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Int. J. Environ. Res. Public Health, Volume 22, Issue 2 (February 2025) – 162 articles

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18 pages, 602 KiB  
Article
Coverage and Characterization of Food Delivery Services Through a Mobile Application in Small and Medium-Sized Cities in Brazil
by Renata Júlia da Costa, Paloma Aparecida Anastacio Barros, Juliana de Paula Matos and Paula Martins Horta
Int. J. Environ. Res. Public Health 2025, 22(2), 293; https://doi.org/10.3390/ijerph22020293 (registering DOI) - 16 Feb 2025
Abstract
This is the first study to analyze the coverage and profile of establishments registered on a meal delivery application (MDA) in small and medium-sized cities in Brazil. The app serves 497 municipalities across 22 states, offering 28,325 establishments. App coverage was measured as [...] Read more.
This is the first study to analyze the coverage and profile of establishments registered on a meal delivery application (MDA) in small and medium-sized cities in Brazil. The app serves 497 municipalities across 22 states, offering 28,325 establishments. App coverage was measured as the ratio of cities served to the total small and medium-sized cities in each Brazilian region. The establishments were categorized using keyword analysis into six groups: International Cuisine, Snacks, Bakery Products, Complete Meals and Side Dishes, Sweets, Ice Creams and Desserts, and Healthy Options. Greater app coverage was observed in the South (13.68%) and Southeast (13.63%) regions. In contrast, lower coverage was noted in the North (2.46%) and Northeast (2.30%) regions. The keyword category ‘Snacks’ was the most used across all Brazilian regions, while ‘Healthy Options’ was the least utilized. Positive correlations were identified between the number of establishments on the app and the Municipal Human Development Index (r = 0.30; p < 0.001), demographic density (r = 0.23; p < 0.001), and urban population (r = 0.55; p < 0.001). The use of keyword categories varied across municipalities based on their demographic and socioeconomic characteristics. Our findings reveal significant asymmetries in app coverage and the types of registered establishments, which may further exacerbate inequalities in food access. Full article
(This article belongs to the Section Global Health)
12 pages, 441 KiB  
Article
Chronic Care in Primary Care: Exploring the Role and Impact of General Practice Pharmacists in Managing Long-Term Conditions in Northern Ireland
by Ahmed Abuelhana, Petra Garlone Clark, Aaron Courtenay, Heather Coleman, Nermeen Ali and Kingston Rajiah
Int. J. Environ. Res. Public Health 2025, 22(2), 292; https://doi.org/10.3390/ijerph22020292 (registering DOI) - 16 Feb 2025
Abstract
The role of General Practice Pharmacists (GPPs) has expanded in response to increasing demands on primary care services, particularly in managing chronic conditions. While GPPs are recognised for their contributions to medication optimisation and patient care, challenges such as role clarity, workload pressures, [...] Read more.
The role of General Practice Pharmacists (GPPs) has expanded in response to increasing demands on primary care services, particularly in managing chronic conditions. While GPPs are recognised for their contributions to medication optimisation and patient care, challenges such as role clarity, workload pressures, and confidence in clinical decision-making remain underexplored. This study aims to investigate the tasks, professional identity, confidence levels, and challenges faced by GPPs in Northern Ireland. A mixed-methods design was employed, incorporating a questionnaire distributed to GPPs across Northern Ireland. The questionnaire comprised 20 multiple-choice questions and 5 open-ended questions, focusing on demographics, tasks, confidence levels, role clarity, and professional challenges. Quantitative data were analysed using descriptive and inferential statistics, while qualitative responses underwent thematic analysis using NVIVO software. A total of 44 GPPs participated, with a majority being female and aged 34–39 years. Most participants had 4–6 years of experience as GPPs. Quantitative findings revealed significant correlations between clinical confidence and factors such as years of experience, age, and employment type. Qualitative analysis revealed key themes: clinical confidence was enhanced by training and experience, but workload pressures often limited time for patient care. Variability in role integration and the lack of public awareness were highlighted as barriers to maximising the GPP role. This study highlights the key challenges of workload distribution and role ambiguity in the GPP role. Delegating administrative tasks and developing clear frameworks for role integration could address these barriers. Additionally, targeted training programs and public education campaigns are essential to enhance the impact of GPPs in primary care. Full article
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16 pages, 3496 KiB  
Article
Access to Interpretable Data to Support Disproportionate Health Risks from Industrial Releases: A Case Study on the Environmental Protection Agency’s Datasets and Their Application to the Latinx Communities of Houston, Texas
by Hannah Wheless and Lori A. Hoepner
Int. J. Environ. Res. Public Health 2025, 22(2), 291; https://doi.org/10.3390/ijerph22020291 (registering DOI) - 16 Feb 2025
Abstract
Latinx communities face disproportionate environmental injustices and are targeted due to systematic economic and political inequities. This research evaluates the ease at which links between industrial releases and risk of adverse health effects can be defined to influence policy change in Houston, TX. [...] Read more.
Latinx communities face disproportionate environmental injustices and are targeted due to systematic economic and political inequities. This research evaluates the ease at which links between industrial releases and risk of adverse health effects can be defined to influence policy change in Houston, TX. The Environmental Protection Agency (EPA)’s Toxic Release Inventory (TRI) is the most comprehensive public database on industrial facilities’ toxic chemical releases in the US. TRI is presented within a risk-based context through the Risk Screening Environmental Indicators (RSEI) scores. TRI and RSEI datasets for Houston in 2022 were assessed in QGIS to analyze chemical release and risk in neighborhoods using Community Tabulation Areas (CTAs), identifying demographics of communities facing disproportionate industrial releases and consequent potential health risks. Geospatial visualizations reflected Latinx communities to house the heaviest polluting industrial facilities in Houston. As a result, these communities face the highest potential risk of adverse health effects due to exposure to a multitude of chemicals—particularly 1,3-butadiene, benzene, and chromium—as reflected in cumulative RSEI scores. An analysis of TRI and RSEI datasets elucidates the burden of gathering and analyzing chemical release data in a public health context, reflecting why change beginning at the local level can be difficult for under-resourced Latinx communities facing industrial pollution. Improving the accessibility and utility of the EPA resources will provide a resource to advocate for data-driven policy change. Full article
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19 pages, 510 KiB  
Article
Developing an Ecotoxicological Classification for Frequently Used Drugs in Primary Care
by Tiphaine Charmillot, Nathalie Chèvre and Nicolas Senn
Int. J. Environ. Res. Public Health 2025, 22(2), 290; https://doi.org/10.3390/ijerph22020290 (registering DOI) - 16 Feb 2025
Abstract
Most drugs excreted in urine are not filtered by wastewater treatment plants and end up in aquatic systems. At concentrations measured in waters, toxic effects on species have been described. Second, most of the drug consumption is attributable to primary care prescriptions. We [...] Read more.
Most drugs excreted in urine are not filtered by wastewater treatment plants and end up in aquatic systems. At concentrations measured in waters, toxic effects on species have been described. Second, most of the drug consumption is attributable to primary care prescriptions. We thus present here, an ecotoxicity classification of the most sold drugs in primary care in Switzerland. Three datasets were combined: (1) surveyed ecotoxic drugs by the Swiss National Surface Water Quality Monitoring Programme and its European equivalent, (2) the top 50 drugs by sale in primary care in Switzerland, and (3) active pharmaceutical ingredient (API) concentrations in Lake Geneva and the rivers of the canton of Vaud between 2017 and 2022. We classified APIs into five categories from the safest to the least safe: (1) APIs found in concentrations (C) <10× their environmental quality standard (EQS·10−1), (2) EQS·10−1 < C < EQS and not listed by the Swiss or the EU Watch List, (3) EQS·10−1 < C < EQS and listed, (4) C > EQS and not listed, and (5) C > EQS and listed. We obtained full ecotoxicological data for 35 APIs. Fifteen APIs were designated as safe (category (1):paracetamol, tramadol, amisulpride, citalopram, mirtazapine, metformin, gabapentin, lamotrigine, primidone, candesartan, irbesartan, atenolol, hydrochlorothiazide, ofloxacin, sulfadiazine), eleven as intermediately safe, and nine were of concern (azithromycin, ciprofloxacin, clarithromycin, , sulfamethoxazole, carbamazepine, diclofenac, ibuprofen, iomeprol, iopromide). Full data were available for only one-third of the drugs most sold in primary care. Where data do exist, we observed significant differences in environmental impact among the same class of drugs. Our classification could therefore help guide doctors to adopt more eco-friendly prescriptions. Full article
12 pages, 287 KiB  
Review
Integrative Treatment Strategies for Chronic Back Pain: A Literature Review with Clinical Recommendations
by Nina H. Russin, Alexis M. Koskan and Lesley Manson
Int. J. Environ. Res. Public Health 2025, 22(2), 289; https://doi.org/10.3390/ijerph22020289 (registering DOI) - 15 Feb 2025
Abstract
Problem: Chronic back pain (CBP) is a major cause of disability, contributing significantly to healthcare costs and primary care visits. Pharmacotherapy alone is insufficient in managing CBP. Integrated behavioral health interventions that include psychoeducation are critical for a more holistic, sustainable treatment of [...] Read more.
Problem: Chronic back pain (CBP) is a major cause of disability, contributing significantly to healthcare costs and primary care visits. Pharmacotherapy alone is insufficient in managing CBP. Integrated behavioral health interventions that include psychoeducation are critical for a more holistic, sustainable treatment of CBP. Objectives: This review explores CBP treatments that includes psychoeducation as part of patient care. Methods: In the Fall of 2024, the first author searched Google Scholar, PubMed, and Scopus using search terms related to chronic back pain and integrated behavioral interventions to increase patients’ self-efficacy to manage CBP. The team included articles in the review that were published more recently and seminal articles in the field of managing CBP. Results: Given the complex biopsychosocial factors influencing CBP, and the individualized nature of each patient’s pain experience, patient psychoeducation should include a multimodal approach, which may include cognitive behavioral strategies to address pain, pain neuroscience education, and education related to lifestyle behaviors such as physical activity, sleep, nutrition, and stress management. Patient education and behavioral interventions integrated within primary care can significantly improve patient engagement and self-reported improvements in pain intensity, functionality, and quality of life. Conclusion: Psychoeducation is foundational for integrative programs aimed at managing CBP. Full article
12 pages, 521 KiB  
Article
Physical Activity as a Mediator in the Relationship Between Body Image Perception and Low Mood in Adolescents
by Geiziane Leite Rodrigues Melo, Larissa Alves Maciel, Rafaela Espírito Santo, Caroline Brand, Cézane Priscila Reuter, Artūras Razbadauskas, Alona Rauckienė-Michaelsson and Cesar Agostinis-Sobrinho
Int. J. Environ. Res. Public Health 2025, 22(2), 288; https://doi.org/10.3390/ijerph22020288 (registering DOI) - 15 Feb 2025
Abstract
Body image (BI) plays a critical role in mental health, with negative perceptions often linked to feelings of low mood. Physical activity (PA) has been shown to enhance self-acceptance and reduce negative emotions, suggesting it may help mitigate the impact of BI on [...] Read more.
Body image (BI) plays a critical role in mental health, with negative perceptions often linked to feelings of low mood. Physical activity (PA) has been shown to enhance self-acceptance and reduce negative emotions, suggesting it may help mitigate the impact of BI on low mood. This study examines the relationship between BI and low mood among adolescents, and explores the role of PA as a mediator in this relationship. The study had a cross-sectional design. Data were collected from 154,183 adolescents (average age 13.6 ± 1.6 years) across 43 countries, using the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey. BI was assessed through self-perceived body size, low mood was measured on a scale from “about every day” to “rarely or never”, and PA was evaluated by the number of days per week participants engaged in at least 60 min of activity. The study used multinomial logistic regression and a mediation model to analyze the relationships of BI, PA, and BMI with low mood. The multinomial logistic regression showed that daily PA reduces the risk of low mood, especially with higher PA frequency, such as PA on 6 days (OR = 0.72) and PA on 5 days (OR = 0.86). Age, BMI, BI, and sex also influence low mood, with males showing lower odds (OR = 0.40 to 0.77), normal weight individuals having a reduced risk, and thinner individuals having lower odds of low mood (OR = 0.12 to 0.50), with PA partially mediating the relationship between BI and low mood (p < 0.001), contributing to 9% of the total effect. PA partially mediates the relationship between BI and low mood, with a direct negative impact of BI on low mood. In addition, girls, older adolescents, and those with negative BI and irregular PA have a higher risk of low mood. Full article
(This article belongs to the Special Issue Health Behavior and Health Promotion in Children and Adolescents)
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16 pages, 426 KiB  
Article
Where Are the Knowledge Gaps in Menopause Across a Population? A National Cross-Sectional Survey in Wales
by Catherine A. Sharp, Nicola Dennis, Gemma Hobson, Marysia Hamilton-Kirkwood and Karen Hughes
Int. J. Environ. Res. Public Health 2025, 22(2), 287; https://doi.org/10.3390/ijerph22020287 - 14 Feb 2025
Abstract
Background: A knowledge gap exists on population understanding and perspectives of menopause. To better support females, it is important to understand different population groups’ perceived knowledge of and attitudes towards menopause. This study explored perceived knowledge of menopause, awareness of menopausal symptoms, perceived [...] Read more.
Background: A knowledge gap exists on population understanding and perspectives of menopause. To better support females, it is important to understand different population groups’ perceived knowledge of and attitudes towards menopause. This study explored perceived knowledge of menopause, awareness of menopausal symptoms, perceived negative impacts of menopause on females’ lives, and attitudes towards menopause. Methods: A national cross-sectional survey (n = 1020) was conducted with residents in Wales aged 16+ years as part of a larger population panel using a multi-method approach (online, telephone, and face-to-face), stratified by NHS health board area, age, sex, deprivation, and ethnicity. Questions on menopause were developed by the research team. Results: Nearly a third (31.1%) of participants reported having low knowledge of menopause, with younger age groups and males reporting the lowest knowledge. Hot flushes were the most recognised menopause symptom (92.2%). The symptom with the greatest gap in awareness between age groups, sexes, and deprivation quintiles was problems with memory or concentration. Most participants perceived menopause to have a large negative impact on females’ mental health (76.1%), working life (69.7%) and physical health (69.6%). Females and 30–49-year-olds were more likely to perceive large negative impacts across all three domains. Most participants (77.8%) agreed that more public discussion is needed on menopause to increase understanding. The greatest support for increasing public discussion was found amongst females and people aged 30–49 years old. Conclusions: At a population level, perceived knowledge of menopause and associated symptoms and perceived impacts on females’ lives varied across socio-demographic groups. While males were less knowledgeable than females, most males perceived negative impacts on females’ lives and agreed with action to improve the menopausal environment. Increasing knowledge in those who experience menopause and in those who support those who experience menopause could help females have a more positive transition process. Full article
(This article belongs to the Special Issue Promoting Women's Sexual and Reproductive Health)
17 pages, 2611 KiB  
Perspective
Emerging Trends and Issues in Geo-Spatial Environmental Health: A Critical Perspective
by Daniel A. Griffith
Int. J. Environ. Res. Public Health 2025, 22(2), 286; https://doi.org/10.3390/ijerph22020286 - 14 Feb 2025
Abstract
This opinion piece postulates that quantitative environmental research and public health spatial analysts unknowingly tolerate certain spatial statistical model specification errors, whose remedies constitute some of the urgent emerging trends and issues in this subfield (e.g., forecasting disease spreading). Within this context, this [...] Read more.
This opinion piece postulates that quantitative environmental research and public health spatial analysts unknowingly tolerate certain spatial statistical model specification errors, whose remedies constitute some of the urgent emerging trends and issues in this subfield (e.g., forecasting disease spreading). Within this context, this paper addresses misspecifications affiliated with omitted variable bias complications arising from ignoring, and hence abandoning, negative spatial autocorrelation latent in georeferenced disease data, and/or being ill-informed about reigning teledependencies (i.e., long-distance spatial correlations). As imperative academic challenges, it advances elegant and convincing arguments to do otherwise. Its two particular themes are positive–negative spatial autocorrelation mixtures, and hierarchical autocorrelation generated by hegemonic urban systems. Comprehensive interpretations and implementations of these two conjectures constitute future research directions. Important conceptualizations for treatments reported in this paper include confounding variables and Moran eigenvector spatial filtering. This paper’s fundamental implication is an advocacy for a prodigious paradigm shift, a marked change in the collective mindsets and applications of spatial epidemiologists when specifying spatial regression equations to describe either environmental health data, or a publicly transparent geographic diffusion of diseases. Full article
(This article belongs to the Special Issue Trends in Modern Environmental Health)
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14 pages, 339 KiB  
Review
Why Do Primary Care Patients Change Their Physicians: An Overview of the Literature
by Mariana Cardoso Ribeiro, Elisa Martins and Filipe Prazeres
Int. J. Environ. Res. Public Health 2025, 22(2), 285; https://doi.org/10.3390/ijerph22020285 - 14 Feb 2025
Abstract
Primary healthcare has an important role in a patient’s long-term health. While patients in most countries are free to change their family physician, fragmented care leads to higher healthcare costs, more preventable hospitalizations, and an increased likelihood of deviation from clinical best practice. [...] Read more.
Primary healthcare has an important role in a patient’s long-term health. While patients in most countries are free to change their family physician, fragmented care leads to higher healthcare costs, more preventable hospitalizations, and an increased likelihood of deviation from clinical best practice. This review aims to identify the main reasons patients change family doctors, summarize the factors influencing these decisions, and highlight areas in healthcare that can be improved to increase patient satisfaction and design better services. An electronic search of the literature was conducted in March 2023 in PubMed and Embase databases for articles in English, French, Portuguese, or Spanish published from 1980 to March 2023. A thematic synthesis approach was applied to the included studies, involving systematic analysis of their findings to identify and categorize analytical themes. Nineteen relevant studies were identified. The following themes were identified as reasons to change family physicians: doctor–patient relationship; consultation schedule and convenience; referrals and positive references; medication and treatment issues; practice management and cost; personal preferences and physician characteristics; and accessibility and distance. The identified themes can serve as valuable targets for developing interventions aimed at enhancing the quality of care provided to patients. Full article
22 pages, 336 KiB  
Review
What Is New in Altitude- and Cold-Related Illnesses of Travel: Appraisal and Summary of the Updated Guidelines from the Wilderness Medical Society
by Arghavan Omidi, Gregory D. Hawley, Dylan Kain, Farah Jazuli, Milca Meconnen, Mark Polemidiotis, Nam Phuong Do, Olamide Egbewumi and Andrea K. Boggild
Int. J. Environ. Res. Public Health 2025, 22(2), 284; https://doi.org/10.3390/ijerph22020284 - 14 Feb 2025
Abstract
Wilderness medicine is a rapidly evolving field and has benefited from expanded research efforts. Moreover, with an escalating occurrence of severe and cataclysmic global climatologic events, human illness arising from interaction with wilderness and recreational environments warrants increasing consideration. Within the last decade, [...] Read more.
Wilderness medicine is a rapidly evolving field and has benefited from expanded research efforts. Moreover, with an escalating occurrence of severe and cataclysmic global climatologic events, human illness arising from interaction with wilderness and recreational environments warrants increasing consideration. Within the last decade, the Wilderness Medical Society (WMS) has aggregated research findings and created guidelines on prevention measures and therapeutic options for acute altitude illness, frostbite injuries, and avalanche and non-avalanche snow burials. As new research emerges, some guidelines have been updated to reflect the most current and sound scientific conclusions. In this review, we have synthesized the evidence-based guidelines and have reviewed the quality of the guidelines according to the Appraisal of Guidelines for Research and Evaluation (AGREE) II framework. Further research efforts can expand the scope of evidence-based practice in travel medicine and ideally standardize the implementation of recommendations within both pre-travel and post-travel medical practices. Full article
(This article belongs to the Special Issue The Impact of Extreme Weather and Climate on Human Health)
12 pages, 538 KiB  
Article
The Mediating Role of Anger and Anxiety in the Association of Social Support with Mobility Among Middle-Age and Older Adults with Knee Osteoarthritis
by Erin R. Harrell, Patricia A. Parmelee and Dylan M. Smith
Int. J. Environ. Res. Public Health 2025, 22(2), 283; https://doi.org/10.3390/ijerph22020283 - 14 Feb 2025
Abstract
Introduction: Osteoarthritis (OA) is one of the leading causes of chronic disability in older adults, often causing significant impairment of mobility. OA symptoms have been linked to mental functioning, including depression, anxiety, and negative affect. Method: To examine whether anger and anxiety mediate [...] Read more.
Introduction: Osteoarthritis (OA) is one of the leading causes of chronic disability in older adults, often causing significant impairment of mobility. OA symptoms have been linked to mental functioning, including depression, anxiety, and negative affect. Method: To examine whether anger and anxiety mediate the relationship between social support and mobility among older adults with knee osteoarthritis, data from the Everyday Quality of Life in Older Blacks and Whites with Osteoarthritis (EQUAL) study (N = 336) were analyzed using Hayes’ PROCESS model in SPSS to test the direct effect of social support on mobility as well as mediation by anxiety and anger. Results: While univariate models for both anxiety and anger were significant, only anxiety mediated the relationship between social support and mobility. Conclusion: Although limited by their cross-sectional nature, the findings suggest that at least part of the association of social support with mobility may be explained by the role of support in alleviating anxiety. Full article
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12 pages, 318 KiB  
Article
Connecting Health and Technology: Validation of Instant Messaging for Use as Diabetes Mellitus Control Strategy in Older Brazilian Adults
by Manoela Vieira Gomes da Costa, Renata Puppin Zandonadi, Verônica Cortez Ginani, Silvana Schwerz Funghetto, Luciano Ramos de Lima, Tania Cristina Morais Santa Barbara Rehem and Marina Morato Stival
Int. J. Environ. Res. Public Health 2025, 22(2), 282; https://doi.org/10.3390/ijerph22020282 - 14 Feb 2025
Abstract
Background: Digital technologies are increasingly being used to promote effective health interventions in the older adult population. This study aimed to develop and validate instant messages with educational content related to glycemic control, delivered via an instant messaging application, as a type 2 [...] Read more.
Background: Digital technologies are increasingly being used to promote effective health interventions in the older adult population. This study aimed to develop and validate instant messages with educational content related to glycemic control, delivered via an instant messaging application, as a type 2 DM control strategy for older adults. Methods: This was a methodological study that developed instant messages containing text and images. The validation process was conducted by a panel of experts composed of nursing, nutrition, and physical education professionals. SPSS version 25.0 was used for the statistical analysis. A CVI was used to measure the experts’ agreement regarding the validity of the content of the educational messages. An exact test of binomial distribution with p > 0.05, indicating statistical significance, and a 0.95 proportion of agreement was used to estimate the statistical reliability of the CVI. Results: Sixty-one text messages were prepared with illustrations as support, and were divided into three themes. The educational messages were validated by experts, with an average CVI score above 0.80 for all indicators. Conclusions: The educational messages developed in this study were considered relevant and clear for older adults and could be applied in the digital environment, with the objective of helping older adults manage type 2 DM. Full article
(This article belongs to the Special Issue Advances in Nursing and Medical Education)
15 pages, 490 KiB  
Review
The Use of Complementary and Alternative Treatments in Adolescent Obesity: A Narrative Review
by Mahesh Shrestha, Ann Harris, Teresa Bailey, Urvi Savant and Dilip R. Patel
Int. J. Environ. Res. Public Health 2025, 22(2), 281; https://doi.org/10.3390/ijerph22020281 - 14 Feb 2025
Abstract
Adolescent obesity is a growing global health problem all around the world. We reviewed the use of complementary and alternative medicine (CAM) for adolescent obesity, examining improvements in BMI or any metabolic indices of obesity. We performed a PubMed and Scopus search for [...] Read more.
Adolescent obesity is a growing global health problem all around the world. We reviewed the use of complementary and alternative medicine (CAM) for adolescent obesity, examining improvements in BMI or any metabolic indices of obesity. We performed a PubMed and Scopus search for articles on CAM treatments in adolescents aged 12–17 years, and included all studies with subjects in that age range. Out of 226 PubMed articles and 14 Scopus articles, 28 articles from PubMed and 1 article from Scopus fit our criteria. Most CAM studies that showed some improvement in BMI were acupuncture- or yoga-based. Yoga-based interventions showed a BMI reduction of 1–2 points, which is similar to results achieved in studies based on physical activity and Orlistat, a weak anti-obesity medication; meanwhile, acupuncture-based studies showed a slightly higher BMI reduction of 2–4 points, similar to that achieved with Liraglutide, a GLP-1 agonist that is a good anti-obesity medication. Herbs and supplements showed improvement in metabolic markers of obesity. Stress interventions in mind–body interventions, music skip-rope exercise, and creative drama in physical activity-based interventions also showed improvement in BMI. Although many of the studies reviewed were RCTs, the small sample size of those RCTs is a limiting factor. There may be a role for investigating this topic in larger populations to generate more effective conclusions. Full article
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13 pages, 577 KiB  
Article
Possible Racial Disparities in the Diagnosis of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)
by Chloe Lisette Jones and Jarred Younger
Int. J. Environ. Res. Public Health 2025, 22(2), 280; https://doi.org/10.3390/ijerph22020280 - 14 Feb 2025
Abstract
Myalgic encephalomyelitis (ME/CFS) a chronic, disabling illness with no established etiopathology. It has been indicated in some population-based studies that Black and ethnic minority populations are underdiagnosed with ME/CFS. The aims of the present study were to (1) identify the agreement between receiving [...] Read more.
Myalgic encephalomyelitis (ME/CFS) a chronic, disabling illness with no established etiopathology. It has been indicated in some population-based studies that Black and ethnic minority populations are underdiagnosed with ME/CFS. The aims of the present study were to (1) identify the agreement between receiving an ME/CFS diagnosis and meeting diagnostic criteria, (2) identify the demographic characteristics associated with receiving a diagnosis, and (3) explore patient satisfaction with healthcare. Self-reported medical history and symptoms were collected via online survey from respondents with and without fatigue. The agreement between self-reporting an ME/CFS diagnosis and meeting the Center for Disease Control’s (CDC) ME/CFS criteria or Institute of Medicine (IOM) criteria was assessed with Cohen’s kappa. Patient characteristics predicting a physician diagnosis were analyzed with logistic regression. Associations between diagnosis, demographics, and healthcare satisfaction were assessed with chi-square tests of independence. There were 1110 responses. The agreement between meeting ME/CFS criteria and reporting an ME/CFS diagnosis was fair (CDC: κ = 0.29; SE = 0.02; IOM: κ = 0.28, SE = 0.03). White respondents had 2.94 greater odds of being diagnosed with ME/CFS than non-White respondents. Having an ME/CFS diagnosis was associated with dissatisfaction with healthcare (χ2 (3, N = 1063) = 14.17, p = 0.003). The findings suggest racial disparities in the diagnostic processes for ME/CFS. Full article
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12 pages, 897 KiB  
Article
Living with Long COVID in a Southern State: A Comparison of Black and White Residents of North Carolina
by William Pilkington, Brooke E. Bauer and Irene A. Doherty
Int. J. Environ. Res. Public Health 2025, 22(2), 279; https://doi.org/10.3390/ijerph22020279 - 14 Feb 2025
Abstract
Long COVID can devastate patients’ overall quality of life, extending to economic, psychosocial, and mental health and day-to-day activities. Clinical research suggests that long COVID is more severe among Black and African American populations in the United States. This study examines the lived [...] Read more.
Long COVID can devastate patients’ overall quality of life, extending to economic, psychosocial, and mental health and day-to-day activities. Clinical research suggests that long COVID is more severe among Black and African American populations in the United States. This study examines the lived and lasting effects of long COVID among a diverse sample of North Carolina residents over one year by using three self-administered questionnaires completed online using Qualtrics. A cross-sectional descriptive analysis of the baseline results is presented. Our study recruited 258 adults, of which 51.5% had long COVID (but may have recovered), 32.3% had a COVID-19 infection at least once, and 16.3% had never had COVID-19. The socioeconomic status of Black participants was lower than that of White participants; however, the economic impact of long COVID was not worse. Across both groups, 64.4% were employed, 28.8% had to change tasks or work less, and 19.8% stopped working. Fewer White (32.6%) than Black (54.8%) participants always/often felt supported by family and friends about having long COVID. The majority of White participants (59.1%) reported that they did not recover from long COVID compared to 29.7% of Black participants. The long COVID/COVID-19 experience affected White and Black participants differently, but both populations continue feel the impacts. Full article
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12 pages, 301 KiB  
Article
Racial Disparities in Outpatient Substance Use Disorder Treatment Completion: Trends and Changes from 2004 to 2024
by Monica F. Wright
Int. J. Environ. Res. Public Health 2025, 22(2), 278; https://doi.org/10.3390/ijerph22020278 - 14 Feb 2025
Abstract
Racial disparities have been found in outpatient substance use disorder (SUD) treatment completion rates. Improvements in access to treatment have sought to decrease these disparities and increase treatment engagement and success. To understand outcomes among different racial groups across time, we assessed (1) [...] Read more.
Racial disparities have been found in outpatient substance use disorder (SUD) treatment completion rates. Improvements in access to treatment have sought to decrease these disparities and increase treatment engagement and success. To understand outcomes among different racial groups across time, we assessed (1) completion rates, (2) racial representation among patients who have completed treatment, (3) general representation of racial groups within treatment, and (4) treatment length between 2004 and 2024. “Completion” is defined as “meeting all treatment goals”. Chi-squared analyses suggest significant differences among racial groups within the completed (x215=158.0, p=<0.001), not-completed (x215=561.75, p=<0.001), and other (x215=186.19, p=<0.001) groups across time. Asian and Other/Multiracial patients experienced the greatest improvement in both representation within treatment overall and proportional representation within the “completer” group over time, despite their overall completion rates fluctuating. White and Black/African American patients decreased in representation, completion rates, and representation in the “completer” group over time, with a peak in 2004–2009. In terms of length of stay, White patients remained in treatment the longest across time, F(5, 4198) = 24.605, p < 0.011, and treatment length increased for other racial groups. While disparities in completion rates decreased and racial representation in treatment increased, discrepancies persist. We discuss these findings within the context of evolving patient populations and changes in treatment provision (e.g., harm reduction frameworks). Full article
18 pages, 3068 KiB  
Article
Perceptions of and Responses to Wildfire Smoke Among New York State Residents: A Cross-Sectional Study
by Erandy I. Barrera, Alistair Hayden, Genevive Meredith and Corinna A. Noel
Int. J. Environ. Res. Public Health 2025, 22(2), 277; https://doi.org/10.3390/ijerph22020277 - 14 Feb 2025
Abstract
Exposure to wildfire smoke (WFS) is associated with detrimental physical and mental health. Periods of sustained WFS are predicted to increase with climate change, affecting populations globally. Using a retrospective cross-sectional study, we assessed perceptions of and responses to WFS in a cohort [...] Read more.
Exposure to wildfire smoke (WFS) is associated with detrimental physical and mental health. Periods of sustained WFS are predicted to increase with climate change, affecting populations globally. Using a retrospective cross-sectional study, we assessed perceptions of and responses to WFS in a cohort of New York State (NYS) residents in Summer 2023. Data were collected using an online survey from October to November 2023. Descriptive statistics summarized respondent experiences, while exploratory analyses identified high-risk populations using chi-square and t-tests. Our sample consisted of 609 primarily healthy, white, and well-educated individuals who spent most of their time in NYS during Summer 2023. Of the 99% that reported experiencing WFS, 92% received and 91% sought out WFS-related air quality information. While only 25% reported a WFS-related illness, 87% experienced at least one symptom with WFS, frequently citing watery eyes (63%), irritated throat (50%), and headaches (49%), with women reporting symptoms more frequently than men (89.1% vs. 81.6%; p = 0.034). A majority (93%) reported taking mitigation actions, including avoiding outdoor activities (75%) and wearing masks (54%). Our results highlight widespread impacts of wildfires in NYS during Summer 2023, with nearly all respondents reporting sustained periods of WFS. Most reported at least one adverse health symptom despite taking preventative measures, indicating that current protective strategies may be insufficient and more effective interventions are needed. Full article
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14 pages, 634 KiB  
Article
Functional Capacity Impairment in Long COVID After 17 Months of Severe Acute Disease
by Fernanda Facioli dos Reis Borges, Andrezza Cristina Barbosa Braga, Bernardo Silva Viana, Jefferson Valente, João Marcos Bemfica, Thaís Sant’Anna, Cássia da Luz Goulart, Fernando Almeida-Val and Guilherme Peixoto Tinoco Arêas
Int. J. Environ. Res. Public Health 2025, 22(2), 276; https://doi.org/10.3390/ijerph22020276 - 13 Feb 2025
Abstract
Long COVID represents a significant challenge in understanding the prolonged impact of the disease. Despite its increasing recognition, detailed insights into the long-term cardiopulmonary consequences remain sparse. This study aimed to evaluate the functional capacity of individuals with persistent symptoms after severe COVID-19 [...] Read more.
Long COVID represents a significant challenge in understanding the prolonged impact of the disease. Despite its increasing recognition, detailed insights into the long-term cardiopulmonary consequences remain sparse. This study aimed to evaluate the functional capacity of individuals with persistent symptoms after severe COVID-19 infection compared to control individuals without symptomatic COVID or mild COVID after 17 months. This is a case-control study assessing 34 individuals divided into two groups regarding functional capacity by distance in a 6-min walk test (D6MWT) associated with gas analysis, spirometry, respiratory muscle strength, and quality of life. During the 6 MWT, an important lower heart rate (HR) was observed for the COVID group (106 ± 10 bpm, difference mean: 21.3; p < 0.001), with greater exertional perception (Borg dyspnea: 4.5 [2.0–9.0], p < 0.001 and Borg fatigue: 4.0 [2.0–7.0], p = 0.01), a significant decrease in the distance covered (416 ± 94 m, difference mean: 107; p = 0.002), and a low value of O2 uptake (V˙O2) (11 ± 5.0 mL/(kg min), difference mean: 8.3; p = 0.005) and minute ventilation (22 ± 8 L/min, difference mean: 18.6; p = 0.002), in addition to very low quality of life scores. Regression analysis showed a significant association between D6MWT and Borg fatigue and Borg dyspnea at rest (p = 0.003; p = 0.009). V˙O2 and HR were also significantly associated with the outcomes of the D6MWT (p = 0.04 and p = 0.004, respectively). In conclusion, individuals who have severe COVID-19 and persist with symptoms have low functional capacity, low V˙O2, low HR behavior, and low quality of life. Full article
(This article belongs to the Special Issue Physical Fitness and Exercise during and after the COVID-19 Pandemic)
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10 pages, 230 KiB  
Perspective
Language Matters: What Not to Say to Patients with Long COVID, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, and Other Complex Chronic Disorders
by Nancy J. Smyth and Svetlana Blitshteyn
Int. J. Environ. Res. Public Health 2025, 22(2), 275; https://doi.org/10.3390/ijerph22020275 - 13 Feb 2025
Abstract
People with Long COVID, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and other complex chronic disorders consistently report having difficulty obtaining effective and compassionate medical care and being disbelieved, judged, gaslighted, and even dismissed by healthcare professionals. We believe that these adversarial interactions and language [...] Read more.
People with Long COVID, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and other complex chronic disorders consistently report having difficulty obtaining effective and compassionate medical care and being disbelieved, judged, gaslighted, and even dismissed by healthcare professionals. We believe that these adversarial interactions and language are more likely to arise when healthcare professionals are confronting complex chronic illnesses without proper training, diagnostic biomarkers, or FDA-approved therapies. These problematic conversations between practitioners and patients often involve specific words and phrases—termed the “never-words”—can leave patients in significant emotional distress and negatively impact the clinician–patient relationship and recovery. Seeking to prevent these destructive interactions, we review key literature on best practices for difficult clinical conversations and discuss the application of these practices for people with Long COVID, ME/CFS, dysautonomia, and other complex chronic disorders. We provide recommendations for alternative, preferred phrasing to the never-words, which can enhance therapeutic relationship and chronic illness patient care via compassionate, encouraging, and non-judgmental language. Full article
24 pages, 1425 KiB  
Article
Cultural Validation of the Fear-of-Intimacy Scale for the Portuguese Population: Exploring Its Relationship with Sociosexual Orientation
by Ângela Leite and Ângela Azevedo
Int. J. Environ. Res. Public Health 2025, 22(2), 274; https://doi.org/10.3390/ijerph22020274 - 13 Feb 2025
Abstract
Objective: This study aims to adapt the Fear-of-Intimacy Scale for the Portuguese population and examine its association with sociosexual orientation, as measured by the Sociosexual Orientation Inventory, highlighting the relevance of this association as a public health issue. Methods: The Fear-of-Intimacy Scale was [...] Read more.
Objective: This study aims to adapt the Fear-of-Intimacy Scale for the Portuguese population and examine its association with sociosexual orientation, as measured by the Sociosexual Orientation Inventory, highlighting the relevance of this association as a public health issue. Methods: The Fear-of-Intimacy Scale was validated through confirmatory factor analyses. A multigroup analysis, employing confirmatory factor analysis, was conducted to evaluate the consistency of the Fear-of-Intimacy Scale across individuals in and out of romantic relationships. The reliability of the model was assessed using various indicators, including Cronbach’s alpha, McDonald’s omega, composite reliability, the average variance extracted (AVE), and the square root of the AVE. Results: The results indicated robust psychometric properties for the Fear-of-Intimacy Scale, with a well-fitting model identified. Configural, metric, and scalar invariance related to being in a romantic relationship or not were established; however, error variance invariance was not achieved. Although most dimensions of the two instruments displayed positive and significant relationships, the correlation values were generally modest. Conclusion: The findings underscore the importance of understanding the relationship between fear of intimacy and sociosexual orientation within the Portuguese context as a significant public health issue. Adapting the Fear-of-Intimacy Scale enables culturally sensitive research and supports clinical interventions aimed at improving relational and psychological well-being, thereby addressing broader public health challenges. Full article
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12 pages, 258 KiB  
Essay
COVID-19 as a Mirror: Reflecting the Pandemic of Racism and the Historical Roots of Health Inequities
by Tiffany J. Grant
Int. J. Environ. Res. Public Health 2025, 22(2), 273; https://doi.org/10.3390/ijerph22020273 - 13 Feb 2025
Abstract
Historically, the attribution of biology to race has shaped societies and manifested in innumerable disparities and irreparable harm, especially in communities of color. From the earliest days of the United States to the present day, the dehumanization and “othering” of African Americans have [...] Read more.
Historically, the attribution of biology to race has shaped societies and manifested in innumerable disparities and irreparable harm, especially in communities of color. From the earliest days of the United States to the present day, the dehumanization and “othering” of African Americans have caused deep racial inequities that have been perpetuated and embedded in American culture. The early months of the COVID-19 pandemic underscored the deep racial inequalities in the US, especially in health outcomes for communities of color. Structural racism has played a critical role in exacerbating disparities, with Black, Hispanic, Latinx, and Indigenous populations experiencing higher rates of severe disease and mortality. The interconnectedness of racism with the social determinants of health, concomitant with higher rates of chronic illnesses like diabetes and hypertension, increases vulnerability to severe COVID-19. Health disparities are compounded by implicit biases in the medical field, a lack of diversity among healthcare providers, and historical medical mistrust among marginalized groups. Underrepresentation in the medical field, biomedical sciences, and academia hinders efforts to address health disparities effectively. This essay seeks to raise awareness of how the concepts of race and racism have resulted in racial hierarchies that perpetuate systems of oppression and impede efforts toward racial and health equity. Specifically, this essay covers time periods in American history, including slavery, the Jim Crow Era, the Civil Rights Movement, and the COVID-19 pandemic, and discusses how addressing race and racism and the achievement of racial health equity require targeted efforts to increase diversity in healthcare and biomedical fields, improve cultural competence, and foster trust between medical professionals and communities of color. Full article
13 pages, 1650 KiB  
Article
Clinical, Meteorological, and Air Quality Factors Associated with Ambulatory Pediatric Respiratory Syncytial Virus Infection in Machala, Ecuador, 2018–2023
by Manika Suryadevara, Dongliang Wang, Freddy Pizarro Fajardo, Jorge-Louis Carrillo Aponte, Froilan Heras, Cinthya Cueva Aponte, Irene Torres and Joseph B. Domachowske
Int. J. Environ. Res. Public Health 2025, 22(2), 272; https://doi.org/10.3390/ijerph22020272 - 13 Feb 2025
Abstract
Implementation of RSV prevention strategies requires an understanding of seasonal virus epidemiology; yet, such data are lacking in many tropical regions. We describe the seasonality and environmental factors associated with RSV activity in Machala, Ecuador. From July 2018 to July 2023, we analyzed [...] Read more.
Implementation of RSV prevention strategies requires an understanding of seasonal virus epidemiology; yet, such data are lacking in many tropical regions. We describe the seasonality and environmental factors associated with RSV activity in Machala, Ecuador. From July 2018 to July 2023, we analyzed nasopharyngeal samples from children younger than 5 years with an acute respiratory illness using Biofire FilmArray v.1.7™. Meteorological data were obtained from Ecuador’s Instituto Nacional de Meteorología e Hidrología. RSV detection was associated with mean outdoor air temperature (threshold 27 °C, area under the curve (AUC) 0.74, p < 0.001) that was even stronger when using a 4-week lag (threshold 27 °C, AUC 0.865, p < 0.001) and with precipitation greater than 0.5 mm/week using a 6-week lag (p = 0.008). This finding could provide guidance for the ideal timing to improve RSV surveillance and implement RSV prevention measures in Machala, including universal administration of extended half-life monoclonal antibody to infants entering their first RSV season. Full article
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15 pages, 329 KiB  
Article
Prevalence and Factors Associated with Common Mental Disorders and Posttraumatic Stress Disorder Among Healthcare Workers in a Reference Center for Infectious Diseases During the COVID-19 Pandemic: A Survey-Based Cross-Sectional Study
by Patrícia Guimarães, Raquel Oliveira, Rocicley Amud, Maria Elisa Bezerra, Paula Rigolon, Eunes Milhomem, José Luiz Lessa, Guilherme Calvet and Sonia Passos
Int. J. Environ. Res. Public Health 2025, 22(2), 271; https://doi.org/10.3390/ijerph22020271 - 13 Feb 2025
Abstract
A cross-sectional survey conducted between July and September 2020 and August and September 2021 estimated the prevalence and predictors of common mental disorders (CMDs) and post-traumatic stress disorder (PTSD) among healthcare workers (HCWs) at an infectious disease referral center during the COVID-19 pandemic. [...] Read more.
A cross-sectional survey conducted between July and September 2020 and August and September 2021 estimated the prevalence and predictors of common mental disorders (CMDs) and post-traumatic stress disorder (PTSD) among healthcare workers (HCWs) at an infectious disease referral center during the COVID-19 pandemic. CMDs were assessed using the General Health Questionnaire (GHQ-12), and PTSD using the Impact of Event Scale-Revised (IES-R). Multivariate logistic regressions identified predictors of CMD and PTSD. The study included 371 HCWs in 2020 and 167 in 2021. The CMD prevalence was 34.3% (95% confidence interval (CI): 29.5–39.4) in 2020 and 30.5% (95% CI: 23.7–38.1) in 2021. The PTSD prevalence was 25.4% (95% CI: 21.0–30.2) in 2020 and 32.7% (95% CI: 25.6–40.5) in 2021. Factors increasing CMD odds included lower education (adjusted odds ratio (AOR) = 3.71, 95% CI: 1.60–8.61), lack of physical activity (AOR = 2.23, 95% CI: 1.33–3.73), and experiencing COVID-19 symptoms (AOR = 1.64, 95% CI: 1.02–2.64) in 2020; chronic diseases (AOR = 3.14, 95% CI: 1.34–7.35) and SARS-CoV-2 testing (AOR = 3.39, 95% CI: 1.13–10.17) raised CMD odds in 2021. Frontline HCWs had lower CMD odds in 2020 (AOR = 0.60, 95% CI: 0.36–1.00) and 2021 (AOR = 0.33, 95% CI: 0.14–0.75). PTSD was associated with having COVID-19 symptoms (AOR = 2.06, 95% CI: 1.23–3.45), living with high-risk individuals (AOR = 1.75, 95% CI: 1.03–2.95), and losing loved ones (AOR = 1.86, 95% CI: 1.09–3.17) in 2020. Chronic diseases increased PTSD odds in 2020 (AOR = 2.20, 95% CI: 1.25–3.86) and 2021 (AOR = 2.30, 95% CI: 1.03–5.13), while age decreased them in 2020 (AOR = 0.95, 95% CI: 0.93–0.98) and 2021 (AOR = 0.95, 95% CI: 0.91–0.99). Younger HCWs with chronic conditions living with high-risk individuals were particularly affected. These findings highlight the urgent need for targeted emotional support and stress management programs for HCWs. Full article
(This article belongs to the Collection COVID-19 Research)
12 pages, 741 KiB  
Article
Musculoskeletal Complaints Among Female Childcare Workers in German Daycare Centres—A Survey Study with a Comparison Group
by Roxana Dauer, Anja Schablon and Albert Nienhaus
Int. J. Environ. Res. Public Health 2025, 22(2), 270; https://doi.org/10.3390/ijerph22020270 - 12 Feb 2025
Abstract
Childcare workers are at risk of musculoskeletal complaints due to various stresses. Comparative studies focusing on this group are lacking. In a cross-sectional study, we asked female childcare workers and women from the general population (comparison group) about musculoskeletal complaints, categorised by body [...] Read more.
Childcare workers are at risk of musculoskeletal complaints due to various stresses. Comparative studies focusing on this group are lacking. In a cross-sectional study, we asked female childcare workers and women from the general population (comparison group) about musculoskeletal complaints, categorised by body regions, and private/occupational risk factors. The childcare workers were recruited from Hamburg daycare centres and the comparison group from the residents’ registration office. The survey was conducted between October 2022 and July 2023. Odds ratios (ORs) were calculated in logistic regressions for factors influencing the occurrence of complaints that limited participants’ work or leisure activities in the past 12 months. Questionnaires from 218 female childcare workers and 250 from the comparison group were analysed. The comparison group had a 17.3% response rate. No response rate could be calculated for childcare workers. ORs for childcare workers were statistically significantly higher for complaints relating to the neck/cervical spine, shoulders/upper arms, knees and lumbar spine/lower back (OR between 1.7 and 3.2). This is the first study to compare the prevalence of musculoskeletal complaints in female childcare workers with other working women. The results show statistically significant differences, highlighting the need for interventions that address individual and workplace factors. Full article
(This article belongs to the Collection Potential Risks and Factors of Women's Health Promotion)
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20 pages, 1248 KiB  
Article
Youth Tobacco Control in the Digital Age: Impact of South Carolina’s Youth Tobacco Education and Vaping Cessation Social Media Programs
by Carolyn A. Stalgaitis, Susan Dang, Catherine Warner, Sharon Biggers, LaQuanna Jackson and Jeffrey W. Jordan
Int. J. Environ. Res. Public Health 2025, 22(2), 269; https://doi.org/10.3390/ijerph22020269 - 12 Feb 2025
Abstract
To maintain relevance, youth tobacco control programs must leverage popular social media platforms and address evolving behaviors. Recognizing this, the South Carolina Department of Public Health and Rescue Agency implemented culturally tailored social media campaigns (Down and Dirty, Fresh Empire), [...] Read more.
To maintain relevance, youth tobacco control programs must leverage popular social media platforms and address evolving behaviors. Recognizing this, the South Carolina Department of Public Health and Rescue Agency implemented culturally tailored social media campaigns (Down and Dirty, Fresh Empire), a broad vaping social media campaign (Behind the Haze), and an Instagram-based vaping cessation program (Quit the Hit, QTH). This study examines program impact. The social media campaigns were evaluated via online cross-sectional surveys in 2019–2023. Analyses examined awareness and reception overall and among target audiences and compared knowledge, attitudes, and beliefs between campaign-aware and unaware participants. The impact of QTH was assessed via online baseline and follow-up surveys in 2021–2023. Analyses examined program feedback and changes in cessation confidence and tobacco use from baseline to follow-up. Over one-third of participants recalled the social media campaigns, and recall of featured facts was higher among the campaign-aware participants than the unaware participants. QTH participants’ confidence in quitting increased from baseline to follow-up, while any 30-day vaping and average number of days of vaping decreased. This innovative social media program reached high-risk youth with educational content and empowered teens to quit vaping, providing a model for comprehensive youth tobacco control programs. Full article
(This article belongs to the Special Issue Evolving Role of Social Media in Health Communication)
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12 pages, 266 KiB  
Article
Mental Health in the Chilean Incarcerated Population: A Screening Approach
by Guillermo Sanhueza, Jessica Candia and Liza Zúñiga
Int. J. Environ. Res. Public Health 2025, 22(2), 268; https://doi.org/10.3390/ijerph22020268 - 12 Feb 2025
Abstract
From both a social and epidemiological perspective, incarcerated individuals in Latin America face a series of accumulated disadvantages in different areas, one of them being the deterioration in their mental health linked to confinement and the negative effects of incarceration. However, since mental [...] Read more.
From both a social and epidemiological perspective, incarcerated individuals in Latin America face a series of accumulated disadvantages in different areas, one of them being the deterioration in their mental health linked to confinement and the negative effects of incarceration. However, since mental health evaluations at the intake phase are virtually non-existent for incarcerated populations in Chile, the diagnosis of, monitoring of, and intervention initiatives on mental health issues are very limited, thus limiting the possibilities of causal relationship analysis and evidence-based interventions. Thus, the first step to making the topic of mental health more visible to public policy is to gather more evidence about it in prison settings. This article analyzed—using a screening approach—the presence, suspicion, or absence of psychopathology using the GHQ-12 instrument among a sample of 1159 incarcerated individuals grouped in 20 prisons throughout Chile. Our main results show that there are about 22.3% of Chilean inmates with presence of some form of psychopathology, plus an additional 51.8% with the criteria for suspected psychopathology; we also found significant, bivariate relationships between various mental health items and gender, the type of prison, and age, so that incarcerated women, younger inmates, and those housed in public prisons reporting more problems than their counterparts. Finally, we discuss the implications of our findings for the improvement of prison life in Chile and the possibility of social reintegration for incarcerated people. Full article
(This article belongs to the Section Global Health)
26 pages, 2226 KiB  
Article
Digital Stress-Preventive Management Competencies: Definition, Identification and Tool Development for Research and Practice
by Glauco Cioffi, Cristian Balducci and Stefano Toderi
Int. J. Environ. Res. Public Health 2025, 22(2), 267; https://doi.org/10.3390/ijerph22020267 - 12 Feb 2025
Abstract
The digital transformation of work and the rise of remote workers (RWs) are gaining growing interest in occupational health science. However, research on managers’ role in well-being can be developed more. Aiming to bridge this gap, this study first defines and explores the [...] Read more.
The digital transformation of work and the rise of remote workers (RWs) are gaining growing interest in occupational health science. However, research on managers’ role in well-being can be developed more. Aiming to bridge this gap, this study first defines and explores the Digital Stress-Preventive Management Competencies (DMCs) and then develops and validates an indicator tool with a three-phase procedure. Phase 1 consisted of a literature review and interviews with experts to identify DMCs, followed by item generation, content analysis and competencies conceptualization. Phase 2 was devoted to tool validation, comprising exploratory and confirmatory factor analysis with 247 RWs. Phase 3 explored the concurrent validity by investigating the relationship between DMCs and psychosocial factors via structural equation modeling (sample Phase 2) and polynomial regression with response surface analysis on 50 manager–team dyads (RWs 218). Two key competencies were identified: supportive ICT-mediated interaction (SIMI) and avoidance of abusive ICT adoption (AAIA). The final nine-item tool revealed a two-factor structure and good psychometric properties. SIMI was associated with superior support and role, while AAIA was linked to demands and control reported by RWs. These findings suggest that the DMCs identified and the related tool have potential applications in future organizational intervention content and for research purposes. Full article
(This article belongs to the Special Issue Advances in Mental Health and Well-Being at the Workplace)
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19 pages, 3705 KiB  
Article
The Effects of Food Security on Academic Performance of University Students at a Hispanic-Serving Institution
by Eva M. Moya, Gregory S. Schober, Amy Wagler, Jessica Ayala-Demeo Brown, Silvia M. Chavez-Baray, Panfeng Liang and Robbie Kennebrew
Int. J. Environ. Res. Public Health 2025, 22(2), 266; https://doi.org/10.3390/ijerph22020266 - 12 Feb 2025
Abstract
Several studies find that low food security has negative effects on academic performance in higher education in the U.S., but the samples for these studies often have low percentages of Hispanic students. Consequently, it remains unclear if food security affects academic performance in [...] Read more.
Several studies find that low food security has negative effects on academic performance in higher education in the U.S., but the samples for these studies often have low percentages of Hispanic students. Consequently, it remains unclear if food security affects academic performance in predominantly Hispanic settings. Our study aims to analyze whether food security affects academic performance at a Hispanic-Serving Institution (HSI). Using original survey data collected on 2020 students enrolled at a large research-intensive HSI and cumulative logit models, we assess whether food security influences concentration and graduation delays among students at an HSI in the U.S.–Mexico border region. Our findings strongly suggest that low food security reduces concentration and increases delays for graduation at the HSI. The results have important implications for HSI leaders who want to improve student success, and we offer recommendations for future programs and investments to build student food security at HSIs. Because food security is a strong social determinant of health, the study is closely related to the topic of addressing social determinants of health to improve Hispanic health outcomes. When universities take action to build food security among HSI students, they simultaneously make an investment to improve Hispanic health outcomes. Full article
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30 pages, 5913 KiB  
Article
System Models for Synchronous Strategies in Operational Healthcare Forecasting
by Arnesh Telukdarie, Logistic Makoni, R. Raghunatha Sarma, Megashnee Munsamy and Sunil Kumar
Int. J. Environ. Res. Public Health 2025, 22(2), 265; https://doi.org/10.3390/ijerph22020265 - 12 Feb 2025
Abstract
The delivery of healthcare in Low-to-Medium-Income Countries (LMICs) has long posed challenges, with established models predominantly found in wealthier nations. These models are found to be either strategic or operational, and very rarely combine these two perspectives. Most importantly, these models lack a [...] Read more.
The delivery of healthcare in Low-to-Medium-Income Countries (LMICs) has long posed challenges, with established models predominantly found in wealthier nations. These models are found to be either strategic or operational, and very rarely combine these two perspectives. Most importantly, these models lack a comprehensive, holistic and synchronous construct that accompanies a systems thinking approach. This research evaluates international best practices, fundamental global theories and existing systems and tools in healthcare through a systems approach. It collates these data to propose a customized systems-based, comprehensive framework for modeling and optimizing both the management and operational tiers of healthcare in LMICs. The approach is based on the adoption of digital tools, inclusive of AI, to analyze, assimilate, align and develop advanced, holistic and inclusive frameworks. The current gap in global healthcare delivery is characterized by an ongoing lack of ability to provide quality and cost-effective care, especially in the LMICs. Despite the fact that developmental challenges are unique and specific to respective countries, there are commonalities with regard to healthcare processes that present opportunities for optimization. The main challenge lies in the effective collation and synchronization of data and tools with the specific contexts of each country. This situation highlights the need for a cohesive systems approach to enhance healthcare delivery in LMICs, allowing for tailored solutions that can bridge existing gaps. This paper presents a strategic model, with initial data quantification guiding the development of the system model. The practical significance of this research lies in its potential to transform healthcare delivery in LMICs, leading to enhanced access and quality of care through optimized systems. Full article
(This article belongs to the Special Issue Digital Health in South Africa)
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15 pages, 2688 KiB  
Review
Trends and Gaps in Colorectal Cancer Screening Research in the Arab World: A 16-Year Bibliometric Analysis (2007–2023)
by Noura Abbas, Laudy Chehade, Hawraa Tarhini, Zahi Abdul Sater and Ali Shamseddine
Int. J. Environ. Res. Public Health 2025, 22(2), 264; https://doi.org/10.3390/ijerph22020264 - 12 Feb 2025
Abstract
Colorectal cancer (CRC) is a significant public health concern, ranking third in incidence and second in mortality worldwide. Despite rising CRC incidence rates in the Arab world, understanding of trends and patterns in CRC screening research remains limited. This study addresses this gap [...] Read more.
Colorectal cancer (CRC) is a significant public health concern, ranking third in incidence and second in mortality worldwide. Despite rising CRC incidence rates in the Arab world, understanding of trends and patterns in CRC screening research remains limited. This study addresses this gap through a bibliometric analysis of CRC screening research in the Arab world from 2007 to 2023. We conducted an extensive literature search in Web of Science and Scopus databases, analyzing 124 articles using the Bibliometrix Package in R. Our findings revealed a 16.5% annual growth in research output, with significant increases from 2014 onwards. Saudi Arabia led in scientific production, followed by Lebanon, Jordan, and Egypt, while Qatar had the highest country production when adjusted for population size. Disparities in research output relative to the CRC burden were evident, especially in lower-resource countries. Three regional clusters were identified: Saudi Arabia, with strong collaborations with Canada and Egypt; a second cluster including Lebanon, UAE, Jordan, Qatar, Iraq, and Oman; and a third cluster featuring Morocco, with significant collaboration with France. Thematic analysis showed a focus on CRC screening awareness, barriers, and adherence but a lack of studies on implementation strategies and cost-effectiveness. This analysis highlights significant trends and gaps in CRC screening research in the Arab world, underscoring the need for increased investment in CRC research and screening initiatives to improve outcomes in the region. Full article
(This article belongs to the Section Global Health)
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