International Journal of Environmental Research and Public Health

15 pages, 1417 KiB

Open AccessArticle

Can an Evidence-Based Mental Health Intervention Indirectly Benefit Caregivers and Peers of Intervention Participants in Rural Sierra Leone?

by Alethea Desrosiers, Kathryn Noon, Matias Placencio-Castro, Nathan B. Hansen, Musu Moigua and Theresa S. Betancourt

Int. J. Environ. Res. Public Health 2025, 22(6), 844; https://doi.org/10.3390/ijerph22060844 (registering DOI) - 28 May 2025

Abstract

This study explored potential indirect mental health benefits of the Youth Readiness Intervention (YRI) among peers and caregivers of YRI participants and control participants via a networks psychometrics approach. We recruited and enrolled index participants who participated in an implementation trial in Sierra [...] Read more.

This study explored potential indirect mental health benefits of the Youth Readiness Intervention (YRI) among peers and caregivers of YRI participants and control participants via a networks psychometrics approach. We recruited and enrolled index participants who participated in an implementation trial in Sierra Leone (N = 165 control index participants; N = 165 YRI index participants). Index participants nominated three of their closest peers (N = 879) and one cohabitating caregiver (N = 284) to complete quantitative assessments on mental health and functioning. We used network psychometrics to explore patterns of association between mental health outcomes and risk/protective factors among YRI participants’ peers and caregivers and those of non-participants. Models of network structures showed several strong associations between mental health symptoms and risk/protective factors. There was a strong association between higher social support and positive coping skills. Additionally, models reflected stronger associations between higher depression symptoms and worse emotion regulation for peers of non-participants only. For caregivers of non-participants, a higher burden of care was strongly associated with worse emotion regulation, which was associated with higher levels of depression and anxiety. On a broader scale, the findings may provide support for wider societal benefits that evidence-based mental health interventions can offer in resource-constrained settings. Full article

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14 pages, 281 KiB

Open AccessArticle

DSM-5 Criteria for Alcohol and Cannabis Use Disorders: Are Older Adults Less Likely to Endorse Certain Criteria?

by Namkee G. Choi, Jeffrey A. Morris and C. Nathan Marti

Int. J. Environ. Res. Public Health 2025, 22(6), 843; https://doi.org/10.3390/ijerph22060843 (registering DOI) - 28 May 2025

Abstract

With increasing substance misuse among older adults, we examined the question of whether older adults may be less likely to endorse certain DSM-5 criteria for alcohol and cannabis use disorders (AUD and CUD). We used the 2021–2023 National Surveys on Drug Use and [...] Read more.

With increasing substance misuse among older adults, we examined the question of whether older adults may be less likely to endorse certain DSM-5 criteria for alcohol and cannabis use disorders (AUD and CUD). We used the 2021–2023 National Surveys on Drug Use and Health (N = 17,494 for AUD and N = 12,264 for CUD) and descriptive statistics to compare the 65+ and under 65 age groups in their endorsements of 11 DSM-5 criteria. A multivariable logistic regression model was fitted for each criterion as the dependent variable with the age group as the independent variable and other characteristics as covariates. For AUD, the 65+ age group was associated with lower odds of endorsing seven out of eleven DSM-5 criteria, including social impairments (e.g., failure to fulfill role obligations (aOR = 0.30, 95% CI = 0.16–0.56); social problems (aOR = 0.46, 95% CI = 0.30–0.71); given-up activities (aOR = 0.66, 95% CI = 0.47–0.94); hazardous use (aOR = 0.53, 95% Yes CI = 0.34–0.81); and physical/psychological problems (aOR = 0.51, 95% CI = 0.37–0.70). For CUD, the 65+ age group was less likely than the under 65 age group to endorse hazardous use (aOR = 0.04, 95% CI = 0.01–0.17) and withdrawal (aOR = 0.39, 95% CI = 0.20–0.73 for criterion A and aOR = 0.16, 95% CI = 0.05–0.48 for criterion B). Clinicians should be aware that older adults might not express the full range of symptoms in the same way as the younger age groups. A more nuanced understanding of older adults’ social context may be needed for accurate diagnosis. Full article

(This article belongs to the Section Behavioral and Mental Health)

11 pages, 539 KiB

Open AccessArticle

Improving Rural Healthcare in Mobile Clinics: Real-Time, Live Data Entry into the Electronic Medical Record Using a Satellite Internet Connection

by Daniel Jackson Smith, Elizabeth Mizelle, Nina Ali, Valery Cepeda, Tonya Pearson, Kayla Crumbley, Dayana Pimentel, Simón Herrera Suarez, Kenneth Mueller, Quyen Phan, Erin P. Ferranti and Lori A. Modly

Int. J. Environ. Res. Public Health 2025, 22(6), 842; https://doi.org/10.3390/ijerph22060842 (registering DOI) - 28 May 2025

Abstract

The Farmworker Family Health Program (FWFHP) annually supports 600 farmworkers in connectivity-challenged rural areas. Traditional paper-based data collection poses validity concerns, prompting a pilot of direct data entry using tablets and satellite internet to enhance efficiency. The purpose of this article is to [...] Read more.

The Farmworker Family Health Program (FWFHP) annually supports 600 farmworkers in connectivity-challenged rural areas. Traditional paper-based data collection poses validity concerns, prompting a pilot of direct data entry using tablets and satellite internet to enhance efficiency. The purpose of this article is to describe, using the TIDier checklist, a real-time, live data-entry EMR intervention made possible by satellite internet. Utilizing a customized REDCap database, direct data entry occurred through tablets and satellite internet. Patients received a unique medical record number (MRN) at the mobile health clinic, with an interprofessional team providing care. Medication data, captured in REDCap before the mobile pharmacy visit, exhibited minimal defects at 6.9% of 319 prescriptions. To enhance data collection efficiency, strategies such as limiting free text variables and pre-selecting options were employed. Adequate infrastructure, including tablets with keyboards and barcode scanners, ensured seamless data capture. Wi-Fi extenders improved connectivity in open areas, while backup paper forms were crucial during connectivity disruptions. These practices contributed to enhanced data accuracy. Real-time data entry in connectivity-limited settings is viable. Replacing paper-based methods streamlines healthcare provision, allowing timely collection of occupational and environmental health metrics. The initiative stands as a scalable model for healthcare accessibility, addressing unique challenges in vulnerable communities. Full article

(This article belongs to the Special Issue Advances and Trends in Mobile Healthcare)

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23 pages, 353 KiB

Open AccessFeature PaperReview

Brief Interventions for Families Seeking Support from Family Services: A Scoping Review

by Victoria Hamilton, Gina-Maree Sartore, Michelle Macvean, Elbina Avdagic, Zvezdana Petrovic, Cathryn Hunter and Catherine Wade

Int. J. Environ. Res. Public Health 2025, 22(6), 841; https://doi.org/10.3390/ijerph22060841 (registering DOI) - 27 May 2025

Abstract

Brief family support interventions may be an effective and acceptable option when demands on services and pressures on families can often mean intensive, long-term family support interventions are an inefficient and unappealing course of action. The purpose of this scoping review was to [...] Read more.

Brief family support interventions may be an effective and acceptable option when demands on services and pressures on families can often mean intensive, long-term family support interventions are an inefficient and unappealing course of action. The purpose of this scoping review was to better understand the nature of non-medical brief interventions targeted at parents and families experiencing adversity or challenging circumstances that may lead them to seek support from family services. We used a systematic search and selection process to identify publications (papers or webpages) about brief interventions for parents and families within three academic databases and 70 websites. Publications were in scope if the interventions were targeted to parents and families, were non-medical in nature, and were brief (no longer than 10 h duration, or up to four sessions). We identified 78 papers and webpages eligible for inclusion in this scoping review, covering 46 brief interventions. Data were extracted by two researchers and charted in a spreadsheet. Most interventions were delivered in the mental health sector, followed by the education, and then community or family services sector, and most often in a clinical setting. Intervention duration varied, ranging from 45 min to a two-day workshop, and were usually aimed at improving the mental health of children and young people. Interventions were delivered to groups of parents, followed by whole families or individual parents. This review highlights the pressing need for high-quality evaluations of brief interventions for family support, and given the diversity of delivery modes, durations and conceptualisation of ‘brief intervention’ in the field and literature, further synthesis of the evidence through systematic reviews is required. This paper advances understanding and clarity on how brief interventions may be beneficial for families experiencing adversity, yet further evaluation and systematic review for acceptability and efficacy is required. Full article

(This article belongs to the Special Issue Promoting Mental Health and Wellbeing in Children and Young People at Risk)

26 pages, 708 KiB

Open AccessReview

Manifestation and Markings of HIV Stigma in Indonesia: A Scoping Review

by Ni Kadek Sudastri, Luh Putu Lila Wulandari and Pande Putu Januraga

Int. J. Environ. Res. Public Health 2025, 22(6), 840; https://doi.org/10.3390/ijerph22060840 (registering DOI) - 27 May 2025

Abstract

Stigma related to HIV hinders access to healthcare services and worsens the quality of life for people living with HIV (PLHIV). A comprehensive understanding of HIV stigma is crucial for designing effective stigma interventions. This scoping review offers an overview of the manifestations [...] Read more.

Stigma related to HIV hinders access to healthcare services and worsens the quality of life for people living with HIV (PLHIV). A comprehensive understanding of HIV stigma is crucial for designing effective stigma interventions. This scoping review offers an overview of the manifestations and markings of HIV stigma in Indonesia. Articles published in PubMed, Scopus, Google Scholar, and other sources were searched. Studies selected were published between 2019 and 2023, written in English, and focused on the manifestations or markings of HIV stigma in Indonesia. A thematic approach was applied to analyze the findings. From an initial pool of 4776 articles, 745 advanced to the title and abstract screening process, with 40 ultimately included in the review. The findings indicate that HIV stigma in Indonesia manifested as avoidance of contact with PLHIV, differential treatment of PLHIV, negative reactions toward PLHIV, and self-stigma. These stigmatizing behaviors were observed across various societal levels, including family members, the general public, colleagues in the workplaces, healthcare providers, and even PLHIV themselves. The findings further reveal the dual burden of stigma experienced by vulnerable populations such as children, adolescents, pregnant women, and key populations. Additionally, this review notes the presence of stigma marking directed at PLHIV, portraying them as dangerous, unclean, immoral, bad and irresponsible, and even sinners. In conclusion, in Indonesia, HIV stigma may take many different forms and occur in many different societal levels. This underscores the need for comprehensive, collective action and cross-sectoral interventions to effectively address these issues. Full article

(This article belongs to the Special Issue Impact of HIV on Children and Adolescents Living with HIV and Their Families)

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15 pages, 354 KiB

Open AccessReview

What Strategies Do Healthcare Providers Use to Promote Adolescents’ Vaping Cessation? A Scoping Review

by Naima Nimmi, Bindu Joseph, Habib Bhurawala, Smita Shah, Anita Munoz and Muhammad Aziz Rahman

Int. J. Environ. Res. Public Health 2025, 22(6), 839; https://doi.org/10.3390/ijerph22060839 (registering DOI) - 27 May 2025

Abstract

Background: Healthcare providers (HCPs) can play a pivotal role in providing vaping cessation support to adolescents. They can screen adolescents for vaping, offer interventions to quit, and educate adolescents about the dangers of vaping, including nicotine addiction. This review aims to assess the [...] Read more.

Background: Healthcare providers (HCPs) can play a pivotal role in providing vaping cessation support to adolescents. They can screen adolescents for vaping, offer interventions to quit, and educate adolescents about the dangers of vaping, including nicotine addiction. This review aims to assess the knowledge, attitudes, and practices of HCPs regarding vaping cessation promotion to adolescents. Methods: We conducted a scoping review following the Arksey and O’Malley framework and searched five databases, including MEDLINE, PubMed, PsycINFO, CINAHL, and Scopus, to identify relevant articles. We created a comprehensive search strategy using keywords relevant to healthcare providers, adolescents, practices, and vaping. Results: A total of 1387 articles were identified from the initial search, and 14 were included. There was considerable variation regarding the knowledge, attitudes, and practices of HCPs in supporting adolescents. Although 50–92% of HCPs reported some knowledge about vaping, significant gaps persisted, especially regarding health effects and cessation strategies. Many HCPs lacked confidence in discussing vaping with adolescent patients. While most of the HCPs, 86%, screened for cigarette smoking, only 14% routinely screened adolescents for vaping. They expressed concerns about vaping as a gateway to tobacco use and believed that it was less harmful than cigarettes. HCPs encountered barriers with a lack of time, knowledge, and screening tools in supporting adolescents to quit vaping, particularly related to counselling, treatment recommendations, and referral procedures. Conclusions: There is an urgent need for enhanced understanding, evidence-based guidelines, and clinical tools for HCPs to address the current vaping epidemic among adolescents. Full article

(This article belongs to the Special Issue Regulating the Use of Electronic Devices for Vaping and Vaping to Promote Youth and Young Adult Health)

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11 pages, 260 KiB

Open AccessArticle

Residential Segregation and Epigenetic Age Acceleration Among Older-Age Black and White Americans

by Reed DeAngelis, Victoria Fisher, John Dou, Kelly Bakulski, David Rigby and Margaret Hicken

Int. J. Environ. Res. Public Health 2025, 22(6), 837; https://doi.org/10.3390/ijerph22060837 (registering DOI) - 27 May 2025

Abstract

Our study tests residential segregation as an explanation for biological aging disparities between Black and White Americans. We analyze data from 288 Black and White older-age adults who participated in Wave 6 (2019) of the Americans’ Changing Lives study, a nationally representative cohort [...] Read more.

Our study tests residential segregation as an explanation for biological aging disparities between Black and White Americans. We analyze data from 288 Black and White older-age adults who participated in Wave 6 (2019) of the Americans’ Changing Lives study, a nationally representative cohort of adults in the contiguous United States. Our outcome of interest is epigenetic age acceleration assessed via five epigenetic clocks: GrimAge, PhenoAge, SkinBloodAge, HannumAge, and HorvathAge. Residential segregation is operationalized at the census tract level using the Getis-Ord G_i* statistic and multilevel modeling procedures that adjust for state-level clustering. We uncover three key findings. First, epigenetic age profiles are comparable among White respondents regardless of where they live. Second, Black respondents express roughly three years of accelerated epigenetic age (GrimAge), relative to White counterparts, regardless of where they live. Third, diminished education levels and homeownership rates, coupled with elevated levels of traumatic stress and smoking, explain why Black residents in segregated Black areas exhibit accelerated epigenetic age. However, these factors do not explain why Black respondents living outside segregated Black areas also exhibit epigenetic age acceleration. Our findings suggest residential segregation only partially explains why Black Americans tend to live shorter lives than White Americans. Full article

16 pages, 556 KiB

Open AccessReview

Mosses in Urban Environments as Passive Biofilters and Organisms Impacted by Asbestos-Contaminated Habitats

by Gergely Zoltán Macher and Dóra Beke

Int. J. Environ. Res. Public Health 2025, 22(6), 838; https://doi.org/10.3390/ijerph22060838 (registering DOI) - 26 May 2025

Abstract

Asbestos cement materials represent a persistent source of environmental contamination, particularly in urban areas where weathering facilitates the release of hazardous chrysotile fibres. Despite extensive research on the human health impacts of asbestos, ecological interactions remain poorly understood. This paper explores the dual [...] Read more.

Asbestos cement materials represent a persistent source of environmental contamination, particularly in urban areas where weathering facilitates the release of hazardous chrysotile fibres. Despite extensive research on the human health impacts of asbestos, ecological interactions remain poorly understood. This paper explores the dual role of bryophytes colonising asbestos cement roofing as passive filters that trap airborne fibres and as vulnerable organisms subjected to asbestos-induced stress. Using a synthesis of recent findings, we assess the capacity of mosses to immobilise chrysotile fibres through their dense, mat-like structures, potentially reducing local dispersion. Simultaneously, we examine physiological and biochemical responses to prolonged fibre exposure, including reduced photosynthetic activity and signs of oxidative stress. The findings highlight a paradoxical function of bryophytes: while they contribute to pollution mitigation, they also accumulate contaminants and suffer from sublethal damage. These interactions may have broader implications for contaminant redistribution, particularly through decomposition and trophic transfer. Understanding these dynamics is essential for advancing ecological risk assessments and developing sustainable remediation strategies in asbestos-contaminated habitats. Full article

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12 pages, 868 KiB

Open AccessArticle

Healthy Homes: Repairs and Maintenance in Remote Northern Territory Housing

by Liam Grealy, Jiunn-Yih Su and David Thomas

Int. J. Environ. Res. Public Health 2025, 22(6), 836; https://doi.org/10.3390/ijerph22060836 (registering DOI) - 26 May 2025

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Abstract

This article examines Healthy Homes, a program intended to initiate a new approach to housing repairs and maintenance in remote communities in the Northern Territory of Australia. It argues that while the evidence for associations between poor housing and poor health outcomes is [...] Read more.

This article examines Healthy Homes, a program intended to initiate a new approach to housing repairs and maintenance in remote communities in the Northern Territory of Australia. It argues that while the evidence for associations between poor housing and poor health outcomes is clear, greater attention should be paid to the implementation of health-focused housing interventions. Healthy Homes was examined through interviews with public servants, Aboriginal community-controlled organisation staff, and householders, alongside participant observation during maintenance projects and Condition Assessment Tool inspections. Routine housing, inspections, and expenditure datasets were also analysed. Across 5498 houses subject to Healthy Homes and over a twenty-month period, only 1315 Condition Assessment Tool inspections were completed, which is the key mechanism for generating preventive maintenance work. Expenditure on repairs and maintenance was stable between the old maintenance model and under Healthy Homes. Most Healthy Homes remote housing maintenance contracts were awarded to Aboriginal business enterprises. This article finds that Healthy Homes did not effectively shift remote property management to prioritise preventive maintenance. Issues with data collection and monitoring, program implementation, and contractual arrangements impeded more consistent and effective attention paid to the condition of housing health hardware. Future investment into the implementation of health-focused remote housing preventive maintenance programs must attend to the details of program design, including the data collection processes and contractual terms for service providers. Full article

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12 pages, 519 KiB

Open AccessArticle

Hand Hygiene Roles, Challenges, and Intervention Feedback from School Staff: A Qualitative Analysis, Belize, 2022–2023

by Anh N. Ly, Christina Craig, Dian Maheia, Yolanda Gongora, Vickie Romero, Rosalva Blanco, Allison Lino, Kelsey McDavid, Allison Stewart, Victoria Trinies, Alexandra Medley, Francis Morey, Russell Manzanero, Matthew Lozier and Kristy O. Murray

Int. J. Environ. Res. Public Health 2025, 22(6), 835; https://doi.org/10.3390/ijerph22060835 (registering DOI) - 26 May 2025

Viewed by 32

Abstract

Hand hygiene (HH) in school settings can reduce the spread of infectious diseases and student absenteeism due to illness. During the COVID-19 pandemic, the World Health Organization recommended HH as a public health measure to prevent disease transmission. Understanding school staff’s experiences with [...] Read more.

Hand hygiene (HH) in school settings can reduce the spread of infectious diseases and student absenteeism due to illness. During the COVID-19 pandemic, the World Health Organization recommended HH as a public health measure to prevent disease transmission. Understanding school staff’s experiences with school-based programs is important for future program development and improvement. As part of a mixed-methods study, we conducted in-depth interviews in March 2022 with school administrators and teachers at 12 primary schools in Belize, selected based on high gaps in HH resources, to understand HH responsibilities, supplies, and challenges. An intervention was implemented to increase HH knowledge and practices among students, which included environmental nudges, supplemental provision of soap, and HH lesson implementation. Follow-up interviews were conducted in June 2023 among school administrators to garner feedback on the intervention. School staff described roles in teaching and managing HH supplies at both timepoints. The environmental nudges and HH lessons were perceived as helpful, but there were gaps remaining in HH practices, which may be partially influenced by practices and beliefs outside of school. Procurement of HH supplies remained a challenge at some schools due to financial constraints. The feedback from school staff will be valuable for the implementation of future hand hygiene programs in schools. Full article

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17 pages, 392 KiB

Open AccessReview

Exploring Male Body Image: A Scoping Review of Measurement Approaches and Mental Health Implications

by Emily Pomichter, Antonio Cepeda-Benito, Shahrzad Ahmadkaraji and John P. DePalma

Int. J. Environ. Res. Public Health 2025, 22(6), 834; https://doi.org/10.3390/ijerph22060834 (registering DOI) - 26 May 2025

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Abstract

Background: Body image (BI) concerns in men—spanning thinness, muscularity, and other related constructs—are increasingly being recognized for their links to depression, anxiety, and self-esteem, yet measurement approaches remain unevenly aligned. Objectives: Our objective was to map the landscape of BI instruments deployed with [...] Read more.

Background: Body image (BI) concerns in men—spanning thinness, muscularity, and other related constructs—are increasingly being recognized for their links to depression, anxiety, and self-esteem, yet measurement approaches remain unevenly aligned. Objectives: Our objective was to map the landscape of BI instruments deployed with cisgender men and women and to examine whether thinness-, muscularity-, and non-specific self-image satisfaction measures differentially relate to key mental health outcomes. Eligibility Criteria: Our eligibility criteria were peer-reviewed, quantitative studies published in English between January 2011 and December 2021. We only included studies with samples ≥30 cisgender men, psychometrically validated BI scales, results reported separately by gender, and U.S.-based investigations. Sources of Evidence: The source of evidence was a systematic search of PsycINFO. Charting Methods: Two reviewers double-screened titles/abstracts and full texts in EPPI-Reviewer. Data on measure orientation; validation sample characteristics; and effect sizes relating BI scores to depression, anxiety, and self-esteem were extracted. The effect sizes were transformed to r and averaged across the studies. Results: Of the 1178 records identified, 191 U.S. studies met the inclusion criteria. Fifty-five distinct BI instruments were used; twelve appeared in six or more studies and were classified as thinness-oriented, muscularity-oriented, or non-specific. The unweighted average correlations with depression ranged from r = 0.23 (muscularity) to 0.34 (non-specific), with anxiety at r = 0.16–0.25 and self-esteem at r = 0.20–0.57. The male samples showed greater heterogeneity of effect sizes, likely reflecting the sampling variability and the multifaceted nature of men’s BI concerns. Conclusions: This review confirms critical gaps in male BI measurement and interpretation. Although thinness- and muscularity-oriented scales each capture facets of men’s BI, exclusive reliance on thinness measures risks overlooking leanness- and musculature-focused pathology. The greater variability of BI–mental health associations in men than women underscore the need for a diverse measurement toolkit that, at minimum, assesses thinness, muscularity, and other appearance-related constructs. Full article

(This article belongs to the Special Issue Mental Health Assessments, Chronic Disease and Health Psychology)

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14 pages, 250 KiB

Open AccessArticle

Parent Perceptions of an Anxiety Prevention Manual for Young Children

by Olutosin Sanyaolu, Ava Robertson, Tabitha Naa Akuyea Addy and Laura Anne Nabors

Int. J. Environ. Res. Public Health 2025, 22(6), 833; https://doi.org/10.3390/ijerph22060833 (registering DOI) - 26 May 2025

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Abstract

Parents are primary “supporters” for helping their children cope with feelings of anxiety, a significant concern for many young children. The current study examined parents’ perceptions of an anxiety management manual. Parents reviewed an anxiety coping manual for elementary school-aged children. This manual [...] Read more.

Parents are primary “supporters” for helping their children cope with feelings of anxiety, a significant concern for many young children. The current study examined parents’ perceptions of an anxiety management manual. Parents reviewed an anxiety coping manual for elementary school-aged children. This manual explained how anxiety influences the body and emotions, as well as presenting cognitive-behavioral anxiety management strategies. The strategies included breathing, imagery (superhero to fight worries and imagine your favorite place), relaxation, talking to supportive others, and using distraction. Convenience samples of 15 parents completed virtual interviews and 6 completed in-person interviews to determine their perceptions of the manual and of worry for today’s children. Qualitative analyses were performed to determine themes in the data. Results indicated that parents would use the manual and key themes, which were (1) learning new strategies for helping their child, (2) discussing children’s worries, and (3) sharing why the worry strategies would be useful (e.g., for emotion regulation). Parents felt that today’s children are worrying more about serious things like school performance and family stressors. Future research needs to examine parent implementation of the strategies over time to determine if the use of anxiety management strategies is related to lower levels of worry for young children, if the strategies reduce anxiety-related stress, and if prevention minimizes the impact of anxiety on emotional functioning. Full article

(This article belongs to the Special Issue Research on Emotional and Cognitive Development in Children)

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29 pages, 31652 KiB

Open AccessArticle

Low-Carbon Practices and Cultural Adaptation Among Older Chinese Migrants: Insights from Walking Interviews on Environmental Policy and Social Integration

by Qing Ni, Hua Dong and Antonios Kaniadakis

Int. J. Environ. Res. Public Health 2025, 22(6), 832; https://doi.org/10.3390/ijerph22060832 - 25 May 2025

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Abstract

This study employs walking interviews to examine the low-carbon practices, cultural adaptation, and policy awareness of older Chinese migrants in the UK within their everyday environments. A total of 20 participants were interviewed in public spaces such as parks, supermarkets, and their homes. [...] Read more.

This study employs walking interviews to examine the low-carbon practices, cultural adaptation, and policy awareness of older Chinese migrants in the UK within their everyday environments. A total of 20 participants were interviewed in public spaces such as parks, supermarkets, and their homes. Using contextual thematic analysis, the study identifies key factors influencing their environmental behaviors. The findings reveal the following: (1) Language barriers, economic pressures, and social isolation limit migrants’ understanding of environmental policies. Many participants rely on self-sufficient ethnic community networks rather than engaging with mainstream sources; (2) Generational differences are evident—younger migrants demonstrate greater theoretical awareness of environmental policies, whereas older migrants exhibit stronger low-carbon behaviors through energy conservation and waste reduction; (3) A balance between cultural identity and consumption habits—while some migrants adjust their dietary, spending, and linguistic habits, core cultural values such as frugality and family responsibility remain unchanged. This study highlights the value of walking interviews in capturing situational insights into low-carbon behaviors and cultural adaptation. It provides empirical evidence for government agencies and community organizations, advocating for cross-cultural environmental education and improved policy communication. Recommendations include targeted environmental training, community-based volunteer initiatives, intergenerational environmental education, and policy dissemination through WeChat, Chinese communities, and ethnic networks. These measures can help bridge the generational gap in policy awareness and promote social integration among older Chinese migrants. Full article

(This article belongs to the Collection 2nd Edition of Achieving Environmental Health Equity: Great Expectations)

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23 pages, 1427 KiB

Open AccessArticle

Disparities in Healthcare Utilization Among Vulnerable Populations During the COVID-19 Pandemic in Brazil: An Intersectional Analysis

by Letícia Perticarrara Ferezin, Rander Junior Rosa, Heriederson Sávio Dias Moura, Mônica Chiodi Toscano de Campos, Felipe Mendes Delpino, Murilo César do Nascimento, Juliana Soares Tenório de Araújo, Ione Carvalho Pinto and Ricardo Alexandre Arcêncio

Int. J. Environ. Res. Public Health 2025, 22(6), 831; https://doi.org/10.3390/ijerph22060831 (registering DOI) - 25 May 2025

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Abstract

Background: Brazil’s Unified Health System (Sistema Único de Saúde—SUS) has played a crucial role in reducing health disparities by providing universal and free healthcare to a diverse population. However, the COVID-19 pandemic exposed significant barriers to healthcare access among vulnerable groups, particularly due [...] Read more.

Background: Brazil’s Unified Health System (Sistema Único de Saúde—SUS) has played a crucial role in reducing health disparities by providing universal and free healthcare to a diverse population. However, the COVID-19 pandemic exposed significant barriers to healthcare access among vulnerable groups, particularly due to the intersection of multiple vulnerabilities. This study aimed to examine how intersectionality—specifically sex/gender, race/ethnicity, and education level—has influenced inequalities in healthcare service utilization among vulnerable populations during the COVID-19 pandemic in Brazil. Methods: This cross-sectional study is part of the “COVID-19 Social Thermometer in Brazil” project, conducted between May 2022 and October 2023 in Brazil’s state capitals and the Federal District, focusing on populations considered socially vulnerable during the pandemic. Participants were selected using sequential sampling and completed a structured questionnaire. Statistical analyses—performed using Excel, RStudio (version 4.3.2), and ArcGIS—included sociodemographic profiling, the construction of the Jeopardy Index (a measure of social vulnerability), and binary logistic regression to explore associations between Jeopardy Index and healthcare service utilization. Results: 3406 participants, the majority were men (60%), aged 30 to 59 years (65.1%), and identified as Black or Brown (72.2%). Most participants were concentrated in the Northeast (26.6%) and North (22.3%) macroregions. A high reliance on public healthcare services (SUS) was observed, particularly in the Southeast (96%). According to the Jeopardy Index, the most socially vulnerable groups—such as women, transgender individuals, Black people, and those with no formal education—were significantly more likely to rely on SUS (OR = 3.14; 95% CI: 1.34–7.35) and less likely to use private healthcare (OR = 0.07; 95% CI: 0.02–0.20), reflecting a 214% higher likelihood of SUS use and a 93% lower likelihood of private service utilization compared to the most privileged group. Conclusions: Our findings reveal that individuals experiencing intersecting social vulnerabilities face marked inequalities in healthcare access. Without SUS, these populations would likely have been excluded from essential care. Strengthening SUS and implementing inclusive public policies are critical to reducing disparities and ensuring equitable healthcare access for historically marginalized groups. Full article

(This article belongs to the Special Issue Measuring Health Inequities Among Vulnerable Populations (2nd Edition))

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17 pages, 679 KiB

Open AccessProtocol

Perspectives of Primary Healthcare Workers on HIV Injectable Pre-Exposure Prophylaxis (PrEP): A Scoping Review Protocol

by Nomvuselelo Nomzamo Mbatha, Nomakhosi Mpofana and Dumile Gumede

Int. J. Environ. Res. Public Health 2025, 22(6), 830; https://doi.org/10.3390/ijerph22060830 - 24 May 2025

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Abstract

South Africa continues to experience a high HIV prevalence, necessitating innovative prevention strategies aligned with the UNAIDS 95-95-95 targets. Long-acting injectable pre-exposure prophylaxis (PrEP), such as cabotegravir (CAB-LA), offers a promising alternative to daily oral regimens. However, the perspectives of primary healthcare workers [...] Read more.

South Africa continues to experience a high HIV prevalence, necessitating innovative prevention strategies aligned with the UNAIDS 95-95-95 targets. Long-acting injectable pre-exposure prophylaxis (PrEP), such as cabotegravir (CAB-LA), offers a promising alternative to daily oral regimens. However, the perspectives of primary healthcare workers (PHCWs)—key implementers of this intervention—remain underexplored. This scoping review aims to systematically map existing literature on PHCWs’ knowledge, awareness, perceptions, barriers, facilitators, and implementation experiences related to injectable PrEP within the South African healthcare context. The review will follow the Arksey and O’Malley framework, enhanced by Levac et al., and will be reported following PRISMA-ScR guidelines. A comprehensive search will be conducted across PubMed, Scopus, CINAHL (EBSCOhost), Web of Science, and Google Scholar, without language or date restrictions. The search strategy will employ both controlled vocabulary (e.g., MeSH and CINAHL Subject Headings) and free-text terms. Studies meeting the inclusion criteria will be managed using EndNote X20 and appraised using the Mixed Methods Appraisal Tool (MMAT) 2018 version. Data will be synthesized thematically and presented narratively and in tabular form. By consolidating PHCWs’ perspectives, this review will identify implementation challenges, training needs, and systemic barriers, informing the development of context-specific strategies for PrEP rollout. The findings are expected to support the design of effective, culturally relevant educational interventions and guide policymakers in strengthening HIV prevention efforts in high-burden settings. Full article

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31 pages, 357 KiB

Open AccessArticle

Māori Health, Wellbeing, and Disability in Aotearoa New Zealand: A National Survey

by Tristram R. Ingham, Bernadette Huatau Jones, Meredith A. Perry, Andrew Sporle, Tom Elliott, Paula Toko King, Gabrielle Baker, Barry Milne, Tori Diamond and Linda Waimarie Nikora

Int. J. Environ. Res. Public Health 2025, 22(6), 829; https://doi.org/10.3390/ijerph22060829 - 23 May 2025

Viewed by 292

Abstract

Māori, the Indigenous people of Aotearoa New Zealand, experience wide-ranging inequities compared with non-Māori. This survey aimed to explore the holistic health, wellbeing, and disability experiences of New Zealand’s Indigenous Māori population from a Māori worldview, addressing gaps in culturally relevant data often [...] Read more.

Māori, the Indigenous people of Aotearoa New Zealand, experience wide-ranging inequities compared with non-Māori. This survey aimed to explore the holistic health, wellbeing, and disability experiences of New Zealand’s Indigenous Māori population from a Māori worldview, addressing gaps in culturally relevant data often overlooked by standard health surveys. A robust cross-sectional survey was conducted with 7359 participants of Māori descent using Kaupapa Māori Research principles. Data were analysed using the Te Pae Māhutonga framework, a Māori health promotion model. Participants demonstrated strong cultural identity, with 32.3% understanding spoken Māori fairly well and 97.3% defining a broad non-nuclear concept of whānau (family). While over half reported high life satisfaction, 58.4% experienced discrimination, mainly based on ethnicity and appearance. Access to healthcare revealed that 32.6% were unable to contact a general practitioner due to cost. Socioeconomic challenges were prevalent; nearly a quarter borrowed from family or friends to meet daily living costs, and over a third economized on fresh produce to save money. This study reveals significant gaps in mainstream health data and demonstrates that a culturally aligned, methodological approach is feasible and crucial for informing policies that address the needs and rights of Māori, as guaranteed under Te Tiriti o Waitangi. These results could inform global, indigenous research addressing culturally relevant health, wellbeing and disability inequities. Full article

(This article belongs to the Special Issue Socio-Economic and Environmental Determinants of Health Disparities and Population Health)

14 pages, 290 KiB

Open AccessArticle

Frequent Users in Psychiatric Consultations: A 6-Year Retrospective Study in the Emergency Department

by Carla Maria Gramaglia, Eleonora Gambaro, Alessandro Feggi, Amalia Jona, Valentina Zanoli, Francesco Gavelli, Gian Carlo Avanzi, Daniela Ferrante, Silviana Maria Patratanu, Erica Valerio and Patrizia Zeppegno

Int. J. Environ. Res. Public Health 2025, 22(6), 828; https://doi.org/10.3390/ijerph22060828 - 23 May 2025

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Abstract

The increasing prevalence of emergency room (ER) visits for mental health concerns presents a significant challenge for healthcare systems. This study aimed to analyze the socio-demographic and clinical characteristics associated with frequent users of psychiatric consultations in the ER of Maggiore della Carità [...] Read more.

The increasing prevalence of emergency room (ER) visits for mental health concerns presents a significant challenge for healthcare systems. This study aimed to analyze the socio-demographic and clinical characteristics associated with frequent users of psychiatric consultations in the ER of Maggiore della Carità University Hospital in Novara, Italy. A retrospective observational study was conducted over a six-year period (2017–2022), including all psychiatric consultations recorded in a hospital database. Frequent users were defined as individuals undergoing at least three psychiatric consultations in the ER within a year. Univariable and multivariable logistic models were employed to identify significant socio-demographic and clinical predictors of frequent use. Of the 1565 individuals who received psychiatric consultations in the ER, 92 (5.88%) were identified as frequent users. Factors associated with higher ER utilization included being unmarried (aOR 1.35, 95% CI 1.02–1.79), younger age (aOR 1.32, 95% CI 1.02–1.72), homelessness, diagnosis of schizophrenia, substance use disorder (aOR 1.49, 95% CI 1.06–2.09), and ongoing psychopharmacological treatment (aOR 1.56, 95% CI 1.12–2.18). These findings highlight the need for targeted interventions to improve care continuity and community-based support for individuals at risk of frequent ER visits for psychiatric reasons. Full article

12 pages, 282 KiB

Open AccessArticle

State Preemption and Local Tobacco Control: Constraints and Opportunities for Innovation in the US

by Rishika Chakraborty, Micah L. Berman, Y. Tony Yang, Yan Li, Yan Wang, Debra Bernat, Sabrina Zhang and Carla J. Berg

Int. J. Environ. Res. Public Health 2025, 22(6), 827; https://doi.org/10.3390/ijerph22060827 - 23 May 2025

Viewed by 128

Abstract

State preemption of local laws may impede tobacco control, yet little research has examined local policy activity before, during, and after preemption. This study addresses this gap. We summarized state laws preempting local smoke-free workplace, youth access, and licensure laws (CDC’s STATE) and [...] Read more.

State preemption of local laws may impede tobacco control, yet little research has examined local policy activity before, during, and after preemption. This study addresses this gap. We summarized state laws preempting local smoke-free workplace, youth access, and licensure laws (CDC’s STATE) and local legislative activity before, during, and after preemption (Americans for Nonsmokers’ Rights Foundation) across 1999–2021. Preemption existed for smoke-free workplaces in 18 states, youth access in 21, and licensure in 13. Regarding smoke-free workplace laws, local laws were passed in 5 of 11 states with preemption throughout; among seven states with partial-period preemption, local laws were enacted before preemption or after repeal in three states but during preemption in two. Regarding youth access, localities adopted laws (e.g., addressing purchase/use/possession or e-cigarettes) in 11 of 18 states with preemption throughout; among the three states with partial-period preemption, localities passed laws before preemption in one state and during preemption in two. For licensure, localities passed laws (e.g., licensing requirements/penalties) in eight of nine states with preemption throughout and three of four states with partial-period preemption. Although state preemption reduced local activity, some localities advanced tobacco control during preemption, underscoring the need for localities to exercise autonomy permitted under preemption. Full article

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

12 pages, 265 KiB

Open AccessArticle

The Influence of Maternal Information Sources on Infant Oral Hygiene Practices for Six-Month-Olds in South Australia: A Cross-Sectional Study

by Meng-Wong Taing, Wanrong Li, Loc G. Do and Diep H. Ha

Int. J. Environ. Res. Public Health 2025, 22(6), 826; https://doi.org/10.3390/ijerph22060826 - 23 May 2025

Viewed by 178

Abstract

This study aimed to investigate the association between the different information sources on infant oral hygiene accessed by mothers and infant oral hygiene practices in South Australia. Information on the oral hygiene practices used in 6-month-old infants—gum/tooth cleaning in the past 3 months, [...] Read more.

This study aimed to investigate the association between the different information sources on infant oral hygiene accessed by mothers and infant oral hygiene practices in South Australia. Information on the oral hygiene practices used in 6-month-old infants—gum/tooth cleaning in the past 3 months, frequency of brushing, and the usage of fluoridated toothpaste—were acquired from the Study of Mothers’ and Infants’ Life Events Affecting Oral Health (SMILE) cohort survey. Descriptive statistics and multivariable logistic regression modelling were used to analyse the relationship between the information sources and infant oral hygiene practices. The majority of mothers (60.4%) reported not having cleaned their 6-month-old’s gums/teeth in the past 3 months. One-third of mothers with 6-month-olds did not seek information on infant oral hygiene. Mothers who sought advice from dentists were more likely to have cleaned their infant’s gums/teeth in the past 3 months, and those with infants whose teeth had erupted were also more likely to clean their infants’ teeth twice or more daily. We can conclude that mothers who sought information on infant oral hygiene from more than one source adopted generally better oral hygiene practices for their infants, with a dentist’s advice notably increasing the likelihood of mothers following the guidelines for cleaning their infants’ teeth. Full article

(This article belongs to the Special Issue Perceptions of Women, Child and Adolescents' Oral Health)

20 pages, 1067 KiB

Open AccessSystematic Review

Barriers and Facilitators of Tobacco Cessation Interventions at the Population and Healthcare System Levels: A Systematic Literature Review

by Sanchita Sultana, Joseph Inungu and Shayesteh Jahanfar

Int. J. Environ. Res. Public Health 2025, 22(6), 825; https://doi.org/10.3390/ijerph22060825 - 23 May 2025

Viewed by 110

Abstract

Background: Tobacco use is responsible for eight million preventable deaths annually, making it a major modifiable risk factor for chronic conditions such as cardiovascular diseases, respiratory illnesses, and over 20 types of cancers. Objective: This study aimed to systematically review the barriers and [...] Read more.

Background: Tobacco use is responsible for eight million preventable deaths annually, making it a major modifiable risk factor for chronic conditions such as cardiovascular diseases, respiratory illnesses, and over 20 types of cancers. Objective: This study aimed to systematically review the barriers and facilitators of tobacco cessation interventions at both the population and healthcare system levels in the U.S. Understanding these determinants is critical for narrowing health disparities, optimizing resource allocation, and ultimately, enhancing tobacco cessation success rates across all demographic groups. Methods: A comprehensive literature search was conducted across the PubMed, Embase, and Web of Science databases, guided by the population, intervention, comparison, and outcome framework and quality assessment guided by PRISMA guidelines. Data extraction focused on study characteristics, intervention types, barriers, facilitators, and cessation outcomes at both the population and health system levels. The random effects forest plots were graphed to estimate pooled effect sizes for both medical and non-medical interventions. Results: A total of 35 studies met the inclusion criteria from an initial pool of 1555 identified records. Socioeconomic disadvantages, digital inequities, and low motivation constitute primary barriers at the individual level, while systemic factors such as healthcare access limitations, inadequate provider engagement, and lack of financial support further hinder cessation efforts. Financial incentives, culturally tailored interventions, and digital engagement strategies significantly improve tobacco cessation outcomes. Public health implications: as identified by the study, tailored interventions, the expansion of health coverage policies to include intervention, digital solutions, and healthcare resource workforce training will help improve tobacco cessation intervention outcomes. 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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28 pages, 813 KiB

Open AccessSystematic Review

Neuroscientific Insights into the Built Environment: A Systematic Review of Empirical Research on Indoor Environmental Quality, Physiological Dynamics, and Psychological Well-Being in Real-Life Contexts

by Aitana Grasso-Cladera, Maritza Arenas-Perez, Paulina Wegertseder-Martinez, Erich Vilina, Josefina Mattoli-Sanchez and Francisco J. Parada

Int. J. Environ. Res. Public Health 2025, 22(6), 824; https://doi.org/10.3390/ijerph22060824 - 23 May 2025

Viewed by 222

Abstract

The research aims to systematize the current scientific evidence on methodologies used to investigate the impact of the indoor built environment on well-being, focusing on indoor environmental quality (IEQ) variables such as thermal comfort, air quality, noise, and lighting. This systematic review adheres [...] Read more.

The research aims to systematize the current scientific evidence on methodologies used to investigate the impact of the indoor built environment on well-being, focusing on indoor environmental quality (IEQ) variables such as thermal comfort, air quality, noise, and lighting. This systematic review adheres to the Joanna Briggs Institute framework and PRISMA guidelines to assess empirical studies that incorporate physiological measurements like heart rate, skin temperature, and brain activity, which are captured through various techniques in real-life contexts. The principal results reveal a significant interest in the relationship between the built environment and physiological as well as psychological states. For instance, thermal comfort was found to be the most commonly studied IEQ variable, affecting heart activity and skin temperature. The research also identifies the need for a shift towards using advanced technologies like Mobile Brain/Body Imaging (MoBI) for capturing real-time physiological data in natural settings. Major conclusions include the need for a multi-level, evidence-based approach that considers the dynamic interaction between the brain, body, and environment. This study advocates for the incorporation of multiple physiological signals to gain a comprehensive understanding of well-being in relation to the built environment. It also highlights gaps in current research, such as the absence of noise as a studied variable of IEQ and the need for standardized well-being assessment tools. By synthesizing these insights, the research aims to pave the way for future studies that can inform better design and policy decisions for indoor environments. Full article

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15 pages, 289 KiB

Open AccessArticle

Influence of Socio-Ecological and Economic Correlates on Marijuana Legalization Policy Across the States of America

by Mashooq Salehin and Vijayan K. Pillai

Int. J. Environ. Res. Public Health 2025, 22(6), 823; https://doi.org/10.3390/ijerph22060823 - 23 May 2025

Viewed by 150

Abstract

Marijuana legalization has been at the center of debate in the social and political realm of the United States. So far, thirty nine states and the District of Columbia have legalized marijuana either for recreational or medical purposes. States are taking a cautious [...] Read more.

Marijuana legalization has been at the center of debate in the social and political realm of the United States. So far, thirty nine states and the District of Columbia have legalized marijuana either for recreational or medical purposes. States are taking a cautious approach to legalization in a policy context consisting of multi-layered sociopolitical systems. Strong arguments from advocacy groups supporting and opposing legalization highlight the significance of assessing the impact of marijuana use and its legalization on the well-being of the community and its members. Utilizing the social determinants of health and system perspectives, this study measures the cumulative effect of six socio-ecological and economic predictors, such as the state’s marijuana use prevalence and median household income, on the dependent variable of marijuana legality scores using discriminant analysis and One-way ANOVA. As hypothesized, the result shows a significant influence of the predictors on the state policy score of marijuana legality. Predicted associations between independent and dependent variables were also found. Findings suggest that without a supportive policy context comprising social, economic, and political factors, marijuana legalization might not have the desired impact on the community. Implications and recommendations for future research are provided. Full article

12 pages, 270 KiB

Open AccessProtocol

The Effectiveness of Indoor Residual Spraying for Malaria Control in Sub-Saharan Africa: A Systematic Protocol Review and Meta-Analysis

by Moses Ocan, Kevin Ouma Ojiambo, Loyce Nakalembe, Geofrey Kinalwa, Alison A. Kinengyere, Sam Nsobya, Emmanuel Arinaitwe and Henry Mawejje

Int. J. Environ. Res. Public Health 2025, 22(6), 822; https://doi.org/10.3390/ijerph22060822 - 23 May 2025

Viewed by 158

Abstract

Background: Indoor residual spraying (IRS) is a core insecticide-based vector control tool employed in most malaria-affected settings globally. However, mosquito vectors have developed resistance to nearly all of the insecticides currently used in IRS. This has necessitated a transition to new classes of [...] Read more.

Background: Indoor residual spraying (IRS) is a core insecticide-based vector control tool employed in most malaria-affected settings globally. However, mosquito vectors have developed resistance to nearly all of the insecticides currently used in IRS. This has necessitated a transition to new classes of insecticides, from mostly using dichlorodiphenyltrichloroethane (DDT) and pyrethroids from 1997 to 2010 to carbamates in 2011 and organophosphates in 2013. In addition, other vector control measures, like the use of long-lasting insecticide-treated bed nets (LLINs), have also been employed for malaria control. Despite the implementation of these mosquito vector control interventions, malaria remains a disease of public health concern, especially in sub-Saharan Africa, which bears over 90% of the disease burden. This review will thus collate evidence on the effectiveness of IRS for malaria control in sub-Saharan Africa. Methods and analysis: The systematic review will be conducted following a priori criteria developed using the PRISMA guidelines. Articles will be obtained through a search of the Web of Science, Google Scholar, Medline via PubMed, Scopus and Embase databases. Mesh terms and Boolean operators (“AND”, “OR”) will be used in the article search. Additionally, websites of malaria research institutions will be searched. The article search will be conducted by two independent librarians (AAK and RS). All identified articles will be transferred to EPPI-reviewer v6.15.1.0 software. Article screening and data abstraction will be performed in duplicate by four reviewers (KOO, LN, GK and MO), and any further disagreements will be resolved through discussion and consensus. We shall extract data on the country, region, study design, insecticide combination, season, susceptibility procedure used, vector control interventions, population, mosquito species, malaria incidence or prevalence, insecticide efficacy, susceptibility, genotypic resistance, vector mortality and knockdown effect. Data analysis will be performed using STATA v17.0. Effect sizes will be statistically pooled using inverse-variance-weighted random-effects meta-analysis. Heterogeneity and publication bias in the articles will be assessed using the I² statistic and a funnel plot, respectively. For the studies that will not be included in the meta-analysis, a narrative synthesis will be written following the Cochrane Consumer and Communication Review Group format. Results: The findings of this review will help generate evidence on the effectiveness of indoor residual spraying using WHO pre-qualified insecticides in malaria control in sub-Saharan Africa. This protocol was registered in PROSPERO, registration number CRD42024517119. Full article

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

11 pages, 469 KiB

Open AccessArticle

Medically Attended Outpatient Parainfluenza Virus Infections in Young Children from a Single Site in Machala, Ecuador

by Manika Suryadevara, Dongliang Wang, Freddy Pizarro Fajardo, Jorge Luis Carrillo Aponte, Froilan Heras, Cinthya Cueva Aponte, Irene Torres and Joseph Domachowske

Int. J. Environ. Res. Public Health 2025, 22(6), 821; https://doi.org/10.3390/ijerph22060821 - 23 May 2025

Viewed by 131

Abstract

Parainfluenza virus (PIV) infections contribute to the overall childhood morbidity from acute respiratory illness, yet virus-specific epidemiologic data are lacking across many regions globally. Here, we describe the clinical manifestations, seasonality, and meteorologic associations with PIV infections in Ecuadorian children. Between July 2018 [...] Read more.

Parainfluenza virus (PIV) infections contribute to the overall childhood morbidity from acute respiratory illness, yet virus-specific epidemiologic data are lacking across many regions globally. Here, we describe the clinical manifestations, seasonality, and meteorologic associations with PIV infections in Ecuadorian children. Between July 2018 and July 2023, we documented demographic and clinical information from children younger than 5 years seen in a single public health clinic with signs and symptoms consistent with an acute respiratory infection. Nasopharyngeal swabs collected at study enrollment underwent multiplex polymerase chain reaction-based diagnostic testing (Biofire FilmArray v. 1.7™). Regional meteorological data from the same period were provided by Ecuador’s Instituto Nacional de Meteorologia e Hidrologia. Parainfluenza viruses were detected in 9% of the 1251 enrolled subjects. PIVs were most frequently detected between March and July, with no change in seasonality following SARS-CoV-2 pandemic onset. Clinical manifestations of PIV infections included non-specific upper respiratory illness (82%), laryngotracheitis (3%), and bronchiolitis (11%). Events of PIV detection were negatively associated with ambient temperature and rainfall. Our findings highlight the contribution that PIVs play in the morbidity associated with pediatric medically attended outpatient respiratory tract infection and provide new insights into the seasonal epidemiology of PIV infections in coastal Ecuador. Full article

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30 pages, 436 KiB

Open AccessReview

Antecedents of Workplace Psychological Safety in Public Safety and Frontline Healthcare: A Scoping Review

by Emily Ip, Rani Srivastava, Liana Lentz, Sandra Jasinoski and Gregory S. Anderson

Int. J. Environ. Res. Public Health 2025, 22(6), 820; https://doi.org/10.3390/ijerph22060820 - 23 May 2025

Viewed by 308

Abstract

Workplace psychological safety (PS) has been recognized as crucial in mitigating organizational stressors and enhancing positive workplace outcomes, particularly in high-risk occupations such as healthcare and public safety. This scoping review aims to synthesize the existing literature on psychological safety in high-risk workplaces [...] Read more.

Workplace psychological safety (PS) has been recognized as crucial in mitigating organizational stressors and enhancing positive workplace outcomes, particularly in high-risk occupations such as healthcare and public safety. This scoping review aims to synthesize the existing literature on psychological safety in high-risk workplaces to identify key antecedents, workplace enhancements, and research gaps. A systematic search of studies published between 2010 and January 2025 was conducted across multiple databases, including CINAHL, Medline, ERIC, JSTOR, PsycInfo, Business Source Ultimate, and Sociological Abstract. Inclusion criteria focused on adult workers in high-risk workplace environments. Following screening and eligibility assessments, 16 studies from six countries were selected for analysis. Data were extracted and thematically analyzed based on leadership styles, organizational structures, and workplace culture related to psychological safety. The review identified three primary antecedents of psychological safety in high-risk workplaces: (1) inclusive and transformational leadership styles, (2) hierarchical structures and power dynamics, and (3) workplace climate and communication culture. Studies consistently found that inclusive leadership, ethical integrity, and transformational leadership were strongly associated with higher psychological safety levels. While hierarchical structures provided the necessary organization, overly rigid hierarchies often suppressed employee voice and innovation. A workplace culture characterized by trust, transparency, and open communication fosters greater psychological safety and improved teamwork and well-being. Full article

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12 pages, 251 KiB

Open AccessArticle

Exploring Vaccine Hesitancy in the Philippines: A Content Analysis of Comments on National TV Channel YouTube Videos

by Daniel Fritz Silvallana, Carlos Elias and Daniel Catalan-Matamoros

Int. J. Environ. Res. Public Health 2025, 22(6), 819; https://doi.org/10.3390/ijerph22060819 (registering DOI) - 22 May 2025

Viewed by 433

Abstract

Examining public attitudes towards COVID-19 vaccination is crucial for understanding the global effort to combat the ongoing pandemic. Social media platforms such as YouTube play a significant role in the dissemination of information and misinformation about the vaccine, making it imperative to analyze [...] Read more.

Examining public attitudes towards COVID-19 vaccination is crucial for understanding the global effort to combat the ongoing pandemic. Social media platforms such as YouTube play a significant role in the dissemination of information and misinformation about the vaccine, making it imperative to analyze user comments to gain insights into vaccine perceptions. Analyzing the Philippines case is particularly significant as it provides insights into the attitudes towards COVID-19 vaccination in a country that has been heavily impacted by the pandemic. The current study investigates the discourse surrounding vaccine hesitancy in comments on YouTube videos announcing the COVID-19 vaccination campaign by the Philippines national TV channels and its impact on engagement levels. A total of 741 YouTube comments were analyzed, with 80% exhibiting vaccine-hesitant related discourse. The results indicate that those with negative attitudes towards COVID-19 vaccination exhibit higher engagement levels than those supporting vaccination (p < 0.05). Additionally, the most commonly used themes in vaccine-hesitant posts were “ingredients”, “health department control”, “pharmaceutical interest”, and “adverse effects”. Moreover, 134 sources were identified among the posts, with vaccine-hesitant posts utilizing more sources than supportive vaccine posts (p < 0.001). The most significant information sources utilized in the posts were related to other YouTube users, politicians, clinicians, and scientific papers. Finally, a total of 890 discourses were coded, with the most frequently used discourse types among vaccine-hesitant posts being negationist, institutional, preventive, political, and pharmaceutical. These findings offer valuable insights into the nature and prevalence of vaccine hesitancy discourse on social media platforms and its impact on public engagement. This study highlights the importance of targeted communication strategies and the provision of accurate information from reliable sources in addressing vaccine hesitancy. Full article

(This article belongs to the Special Issue Evolving Role of Social Media in Health Communication)

12 pages, 279 KiB

Open AccessReview

A Call to Integrate Measures of Environmental Context into Research on Maternal Brain Health

by Sofia I. Cárdenas and Bridget L. Callaghan

Int. J. Environ. Res. Public Health 2025, 22(6), 818; https://doi.org/10.3390/ijerph22060818 - 22 May 2025

Viewed by 126

Abstract

Environmental factors—especially those related to interpersonal relationships and physical resources—profoundly impact women’s neurobiology and mental health. Despite this, environmental factors, including socioeconomic status, early life adversity, and neighborhood resources, are less explored within the maternal brain literature. This literature highlights pregnancy as a [...] Read more.

Environmental factors—especially those related to interpersonal relationships and physical resources—profoundly impact women’s neurobiology and mental health. Despite this, environmental factors, including socioeconomic status, early life adversity, and neighborhood resources, are less explored within the maternal brain literature. This literature highlights pregnancy as a developmental phase in adult women’s lifespans marked by neurobiological shifts supporting fetal development and optimizing caregiving behaviors. While neurobiological shifts during this period are well-documented, pregnancy is also associated with a heightened risk for mental health challenges. This narrative review, focusing on the last 10 years, examines the research that underscores the importance of integrating environmental factors into research frameworks to comprehensively understand their effects on maternal neurobiology and mental health throughout pregnancy. Building on this research, authors discuss future research methodologies that will support a more comprehensive understanding of the intersection between environmental contexts, maternal neurobiology, and mental health. Full article

(This article belongs to the Special Issue How Reproductive Life Events Influence Women's Mental Health)

12 pages, 247 KiB

Open AccessArticle

Equitable Healthcare Access for Type 2 Diabetes Patients Under a Low-Income Group Health Care Scheme: A Sustainable Development Goal Perspective

by Sin Wei Tey, Kingston Rajiah, Mari Kannan Maharajan, Norasila Binti Zakaria and Nor Haslinda Binti Ishak

Int. J. Environ. Res. Public Health 2025, 22(6), 817; https://doi.org/10.3390/ijerph22060817 - 22 May 2025

Viewed by 163

Abstract

Objective: The purpose of this study is to explore the factors influencing access to healthcare services among Type 2 Diabetes Mellitus (T2DM) patients enrolled in the PEKA B40 programme at a public health clinic in Melaka, Malaysia. It aims to examine how key [...] Read more.

Objective: The purpose of this study is to explore the factors influencing access to healthcare services among Type 2 Diabetes Mellitus (T2DM) patients enrolled in the PEKA B40 programme at a public health clinic in Melaka, Malaysia. It aims to examine how key dimensions—availability, accessibility, accommodation, and acceptance—affect patients’ experiences and the utilisation of diabetes-related healthcare services. This study also seeks to identify gaps and challenges within the current healthcare delivery system, particularly for low-income populations, to inform strategies for improving equitable and sustainable access to care. Methods: This study was conducted in a public health clinic in Melaka, Malaysia. Purposive sampling was used among T2DM patients under the “Health Care Scheme for Group B40” programme in a public health clinic in Melaka, Malaysia. The study included participants with at least a 6-month history of T2DM to ensure substantial experience in accessing healthcare services. Results: Fifteen patients participated in this study. Elderly individuals, retirees, and those with average incomes demonstrated higher healthcare service utilisation. Ethnic diversity was crucial, revealing its impact on health behaviours and healthcare-seeking patterns. Primary or secondary education levels among participants highlighted the necessity for targeted health literacy efforts. Conclusions: This study highlighted notable awareness and satisfaction among patients concerning the availability, accessibility, and accommodation of services, particularly emphasising the importance of geographical proximity in healthcare services. However, challenges faced by elderly individuals in accessing social support are also highlighted. The potential of enhancing the amenities of healthcare facilities to improve patient experiences is also reflected in our results. These insights provide evidence for the effectiveness of the Malaysian healthcare system in catering to a diverse demographic and can also be helpful in refining healthcare strategies and further optimising patient-centred care in Malaysia. Full article

(This article belongs to the Special Issue Access to Public Health Services and Challenges to Healthcare Management)

21 pages, 1019 KiB

Open AccessReview

Health Knowledge About Early Diagnosis of Autism Spectrum Disorders: A Case for Soft Transdiagnostic Approaches to Better Represent the Clinical and Scientific Reality of ASD

by Mirah Dow and Ting Wang

Int. J. Environ. Res. Public Health 2025, 22(6), 816; https://doi.org/10.3390/ijerph22060816 - 22 May 2025

Viewed by 137

Abstract

Objective: This study explores the current state of science regarding DSM-5 diagnostic criteria for Autism Spectrum Disorder (ASD) in young children. It examines the effectiveness of existing diagnostic methods and evaluates the potential of transdiagnostic approaches for early intervention. Method: A systematic literature [...] Read more.

Objective: This study explores the current state of science regarding DSM-5 diagnostic criteria for Autism Spectrum Disorder (ASD) in young children. It examines the effectiveness of existing diagnostic methods and evaluates the potential of transdiagnostic approaches for early intervention. Method: A systematic literature review was conducted using MEDLINE, PsycINFO, and the Psychology and Behavioral Sciences Collection, focusing on peer-reviewed studies published between 2020 and 2023. The search followed PRISMA guidelines, selecting articles investigating ASD diagnosis in toddlers and preschoolers using DSM-5 criteria, behavioral assessments, and emerging diagnostic tools. Results: Findings indicate that DSM-5 provides a structured framework for ASD diagnosis, but it has limitations in early identification. It is necessary to integrate multiple assessment tools. Recent research highlights transdiagnostic models, which move beyond rigid diagnostic categories to capture the complexities of ASD presentation in young children. Conclusion: The literature supports a shift towards a transdiagnostic approach that combines behavioral, biological, and environmental assessments. This study underscores the need for interdisciplinary collaboration to refine ASD diagnostic frameworks to ensure more accurate and timely diagnoses that better serve affected children and their families. Full article

(This article belongs to the Section Behavioral and Mental Health)

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9 pages, 244 KiB

Open AccessEditorial

Integrating Exposome into Lifecourse Understanding of Cognitive Ageing and Dementia: Current Evidence, Methodological Challenges, and Future Directions

by Jessica Gong and Paola Zaninotto

Int. J. Environ. Res. Public Health 2025, 22(6), 815; https://doi.org/10.3390/ijerph22060815 - 22 May 2025

Viewed by 160

Abstract

Cognitive decline and dementia represent some of the most pressing challenges to global public health, especially amid rapidly ageing populations worldwide [...] Full article

(This article belongs to the Special Issue Exposomic Approach to Dementia and Cognitive Ageing)

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Int. J. Environ. Res. Public Health, Volume 22, Issue 6 (June 2025) – 31 articles

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