International Journal of Environmental Research and Public Health

20 pages, 1227 KiB

Open AccessReview

A Rapid Review of Ethical and Equity Dimensions in Telerehabilitation for Physiotherapy and Occupational Therapy

by Mirella Veras, Jennifer Sigouin, Louis-Pierre Auger, Claudine Auger, Sara Ahmed, Zachary Boychuck, Sabrina Cavallo, Martine Lévesque, Stacey Lovo, William C. Miller, Michelle Nelson, Nahid Norouzi-Gheidari, Jennifer O’Neil, Kadija Perreault, Reg Urbanowski, Lisa Sheehy, Hardeep Singh, Claude Vincent, Rosalie H. Wang, Diana Zidarov, Anne Hudon and Dahlia Kairy Show full author list Hide full author list

Int. J. Environ. Res. Public Health 2025, 22(7), 1091; https://doi.org/10.3390/ijerph22071091 (registering DOI) - 9 Jul 2025

Abstract

Introduction: The rapid adoption of telerehabilitation in physiotherapy and occupational therapy has transformed healthcare delivery, offering new opportunities for patient-centered care. However, its implementation raises critical ethical and equity-related questions that require proactive strategies to ensure fair and responsible practices. This review examines [...] Read more.

Introduction: The rapid adoption of telerehabilitation in physiotherapy and occupational therapy has transformed healthcare delivery, offering new opportunities for patient-centered care. However, its implementation raises critical ethical and equity-related questions that require proactive strategies to ensure fair and responsible practices. This review examines how ethical disparities and equity-related challenges are reflected in the existing literature on telerehabilitation. Objective: To investigate the presence of ethical-disparity and equity-related aspects in the provision of telerehabilitation in physiotherapy and occupational therapy as reflected in the literature. Data Sources: A rapid review methodology was employed to explore ethical and equity-related challenges in telerehabilitation. The search included articles published in English and French between 2010 and 2023 from the Medline and Embase databases. Study Selection: Articles were selected based on their relevance to ethical and equity considerations in telerehabilitation. A total of 1750 sources were initially identified, with 67 articles meeting the eligibility criteria for inclusion in this review. Data Extraction: Data were extracted based on variables such as age, gender, ethnicity, morbidity, cost, privacy, confidentiality, and autonomy. The data extraction and analysis were guided by the Progress Plus and Metaverse Equitable Rehabilitation Therapy frameworks. Data Synthesis: The findings were analyzed and discussed using a narrative synthesis approach. The results highlighted key ethical considerations, including adverse events, patient autonomy, and privacy issues. Equity-related aspects were examined, access to rehabilitation services and gender considerations. Disparities in technology access, socioeconomic status, and ethnicity were also identified. Conclusions: This rapid review highlights the growing relevance of ethical and equity considerations in the design and delivery of telerehabilitation within physiotherapy and occupational therapy. The findings show inconsistent reporting and limited depth in addressing key domains such as patient autonomy, privacy, and adverse events, alongside disparities related to age, gender, socioeconomic status, and geographic access. Although telerehabilitation holds promise for expanding access, particularly in underserved areas, this potential remains unevenly realized. The review underscores the critical need for structured, equity-driven, and ethically grounded frameworks such as the Metaverse Equitable Rehabilitation THerapy (MERTH) framework to guide future implementation, research, and policy. Full article

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30 pages, 998 KiB

Open AccessArticle

Barriers to Immunosuppressant Medication Adherence in Thoracic Transplant Recipients: Initial Findings

by Sparkle Springfield-Trice, Grishma Reddy, Cara Joyce, Benito M. Garcia, Palak Shah, Sean Agbor-Enoh and Hannah Valantine

Int. J. Environ. Res. Public Health 2025, 22(7), 1090; https://doi.org/10.3390/ijerph22071090 - 8 Jul 2025

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Abstract

Although transplantation remains the gold-standard treatment for patients with end-organ failure, lifelong adherence to immunosuppressant medication is required to prevent rejection, graft failure, and mortality. Given the increase in thoracic organ transplantation, it is crucial to better understand the associated barriers to treatment. [...] Read more.

Although transplantation remains the gold-standard treatment for patients with end-organ failure, lifelong adherence to immunosuppressant medication is required to prevent rejection, graft failure, and mortality. Given the increase in thoracic organ transplantation, it is crucial to better understand the associated barriers to treatment. Examining sociodemographic, transplant, healthcare access, post-transplant treatment, and patient-related psychosocial factors may help to elucidate treatment barriers that have not been previously considered in the existing literature. This single-site cross-sectional study surveyed 65 thoracic (heart and lung) transplant recipients (mean age: 62 years; 76.2% male; 72.3% White, and 21.5% Black) via phone interviews. Immunosuppressant nonadherence was found in 49.2% of participants (46.9% heart, 51.5% lung). In a four-week period, 20% of participants missed at least one dose, 40% did not take their medications on time, and 1% stopped completely. Significant correlates of nonadherence included poorer diet quality, fewer comorbidities, and maladaptive coping responses to perceived discrimination. This preliminary study highlights the importance of considering the social determinants of health—particularly post-transplant treatment and psychosocial patient-related factors—to inform post-transplant care. Addressing such variables may improve medication adherence and, subsequently, overall health outcomes. Further research with larger samples is needed to better understand the associated correlates and inform effective interventions for enhanced medication adherence. Full article

(This article belongs to the Special Issue 3rd Edition: Social Determinants of Health)

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24 pages, 1152 KiB

Open AccessArticle

Analysis of the Correlation Between the Governance and Quality of Biomedical Waste Management in Public Health Facilities in Togo, 2024

by Sarakawa Abalo Niman, Edem Komi Koledzi and Nitale M’balikine Krou

Int. J. Environ. Res. Public Health 2025, 22(7), 1089; https://doi.org/10.3390/ijerph22071089 - 8 Jul 2025

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Abstract

Increasing the use of healthcare facilities has resulted in the growing production of biomedical waste, which poses health risks to users, health professionals, and the environment. The aim of this research is to study the correlation between governance in Togo’s public health facilities [...] Read more.

Increasing the use of healthcare facilities has resulted in the growing production of biomedical waste, which poses health risks to users, health professionals, and the environment. The aim of this research is to study the correlation between governance in Togo’s public health facilities and the quality of biomedical waste management within these facilities. Methods: This was a cross-sectional, descriptive, and analytical study conducted from September to December 2024. It involved 264 public health facilities of all types in all health regions of Togo. Health facilities were selected using the simple random selection technique. Healthcare providers were selected using the reasoned choice technique. The statistical tests used were the chi-square test and logistic regression, which enabled proportions to be compared and confounding factors to be eliminated, respectively. Results: Multivariate analysis revealed a statistically significant association between the organization and training component of governance and the quality of biomedical waste management (BMWM) in health facilities (OR = 3.79; 95% CI [1.79–8.03]; p < 0.001). This relationship suggests that health facilities with functional infection prevention and control (ICP) or BMWM committees, trained staff at all levels (nursing, technical, and administrative), and dedicated waste management personnel are more likely to implement compliant waste management practices. Analyses of the data also revealed that, among the criteria for assessing the quality of biomedical waste management (BMWM), the most significant were sorting (OR = 1.482; 95% CI [1.286; 1.708]), quantification (OR = 2.026; 95% CI [1.491; 2.753]), transportation (OR = 1.403; 95% CI [1.187; 1.66]), and disposal infrastructure (OR = 1.604; 95% CI [1.298; 1.982]). The application of this grid shows that 17.8% of the health facilities surveyed had a score equal to or above 80% on all the criteria used to assess the quality of biomedical waste management, and they were therefore managing waste in an “acceptable” manner. The study highlights key findings in biomedical waste management practices, providing actionable insights for improving public health safety. Full article

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12 pages, 383 KiB

Open AccessArticle

Public Opinion Study on School Health Education Programs: Family Needs Assessment Study

by Hacer Efe and Ünsal Umdu Topsakal

Int. J. Environ. Res. Public Health 2025, 22(7), 1088; https://doi.org/10.3390/ijerph22071088 - 8 Jul 2025

Viewed by 38

Abstract

Health education programs are important interventions aimed at the acquisition of health knowledge and behaviors that are necessary throughout the lives of individuals of all ages. Considering the importance of health education in structuring the health of the society, it is very important [...] Read more.

Health education programs are important interventions aimed at the acquisition of health knowledge and behaviors that are necessary throughout the lives of individuals of all ages. Considering the importance of health education in structuring the health of the society, it is very important that health education responds to the needs of society and meets its expectations. At this point, public health is protected by providing access to families and communities through health education. In this context, a needs analysis study was conducted with families (students and parents) to establish a health education framework. The study group consisted of 289 volunteer primary and secondary school students and 60 parents who agreed to participate in the study. Semi-structured interviews were conducted with students and parents using a descriptive approach. The needs analysis form prepared by the researchers was used in the interviews and content analysis was applied to the obtained data. The qualitative data obtained from the analyses were interpreted. As a result of the study, it was found that families have expectations and needs in first aid and daily life behaviors (nutrition, hygiene, oral health and diseases) in school health education, and accordingly, school health education can be focused on these specified areas. The fact that families found health knowledge insufficient and considered health education important emphasizes the importance of the knowledge provided by health education and the results. The family health education views obtained in the study can be used in future studies to improve family health behaviors and community health. In addition, family-based school health education can be disseminated with contemporary interventions. Full article

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13 pages, 314 KiB

Open AccessArticle

Food Insecurity and Associated Factors Among Adolescents from Inland Northeast Brazil: A Cross-Sectional Study

by Maria Eliza Dantas Bezerra Romão, Maria Helena Rodrigues Galvão, Fábio Correia Sampaio, Jocianelle Maria Félix Fernandes Nunes and Franklin Delano Soares Forte

Int. J. Environ. Res. Public Health 2025, 22(7), 1087; https://doi.org/10.3390/ijerph22071087 - 8 Jul 2025

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Abstract

This study aimed to investigate food insecurity (FI) and its association with sociodemographic characteristics and behavioral and dental alterations in adolescents from a county in the inland of northeastern Brazil. Data on 192 adolescents aged 11–14 years were analyzed in the public school [...] Read more.

This study aimed to investigate food insecurity (FI) and its association with sociodemographic characteristics and behavioral and dental alterations in adolescents from a county in the inland of northeastern Brazil. Data on 192 adolescents aged 11–14 years were analyzed in the public school system in Juripiranga, Paraíba, Northeast Brazil. The adolescents and their guardians responded to the Brazilian Food Insecurity Scale, the Strength and Difficulties Questionnaire for the caregiver, the Strength and Difficulties Questionnaire for children and adolescents, and a sociodemographic questionnaire. Academic performance was observed by calculating the median of the final assessments of basic school subjects. The prevalence of FI was 69.19, and FI was associated with a family income of up to one minimum wage per month (prevalence ratio [PR]: 1.90; 95% confidence interval [95% CI]: 1.20–3.01), no practice of religion by the guardian (PR: 1.34; 95% CI: 1.04–1.73), behavior considered inappropriate by the guardian (PR: 1.33; 95% CI: 1.02–1.73), and academic performance (PR: 1.35; 95% CI: 1.05–1.72). FI is considered a complex and multifactorial problem that requires appropriate intervention to deal with multiple social determinants. The results point to the need for integrated public policies between the health, education, social assistance, and food security sectors. Full article

(This article belongs to the Special Issue Oral Health Outcomes from Childhood to Adulthood)

10 pages, 259 KiB

Open AccessArticle

Vaping Education: A Two-Year Study Examining Health Literacy and Behaviors in a Southeastern State

by Adrienne M. Duke-Marks, James Benjamin Hinnant, Jessica R. Norton and Linda M. Gibson-Young

Int. J. Environ. Res. Public Health 2025, 22(7), 1086; https://doi.org/10.3390/ijerph22071086 - 8 Jul 2025

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Abstract

Electronic nicotine delivery systems (vapes) are the most used nicotine products among U.S. adolescents, with usage increasing significantly from 2017 to 2019. School-based prevention programs are a critical strategy for curbing youth vaping. This study utilized a retrospective pre/post survey to evaluate the [...] Read more.

Electronic nicotine delivery systems (vapes) are the most used nicotine products among U.S. adolescents, with usage increasing significantly from 2017 to 2019. School-based prevention programs are a critical strategy for curbing youth vaping. This study utilized a retrospective pre/post survey to evaluate the effectiveness of a two-year school-based vaping prevention program utilizing a condensed version of the Stanford University Tobacco Prevention Toolkit. The program was implemented in-person and online across two years in a southeastern U.S. state. In year one, evalua-tion data were collected from 4252 youths from 20 rural counties who completed the in-person survey during the 2018–2019 program year. In year two, 1347 youths from 13 rural and urban counties completed the survey during the program year of 2019–2020. The key findings indicate significant increases in knowledge about vaping risks post-program. The findings from year one indicate that increases in knowledge about e-cigarettes were negatively related to the frequency of vaping, but this was not replicated in year two. Moreover, knowledge did not influence vaping frequency if youths had already started vaping, while pre-program knowledge did not predict the frequency of vaping in either year. These results suggest that vaping prevention education outcomes among youths are mixed. Full article

(This article belongs to the Special Issue Environmental Exposures and Epigenomics in Health and Disease)

13 pages, 273 KiB

Open AccessArticle

Barriers to Physical Activity Participation Among University Staff: A Cross-Sectional Study

by Sami Elmahgoub, Hassan Mohamed, Farah Abu Khadra, Aseel Aburub, Mohamed I. Mabrouk, Adel Eltaguri and Ákos Levente Tóth

Int. J. Environ. Res. Public Health 2025, 22(7), 1085; https://doi.org/10.3390/ijerph22071085 (registering DOI) - 8 Jul 2025

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Abstract

Regular physical activity (PA) is crucial for health, yet many individuals face barriers to engage in an active lifestyle. This study aimed to identify and analyze the barriers preventing university staff from participating in PA. A cross-sectional quantitative approach was utilized, distributing surveys [...] Read more.

Regular physical activity (PA) is crucial for health, yet many individuals face barriers to engage in an active lifestyle. This study aimed to identify and analyze the barriers preventing university staff from participating in PA. A cross-sectional quantitative approach was utilized, distributing surveys to a diverse sample of 238 university staff aged 19 to 77 years, with an average age of 40. The survey was designed to identify the barriers that individuals face in adhering to physical PA and collected data on various internal and external factors influencing PA participation. Younger participants reported significantly higher scores for lack of energy and motivation compared to older age groups. Additionally, female participants experienced greater internal and external barriers than their male counterparts. Furthermore, university employees experienced significantly higher internal barriers, namely a lack of energy and lack of motivation. The primary barrier to PA participation among university staff was a lack of time. This study highlights the need for supportive environments that address these obstacles to promote PA participation. The findings offer valuable insights for university administrations and policymakers, emphasizing the importance of targeted interventions and supportive policies to enhance the health and activity levels of university staff. Full article

17 pages, 259 KiB

Open AccessArticle

Effective Social Support to Enable Older Adults Living Alone in Japan to Continue Living at Home

by Miwako Naoe and Yasuhiro Kawahara

Int. J. Environ. Res. Public Health 2025, 22(7), 1084; https://doi.org/10.3390/ijerph22071084 - 7 Jul 2025

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Abstract

Japan has the world’s fastest-aging population. The number of older adults living alone has increased rapidly; however, the number of people waiting for nursing care facilities is high, especially in urban areas, and home care is unavoidable. Few studies have focused on older [...] Read more.

Japan has the world’s fastest-aging population. The number of older adults living alone has increased rapidly; however, the number of people waiting for nursing care facilities is high, especially in urban areas, and home care is unavoidable. Few studies have focused on older adults living alone who require nursing care, and almost no reports have examined the factors influencing the continuation or discontinuation of living alone. Furthermore, no reports were found that classified nursing care levels for the survey. This study’s purpose was to clarify what kind of long-term care for older adults living alone in urban areas is most effective in enabling them to continue living at home. A total of 122 older adults in need of long-term care in Osaka City were divided into two groups; one group was those who continued to live alone in December 2022, the other was those who had to discontinue doing so after January 2020. A questionnaire was distributed to the care managers responsible for older adults living alone who required nursing care. The participants’ basic attributes, long-term care services usage, and the characteristics of instrumental activities of daily living (IADL) support were compared according to care level using Fisher’s exact test. The relevant effective factors for continuing to live alone were extracted using a multivariate logistic regression analysis. The results showed differences in the characteristics of both groups at both care level categories used in the study, Support Care Level 1–Nursing Care Level 2 and Nursing Care Level 3–5. Among the support items, indoor temperature control was suggested as a factor that influences continued living alone. Full article

15 pages, 597 KiB

Open AccessArticle

Impact of the Association Between Nutritional Status and Oral Health-Related Quality of Life in Older Adults from Two Cities in Southern Brazil: A Cross-Sectional Study

by Natália Marcumini Pola, Bernardo da Fonseca Orcina, Betina Dutra Lima, Paulo Roberto Grafitti Colussi and Francisco Wilker Mustafa Gomes Muniz

Int. J. Environ. Res. Public Health 2025, 22(7), 1083; https://doi.org/10.3390/ijerph22071083 - 7 Jul 2025

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Abstract

Objectives: This study aimed to evaluate the association between nutritional status and oral health-related quality of life (OHRQoL) in older adults from population-based studies of two cities in southern Brazil. Methods: A total of 569 community-dwelling individuals aged 60 years and older were [...] Read more.

Objectives: This study aimed to evaluate the association between nutritional status and oral health-related quality of life (OHRQoL) in older adults from population-based studies of two cities in southern Brazil. Methods: A total of 569 community-dwelling individuals aged 60 years and older were included. Sociodemographic, dental, and behavioral data were collected. Nutritional status was evaluated using the Mini Nutritional Assessment (MNA). OHRQoL, the primary outcome, was measured using the Oral Health Impact Profile-14 (OHIP-14) questionnaire. Poisson regression with robust variance was applied in crude and adjusted analyses to evaluate the impact of nutritional status on OHIP-14 outcomes. Results: The prevalence of risk of malnutrition was 31.6%, while the mean OHIP-14 was 4.86 ± 7.55. Individuals with malnutrition risk (7.44 ± 9.95) showed overall OHIP-14 scores significantly higher than those with normal nutrition (3.65 ± 5.76) (p < 0.001). A similar trend in results was detected in all domains of OHIP-14 (p < 0.05). In the adjusted analysis, individuals at risk of malnutrition had a 66% higher prevalence ratio (PR) (95% confidence interval [95% CI]: 1.23–2.23) of having poorer OHRQoL. Associations were also observed for the severity (PR: 1.69; 95% CI: 1.31–2.19) and extent (PR: 2.33; 95% CI: 1.55–3.49) of OHIP-14. Conclusions: In conclusion, poorer nutritional status is significantly associated with a higher impact on OHRQoL in older adults. Full article

(This article belongs to the Special Issue Oral Health and Quality of Life in Older Adults)

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13 pages, 524 KiB

Open AccessArticle

The Effectiveness of Two Interventions for Improving Knowledge of Emergency Preparedness Amongst Enrollees of the World Trade Center Health Registry: A Randomized Controlled Trial

by Howard E. Alper, Lisa M. Gargano, Meghan K. Hamwey, Lydia F. Leon and Liza Friedman

Int. J. Environ. Res. Public Health 2025, 22(7), 1082; https://doi.org/10.3390/ijerph22071082 - 7 Jul 2025

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Abstract

Natural and man-made disasters are occurring more frequently, making household emergency preparedness essential for an effective response. Enrollees of the World Trade Center Health Registry have been found to be less prepared than the US national average despite their prior disaster exposure. The [...] Read more.

Natural and man-made disasters are occurring more frequently, making household emergency preparedness essential for an effective response. Enrollees of the World Trade Center Health Registry have been found to be less prepared than the US national average despite their prior disaster exposure. The purpose of this study was to evaluate and compare the effectiveness of two interventions—a mailed brochure and a structured phone call—for increasing emergency preparedness knowledge among this population. We conducted a two-arm parallel group trial between February 2019 and August 2020. Participants were Registry enrollees who completed the Wave 4 Registry (2015–2016) survey, whose primary language was English or Spanish, who lived in New York City, and who did not report being a rescue and recovery worker affiliated with FDNY or NYPD. Enrollees were randomized to receive either a brochure by mail summarizing the components of emergency preparedness or a 15 min phone call describing the same. The primary outcome measure was the number of “yes” responses to the ten-item CDC CASPER emergency preparedness questionnaire, measured at baseline and post-intervention. Enrollees were sequentially alternatively assigned to either the brochure or phone call groups. In total, 705 enrollees were assigned to the brochure (n = 353) or phone call (n = 352) groups, and a total of 702 enrollees were analyzed. The Incident Rate Ratio (IRR) for the effect of time was 1.17 (95% CI = (1.14, 1.20)) and for intervention was 1.00 (95% CI = (0.95, 1.05)) Both the brochure and phone call interventions improved knowledge of emergency preparedness from baseline to post-intervention assessment, and to the same extent. Full article

(This article belongs to the Section Environmental Health)

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24 pages, 1100 KiB

Open AccessArticle

A Mixed Methods Exploration of Social Media Use for Health Information in Under-Resourced Communities

by Nishita Matangi, Maud Joachim-Célestin, Cristie Granillo, Valeria Rodarte, Beverly Buckles, Theresa Ashby, Nikhil Thiruvengadam and Susanne Montgomery

Int. J. Environ. Res. Public Health 2025, 22(7), 1081; https://doi.org/10.3390/ijerph22071081 - 6 Jul 2025

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Abstract

Social media (SM) use and the burden on healthcare systems have concurrently increased, with the latter resulting in longer wait times and higher costs. As a result, more people seem to use social media to access health information (HI). This study explores how [...] Read more.

Social media (SM) use and the burden on healthcare systems have concurrently increased, with the latter resulting in longer wait times and higher costs. As a result, more people seem to use social media to access health information (HI). This study explores how SM is used for accessing HI within an under-resourced community. In this mixed methods study, respondents (N = 256) completed online English and Spanish Qualtrics surveys assessing their use of healthcare services and social media, and its use for HI. We also explored respondents’ experience in understanding and using the HI they found on SM. Qualitative inquiries (N = 7) included focus groups and key informant interviews and expanded on the survey results. Results indicated that most participants used SM for HI. Instagram, Snapchat and TikTok were associated with looking up HI before and after receiving care and for health decision-making and for considering treatments or medication after seeing information about these on social media. To create effective messaging that is accepted, relatable and easy to access for the audiences they seek to reach, healthcare organizations must understand how SM is used as a source of HI. Exploring the associations between SM algorithms, health literacy, access to healthcare and SM use can help improve health communication strategies to be used on SM platforms. Full article

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17 pages, 567 KiB

Open AccessArticle

Digital Stress Scale (DSC): Development and Psychometric Validation of a Measure of Stress in the Digital Age

by Agathi Argyriadi, Dimitra Katsarou, Athina Patelarou, Kalliopi Megari, Evridiki Patelarou, Stiliani Kotrotsiou, Konstantinos Giakoumidakis, Shabnam Abdoola, Evangelos Mantsos, Efthymia Efthymiou and Alexandros Argyriadis

Int. J. Environ. Res. Public Health 2025, 22(7), 1080; https://doi.org/10.3390/ijerph22071080 - 6 Jul 2025

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Abstract

(1) Background: The integration of digital technologies such as electronic health records (EHRs), telepsychiatry, and communication platforms has transformed the mental health sector a lot compared to in previous years. While these tools enhance service delivery, they also introduce unique stressors. Despite growing [...] Read more.

(1) Background: The integration of digital technologies such as electronic health records (EHRs), telepsychiatry, and communication platforms has transformed the mental health sector a lot compared to in previous years. While these tools enhance service delivery, they also introduce unique stressors. Despite growing concerns, there is no validated instrument specifically designed to measure the digital stress experienced by mental health professionals. (2) Methods: This study involved the development and psychometric validation of the Digital Stress Scale (DSC). The process included item generation through a literature review and qualitative interviews, expert panel validation, and a two-phase statistical evaluation. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were conducted on responses from 423 licensed mental health professionals using EHRs and digital communication tools. The scale’s reliability and convergent validity were assessed via internal consistency and correlations with established mental health measures. (3) Results: The final DSC included four subscales: digital fatigue, technostress, digital disengagement, and work–life digital boundaries. CFA supported the factor structure (CFI = 0.965, RMSEA = 0.038), and the overall reliability was acceptable (Cronbach’s Alpha = 0.87). Descriptive analysis showed moderate-to-high levels of digital stress (M = 11.94, SD = 2.72). Digital fatigue was the strongest predictor of total stress (β = 1.00, p < 0.001), followed by technostress and work–life boundary violations. All subscales were significantly correlated with burnout (r = 0.72), job dissatisfaction (r = −0.61), and perceived stress (r = 0.68), all with a p < 0.001. (4) Conclusions: The DSC is a valid and reliable tool for assessing digital stress among mental health professionals. Findings point out the urgent need for policy-level interventions to mitigate digital overload, promote healthy work–life boundaries, and enhance digital competency in mental health settings. Full article

(This article belongs to the Special Issue Exploring Mental Health Challenges and Support Systems)

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13 pages, 1037 KiB

Open AccessArticle

Assessment of Static Balance Metrics in Community-Dwelling Older Adults Categorized Using the Fall Risk Appraisal Matrix

by Jethro Raphael M. Suarez, Joon-Hyuk Park and Ladda Thiamwong

Int. J. Environ. Res. Public Health 2025, 22(7), 1079; https://doi.org/10.3390/ijerph22071079 - 6 Jul 2025

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Abstract

The Fall Risk Appraisal Matrix (FRAM) is a simple fall risk assessment tool that categorizes older adults into four separate groups based on their fear of falling (FOF) and static balance performance. Static balance for the FRAM is evaluated solely by postural sway [...] Read more.

The Fall Risk Appraisal Matrix (FRAM) is a simple fall risk assessment tool that categorizes older adults into four separate groups based on their fear of falling (FOF) and static balance performance. Static balance for the FRAM is evaluated solely by postural sway distance, which does not account for other static balance parameters, such as sway area, anterior–posterior (AP) sway range, medial–lateral (ML) sway range, and sway velocity. The objective of this study was to compare these additional metrics across the FRAM groups to assess their relevance and validity for inclusion in static balance performance assessment. Hence, these measures were compared among the four different fall risk groups within the FRAM (203 participants; mean age = 75.0 ± 7.2 years) using Kruskal–Wallis test, followed by Dunn’s post hoc tests with Bonferroni correction. All balance metrics were significantly greater in the Incongruent (poor balance/low FOF) and Congruent (poor balance/high FOF) groups than the Rational (good balance/low FOF) group, as well as in the Congruent group than the Irrational (good balance/high FOF) group (p < 0.001). Additionally, AP sway range and sway velocity significantly differed between the Irrational and Incongruent groups (p < 0.001). The results suggest that the inclusion of these additional static balance measures, in addition to sway distance, reveals specific tendencies in static balance among different fall risk groups, which can serve as a reference for other researchers and future studies to develop more individually tailored intervention programs based on their static balance specificities. Full article

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12 pages, 452 KiB

Open AccessReview

The Effect of Exposure to Alcohol Media Content on Young People’s Alcohol Use: A Qualitative Systematic Review and Meta-Synthesis

by Sophie Getliff and Alex B. Barker

Int. J. Environ. Res. Public Health 2025, 22(7), 1078; https://doi.org/10.3390/ijerph22071078 - 6 Jul 2025

Viewed by 105

Abstract

Alcohol harm continues to present a public health priority. Whilst we know that a relationship exists between exposure to content and alcohol initiation and use in young people, the mechanism behind this effect is not well understood. Using the social identity approach as [...] Read more.

Alcohol harm continues to present a public health priority. Whilst we know that a relationship exists between exposure to content and alcohol initiation and use in young people, the mechanism behind this effect is not well understood. Using the social identity approach as a meaning-making lens, a systematic review of the qualitative literature and meta-synthesis was conducted using Medline (all years), Embase (all years), and PsycINFO (all years). The inclusion criteria included studies which qualitatively explored the effect of exposure to content or marketing in young people (aged < 26). Twenty-two articles were identified and included in the synthesis and assessed for bias using the Downe and Walsh checklist. Four themes were identified: normalisation of alcohol use, branding and identity, marketing strategies, and acting in identity congruence. A line of argument was constructed arguing that alcohol content and marketing are often targeted at and work through social identities and cultural norms to normalise alcohol use and lead to increased consumption through embedding content and marketing in culture. These findings have implications for stricter regulations around alcohol marketing and the protection of young people from alcohol content. Full article

(This article belongs to the Section Global Health)

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19 pages, 1037 KiB

Open AccessArticle

Occupational Balance in Refugees: The Role of Well-Being, Participation, and Perceived Discrimination

by Kardelen Yıldırım, Gülşah Zengin Yazıcı, Beyzanur Demirci, Sümeyye Sarışahin and Sedef Şahin

Int. J. Environ. Res. Public Health 2025, 22(7), 1077; https://doi.org/10.3390/ijerph22071077 - 6 Jul 2025

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Abstract

Although the experiences of forced migration among refugees have been widely studied, the relationships between occupational balance, well-being, participation, and perceived discrimination remain poorly understood. This study aimed to examine these interrelationships and to explore the predictive role of occupational balance in each [...] Read more.

Although the experiences of forced migration among refugees have been widely studied, the relationships between occupational balance, well-being, participation, and perceived discrimination remain poorly understood. This study aimed to examine these interrelationships and to explore the predictive role of occupational balance in each domain. Data were collected between February and March 2025 from 260 Syrian refugees aged 18–65 using validated instruments: the Occupational Balance Questionnaire, Personal Well-Being Index–Adult, Participation Scale, and Perceived Discrimination Scale. Occupational balance was significantly correlated with well-being, participation, and perceived discrimination (all p < 0.001). However, regression analyses revealed that only well-being (β = 0.114, p < 0.001) and participation (β = −0.107, p = 0.002) significantly predicted occupational balance; perceived discrimination had no direct effect. These findings highlight the critical role of occupational balance in fostering psychosocial integration. Enhancing refugees’ well-being and participation may support their adaptation processes. Community-based, culturally responsive interventions that target these domains could promote social inclusion, continuity of roles, and long-term psychosocial stability among displaced populations in host societies. Full article

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20 pages, 861 KiB

Open AccessArticle

A Longitudinal Ecologic Analysis of Neighborhood-Level Social Inequalities in Health in Texas

by Catherine Cubbin, Abena Yirenya-Tawiah, Yeonwoo Kim, Bethany Wood, Natasha Quynh Nhu Bui La Frinere-Sandoval and Shetal Vohra-Gupta

Int. J. Environ. Res. Public Health 2025, 22(7), 1076; https://doi.org/10.3390/ijerph22071076 - 5 Jul 2025

Viewed by 20

Abstract

Most health studies use cross-sectional data to examine neighborhood context because of the difficulty of collecting and analyzing longitudinal data; this prevents an examination of historical trends that may influence health outcomes. Using the Neighborhood Change Database, we categorized longitudinal (1990–2010) poverty and [...] Read more.

Most health studies use cross-sectional data to examine neighborhood context because of the difficulty of collecting and analyzing longitudinal data; this prevents an examination of historical trends that may influence health outcomes. Using the Neighborhood Change Database, we categorized longitudinal (1990–2010) poverty and White concentration trajectories (long-term low, long-term moderate, long-term high, increasing, or decreasing) for Texas census tracts and linked them to tract-level health-related characteristics (social determinants of health [SDOH] in 2010, health risk and preventive behaviors [HRPB] in 2017, and health status/outcomes [HSO] in 2017) from multiple sources (N = 2961 tracts). We conducted univariate and bivariate descriptive analyses, followed by linear regressions adjusted for population density. SDOH, HRPB, and HSO measures varied widely across census tracts. Both poverty and White concentration trajectories were strongly and consistently associated with a wide range of SDOH. Long-term high-poverty and low-White tracts showed the greatest disadvantages, while long-term low-poverty and high-White tracts had the most advantages. Neighborhoods undergoing changes in poverty or White concentrations, either increasing or decreasing, had less advantageous SDOH compared with long-term low-poverty or long-term high-White neighborhoods. While associations between poverty, White concentration trajectories, and SDOH were consistent, those with HRPB and HSO were less so. Understanding impact of the relationships between longitudinal neighborhood poverty and racial/ethnic composition on health can benefit stakeholders designing policy proposals and intervention strategies. Full article

(This article belongs to the Special Issue 3rd Edition: Social Determinants of Health)

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17 pages, 1334 KiB

Open AccessArticle

Well-Being of Family Caregivers of Individuals with Spinal Cord Injury: The Moderating Effects of Online Versus In-Person Social Support

by Victoria Bogle, William C. Miller, Heather Cathcart and Somayyeh Mohammadi

Int. J. Environ. Res. Public Health 2025, 22(7), 1075; https://doi.org/10.3390/ijerph22071075 - 5 Jul 2025

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Abstract

Objective: Family members of individuals with spinal cord injury often take on caregiving responsibilities, which can lead to caregiver burden. One factor that can mitigate the adverse effects of caregiving, such as caregiver burden, is receiving social support. Caregivers can obtain support from [...] Read more.

Objective: Family members of individuals with spinal cord injury often take on caregiving responsibilities, which can lead to caregiver burden. One factor that can mitigate the adverse effects of caregiving, such as caregiver burden, is receiving social support. Caregivers can obtain support from people they meet in person (in-person support) and on social media platforms (online support). The current cross-sectional correlational design study investigated the moderating effect of in-person and online support on the association between relationship quality, caregiver competence, caregiver distress, and caregiver burden (dependent variables). Methods: Family caregivers of an individual with spinal cord injury (n = 115) completed an online survey assessing relationship quality, competence, distress, burden, and in-person and online supports. Results: Moderation analyses showed that the negative associations between relationship quality and physical burden (B = −0.58; p = 0.019) and caregiver competence and physical burden (B = −0.73; p = 0.013) were more pronounced at higher levels of online social support. Furthermore, the magnitude of the negative associations between relationship quality and emotional burden (B = −0.52; p < 0.001) and caregiver competence and emotional burden (B = −0.34, p = 0.012) were more pronounced at higher levels of in-person social support. Moderation analyses also revealed that the positive association between distress and social burden (B = 0.47; p = 0.029) and emotional burden (B = 0.26; p = 0.045) were stronger when caregivers reported higher levels of online support. Conclusions: In-person and online support can buffer some aspects of caregiver burden on caregiver well-being. While online support is usually considered beneficial, greater online engagement may contribute to higher levels of burden when the distress is high. It is possible, however, that caregivers who are more distressed engage more with online media to receive support. Full article

(This article belongs to the Special Issue Family Caregiving, Nursing and Health Promotion)

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10 pages, 1006 KiB

Open AccessArticle

U.S. Federal and State Medicaid Spending: Health Policy Patterns by Political Party Leadership and Census Demographics

by Jamaji C. Nwanaji-Enwerem and Pamaji Nwanaji-Enwerem

Int. J. Environ. Res. Public Health 2025, 22(7), 1074; https://doi.org/10.3390/ijerph22071074 - 4 Jul 2025

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Abstract

Medicaid is a vital public health program, serving over 70 million Americans from many backgrounds. Understanding how Medicaid spending varies by political leadership and demographic factors can inform policy discussions and advocacy efforts. We conducted a cross-sectional descriptive analysis of state Medicaid spending [...] Read more.

Medicaid is a vital public health program, serving over 70 million Americans from many backgrounds. Understanding how Medicaid spending varies by political leadership and demographic factors can inform policy discussions and advocacy efforts. We conducted a cross-sectional descriptive analysis of state Medicaid spending using publicly available data. Our findings show that individuals identifying as White comprise the largest single racial group of Medicaid beneficiaries both nationally and in most states. While the 2020 Census Diversity Index correlated strongly with total Medicaid spending, no significant association was found with per enrollee spending or the federal share of Medicaid funding. States led by Democrats had higher total Medicaid spending when compared to Republican-led states. However, Republican-led states received a larger proportion of federal Medicaid funding. Among political leadership levels, Senate representation showed the strongest relationship with Medicaid spending trends compared to gubernatorial leadership and presidential voting history. In conclusion, we demonstrate that Medicaid spending impacts all racial groups and both major political parties. However, funding structures and political representation reflect distinct spending patterns. Given the evolving demographic and political landscape, ongoing policy discussions should ensure that Medicaid remains a public health program that remains effective at safeguarding human health. Full article

(This article belongs to the Special Issue Health Economics Perspectives on Health Promotion and Health Equity)

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13 pages, 761 KiB

Open AccessArticle

Ex-Vapers’ Perspectives on Helpful and Unhelpful Influences During Their Quit Journeys

by Mohammed Al-Hamdani, Courtney McKay, Katelynn Carter-Rogers and Steven Smith

Int. J. Environ. Res. Public Health 2025, 22(7), 1073; https://doi.org/10.3390/ijerph22071073 - 4 Jul 2025

Viewed by 26

Abstract

There is limited understanding of what influences vaping cessation, especially as vaping regulations change, and different jurisdictions have different regulations. This study involves 281 ex-vapers (16–24 years) from Nova Scotia, Canada. A content analysis was used to understand and compare youth and young [...] Read more.

There is limited understanding of what influences vaping cessation, especially as vaping regulations change, and different jurisdictions have different regulations. This study involves 281 ex-vapers (16–24 years) from Nova Scotia, Canada. A content analysis was used to understand and compare youth and young adults’ (YA) experiences of quitting vaping. Both helpful and unhelpful factors for quitting vaping were identified; each category had five themes and twenty-one sub-themes. Helpful factors were consistent across both age categories and included planned and unplanned vaping control interventions, health concerns, social support, evidence-based support, and unassisted quitting methods. Similarly, the five themes identified as unhelpful factors were consistent for both age groups: negative personal implications, negative social influences, planned and unplanned vaping control interventions, the side effects of previous use, and simultaneous and alternative substance use. Policies that limit access and raise awareness about lung health and well-being can help youth quit vaping. For YAs, increasing awareness about social support and health concerns is crucial. Raising e-cigarette costs and reducing vaping normalization supports quitting for YAs. Stress reduction and training to handle social pressure could aid youth, while YAs might benefit from treatment for other substance use to help with nicotine quitting. 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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16 pages, 283 KiB

Open AccessArticle

Examining the Impact of the COVID-19 Pandemic on Suicide-Attempt Survivors

by Martina Fruhbauerova, Julie Cerel, Athena Kheibari, Alice Edwards, Jessica Stohlmann-Rainey and Dese’Rae Stage

Int. J. Environ. Res. Public Health 2025, 22(7), 1072; https://doi.org/10.3390/ijerph22071072 - 4 Jul 2025

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Abstract

Despite initial concerns about the severe negative impact of COVID-19 on individuals with a history of mental health problems and suicide attempts, its effects remain unclear. This study examined the pandemic’s impact on individuals with and without lived experience of suicide attempts. An [...] Read more.

Despite initial concerns about the severe negative impact of COVID-19 on individuals with a history of mental health problems and suicide attempts, its effects remain unclear. This study examined the pandemic’s impact on individuals with and without lived experience of suicide attempts. An online nationwide sample of 1351 adults from the United States completed questionnaires from 26 May to 25 June 2021. A history of suicide attempt(s) (n = 159; 12%) was associated with significantly higher odds of utilizing mental health services, hospitalization for psychiatric reasons, and contacting hotlines. This history predicted worse outcomes in functioning, optimism, despair, and impairment. Notably, 57.6% of these individuals believed surviving a suicide attempt made them more resilient, while 21.9% expressed uncertainty about its impact on their resilience. In sum, participants with a history of suicide attempt(s) reported more depressive symptoms, worse daily functioning, more despair, less optimism, and greater service utilization during the pandemic, yet many also cited increased resilience due to their suicide history. Full article

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

19 pages, 868 KiB

Open AccessArticle

Improving Access to Radiotherapy in Gauteng: A Framework for Equitable Cancer Care

by Portia N. Ramashia, Pauline B. Nkosi and Thokozani P. Mbonane

Int. J. Environ. Res. Public Health 2025, 22(7), 1071; https://doi.org/10.3390/ijerph22071071 - 3 Jul 2025

Viewed by 11

Abstract

Radiotherapy, a critical component of cancer treatment, faces significant challenges in Gauteng, South Africa. These disparities hinder the achievement of Sustainable Development Goal 3, primarily due to systemic issues, socioeconomic barriers, and limitations within the health system. This article presents the House framework, [...] Read more.

Radiotherapy, a critical component of cancer treatment, faces significant challenges in Gauteng, South Africa. These disparities hinder the achievement of Sustainable Development Goal 3, primarily due to systemic issues, socioeconomic barriers, and limitations within the health system. This article presents the House framework, designed to enhance access to radiotherapy services by integrating the WHO Health Systems framework with the dimensions of access proposed by Penchansky and Thomas. The framework is visually represented as a house, with Policy & Governance as the foundation, WHO building blocks as pillars, and Equitable Cancer Care and Improved Outcomes as the roof. A mixed-methods approach was utilized, combining quantitative data from radiotherapy facilities and qualitative insights from healthcare professionals to identify barriers and potential solutions. Findings indicate significant disparities in resource distribution and accessibility between public and private institutions, compounded by socioeconomic factors like transport costs and lack of awareness. The article discusses innovative proposed framework using the 5As of access as potential solutions. The House framework serves as a valuable tool for policymakers and healthcare providers aiming to improve radiotherapy access and promote equitable cancer care in Gauteng, ultimately working towards reducing disparities in cancer outcomes. Full article

(This article belongs to the Special Issue Advancing Health Equity—Addressing Cancer Disparities)

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25 pages, 647 KiB

Open AccessArticle

Self-Management at Work’s Moderating Effect on the Relations Between Psychosocial Work Factors and Well-Being

by Carol-Anne Gauthier, Tyler Pacheco, Élisabeth Proteau, Émilie Auger and Simon Coulombe

Int. J. Environ. Res. Public Health 2025, 22(7), 1070; https://doi.org/10.3390/ijerph22071070 - 3 Jul 2025

Viewed by 19

Abstract

Mental health self-management (MHS) strategies may help workers with mental health concerns preserve and enhance their well-being. However, little research has explored how these strategies may help mitigate the effects of negative psychosocial work factors (PWFs) on well-being outcomes. This cross-sectional study investigated [...] Read more.

Mental health self-management (MHS) strategies may help workers with mental health concerns preserve and enhance their well-being. However, little research has explored how these strategies may help mitigate the effects of negative psychosocial work factors (PWFs) on well-being outcomes. This cross-sectional study investigated (1) the relationship between PWFs and well-being, (2) the association between MHS at work and well-being, and (3) the moderating role of self-management in preventing negative PWFs’ deleterious effects. A sample of 896 Francophone workers in Canada completed a questionnaire that included self-reported measures related to workplace, self-management, and well-being. Structural equation modeling (conducted via the MPlus software, version 8.6) revealed that psychological demands were negatively related to positive well-being outcomes and positively associated with adverse well-being outcomes. Competency-related autonomy was positively associated with flourishing, and recognition was positively associated with flourishing and positive well-being at work, as well as being negatively associated with burnout and depression. Surprisingly, supervisor support was negatively related to positive well-being and positively related to burnout and depression. MHS was positively associated with positive well-being at work, flourishing, and work performance, but had no relationship with negative mental health. MHS significantly moderated the relationship between each PWF and well-being at work in both beneficial and adverse ways, depending on the specific well-being indicator being considered. From a workplace well-being perspective, this suggests that although self-management may help workers preserve and enhance their positive well-being, organizations must also directly target PWFs to prevent negative well-being outcomes. Full article

(This article belongs to the Special Issue Health Literacy, Promotion and Prevention Improve Workers’ Health)

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12 pages, 468 KiB

Open AccessReview

Hot Weather and Violence Against Women: A Global Scoping Review

by Chiratidzo Hope Mulambo, Rishu Thakur and Supriya Mathew

Int. J. Environ. Res. Public Health 2025, 22(7), 1069; https://doi.org/10.3390/ijerph22071069 - 3 Jul 2025

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Abstract

Temperature increases due to climatic changes have been increasingly recognized as posing significant public health challenges, with wide-ranging socio-economic implications. This scoping review examines the relationship between high temperatures and violence against women (VAW) globally. Nine studies from both high-income and low- and [...] Read more.

Temperature increases due to climatic changes have been increasingly recognized as posing significant public health challenges, with wide-ranging socio-economic implications. This scoping review examines the relationship between high temperatures and violence against women (VAW) globally. Nine studies from both high-income and low- and middle-income countries were included in this review. The findings suggest an overall positive association between high temperatures and rates of VAW. Theoretical frameworks, including the temperature–aggression hypothesis and routine activity theory, offer insights into the mechanisms driving this relationship. Key risk factors such as socioeconomic status, urban heat island effects, rurality, patriarchal norms, and alcohol consumption were considered to be risk factors affecting rates of VAW. Despite growing evidence, research gaps persist, particularly in regions with high rates of VAW and in the form of qualitative studies that capture women’s lived experiences. The positive associations between temperature and VAW underscore the urgency of integrating gender-sensitive strategies into climate adaptation policies to mitigate the compounding risks of climate change and gender-based violence. Full article

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

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13 pages, 280 KiB

Open AccessArticle

The Hidden Danger of Unintentional Child Injuries in an Urban Domestic Environment: Considering Unintentional Injuries from Another Angle

by Ping Tang, Qin Fan, Jingmin Sun, Jianlin Ji, Liling Yang, Wenjuan Tang and Qunfeng Lu

Int. J. Environ. Res. Public Health 2025, 22(7), 1068; https://doi.org/10.3390/ijerph22071068 - 3 Jul 2025

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Abstract

Background: Unintentional injuries are the primary cause of death and disability among children. This study aimed to examine the current status of home environments for children aged 0–6 years in the Shanghai area of China and assess the factors that pose safety hazards [...] Read more.

Background: Unintentional injuries are the primary cause of death and disability among children. This study aimed to examine the current status of home environments for children aged 0–6 years in the Shanghai area of China and assess the factors that pose safety hazards for unintentional injuries within households. Methods: A cross-sectional survey was carried out in Shanghai between November 2021 and October 2023. Results: Parents from 1825 families, with 929 (50.90%) boys and 896 (49.10%) girls, participated in this research. In all, 752 children (41.21%) experienced unintentional injuries. The home environment posed a high risk of unintentional injuries in 1008 families (55.23%), medium risk in 381 families (20.88%), and low risk in 436 families (23.89%). The results showed a negative correlation between the occurrence of unintentional injuries and the status of the family environment; children in families with high-risk home environments were more likely to experience unintentional injuries (odds ratio [OR] = 1.490, confidence interval [CI] = 1.216–1.826), fall injuries (OR = 1.605, CI = 1.268–2.031), and external injuries (OR = 1.578, CI = 1.159–2.148). Conclusions: Parents should enhance their safety awareness by focusing on potential hazards at home and taking appropriate measures to improve the home environment, thereby creating a safe and comfortable setting for the healthy growth of their children. Full article

(This article belongs to the Section Environmental Health)

18 pages, 673 KiB

Open AccessArticle

Children’s Nature Use and Related Constraints: Nationwide Parental Surveys from Norway in 2013 and 2023

by Vegard Gundersen, Zander Venter, Odd Inge Vistad, Berit Junker-Köhler and Line Camilla Wold

Int. J. Environ. Res. Public Health 2025, 22(7), 1067; https://doi.org/10.3390/ijerph22071067 - 3 Jul 2025

Viewed by 15

Abstract

A growing number of research studies show that children spend less time in natural environments, which may have detrimental effects on children’s mental and physical health. This study explores changes in children’s (6–12 years) use of nearby nature and constraints on playing in [...] Read more.

A growing number of research studies show that children spend less time in natural environments, which may have detrimental effects on children’s mental and physical health. This study explores changes in children’s (6–12 years) use of nearby nature and constraints on playing in nature between 2013 and 2023. We apply an ecological approach, including individual, social, and structural constraints on outdoor play. The study is based on national surveys of parents reporting child play behavior for eight activity categories and nineteen categories of constraints/motivation. Findings reveal a decreasing tendency for time spent on all activity categories and increasing constraints for 17 of 19 categories during the study period. Our ecological approach reveals that there is less time for children’s nature use in contemporary society, and activities are more common in built areas than in nature. The survey identifies some important socio-cultural differences regarding gender, age, and residential setting. In future research, the focus should be on how reduced connection to nature affects children’s mental and physical health, and beyond this, how it affects the understanding of and care for nature among future generations. Full article

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31 pages, 587 KiB

Open AccessReview

Transition of Mental Health Services from Institutional to Community-Based Care Abroad and Its Context for Slovenia—Advantages and Risks

by Katja Horvat Golob, Alenka Temeljotov Salaj and Brigita Novak Šarotar

Int. J. Environ. Res. Public Health 2025, 22(7), 1066; https://doi.org/10.3390/ijerph22071066 - 3 Jul 2025

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Abstract

Deinstitutionalization is a transition from psychiatric hospitals and other mental health institutions as the primary setting for treatment of individuals with chronic mental health disorders to a range of services, including psychiatric care, that support independent functioning of an individual within the community. [...] Read more.

Deinstitutionalization is a transition from psychiatric hospitals and other mental health institutions as the primary setting for treatment of individuals with chronic mental health disorders to a range of services, including psychiatric care, that support independent functioning of an individual within the community. The transition has been encouraged by guidelines from the European Expert Group and further specified in the Slovenian Resolution on the National Programme of Mental Health 2018–2028. This integrated systematic and narrative literature review includes 47 international articles from PubMed, along with information on Slovenian mental health legislation and its implementation, to provide insights into deinstitutionalization abroad and its relevance for Slovenia. Although the transition to community-based care is welcomed for promoting independence and respecting individuals’ wants, there are cases where institutional care remains necessary to ensure safety and treatment during the exacerbation of chronic mental health disorders. The quality of care and outcomes generally improve with community-based care. However, the closure of institutions can lead to many unintended consequences, such as the revolving door phenomenon and transinstitutionalization. Both the advantages of community-based care and the important roles of mental health hospitals and other institutions are emphasized. Full article

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13 pages, 259 KiB

Open AccessArticle

COVID-19 and the Syndemic of Intimate Partner Violence, Mental Health, Substance Use, and HIV Care Engagement Among Black Sexual Minority Men Living with HIV in the US South

by Carrie L. Nacht, Hannah E. Reynolds, Chadwick K. Campbell, Kirstin Kielhold, Wilson Vincent, Daniel E. Siconolfi, Susan M. Kegeles and Erik D. Storholm

Int. J. Environ. Res. Public Health 2025, 22(7), 1065; https://doi.org/10.3390/ijerph22071065 - 3 Jul 2025

Viewed by 14

Abstract

Background: Black sexual minority men (BSMM) are disproportionately affected by HIV incidence and have lower rates of HIV care engagement (e.g., retention in care, viral suppression), particularly in the US South. The COVID-19 pandemic exacerbated co-occurring psychosocial syndemic factors (e.g., depression, violence, substance [...] Read more.

Background: Black sexual minority men (BSMM) are disproportionately affected by HIV incidence and have lower rates of HIV care engagement (e.g., retention in care, viral suppression), particularly in the US South. The COVID-19 pandemic exacerbated co-occurring psychosocial syndemic factors (e.g., depression, violence, substance use) that disproportionately impact BSMM living with HIV (BSMM+), but the impact of the pandemic on HIV care engagement among BSMM+ in the US South has not been explored in depth. Methods: BSMM+ (n = 27) were recruited from a longitudinal cohort in Dallas and Houston, Texas. Participants with less-than-optimal HIV care engagement, previous experiences of intimate partner violence (IPV), and prevalence of self-reported substance use were purposively selected for in-depth interviews from June 2022 to August 2023. Interviews lasted 54 min on average and were audio-recorded, transcribed, and de-identified before applying a thematic analysis approach. Results: Over half of participants experienced a relationship with IPV, used illicit substances in the past 60 days, and were depressed. Interviews highlighted that, during the COVID-19 pandemic, heightened levels of depression, substance use, and IPV individually and synergistically inhibited ART adherence and HIV care engagement. Participants described how IPV served to worsen their mental health and substance use, which, in turn, were the core drivers of poor HIV care engagement. Conclusions: The findings suggest that the COVID-19 pandemic exacerbated the syndemics of IPV, mental health, and substance use, and these acted as barriers to HIV care engagement. Future adherence interventions should synergistically address syndemic factors to maximize effectiveness. Full article

(This article belongs to the Special Issue HIV Care Engagement and Quality of Life Among People Living with HIV)

17 pages, 1269 KiB

Open AccessArticle

Reconstructing Cross-Cultural Meanings of Addiction Among Women from Three Countries

by Caitlyn D. Placek, Lora Adair, Ishita Jain, Sugandh Gupta, Vandana Phadke and Maninder Singh

Int. J. Environ. Res. Public Health 2025, 22(7), 1064; https://doi.org/10.3390/ijerph22071064 - 3 Jul 2025

Viewed by 157

Abstract

The gender gap in drug use is narrowing in regions where access to criminalized substances, such as opioids, is increasing. While research shows that substance use is gendered, less is known about the cultural norms and values shaping women’s drug use, as most [...] Read more.

The gender gap in drug use is narrowing in regions where access to criminalized substances, such as opioids, is increasing. While research shows that substance use is gendered, less is known about the cultural norms and values shaping women’s drug use, as most studies focus on men. Cross-national comparisons of cultural models of addiction are needed to better understand how addiction is perceived and to inform culturally responsive treatment approaches for women. This study examined cultural models of addiction among reproductive-aged women receiving treatment for substance misuse in London, Toronto, and Delhi. Participants completed a semi-structured questionnaire with open-ended and free-list prompts. Findings revealed shared cultural models attributing drug use to psychological factors, such as self-medicating to manage negative emotions or enhance positive ones, as well as relational, developmental, and biological influences. In conclusion, the study highlights the importance of incorporating cultural models into research and treatment. By using an inductive approach to explore meanings surrounding drug use among people in recovery, researchers can better understand how interventions are received and interpreted through existing internal frameworks. Full article

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

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15 pages, 785 KiB

Open AccessReview

Health Care and Access to Quality Social-Health Services of the Roma and Sinti: A Scoping Review

by Danilo Buonsenso, Davide Pata, Francesca Raffaelli, Giorgio Malorni, Francesca Colaiaco and Walter Malorni

Int. J. Environ. Res. Public Health 2025, 22(7), 1063; https://doi.org/10.3390/ijerph22071063 - 2 Jul 2025

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Abstract

Background: The aim of this scoping review is to analyze the health status of Roma and Sinti in Europe, highlighting the issues faced by children and women. In addition, we want to examine the access of these groups to health care services and [...] Read more.

Background: The aim of this scoping review is to analyze the health status of Roma and Sinti in Europe, highlighting the issues faced by children and women. In addition, we want to examine the access of these groups to health care services and to identify possible interventions to increase their use. Methods: Our research was conducted on Pubmed, Google Scholar, and the Trip Database. We selected articles written in English, Spanish, and Italian published since 2015. Results: Studies have shown that the health status of Roma and Sinti populations is generally worse than that of the rest of the population. Limited access to care is due to several specific factors, such as beliefs, traditions, and the lack of awareness of widespread direct and indirect discrimination against these groups by healthcare professionals. The studies reviewed have shown how mistrust can be broken down through multi-centered interventions linked to information, education, and communication through mediators able to interact with these populations, as well as through appropriate training of the health workers in charge. Conclusions: The health of the Roma and Sinti populations is commonly worse than that of the rest of the population. This is particularly true for the large proportion of people confined to suburban camps. However, the available evidence signals the low quality of life they experience and the need for interventions involving the communities and the establishment of ad hoc orientation or initial care contact points in the segregated areas. This could lead to an improvement in the integration of this population into the National Health Systems’ activities. Full article

(This article belongs to the Special Issue Advances in Primary Health Care and Community Health)

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24 pages, 360 KiB

Open AccessArticle

Depression and Anxiety Outcomes Among Young Adults Who Self-Reported Experiencing Commercial Sexual Exploitation in Adolescence

by Sarah M. Godoy, Adam R. Englert, Nofar Mazursky, Luisa Prout and William J. Hall

Int. J. Environ. Res. Public Health 2025, 22(7), 1062; https://doi.org/10.3390/ijerph22071062 - 2 Jul 2025

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Abstract

The commercial sexual exploitation (CSE) of children is a distinct form of sexual trauma, resulting in immediate mental health issues. Few studies explore associations between family-level factors in adolescence and health outcomes in adulthood among this population. Utilizing a nationally representative dataset, we [...] Read more.

The commercial sexual exploitation (CSE) of children is a distinct form of sexual trauma, resulting in immediate mental health issues. Few studies explore associations between family-level factors in adolescence and health outcomes in adulthood among this population. Utilizing a nationally representative dataset, we explored differences and associations between mental health outcomes and domains of the Family Health Development framework among respondents who self-reported CSE (N = 502; mean age = 15.03, SD = 1.34; 67% male; 50% white). We conducted ordinary least squares and binary logistic regressions using a hierarchical approach to analyze the CES-D depression scale, anxious personality scale, and self-reported diagnoses of depression and anxiety/panic disorder. At Wave IV, when participants were aged 24–32, 20% of participants reported ever having a diagnosis of depression, and 12% reported ever having an anxiety/panic disorder diagnosis. Family receipt of public assistance during adolescence significantly predicted depression and anxiety symptoms in adulthood, highlighting associations between family structure and mental health. Gender and race significantly predicted anxiety symptoms and having a diagnosis of depression and anxiety/panic disorder. Findings underscore the need for targeted training and comprehensive health screenings for providers to better understand and address the long-term mental health needs of CSE-impacted groups. Full article

(This article belongs to the Special Issue Biopsychosocial Predictors of Vulnerability, Resilience, and Intervention Responsiveness Among Trauma-Exposed Populations)

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Int. J. Environ. Res. Public Health, Volume 22, Issue 7 (July 2025) – 122 articles

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