntandazo Dlatu, Wezile Wilson Chitha, Teke Apalata and Lindiwe Modest Faye

Int. J. Environ. Res. Public Health 2025, 22(12), 1823; https://doi.org/10.3390/ijerph22121823 - 5 Dec 2025

Abstract

Background: Household contacts of smear-positive tuberculosis (TB) patients face an elevated risk of infection and disease progression, particularly young children and individuals living in overcrowded households. Despite WHO recommendations for systematic contact screening and provision of TB preventive therapy (TPT), implementation remains suboptimal [...] Read more.

Background: Household contacts of smear-positive tuberculosis (TB) patients face an elevated risk of infection and disease progression, particularly young children and individuals living in overcrowded households. Despite WHO recommendations for systematic contact screening and provision of TB preventive therapy (TPT), implementation remains suboptimal in high-burden rural areas. This study aimed to develop a practical framework for identifying and prioritizing high-risk families by examining demographic predictors, household clustering, and machine learning-based risk models. Methods: A total of 437 household contacts linked to smear-positive index cases were assessed and classified as high or low risk. Statistical analyses included descriptive measures, χ² tests, Z-tests for age-group differences, and multivariable logistic regression. Household-level vulnerability patterns were explored using network visualizations, clustered heatmaps, and risk-ranking charts. Three machine learning models, logistic regression, random forest, and gradient boosting, were trained using demographic and household variables with 5-fold cross-validation and an 80/20 hold-out test split. Model performance was evaluated using the AUROC, AUPRC, accuracy, F1-score, calibration curves, and decision curve analysis. Results: Of the 437 contacts, 290 (66.4%) were classified as high risk. A younger age was strongly associated with high-risk status (χ² = 16.61, p = 0.005), with children aged 0–4 years being significantly more likely to be in a high-risk category (Z = 2.706). Gender showed no significant association (p = 0.523). Logistic regression identified younger age (aOR = 2.41, 95% CI: 1.48–3.94) and larger household size (aOR = 1.12 per additional member, 95% CI: 1.01–1.25) as independent predictors of the outcome. Visual analytics revealed apparent clustering of high-risk individuals within “hotspot families,” enabling prioritization through composite risk scores. Gradient boosting achieved the strongest performance (AUROC = 0.65; AUPRC = 0.76), with acceptable calibration (Brier score = 0.21) and a positive net clinical benefit in the decision curve analysis. Conclusions: TB risk is highly clustered at the household level, with large families and young children carrying disproportionate vulnerability. Combining demographic risk assessment, household-level visualization, and predictive modeling provides a practical, data-driven approach to prioritizing households during contact investigation. These findings support the WHO’s family-centered strategy and underscore the need to strengthen clinical governance and community-engaged education to optimize TB prevention in resource-limited rural settings. Full article

(This article belongs to the Section Global Health)

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15 pages, 1272 KB

Open AccessReview

Illness Among Mental Health Service Workers and Its Repercussions: A Scoping Review

by José Mateus Bezerra da Graça, José Adelmo da Silva Filho, Eslia Maria Nunes Pinheiro, Rosiane Davina da Silva, José Benedito dos Santos Batista Neto and Elisângela Franco de Oliveira Cavalcante

Int. J. Environ. Res. Public Health 2025, 22(12), 1822; https://doi.org/10.3390/ijerph22121822 - 5 Dec 2025

Abstract

Various structural, organizational, and subjective factors contribute to psychological distress, exacerbated by adverse working conditions in mental health services and resulting in significant impacts on workers’ health. This study aims to map the existing literature on work-related factors and consequences associated with the [...] Read more.

Various structural, organizational, and subjective factors contribute to psychological distress, exacerbated by adverse working conditions in mental health services and resulting in significant impacts on workers’ health. This study aims to map the existing literature on work-related factors and consequences associated with the illness of mental health service workers. A scoping review was conducted following the PRISMA-ScR guidelines. The review question was formulated based on the population, concept, and context framework. Searches were performed in eight electronic databases, and the findings were synthesized in synoptic tables. A total of 28 studies were included, addressing factors encompassing structural, organizational, and procedural aspects of the work environment, as well as social and relational elements involving the healthcare team, users, and their families, all contributing to workers’ illness. The main challenges identified include work overload, excessive working hours, inadequate physical infrastructure, insufficient supplies, understaffing, lack of managerial support, and exposure to physical, biological, chemical, and ergonomic risks. The analysis of work-related factors in mental health services reveals a concerning scenario of physical, emotional, and mental strain among professionals. Full article

(This article belongs to the Section Health Care Sciences)

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1 pages, 177 KB

Open AccessRetraction

RETRACTED: Chou et al. Muscle Damage and Performance After Single and Multiple Simulated Matches in University Elite Female Soccer Players. Int. J. Environ. Res. Public Health 2021, 18, 4134

by Tai-Ying Chou, Kazunori Nosaka and Trevor C. Chen

Int. J. Environ. Res. Public Health 2025, 22(12), 1821; https://doi.org/10.3390/ijerph22121821 - 5 Dec 2025

Abstract

The journal retracts the article titled “Muscle Damage and Performance after Single and Multiple Simulated Matches in University Elite Female Soccer Players” [...] Full article

17 pages, 462 KB

Open AccessReview

The Environmental Determinants of Skin Health: Linking Climate Change, Air Pollution, and the Dermatologic Disease Burden

by Tarek Zieneldien, Sophia Ma, Isabella J. Tan, Janice Kim, Daniel Busot and Bernard A. Cohen

Int. J. Environ. Res. Public Health 2025, 22(12), 1820; https://doi.org/10.3390/ijerph22121820 - 4 Dec 2025

Abstract

Climate change has a widespread impact on health across the continuum, influencing skin disease patterns, access to dermatologic care, and the burden of climate-sensitive conditions. Environmental changes driven by climate change impact the skin’s ability to maintain homeostasis, contributing to the onset and [...] Read more.

Climate change has a widespread impact on health across the continuum, influencing skin disease patterns, access to dermatologic care, and the burden of climate-sensitive conditions. Environmental changes driven by climate change impact the skin’s ability to maintain homeostasis, contributing to the onset and exacerbation of various dermatologic diseases. Psoriasis, acne vulgaris, atopic dermatitis, photoaging, melasma, and skin cancers have been associated with repeated exposure to rising levels of pollutants. Furthermore, the depletion of the stratospheric ozone layer has contributed to an elevated risk of developing skin cancer—including melanoma, basal cell carcinoma, and squamous cell carcinoma—due to increased exposure to ultraviolet radiation. Notably, while melanoma is linked to intense, intermittent UV exposure and sunburns, basal cell and squamous cell carcinomas are more strongly associated with cumulative or chronic sun exposure over a lifetime. According to the World Health Organization, air pollution contributes to more than 700,000 premature deaths each year, and a 1% decrease in ozone thickness corresponds with a 2% rise in melanoma incidence. This review also identifies research gaps, such as limited longitudinal studies, underrepresentation of pediatric and elderly populations, and limited exploration of nitrosative stress mechanisms. Due to these factors, practitioners should be aware of both the current and projected impacts of climate change in their regions to effectively identify and manage associated conditions and exacerbations. Full article

(This article belongs to the Special Issue Advancing One Health Approaches for Health Promotion and Disease Prevention: Transdisciplinary Perspectives)

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10 pages, 406 KB

Open AccessReview

Post-Cessation Weight Gain Across Smoking Cessation Therapies: A Review of Secondary Analyses from the ZESCA, EVITA, and E3 Trials

by Audrey Lelièvre, Tetiana Zolotarova and Mark J. Eisenberg

Int. J. Environ. Res. Public Health 2025, 22(12), 1819; https://doi.org/10.3390/ijerph22121819 - 4 Dec 2025

Abstract

Background: Post-cessation weight gain is a barrier to smoking abstinence, yet evidence on the role of e-cigarettes in mitigating this remains limited. Objective: To examine weight-related effects of e-cigarettes in comparison with established cessation methods. Methods: We reviewed data from three cessation trials [...] Read more.

Background: Post-cessation weight gain is a barrier to smoking abstinence, yet evidence on the role of e-cigarettes in mitigating this remains limited. Objective: To examine weight-related effects of e-cigarettes in comparison with established cessation methods. Methods: We reviewed data from three cessation trials we conducted between 2005 and 2020. In ZESCA and EVITA, patients were randomized to bupropion or varenicline versus placebo. In the E3 trial, participants were randomized to counseling alone or with nicotine or non-nicotine e-cigarettes. Post hoc analyses assessed weight at 52 weeks for bupropion and varenicline, and 12 weeks for e-cigarettes. Synthesis: Abstinent individuals showed significant weight gain from baseline across the trials. In ZESCA and EVITA, abstinent participants gained more weight than intermittent and persistent smokers at 52 weeks (ZESCA: 4.8 vs. 2.0 vs. 3.0 kg, EVITA: 4.8 vs. 2.0 vs. −0.7 kg, respectively). Abstinent individuals gained more weight than persistent smokers (ZESCA: 3.4 kg, EVITA: 5.5 kg). In the E3 trial, abstinent participants with nicotine e-cigarettes gained more weight than those using non-nicotine e-cigarettes or counseling at 12 weeks (2.7 vs. 2.3 vs. 2.1 kg, respectively). Conclusions: Abstinent individuals experienced significant weight gain regardless of cessation treatment. Long-term effects of e-cigarettes on weight remain unclear. Full article

15 pages, 1262 KB

Open AccessArticle

Real-Life Assessment of Multi-Pollutant Exposure and Its Impact on the Ocular Surface: The Bike-Eye Pilot Study on Urban Cyclists in Bologna

by Roberto Battistini, Natalie Di Geronimo, Emanuele Porru, Valeria Vignali, Andrea Simone, Suzanne Clougher, Silvia Odorici, Francesco Saverio Violante, Luigi Fontana and Piera Versura

Int. J. Environ. Res. Public Health 2025, 22(12), 1818; https://doi.org/10.3390/ijerph22121818 - 4 Dec 2025

Abstract

Background: Urban air pollution, particularly fine particulate matter (PM2.5 and PM10), poses health risks, including damage to the ocular surface. This pilot study (BIKE-EYE) aimed to assess ocular exposure to airborne pollutants during bicycle commuting and to evaluate particle presence in human [...] Read more.

Background: Urban air pollution, particularly fine particulate matter (PM2.5 and PM10), poses health risks, including damage to the ocular surface. This pilot study (BIKE-EYE) aimed to assess ocular exposure to airborne pollutants during bicycle commuting and to evaluate particle presence in human tear fluid. Methods: Fifteen healthy volunteers wore portable sensors measuring PM2.5 and PM10 during daily bike commutes over six months. Exposure was calculated as time-weighted integrals over the ten days preceding an ophthalmologic exam assessing conjunctival hyperemia, epithelial damage, tear film quality, and meibomian gland function. Ocular symptoms were assessed via the Ocular Surface Disease Index (OSDI). Tear samples were analyzed using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS). Results: Higher pollutant exposure was significantly associated with conjunctival hyperemia and corneal epithelial damage, while temperature and humidity showed no effect. OSDI scores moderately correlated with PM levels. SEM/EDS analysis confirmed airborne particles in post-exposure tear samples, including carbonaceous material, aluminosilicates, iron, and sulfur compounds. Conclusions: Ocular surface alterations and conjunctival hyperemia were significantly associated with air pollution exposure, while subjective symptoms showed weaker trends. The detection of particulate matter in human tear fluid supports the use of the ocular surface as a sensitive, non-invasive tool for biomonitoring. These findings highlight its potential role in early warning systems for pollution-related health effects, with implications for public health surveillance and urban planning. Full article

(This article belongs to the Section Environmental Health)

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23 pages, 816 KB

Open AccessArticle

Urban Housing and Hypertension Among Women in India: Comparing Slum and Non-Slum Contexts Using National Survey Data

by Uchita Vaid and Wanting Jiang

Int. J. Environ. Res. Public Health 2025, 22(12), 1817; https://doi.org/10.3390/ijerph22121817 - 4 Dec 2025

Abstract

Housing conditions are increasingly recognized as critical determinants of non-communicable diseases; however, their influence on hypertension (HTN) risk remains underexplored in low- and middle-income countries. In urban India, structural disparities in housing are especially pronounced between slum and non-slum areas, making comparative analysis [...] Read more.

Housing conditions are increasingly recognized as critical determinants of non-communicable diseases; however, their influence on hypertension (HTN) risk remains underexplored in low- and middle-income countries. In urban India, structural disparities in housing are especially pronounced between slum and non-slum areas, making comparative analysis crucial for understanding context-specific health risks. This study examines the relationship between multidimensional housing conditions and HTN risk among women aged 18–49, drawing on data from 68,422 respondents in the fourth National Family Health Survey. A composite housing index was developed to capture six dimensions: structural quality, housing services access, indoor air quality, crowding, tenure security, and asset ownership. Survey-weighted logistic regressions were used to assess associations between housing conditions and HTN, controlling for key socio-demographic and health-related factors. We found that overall HTN prevalence was lower in slum households (11.6%) than in non-slum households (16.0%). Unexpectedly, slum households reported better structural durability and indoor air quality than non-slum households, suggesting incremental improvements in notified or tenure-secure slums. Better tenure security and asset ownership were found to be protective factors for HTN risk, while better structural quality was associated with higher HTN odds in non-slum areas. Crowding showed contrasting effects: in slums, higher crowding increased HTN risk, whereas in non-slums, lower crowding was associated with higher HTN. These findings highlight the context-dependent nature of housing-health links. Targeted interventions that address both physical infrastructure and broader living conditions can play a vital role in reducing urban hypertension disparities among women in India. Full article

(This article belongs to the Special Issue Advancing Environmental Health in Urban Areas)

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17 pages, 500 KB

Open AccessArticle

Travel Distance and Its Impact on Wait Time for Positron Emission Tomography–Computed Tomography in Patients with Cancers

by Dat T. Tran, Xiaoxiao Liu, Alka B. Patel, Rizwan Shahid and Maki Ueyama

Int. J. Environ. Res. Public Health 2025, 22(12), 1816; https://doi.org/10.3390/ijerph22121816 - 4 Dec 2025

Abstract

To examine travel distance and its impact on wait time for positron emission tomography–computed tomography (PET/CT) in patients with lung and prostate cancers and lymphoma in Alberta. We used the Alberta cancer registry and diagnostic imaging database to identify patients with lung and [...] Read more.

To examine travel distance and its impact on wait time for positron emission tomography–computed tomography (PET/CT) in patients with lung and prostate cancers and lymphoma in Alberta. We used the Alberta cancer registry and diagnostic imaging database to identify patients with lung and prostate cancers and lymphoma who had a PET/CT scan during April 2017 and March 2023. The Alberta Facilities Distance/Time Look Up Table was used to calculate travel distance from the patient’s residence to the PET/CT facility. Negative binomial regression was used to assess the association between travel distance and wait time for PET/CT. The study included 9503 patients. Lung cancer accounted for 43.4% of the patients, followed by lymphoma (37.1%) and prostate (19.5%) cancer. There were more female patients with lung cancer (55.5%) than lymphoma (42.9%; p < 0.001). The mean (SD) age was 66.8 (13.8) years and lymphoma patients were younger (59.6 years) than lung (70.3 years; p < 0.001) or prostate (72.7 years; p < 0.001) cancer patients. Diabetes (14.2%) was the most prevalent comorbidity. The median (IQR) travel distance was 21 (12–121) km and this was shorter for urban (16 km) than rural (148 km; p < 0.001) patients, but the wait time was similar (median = 20 vs. 21 days; p = 0.378). There were no significant associations between travel distance and wait time (IRR = 1.00; p = 0.108). The results were robust in subgroup analyses by type of cancer and scan priority. There were no associations between travel distance and wait time for PET/CT. Additional research is warranted to examine the potential impact of longer travel distances on overall access to care and patient outcomes. Full article

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13 pages, 710 KB

Open AccessArticle

Behavioral and Sociodemographic Predictors of Diabetes Among Non-Hispanic Multiracial Adults in the United States: Using the 2023 Behavioral Risk Factor Surveillance System

by Ermias Turuse, Sherli Koshy-Chenthittayil, Amy E. L. Stone, Edom Gelaw and Courtney Coughenour

Int. J. Environ. Res. Public Health 2025, 22(12), 1815; https://doi.org/10.3390/ijerph22121815 - 4 Dec 2025

Abstract

Background: Diabetes disproportionately affects U.S. subgroups, yet non-Hispanic multiracial adults are underrepresented in epidemiologic studies. This study aimed to examine behavioral and sociodemographic predictors of diabetes in this population. Methods: We analyzed data from the 2023 Behavioral Risk Factor Surveillance System (BRFSS) using [...] Read more.

Background: Diabetes disproportionately affects U.S. subgroups, yet non-Hispanic multiracial adults are underrepresented in epidemiologic studies. This study aimed to examine behavioral and sociodemographic predictors of diabetes in this population. Methods: We analyzed data from the 2023 Behavioral Risk Factor Surveillance System (BRFSS) using a cross-sectional design that incorporated survey weights, strata, and primary sampling units. Binary logistic regression was employed to identify predictors of diabetes, including variables with p ≤ 0.20 from bivariate models in the multivariable analysis. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. Results: The study included a total of 6429 participants. Obesity (AOR = 4.16; 95% CI: 3.33, 33.23), being overweight (AOR = 2.05; 1.62, 2.60), poor general health (AOR = 2.82; 2.38, 38.35), age ≥ 65 years (AOR = 3.08; 2.60, 3.65), male sex (AOR = 1.34; 1.15, 1.58), and health insurance (AOR = 2.14; 1.35, 3.61) were associated with higher odds of diabetes. Physical activity (AOR = 0.76; 0.64, 0.90) and alcohol consumption (AOR = 0.55; 0.47, 47.65) were linked to lower odds of diabetes. Smoking status showed no significant association after adjustment. Conclusions: In non-Hispanic multiracial adults, factors such as adiposity and older age increased the risk of diabetes, while physical activity and alcohol consumption offered protective benefits. These findings indicate that current diabetes prevention strategies are applicable to this subgroup, and public health initiatives should prioritize their inclusion in outreach, screening, and intervention efforts. Full article

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14 pages, 285 KB

Open AccessArticle

Knowledge and Preventive Practices Toward COVID-19 Among Sex Workers in Chiang Mai, Thailand

by Sameen Ashfaq, Kriengkrai Srithanaviboonchai, Patumrat Sripan, Arunrat Tangmunkongvorakul and Natthapol Kosashunhanan

Int. J. Environ. Res. Public Health 2025, 22(12), 1814; https://doi.org/10.3390/ijerph22121814 - 3 Dec 2025

Abstract

Sex workers were disproportionately affected by the COVID-19 pandemic due to precarious working conditions. This cross-sectional study was conducted in 2022 among 264 sex workers in Chiang Mai, Thailand, during the transition to the endemic phase, to evaluate their COVID-19 knowledge and preventive [...] Read more.

Sex workers were disproportionately affected by the COVID-19 pandemic due to precarious working conditions. This cross-sectional study was conducted in 2022 among 264 sex workers in Chiang Mai, Thailand, during the transition to the endemic phase, to evaluate their COVID-19 knowledge and preventive practices. Face-to-face interviews were used. Descriptive statistics were used to describe sample characteristics. Factors associated with knowledge and preventive practices were identified using the Mann–Whitney U test or Kruskal–Wallis test as appropriate. Independent factors associated with preventive practices were assessed through linear regression. The median scores for knowledge and preventive practices were 10 (interquartile range (IQR) = 9–10) and 5 (IQR = 3–5), respectively. In univariate analysis, females scored higher in knowledge than males. For preventive practices, females vs. males, older vs. younger, heterosexual vs. homosexual/bisexual, longer vs. shorter career, worked in massage parlors vs. pubs/bars, and having child vs. none showed higher rates. In multivariate analysis, being male (β = −1.87; 95%CI; −0.87 to −0.88) and single (β = −1.15; 95%CI; −2.28 to −0.02) were independent predictors of lower rates of preventive practices. Despite having good knowledge, certain groups of sex workers’ COVID-19 preventive behaviors remain inadequate, emphasizing the need for targeted interventions to enhance pandemic preparedness. Full article

(This article belongs to the Section Global Health)

17 pages, 326 KB

Open AccessArticle

I Don’t Really Know Much About PrEP: Examining Black HBCU Women’s Pre-Exposure Prophylaxis Knowledge and Awareness

by Marissa N. Robinson, Brittany M. Williams, Gloria Aidoo-Frimpong, Reginald A. Blockett, Calvin R. Lowery, Michelle Sandoval-Rosario and Rasheeta Chandler

Int. J. Environ. Res. Public Health 2025, 22(12), 1813; https://doi.org/10.3390/ijerph22121813 - 3 Dec 2025

Abstract

Despite HIV/AIDS disproportionately impacting Black women in the United States, HIV knowledge, awareness, and uptake of prevention efforts like pre-exposure prophylaxis (PrEP) have been limited for this community. Since campus leaders can maintain the attention of Black college women for a sustained period, [...] Read more.

Despite HIV/AIDS disproportionately impacting Black women in the United States, HIV knowledge, awareness, and uptake of prevention efforts like pre-exposure prophylaxis (PrEP) have been limited for this community. Since campus leaders can maintain the attention of Black college women for a sustained period, they are an ideal demographic for PrEP interventions. Accordingly, the purpose of this study was to assess the awareness and knowledge of PrEP among Black Historically Black Colleges and University (HBCU) women, informing future possibilities and strategies for PrEP interventions and uptake. The lead author employed a descriptive, qualitative approach to collect data from five focus groups of Black HBCU women. Within this, the authors examined Black HBCU women’s PrEP knowledge and awareness in their own words and on their own terms. The results revealed that Black HBCU women have notable gaps in knowledge and limited awareness about PrEP and sexual health, with some assuming PrEP is only for men who have sex with men (MSM). Others believed it was used to manage an existing HIV diagnosis. Given that these participants perceived PrEP as primarily for MSMs, there is a clear gap in public health practice. Therefore, it is essential to focus future HIV prevention efforts on college-aged Black women by exploring their perspectives and considering how institutions like student activities, Greek Life, and campus health services can contribute to PrEP education for HIV prevention. Full article

(This article belongs to the Special Issue Women and Pre-Exposure Prophylaxis for HIV Prevention)

19 pages, 698 KB

Open AccessArticle

Evaluation of Childhood Atopic Dermatitis and Environmental Factors in Turkey with Decision Tree Model

by Nesrullah Ayşin, Mehmet Bulduk, Veysel Can, Eda Nur Muhafiz, Bahattin Bulduk and Emine Kurt Can

Int. J. Environ. Res. Public Health 2025, 22(12), 1812; https://doi.org/10.3390/ijerph22121812 - 2 Dec 2025

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Abstract

Objective: This study aims to examine the relationship between atopic dermatitis (AD), one of the most common dermatological conditions in children, and environmental factors, including meteorological variables and air pollution. Methods: This retrospective cross-sectional study analyzed the medical records of 21,407 pediatric patients [...] Read more.

Objective: This study aims to examine the relationship between atopic dermatitis (AD), one of the most common dermatological conditions in children, and environmental factors, including meteorological variables and air pollution. Methods: This retrospective cross-sectional study analyzed the medical records of 21,407 pediatric patients aged 0 to 18 years who presented to the city hospital in Agri, Turkey, between 2020 and 2024. Admission dates were matched with meteorological data (wind speed, atmospheric pressure, humidity, temperature) and air pollution indicators (PM₁₀, SO₂, NO₂, NOx, NO, O₃). Statistical analyses included t-tests, correlation analyses, binary logistic regression, and a CHAID decision tree model. Results: AD accounted for 10.1% of all dermatology-related visits. AD admissions increased particularly during the first half of the year and were significantly associated with higher O₃ levels, whereas increased PM₁₀ levels were associated with a lower likelihood of AD admissions. Logistic regression showed that age, sex, semiannual period, atmospheric pressure, PM₁₀, and O₃ were significant predictors of AD. The decision tree model identified age, period, and O₃ as the strongest discriminating variables for AD. Conclusion: AD was found to be more sensitive to environmental and seasonal variations compared with other dermatitis types. In particular, elevated ozone levels and temporal factors played a notable role in increasing AD presentations. These findings may inform environmental risk management and preventive strategies for children with AD. Full article

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16 pages, 1755 KB

Open AccessArticle

Application of Computational Simulation for Occupational Safety Assessment in a Psychiatric Hospital

by Ruan Lucas, Carmen Riascos, Eugenio Merino and Jader Borges

Int. J. Environ. Res. Public Health 2025, 22(12), 1811; https://doi.org/10.3390/ijerph22121811 - 2 Dec 2025

Viewed by 112

Abstract

Psychiatric hospitals present occupational hazards, with patients’ unexpected behaviors constituting a unique factor that makes the safety climate crucial for preventing injuries and ensuring a healthy work environment. In this context, this study analyzed occupational injuries and safety conditions in a psychiatric hospital [...] Read more.

Psychiatric hospitals present occupational hazards, with patients’ unexpected behaviors constituting a unique factor that makes the safety climate crucial for preventing injuries and ensuring a healthy work environment. In this context, this study analyzed occupational injuries and safety conditions in a psychiatric hospital in southern Brazil, employing system dynamics (SD)-based computational simulation as a decision-support tool. The study was carried out in five stages: definition of the case study; collection and descriptive analysis of injury data; development of safety indicators; SD modeling and simulation; and model validation through sensitivity analysis. The simulation results indicated that: (i) a 10% increase in personal protective equipment (PPE) usage reduced perceived risk to 76.48%; (ii) a 25% increase in patients’ unexpected behaviors resulted in six additional injuries; and (iii) standardizing 50% of activities could prevent seven injuries per year. The findings suggest that computational simulation enhances analytical capacity and demonstrate that the safety climate is directly influenced by mitigating occupational risks, implementing standardized internal procedures, training personnel, and establishing effective safety indicators. Full article

(This article belongs to the Special Issue Health-Related Risk Caused by Occupational Environmental Exposure)

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15 pages, 305 KB

Open AccessArticle

Assessment of Quality of Life in the Early Postoperative Period in Patients with Lung Cancer

by Stana Pačarić, Tajana Turk, Ivan Erić, Marko Babić, Suzana Luketić, Nika Srb, Andrea Milostić Srb, Anamarija Petek Erić and Mario Duvnjak

Int. J. Environ. Res. Public Health 2025, 22(12), 1810; https://doi.org/10.3390/ijerph22121810 - 30 Nov 2025

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Abstract

Measuring quality of life (QoL) in patients with early-stage lung cancer is an important aspect of treatment success. This study assessed QoL in the early postoperative period in patients with lung cancer, with regard to the type of cancer. This single-center study was [...] Read more.

Measuring quality of life (QoL) in patients with early-stage lung cancer is an important aspect of treatment success. This study assessed QoL in the early postoperative period in patients with lung cancer, with regard to the type of cancer. This single-center study was conducted on 64 patients who underwent surgery for non-small cell (NSCLC) and small cell (SCLC) lung cancer. Quality of life questionnaires (QLQs) of the European Organization for Research and Treatment of Cancer (EORTC) were used. The EORTC QLQ-C30 questionnaire assesses the quality of life of cancer patients, and the EORTC QLQ-LC13 questionnaire is a lung cancer module. In the group of patients with NSCLC, the general health status (p < 0.001), physical functioning (p = 0.004), emotional functioning (p = 0.005) and total functional scale (p = 0.01) were significantly better assessed, fatigue was less pronounced (p = 0.005), nausea/vomiting (p = 0.04), pain (p = 0.004), breathing difficulties were less pronounced (p = 0.03), loss of appetite was less pronounced (p = 0.005), and the symptom scale was significantly less pronounced (p = 0.002) compared to patients with SCLC. In the QLQ-LC13 symptom scale, SCLC patients had more cough (p = 0.02), dyspnea (p = 0.03), dysphagia (p = 0.005), peripheral neuropathy (p = 0.04), chest pain (p < 0.001), arm or shoulder pain (p < 0.001), and pain in other parts of the body (p = 0.005) compared to NSCLC patients. Patients with NSCLC evaluated the functioning scales better and had less pronounced symptoms on the symptom scale, while patients with SCLC evaluated the treatment symptoms worse on the symptom scale, especially the symptom of pain, which had an impact on the quality of life of the patients. The results of this study could contribute to raising public awareness about the quality of life of lung cancer patients. Full article

(This article belongs to the Special Issue Exploring Quality of Life in Nursing and Patient Care)

16 pages, 796 KB

Open AccessArticle

Adaptation and Validation of the Brazilian Portuguese Version of the Mental Health Knowledge Schedule (MAKS-BR) in the Context of Primary Health Care

by Larissa Moraes Moro, Vinícius Perinetto Pontel, Clarissa Pinto Pizarro de Freitas, Adriane Xavier Arteche and Kátia Bones Rocha

Int. J. Environ. Res. Public Health 2025, 22(12), 1809; https://doi.org/10.3390/ijerph22121809 - 30 Nov 2025

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Abstract

This study aimed to translate the Mental Health Knowledge Schedule (MAKS) to Brazilian Portuguese, adapt it to the Brazilian primary health care context, and evaluate its psychometric properties. The adaptation process involved three stages: translation, back-translation, and peer-group evaluation. To achieve a valid [...] Read more.

This study aimed to translate the Mental Health Knowledge Schedule (MAKS) to Brazilian Portuguese, adapt it to the Brazilian primary health care context, and evaluate its psychometric properties. The adaptation process involved three stages: translation, back-translation, and peer-group evaluation. To achieve a valid and reliable instrument, the Brazilian Portuguese version of the questionnaire (MAKS-BR) was administered through an anonymous, online self-administered questionnaire to a convenience sample of 289 primary care professionals with a mean age of 39.6 years (SD = 9.6 years), 90% of whom were women. The instrument, in its final 11-item model, presented satisfactory fit and comparative indices with a two-factor model. The first factor aggregates items related to mental health knowledge, while the second included items related to recognition and familiarity with various mental health conditions. The network findings support the discriminant validity of the two dimensions, while also underscoring the integrative nature of mental health literacy, in which knowledge and recognition processes are interconnected yet functionally distinct. Our findings suggest that the MAKS is an adequate instrument for assessing mental health knowledge, considering the linguistic and cultural contexts of Brazil. Full article

(This article belongs to the Special Issue Mental Health Services in Primary Care Settings: Challenges, Opportunities and Best Practices)

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16 pages, 558 KB

Open AccessArticle

Maternal Coffee Consumption During Pregnancy and Attention-Deficit/Hyperactivity Disorder in Offspring: A Case–Control Study and Meta-Analysis

by Ahmed Arafa, Amira S. A. Said, Ehab Elkady, Tarig A. Y. Ali and Doaa Mahmoud Khalil

Int. J. Environ. Res. Public Health 2025, 22(12), 1808; https://doi.org/10.3390/ijerph22121808 - 30 Nov 2025

Viewed by 294

Abstract

Background: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder. Maternal diet can influence fetal neurodevelopment, and coffee is widely consumed during pregnancy and may have adverse effects on fetal development. This study aimed to investigate the association between maternal coffee consumption during pregnancy [...] Read more.

Background: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder. Maternal diet can influence fetal neurodevelopment, and coffee is widely consumed during pregnancy and may have adverse effects on fetal development. This study aimed to investigate the association between maternal coffee consumption during pregnancy and ADHD risk in offspring. Methods: First, we conducted a case–control study in Egypt, enrolling 176 mothers of children with ADHD and 504 mothers of typically developing children. ADHD was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for ADHD associated with frequent maternal coffee consumption during pregnancy. Then, we combined the results of this case–control study with those from prior studies in a meta-analysis. Between-study heterogeneity was assessed using the I² statistic, and publication bias was evaluated by Egger’s regression test. Results: In the case–control study, frequent maternal coffee consumption during pregnancy was associated with a higher risk of ADHD in offspring (OR = 1.85; 95% CI: 1.17, 2.92). This association persisted after additional adjustments for antenatal, natal, and neonatal factors (OR = 1.82; 95% CI: 1.07, 3.09). Consistently, the meta-analysis showed a higher risk of ADHD associated with maternal coffee consumption during pregnancy (n = 7, OR = 1.33; 95% CI: 1.13, 1.57), with no between-study heterogeneity (I² = 8.89%, p = 0.36) or publication bias (z = 0.10, p = 0.92). Conclusions: Both our case–control study and meta-analysis suggest that higher maternal coffee consumption during pregnancy may increase the risk of ADHD in children. Still, prospective cohort studies with objective caffeine biomarkers are needed to clarify causality and determine safe exposure levels. Full article

(This article belongs to the Special Issue Nutritional Epidemiology and Public Health: Promoting Population Health and Diseases Prevention Through Dietary Research)

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33 pages, 881 KB

Open AccessReview

Global Health Governance and the WHO Pandemic Agreement: A Scoping Review of Challenges and Analysis of Reforms

by Kadria Ali Abdel-Motaal, Wafa Abu El Kheir-Mataria and Sungsoo Chun

Int. J. Environ. Res. Public Health 2025, 22(12), 1807; https://doi.org/10.3390/ijerph22121807 - 30 Nov 2025

Viewed by 180

Abstract

Background: The COVID-19 pandemic exposed persistent weaknesses in global health governance, particularly in preparedness, equity, and accountability. The WHO Pandemic Agreement, adopted in May 2025, aims to address these systemic gaps through a binding international framework. Objective: To identify key challenges in global [...] Read more.

Background: The COVID-19 pandemic exposed persistent weaknesses in global health governance, particularly in preparedness, equity, and accountability. The WHO Pandemic Agreement, adopted in May 2025, aims to address these systemic gaps through a binding international framework. Objective: To identify key challenges in global pandemic preparedness and health governance reported in the literature (2019–2024) through a systematic scoping review, and to evaluate how these challenges are addressed in the provisions of the WHO Pandemic Agreement via qualitative document analysis. Methods: Using Joanna Briggs Institute methodology and PRISMA-ScR guidelines, we systematically identified and thematically analyzed 52 peer-reviewed studies published between 2020 and 2024. The thematic results informed a qualitative document analysis of the WHO Pandemic Agreement text to assess the extent to which its provisions address the identified challenges. Results: Persistent gaps in governance (limited enforceability, fragmented coordination), equity (inequitable access to medical countermeasures), capacity (technology transfer and financing), and accountability were identified. Health systems in low- and middle-income countries continue to face critical resource constraints and lack robust mechanisms to ensure accountability and continuous learning. Document analysis showed the WHO Pandemic Agreement addresses coordination and financing but offers limited advances in enforcement, technology transfer, and independent monitoring. Conclusion: The WHO Pandemic Agreement introduces important institutional and financing measures, but persistent gaps remain in enforcement, technology transfer, and inclusive implementation. Strengthening these domains is crucial to achieving equitable and resilient preparedness. By systematically linking evidence from the pandemic preparedness literature to Treaty provisions, this study offers a novel analytical framework for assessing how global health treaties respond to research-identified challenges. Full article

(This article belongs to the Section Global Health)

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25 pages, 819 KB

Open AccessArticle

Psychoactive Substance Use and Its Association with Mental Health Symptomatology Among Latvian Medical Students: A Cross-Sectional Study

by Warnakulasuriya S. A. V. Fernando, Aviad David, Nicolo Cianci, Anastasija Sevcenko, Jelena Vrublevska, Elmars Rancans and Lubova Renemane

Int. J. Environ. Res. Public Health 2025, 22(12), 1806; https://doi.org/10.3390/ijerph22121806 - 30 Nov 2025

Viewed by 317

Abstract

Medical students are at elevated risk for psychoactive substance use and mental health challenges due to academic pressures and environmental stressors. This study aimed to determine the prevalence and trends of psychoactive substance use among medical students at Riga Stradins University (RSU) and [...] Read more.

Medical students are at elevated risk for psychoactive substance use and mental health challenges due to academic pressures and environmental stressors. This study aimed to determine the prevalence and trends of psychoactive substance use among medical students at Riga Stradins University (RSU) and to examine associations with symptoms of anxiety, depression, and resilience to stress. A bilingual, anonymous cross-sectional study was conducted using a SurveyMonkey-hosted questionnaire. The survey included a socio-demographic questionnaire, the Generalized Anxiety Disorder Questionnaire-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), the Brief Resilience Scale (BRS), and the World Health Organization Alcohol, Smoking, and Substance Involvement Screening Test (WHO ASSIST V3.1). A total of 559 RSU medical students participated (response rate: 31.8%). Lifetime substance use prevalence was highest for caffeine 98.7%, alcohol 93.9%, tobacco 68.4%, and cannabis 50.9%. High-risk use was noted for tobacco 6.8%, inhalants 4.2%, cocaine 3.6%, and alcohol 1.4%. Significant differences in total substance use were observed by gender (p = 0.006) and depression symptom severity by PHQ-9 (p < 0.001), which were predictors of the total involvement score. The findings suggest that further attention to mental health and substance use patterns among medical students may be beneficial for student well-being and professional development. Full article

(This article belongs to the Special Issue Substance Use Research Methods: Ethics, Culture, and Health Equity)

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16 pages, 1715 KB

Open AccessStudy Protocol

Greening Schoolyards to Improve Child Health: A Quasi-Experimental Study Protocol in Belgian and Dutch Primary Schools

by Bo H. W. van Engelen, Lore Verheyen, Bjorn Winkens, Michelle Plusquin, Robert Malina and Onno C. P. van Schayck

Int. J. Environ. Res. Public Health 2025, 22(12), 1805; https://doi.org/10.3390/ijerph22121805 - 29 Nov 2025

Viewed by 152

Abstract

Background: Childhood obesity and mental health problems are major public health concerns worldwide. Early-life exposure to green spaces has been shown to promote physical activity, reduce obesity risk, and improve cognitive and emotional development. Schoolyards offer a unique opportunity to promote health, as [...] Read more.

Background: Childhood obesity and mental health problems are major public health concerns worldwide. Early-life exposure to green spaces has been shown to promote physical activity, reduce obesity risk, and improve cognitive and emotional development. Schoolyards offer a unique opportunity to promote health, as children spend a large proportion of their time at school. Methods: This quasi-experimental protocol study investigates the effects of transforming gray schoolyards into biodiverse green spaces on children’s health and well-being. Four primary schools in Limburg (Belgium and The Netherlands) were recruited: two intervention schools and two control schools. Children aged 7–12 years were enrolled, with baseline data collected in November 2021 and follow-up measurements scheduled every six months until November 2023. Outcomes include body mass index (BMI) z-score (primary outcome), waist circumference, diet, cognitive performance, psychological well-being, biodiversity knowledge, and physical activity. Data will be analyzed using linear mixed models, and cost-effectiveness analyses will be performed. Expected Results: Improvements in BMI z-scores, cognitive functioning, dietary behavior, and psychological well-being are expected among children in green schoolyards compared to those in control schools. Increased biodiversity awareness and reduced exposure to black carbon are also anticipated. Conclusions: This study is designed to provide evidence on the health impacts of greener schoolyards and contribute to strategies for promoting child development through environmental interventions. Full article

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16 pages, 1423 KB

Open AccessArticle

Treatment Outcomes of Tuberculosis in the Eastern Cape: Clinical and Socio-Demographic Predictors from Two Rural Clinics

by Evidence L. Nxumalo, Ncomeka Sineke, Ntandazo Dlatu, Teke Apalata and Lindiwe Modest Faye

Int. J. Environ. Res. Public Health 2025, 22(12), 1804; https://doi.org/10.3390/ijerph22121804 - 29 Nov 2025

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Abstract

Background: Tuberculosis (TB) remains a leading cause of morbidity and mortality, with South Africa among the highest-burden countries. The Eastern Cape is particularly affected due to poverty, HIV co-infection, and weak health systems. Understanding treatment outcomes and their determinants is required to [...] Read more.

Background: Tuberculosis (TB) remains a leading cause of morbidity and mortality, with South Africa among the highest-burden countries. The Eastern Cape is particularly affected due to poverty, HIV co-infection, and weak health systems. Understanding treatment outcomes and their determinants is required to achieve the WHO End TB Strategy targets. The objective of this study was to examine treatment outcomes for tuberculosis (TB) in both rural and urban clinics within the Eastern Cape Province. We aimed to identify the socio-demographic, clinical, and geographic factors that influence treatment success or failure. We included simple geographic visualisations comparing treatment outcomes between the two participating clinics to inform the development of targeted interventions aimed at enhancing TB control efforts. Methods: A retrospective cohort study of 385 TB patients treated at two public clinics in the Eastern Cape (2020–2024) was conducted. Socio-demographic, clinical, and geographical data were extracted from records. Outcomes were classified using WHO and South African National TB Programme guidelines. Logistic regression identified predictors of success, and spatial analysis mapped treatment outcomes. Results: The mean patient age was 40.6 years; 69.1% were HIV-positive, and 89.9% had pulmonary TB. The overall treatment success rate was 63.8%, below the WHO target of ≥85%. Pulmonary TB was independently associated with greater odds of success (aOR = 2.86, 95% CI: 1.23–6.65), while older age predicted poorer outcomes (aOR = 0.98, 95% CI: 0.963–0.998). HIV status and socioeconomic variables were not independently associated after adjustment, although poverty and unemployment were widespread. Spatial mapping showed clustering of poor outcomes in specific clinics, highlighting geographic and health system disparities. Conclusions: TB treatment outcomes in the Eastern Cape remain unsatisfactory. Older patients and those with extrapulmonary TB face higher risks of unfavourable outcomes, underscoring the need for closer monitoring and adherence support. Integrated TB/HIV care, social protection, and geographically targeted interventions are essential to strengthen health systems and reduce inequalities. Full article

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24 pages, 1580 KB

Open AccessArticle

Co-Creating Strategies and Recommendations to Enhance the Physical Activities of Undergraduate Students at a South African University: A Social Ecological Approach

by Chanté Johannes, Nicolette V. Roman, Sunday O. Onagbiye, Simone Titus and Lloyd Leach

Int. J. Environ. Res. Public Health 2025, 22(12), 1803; https://doi.org/10.3390/ijerph22121803 - 28 Nov 2025

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Abstract

Engagement in physical activity (PA) has been considered to be influenced by multiple psychosocial factors (such as mental health, motivation and social support). However, current interventions often neglect these complex interactions. The Social Ecological Model (SEM) highlights the need for context-specific strategies addressing [...] Read more.

Engagement in physical activity (PA) has been considered to be influenced by multiple psychosocial factors (such as mental health, motivation and social support). However, current interventions often neglect these complex interactions. The Social Ecological Model (SEM) highlights the need for context-specific strategies addressing individual, social, environmental, and public engagement domains to enhance student PA. Therefore, this study aimed to develop strategies and recommendations to enhance the PA levels of undergraduate university students by using a SEM Approach. A co-creative consensus workshop, held between July and August 2024, was employed. The stakeholder group (n = 25) comprised undergraduate university students, professors and academic doctors specialising in PA and health-related disciplines. Data generated from the workshop were uploaded into Atlas Ti. V8 and thematically analysed. The co-created strategies underscore the importance of a multi-level approach to enhancing PA participation among undergraduate students. A total of 32 strategies were developed, reflecting the interconnected influence of psychosocial factors across the levels of the SEM. These include strategies related to PA (9), mental health (7), motivation (9), and social support (7). By developing context-specific strategies and recommendations that address individual, social, physical, and public engagement levels, the research offers practical, student-centred solutions to enhance PA participation. The co-created strategies hold the potential to foster long-term behavioural change and promote active, healthier lifestyles within the South African university context. Full article

(This article belongs to the Special Issue Physical Activity, Physical Education, Exercise and Public Health)

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21 pages, 550 KB

Open AccessArticle

Maternal Expectations and Overinvolvement, and Child Emotion Regulation in Children with and Without Anxiety Disorders: An Experimental Observational Study

by Eva-Maria Fassot, Brunna Tuschen-Caffier, Vera Hauffe and Julia Asbrand

Int. J. Environ. Res. Public Health 2025, 22(12), 1802; https://doi.org/10.3390/ijerph22121802 - 28 Nov 2025

Viewed by 335

Abstract

This study explores how child emotion regulation (ER) and maternal overinvolvement contribute to the maintenance of anxiety disorders (ADs) in children. Building on the tripartite model on the impact of the family on children’s emotion regulation and adjustment, it experimentally examines the impact [...] Read more.

This study explores how child emotion regulation (ER) and maternal overinvolvement contribute to the maintenance of anxiety disorders (ADs) in children. Building on the tripartite model on the impact of the family on children’s emotion regulation and adjustment, it experimentally examines the impact of maternal expectations on overinvolvement and child distress. 65 children with ADs (ages 8–15) and 64 healthy controls (HCs) and their mothers participated in a tangram task, with manipulated maternal expectations. Mother–child interactions were observed for maternal involvement and child behavior (ER, distress), with children reporting their emotional reactivity. Against expectations, maternal involvement did not differ between groups and was not influenced by expectations. HC children had better ER abilities than those with ADs. Emotional reactivity moderated the relationship between overinvolvement and ER problems. Children with ADs exhibited more distress, unaffected by maternal expectations. Further research is needed to clarify the relationship between parental behavior and child behavior, particularly regarding emotional reactivity. Full article

(This article belongs to the Special Issue The Impact of Family Capabilities on the Wellbeing and Mental Health of Family Members)

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15 pages, 293 KB

Open AccessArticle

Predictors of Teenage Fatherhood Among Justice-Involved Adolescents

by Naomi McGoldrick, Colleen Sbeglia, Lauren Wyckoff, Paul J. Frick, Laurence Steinberg and Elizabeth Cauffman

Int. J. Environ. Res. Public Health 2025, 22(12), 1801; https://doi.org/10.3390/ijerph22121801 - 28 Nov 2025

Viewed by 216

Abstract

Justice-involved boys are more likely to become teenage fathers than their community peers. This is linked to numerous negative outcomes, including increased delinquent behavior. To help legal practitioners better identify which boys are at risk of becoming a teen parent, this study identifies [...] Read more.

Justice-involved boys are more likely to become teenage fathers than their community peers. This is linked to numerous negative outcomes, including increased delinquent behavior. To help legal practitioners better identify which boys are at risk of becoming a teen parent, this study identifies factors at the time of boys’ very first arrest that prospectively predict their odds of becoming a teen father. Data were drawn from a longitudinal study of 1216 adolescent boys at the time of their first arrest. Binary logistic regression models were used to predict the odds of becoming a teen father across three domains: individual factors, social and contextual factors, and risky behaviors. Approximately 15% of the total sample (n = 171) reported becoming a teen father after their first arrest. At the time of first arrest, poorer neighborhood conditions, increased peer delinquency, substance use, and self-reported offending history increased the odds that boys would become a teen father. Additional models indicated that substance use was the strongest driver of teen fatherhood. However, all factors failed to reached significance once condom use was included in this model. Practical implications for policymakers are discussed, along with suggestions for interventions to reduce teen pregnancy. Full article

(This article belongs to the Special Issue Understanding Health Risks and Protective Factors in Youth Delinquency)

23 pages, 837 KB

Open AccessArticle

Policy, Price, and Perception: A Phenomenological Qualitative Study of the Rural Food Environment Among Latina Households

by Natalia B. Santos, Thais F. Alves, TinaMaria Fernandez and Chad Abresch

Int. J. Environ. Res. Public Health 2025, 22(12), 1800; https://doi.org/10.3390/ijerph22121800 - 28 Nov 2025

Viewed by 199

Abstract

Food insecurity disproportionately affects Hispanic households in the US. This study examines food access perceptions among rural Latinos, acknowledging that food environments are complex systems influenced by factors such as availability, accessibility, affordability, acceptability, and accommodation. This phenomenological qualitative study was conducted with [...] Read more.

Food insecurity disproportionately affects Hispanic households in the US. This study examines food access perceptions among rural Latinos, acknowledging that food environments are complex systems influenced by factors such as availability, accessibility, affordability, acceptability, and accommodation. This phenomenological qualitative study was conducted with adult Latinas living in Nebraska’s rural areas. Data was collected through participatory mapping, semi-structured interviews guided by the five dimensions of food access, and demographic surveys. Eighteen women participated in in-person interviews, and 68.3% of participants met the criteria for food insecurity. While chain stores were the primary shopping option in rural areas, challenges included limited availability of foods that are culturally relevant and accommodate special dietary needs. Ethnic stores were valued for cultural relevance despite concerns about quality and pricing. Overall, affordability was a significant barrier due to high rural costs, worsened by challenges in navigating nutrition program benefits and documentation status. Research or interventions targeting improvements in rural food security must extend beyond mere store availability, focusing on economic development, policy reform, and enhanced education in assistance programs to address these complex challenges. Full article

(This article belongs to the Special Issue System Approaches to Improving Latino Health)

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Int. J. Environ. Res. Public Health, Volume 22, Issue 12 (December 2025) – 66 articles

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