International Journal of Environmental Research and Public Health

11 pages, 281 KB

Open AccessArticle

The Intergenerational Impact of Parental Immigration Status: Educational and Health Outcomes Among Children of Undocumented Immigrants

by Igor Ryabov

Int. J. Environ. Res. Public Health 2026, 23(1), 108; https://doi.org/10.3390/ijerph23010108 - 14 Jan 2026

Abstract

This study examines how parental legal status operates as a fundamental social determinant of health and educational equity, focusing on long-term outcomes among U.S.-born and foreign-born children of immigrants. We hypothesized that intergenerational stress and institutional exclusion associated with undocumented status would lead [...] Read more.

This study examines how parental legal status operates as a fundamental social determinant of health and educational equity, focusing on long-term outcomes among U.S.-born and foreign-born children of immigrants. We hypothesized that intergenerational stress and institutional exclusion associated with undocumented status would lead to lower educational attainment and poorer health. Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative cohort, participants were classified by inferred parental legal status: native-born, documented immigrant, and undocumented immigrant. Outcomes included high school graduation, college enrollment, depression scores, and chronic health conditions. Children of undocumented parents exhibited the most adverse outcomes—lower graduation (63.8%) and college enrollment rates (39.9%), higher depression, and greater chronic illness. In models controlling for socioeconomic factors, parental undocumented status independently predicted reduced odds of college enrollment (OR = 0.61, p < 0.001) and increased odds of reporting fair/poor health (OR = 2.10, p < 0.001). Findings highlight legal precarity as a potent driver of intergenerational disadvantage and underscore the need for policies addressing the barriers faced by children in undocumented families to promote health and educational equity. Full article

(This article belongs to the Special Issue Addressing Risk Behavior in Children and Adolescents)

13 pages, 617 KB

Open AccessArticle

Neuromuscular and Functional Adaptations Promoted by Lower Limb Isometric Training with NMES Conditioning Contractions in Older Adults

by Jacopo Stafuzza, Federica Gonnelli, Mattia D’Alleva, Maria De Martino, Lara Mari, Simone Zaccaron, Mirco Floreani, Alessio Floreancig, Davide Padovan, Giacomo Ursella, Gabriele Brugnola, Enrico Rejc and Stefano Lazzer

Int. J. Environ. Res. Public Health 2026, 23(1), 107; https://doi.org/10.3390/ijerph23010107 - 13 Jan 2026

Abstract

Aging induces sarcopenia and reduces bone mineral density, altering body composition. These modifications contribute to physical decline, increase non-communicable disease risk and increase the likelihood of hospitalization, thereby representing a substantial public health burden. In this study, we assessed the effects of isometric [...] Read more.

Aging induces sarcopenia and reduces bone mineral density, altering body composition. These modifications contribute to physical decline, increase non-communicable disease risk and increase the likelihood of hospitalization, thereby representing a substantial public health burden. In this study, we assessed the effects of isometric training with neuromuscular electrical stimulation conditioning contractions (ISO-NMES) and dynamic resistance training (DRT) on physical and functional capacities. Moreover, we investigated the impact of ISO-NMES training on the force and power of the trained and untrained leg. Eighteen sessions of ISO-NMES training for knee extensors were performed by 10 older adults (age: 70.1 ± 4.9 years; ISO-NMES group). The DRT group (n = 12; age: 70.5 ± 2.8 years) performed 18 sessions of dynamic resistance training at a local fitness center. Maximum voluntary contraction (MVC) and peak power (P) of lower limbs as well as functional capacities assessed with the 5 Sit to Stand, Timed Up and Go and 6 Minutes Walking Tests were examined in both groups before and after the related training protocols. At the end of the training period, only the ISO-NMES group had improved MVC (+30.4%, p < 0.001) and bilateral force (ISO-NMES: +6.3%, p = 0.032). Moreover, both groups had significantly improved functional capacities. Finally, in the ISO-NMES group, MVC, force and power significantly increased in both legs with a greater effect for MVC in the trained than untrained leg (+30.4 vs. +13.5%, p < 0.001). These findings suggest that ISO-NMES training was an effective strategy to improve physical and functional capacities in older adults. Thus, it could be considered as a potential intervention, particularly when the mobility to perform physical training is limited. Full article

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20 pages, 658 KB

Open AccessArticle

History of Trauma Exposure and Post-Traumatic Stress Spectrum Symptoms in a Sample of Bariatric Surgery Candidates: Clinical Correlates and Association with Maladaptive Eating Behaviours

by Claudia Carmassi, Sara Fantasia, Andrea Bordacchini, Berenice Rimoldi, Debora Andreoli, Gabriele Massimetti, Marly Simoncini, Lorenzo Conti and Valerio Dell’Oste

Int. J. Environ. Res. Public Health 2026, 23(1), 106; https://doi.org/10.3390/ijerph23010106 - 13 Jan 2026

Abstract

Obesity is a growing health concern in Western countries and the link between obesity and mental disorders has been extensively studied, although less attention has been paid to post-traumatic stress spectrum symptoms (PTSS). This observational study aimed at exploring the correlations between lifetime [...] Read more.

Obesity is a growing health concern in Western countries and the link between obesity and mental disorders has been extensively studied, although less attention has been paid to post-traumatic stress spectrum symptoms (PTSS). This observational study aimed at exploring the correlations between lifetime trauma exposure and its related PTSS and maladaptive eating behaviours in obese patients who are candidates for bariatric surgery. A total of 189 obese candidates for bariatric surgery were recruited at the Azienda Ospedaliero-Universitaria Pisana (AOUP) and assessed by the Trauma and Loss Spectrum—Self-Report (TALS-SR Lifetime Version), Emotional Eating Scale (EES), Night Eating Questionnaire—Italian Version (I-NEQ), Grazing Questionnaire (GQ), and Eating Disorder Examination (EDE-Q), Eating Disorder Inventory (EDI). Based on the TALS-SR (Lifetime Version) scores, patients were dichotomised as either with low PTSS scores or high PTSS scores. Results showed high PTSS scores in more than a third of the sample (36.5%), with these individuals showing statistically significant higher total and EES domain scores, total and controllability GQ domain scores, I-NEQ mood/sleep domain scores, and EDE-Q shape concern domain score. A logistic regression showed an association between higher burden of emotional eating and greater probability of lifetime PTSS. PTSS appear to be frequent among bariatric surgery candidates and are related with maladaptive eating behaviours, suggesting accurate evaluation to optimise surgical outcomes. Full article

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

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15 pages, 288 KB

Open AccessArticle

Symptoms and Diagnoses Prior to Suicide in Children and Young Adults—A Swedish Medical Record Review

by Anna-Lena Hansson, Per Johnsson, Sophia Eberhard, Erik Bergqvist, Elin Fröding Saric, Linda Karlsson, Sara Lindström, Margda Waern and Åsa Westrin

Int. J. Environ. Res. Public Health 2026, 23(1), 105; https://doi.org/10.3390/ijerph23010105 - 13 Jan 2026

Abstract

Suicide in children and young adults is a leading cause of premature mortality, and there is a need to develop a more profound understanding of the factors that contribute to these deaths. This study is part of the nationwide Retrospective Investigation of Health [...] Read more.

Suicide in children and young adults is a leading cause of premature mortality, and there is a need to develop a more profound understanding of the factors that contribute to these deaths. This study is part of the nationwide Retrospective Investigation of Health Care Utilization in Individuals who died by Suicide in Sweden 2015, conducted at Lund University, Sweden. The aim was to examine symptoms and diagnoses in children and young adults who died by suicide, as documented in their medical records at their last visits for primary care, somatic specialist care, or psychiatric care 24 months prior to suicide, and to apply contemporary psychological research in youth suicidality to the findings to formulate clinical implications. The proportions of symptoms and diagnoses in children (0–17 years), young adults (18–24 years), males, and females are described. The main symptoms noted in the cohort were depressive symptoms (28%), anxiety symptoms (26%), and pain (25%). The diagnoses predominately covered mental and behavioural disorders, and the most frequent of the mental and behavioural diagnoses were neurotic, stress-related, and somatoform disorders (32%) and mood (affective) disorders (29%). The diagnoses and symptoms were not sufficient to uncover suicidality in children and young adults. The clinical implications for alternative assessments and preventive interventions are discussed. Full article

(This article belongs to the Special Issue Mental Health and Health Promotion in Young People)

25 pages, 512 KB

Open AccessSystematic Review

A Review of Dementia Caregiver Interventions: Valuing Psychological Well-Being and Economic Impact Through the State-Preference Method

by Anna Consiglio, Antonella Lopez and Andrea Bosco

Int. J. Environ. Res. Public Health 2026, 23(1), 104; https://doi.org/10.3390/ijerph23010104 - 12 Jan 2026

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Abstract

Objectives. To integrate clinical and economic evidence on the main non-pharmacological interventions aimed to reduce the burden of caregivers of people with dementia, with specific attention to stated preference measures (SPM), Willingness-to-Pay (WTP) and Willingness-to-Accept (WTA), alongside other cost-effectiveness indicators (ICER, QALY). Methods. [...] Read more.

Objectives. To integrate clinical and economic evidence on the main non-pharmacological interventions aimed to reduce the burden of caregivers of people with dementia, with specific attention to stated preference measures (SPM), Willingness-to-Pay (WTP) and Willingness-to-Accept (WTA), alongside other cost-effectiveness indicators (ICER, QALY). Methods. A systematic review was conducted on randomized and quasi-experimental evaluations, economic models, and preference studies concerning psychoeducational/coping interventions, activity-centered/occupational programs (TAP), technological solutions and tele-support, and goal-oriented cognitive rehabilitation (CR). For each study, the following indexes were extracted: design, sample size, psychological outcomes (anxiety/depression, burden, engagement), utility per QALY, costs per perspective (the health–social and the broader societal perspectives), ICER, WTP/WTA, and sensitivity results. Results. Psychoeducational programs and CR show consistent benefits on distress, anxiety/depression, and caregiver quality of life; TAP reduces caregiver burden and patient behavioral problems, with favorable signs of cost–effectiveness; results on the effects of technologies are heterogeneous, but online modules with telephone support improve psychological morbidity. QALY improvement is generally modest, but the probability of cost-effectiveness remains high when costs do not differ significantly from treatment as usual, or when, from a societal perspective, the unpaid caregiving time of the caregiver is valued. Preference studies indicate positive WTP for additional hours of home care, health–social integration, and facilitated groups; evidence on WTA is scarcer and methodologically variable. Conclusions. Short, structured interventions with a human support component offer good value-for-money; the adoption of societal perspectives and the systematic use of WTP/WTA can better capture the value perceived by caregivers. Heterogeneity issues persist. Full article

(This article belongs to the Topic Healthy, Safe and Active Aging, 2nd Edition)

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19 pages, 703 KB

Open AccessReview

Discrimination and Gender: An Umbrella Review of Psychological Evidence

by Giulia Lausi

Int. J. Environ. Res. Public Health 2026, 23(1), 103; https://doi.org/10.3390/ijerph23010103 - 12 Jan 2026

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Abstract

Gender discrimination is a pervasive and multifaceted phenomenon rooted in cognitive, emotional, and social mechanisms that operate across individual, interpersonal, and structural levels. This umbrella review synthesizes systematic reviews and meta-analyses published between 2013 and 2024 examining the relationship between gender, stereotypes, and [...] Read more.

Gender discrimination is a pervasive and multifaceted phenomenon rooted in cognitive, emotional, and social mechanisms that operate across individual, interpersonal, and structural levels. This umbrella review synthesizes systematic reviews and meta-analyses published between 2013 and 2024 examining the relationship between gender, stereotypes, and discrimination. Following PRISMA 2020 guidelines, searches were conducted across PubMed/MEDLINE, Scopus, and Web of Science, yielding 22 eligible reviews after screening 684 records. Thematic synthesis identified two overarching domains: manifestations of discrimination and health and professional outcomes. Discrimination emerged as structural, interpersonal, and implicit, operating through institutional barriers, microaggressions, and stereotyping mechanisms. These dynamics were found to significantly affect mental health, and particularly anxiety, depression, and psychological distress, as well as physical health, including cardiovascular outcomes and maternal morbidity. Professional and social functioning were also impaired, with gender-based inequalities documented in pay, promotion, and role allocation across multiple occupational contexts. Despite consistent evidence of harm, the literature revealed limited consensus in conceptualization and a lack of longitudinal and intervention research. Collectively, findings underscore that gender discrimination constitutes both a public health concern and a systemic social mechanism that shapes individual cognition, emotion, and behaviour, demanding multi-level psychological and policy responses. Full article

(This article belongs to the Special Issue Silent Scars: Violence, Trauma and the Health Equity of Women and Children)

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22 pages, 495 KB

Open AccessArticle

Bridging the Gap: A Mixed-Methods Evaluation of a New Rural Maternity Care Center Amid Nationwide Closures

by Kathryn Wouk, Ellen Chetwynd, Emily C. Sheffield, Marni Gwyther Holder, Kelly Holder, Isabella C. A. Higgins, Moriah Barker, Tim Smith, Breanna van Heerden, Dana Iglesias, Andrea Dotson and Margaret Helton

Int. J. Environ. Res. Public Health 2026, 23(1), 102; https://doi.org/10.3390/ijerph23010102 - 12 Jan 2026

Viewed by 146

Abstract

The closure of rural maternity units in hospitals across the United States contributes to health inequities; however, little is known about the effects of reopening maternity services in this context. We conducted a mixed-methods study to characterize labor and delivery outcomes and patient [...] Read more.

The closure of rural maternity units in hospitals across the United States contributes to health inequities; however, little is known about the effects of reopening maternity services in this context. We conducted a mixed-methods study to characterize labor and delivery outcomes and patient experiences associated with the reopening of a rural Level 1 Maternity Care Center (MCC) at a critical access hospital. We compared clinical outcomes and distance to care for patients who gave birth at the rural MCC in the three years after its opening with outcomes from a similar low-risk and geographically located sample who gave birth at a large suburban academic medical center in the same hospital system in the three years before the MCC reopened. We also conducted in-depth interviews with patients who gave birth at the MCC. Labor and delivery outcomes were similar across both groups, with significantly more care provided by family physicians and midwives and lower neonatal intensive care unit use at the MCC. The opening of the MCC halved the distance patients traveled to give birth, and patients reported high rates of satisfaction. Rural maternity care centers can improve access to quality care closer to home using a resource-appropriate model. Full article

(This article belongs to the Special Issue Access and Utilization of Maternal Health Services in Rural Areas)

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12 pages, 272 KB

Open AccessArticle

School Administrator and Food Vendor Perspectives on Stocking and Promoting Healthier Offerings in Indonesian Primary Schools: Findings from a Pilot Study

by Esther M. Nguyen, Hamam Hadi, Emma C. Lewis, Madelyn Sijangga, Herwinda Kusuma Rahayu, Muhammad Evan Takamitsu Kurniawan and Joel Gittelsohn

Int. J. Environ. Res. Public Health 2026, 23(1), 101; https://doi.org/10.3390/ijerph23010101 - 12 Jan 2026

Viewed by 39

Abstract

Childhood overweight and obesity is a growing public health challenge in Indonesia, affecting approximately one in five school-aged children. Because children spend substantial time at school and frequently obtain meals and snacks from on-site canteens, these settings represent an important opportunity for nutrition-focused [...] Read more.

Childhood overweight and obesity is a growing public health challenge in Indonesia, affecting approximately one in five school-aged children. Because children spend substantial time at school and frequently obtain meals and snacks from on-site canteens, these settings represent an important opportunity for nutrition-focused interventions. As an initial step towards understanding factors influencing canteen stocking decisions, we assessed perceived taste, acceptability, and feasibility of healthier local foods and beverages from the perspectives of canteen owners and school administrators (n = 10) across five primary schools (n = 2 urban, n = 3 rural) in Magelang, Indonesia. Participants completed in-person taste tests of selected food and beverage options and participated in in-depth interviews exploring drivers of stocking decisions. IndoMilk (multi-cereal, reduced-sugar dairy beverage) received the most favorable taste ratings and was perceived as the most feasible option to sell, followed by sate telur puyuh (braised quail eggs) and sate buah (fresh fruit skewers). In contrast, gethuk (cassava/coconut cake) and polo pendem (steamed tubers with boiled peanuts) were viewed as less appealing to children and unlikely to be sold. Participants identified children’s taste preferences, affordability, visual appeal, and profitability as key considerations influencing stocking decisions, while perceptions of nutrition varied. Findings from this pilot study highlight contextual factors shaping school canteen food environments and may inform future interventions aimed at introducing healthier options while accounting for children’s preferences and canteen operational constraints. Full article

(This article belongs to the Special Issue The Role of the Food Environment in the Health of Children and Adolescents)

15 pages, 641 KB

Open AccessProtocol

One Health Approach to Nutritional Status and Well-Being in Food Supply Chain Workers: A Study Protocol

by Mariacristina Siotto, Carola Cocco, Chiara Bertoncini, Alessandro Guerrini, Valeria Habib, Erika Antonacci, Elisabetta Ruco and Irene Giovanna Aprile

Int. J. Environ. Res. Public Health 2026, 23(1), 99; https://doi.org/10.3390/ijerph23010099 - 11 Jan 2026

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Abstract

The agri-food supply chain is a relevant contributor to the Italian economy but shows a high incidence of occupational injuries and musculoskeletal disorders, such as lower back pain. Repetitive manual handling and biomechanical overload highlight the need for a prevention-oriented, system-level assessment. This [...] Read more.

The agri-food supply chain is a relevant contributor to the Italian economy but shows a high incidence of occupational injuries and musculoskeletal disorders, such as lower back pain. Repetitive manual handling and biomechanical overload highlight the need for a prevention-oriented, system-level assessment. This protocol aims to implement a harmonized One Health approach procedure for the multidimensional evaluation of food supply chain workers in real-world settings. The protocol integrates bioelectrical impedance vector analysis (BIVA), nutritional parameters, quality-of-life and psychological measures, and assessments of systemic oxidative stress and systemic serotonin levels. Data from active workers will be compared with those from sedentary individuals. The study will evaluate whether BIVA profiles differ between these groups and examine how the additional indicators contribute to a multidimensional well-being framework. By operationalizing an integrated One Health approach that bridges nutritional, psychological, and biomarker domains, this protocol is designed to guide targeted preventive and educational strategies and inform evidence-based occupational and public health policies across the food supply chain. Trial registration: NCT06896877 (ClinicalTrials.gov), 26 March 2025. Full article

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20 pages, 413 KB

Open AccessArticle

Women’s Postpartum Experiences of Hypertensive Disorders of Pregnancy: A Qualitative Study of Barriers and Enablers to Healthy Lifestyle Behaviours

by Lynne Roberts, Chris Rossiter, Elizabeth Denney-Wilson, Megan Gow and Amanda Henry

Int. J. Environ. Res. Public Health 2026, 23(1), 100; https://doi.org/10.3390/ijerph23010100 - 11 Jan 2026

Viewed by 182

Abstract

Background: Hypertensive disorders of pregnancy (HDP) have significant implications for women’s long-term health, including at least a twofold increased lifetime risk of cardiovascular disease (CVD). The Blood Pressure Postpartum (BP²) Study was a three-arm randomised trial evaluating follow-up and lifestyle behaviour [...] Read more.

Background: Hypertensive disorders of pregnancy (HDP) have significant implications for women’s long-term health, including at least a twofold increased lifetime risk of cardiovascular disease (CVD). The Blood Pressure Postpartum (BP²) Study was a three-arm randomised trial evaluating follow-up and lifestyle behaviour change strategies during the first year after HDP. Methods: This qualitative sub-study, embedded within the BP² Study, explored women’s experiences of life in the first year following HDP. Semi-structured telephone interviews were conducted with 34 women, approximately 10–12 months postpartum. Interviews were transcribed verbatim and a thematic analysis was undertaken. Results: Participants reflected on their experiences post-HDP; three major themes were identified: Navigating life with a newborn, The value of support, and Processing and Moving forward. Some women felt informed and empowered to make positive lifestyle changes; others were still processing their HDP experience and/or feeling overwhelmed by the demands of early motherhood. Responses were influenced by their HDP experience, available support, prior experience with healthy behaviours, and financial stability. Conclusions: The findings highlight that postpartum women who experienced HDP face unique challenges, including physical recovery, emotional processing, and intensive infant care. It often takes time for these women to begin prioritising their own health, as they navigate these challenges. The insights generated from women’s experiences suggest that flexible, accessible, and individually tailored support may facilitate postpartum health, promote lifestyle change, and help reduce long-term CVD risk. Full article

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

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Graphical abstract

9 pages, 295 KB

Open AccessProtocol

Mapping Socioecological Interconnections in One Health Across Human, Animal, and Environmental Health: A Scoping Review Protocol

by Jessica Farias Dantas Medeiros, Leonor Maria Pacheco Santos, Sindy Maciel Silva, Jorge Otávio Maia Barreto, Johnathan Portela da Silva Galdino, Eveline Fernandes Nascimento Vale, Kary Desiree Santos Mercedes, Mayara Suelirta da Costa, Juliana Michelotti Fleck, Karine Suene Mendes Almeida, Verônica Cortez Ginani, Wildo Navegantes de Araújo, Diule Vieira de Queiroz and Christina Pacheco

Int. J. Environ. Res. Public Health 2026, 23(1), 98; https://doi.org/10.3390/ijerph23010098 - 10 Jan 2026

Viewed by 153

Abstract

The One Health framework highlights the interconnectedness of human, animal, and environmental health, requiring interdisciplinary and multisectoral collaboration to address complex global health challenges. This scoping review protocol aims to guide the systematic mapping on how studies and policy initiatives have incorporated socioecological [...] Read more.

The One Health framework highlights the interconnectedness of human, animal, and environmental health, requiring interdisciplinary and multisectoral collaboration to address complex global health challenges. This scoping review protocol aims to guide the systematic mapping on how studies and policy initiatives have incorporated socioecological interconnections within the One Health paradigm, following the Joanna Briggs Institute guidance and the PRISMA Scr checklist. The experimental design includes searches in PubMed, Scopus, Web of Science, LILACS, Health Systems Evidence, Social Systems Evidence, and Google Scholar for the period from 2004 to 2025. The strategy, developed with librarian support and peer reviewed, includes terms in English, Portuguese, and Spanish. Pilot searches retrieved 5333 PubMed and 470 LILACS records. Eligible documents must explicitly present two or more of the six One Health dimensions: policies to strengthen health systems; antimicrobial resistance; food safety; environmental health; emerging and re-emerging zoonotic epidemics and pandemics; endemic zoonotic, neglected tropical and vector-borne diseases. A standardized tool was developed for data extraction, synthesizing in narrative, tabular, and graphical formats. The protocol’s utilization will provide comprehensive mapping of practices and policies, identifying achievements, barriers, and knowledge gaps to inform future strategies and strengthen global health governance. Full article

14 pages, 299 KB

Open AccessArticle

Pesticide Exposure and Mucocutaneous Symptoms Among Thai Agricultural Workers: A Cross-Sectional Study

by Warin Intana, Chime Eden and Weeratian Tawanwongsri

Int. J. Environ. Res. Public Health 2026, 23(1), 97; https://doi.org/10.3390/ijerph23010097 - 10 Jan 2026

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Abstract

Exposure to plant protection products (pesticides) is common among agricultural workers and may represent an underrecognized cause of mucocutaneous disease. We conducted a descriptive cross-sectional survey in agricultural communities in southern Thailand (August–November 2025) to estimate the prevalence, clinical characteristics, and dermatology-specific quality-of-life [...] Read more.

Exposure to plant protection products (pesticides) is common among agricultural workers and may represent an underrecognized cause of mucocutaneous disease. We conducted a descriptive cross-sectional survey in agricultural communities in southern Thailand (August–November 2025) to estimate the prevalence, clinical characteristics, and dermatology-specific quality-of-life impact of pesticide-attributed symptoms. Agricultural workers with pesticide use or exposure within the preceding 12 months were recruited via convenience sampling; participants provided consent and completed standardized interviewer-administered questionnaires assessing demographics, pesticide exposure history and application practices, personal protective equipment (PPE) use, self-reported cutaneous and mucosal symptoms (ocular and oral/nasal), and the Dermatology Life Quality Index (DLQI). Of the 354 eligible individuals, 228 participated in the study, and 226 were included in the analyses. The median age was 54 years (interquartile range [IQR], 15), and 82.7% were male. Overall, 14.6% reported pesticide-attributed cutaneous symptoms, 5.3% reported ocular mucosal symptoms, and 0.4% reported oral/nasal mucosal symptoms. Cutaneous manifestations were predominantly symptoms occurring after exposure, with pruritic, erythematous eruptions affecting the arms and hands that typically resolved within 1–7 days after cessation of exposure. Among symptomatic participants, the median DLQI was 0.5 (IQR 3.0); however, DLQI scores were significantly higher among participants who reported pesticide-attributed cutaneous symptoms (p < 0.001) and ocular symptoms (p < 0.001). These findings suggest that pesticide-associated mucocutaneous effects are generally mild yet clinically meaningful, underscoring the need to strengthen PPE training, risk communication, and occupational health surveillance in agricultural settings. Full article

(This article belongs to the Section Environmental Health)

24 pages, 2495 KB

Open AccessArticle

Bridging Financial Inclusion and Health Equity in LMICs: Evidence from a Half-Century of Bibliometric Data

by Hasan Mhd Nazha, Masah Alomari and Mhd Ayham Darwich

Int. J. Environ. Res. Public Health 2026, 23(1), 96; https://doi.org/10.3390/ijerph23010096 - 10 Jan 2026

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Abstract

Health equity and financial inclusion (FI) are at the core of the Sustainable Development Goals, yet their intersection remains critically under-studied. This bibliometric study maps this emergent and fragmented field by analyzing 24,140 publications from Scopus, PubMed, Web of Science, and Lens.org over [...] Read more.

Health equity and financial inclusion (FI) are at the core of the Sustainable Development Goals, yet their intersection remains critically under-studied. This bibliometric study maps this emergent and fragmented field by analyzing 24,140 publications from Scopus, PubMed, Web of Science, and Lens.org over five decades. Employing co-citation and co-word analysis via VOSviewer, chart research trends, governance frameworks, and policy linkages were systematically presented. The analysis reveals that less than 0.3% of the identified literature explicitly bridges financial inclusion with health outcomes, and direct investigations into health equity are virtually absent. Despite recent growth, fundamental gaps persist, including a lack of empirical studies on digital financial tools in low- and middle-income countries (LMIC) health contexts and insufficient focus on disadvantaged populations. As the first comprehensive empirical mapping of this nexus, this study underscores the urgency for scholarly and policy action to strategically leverage financial instruments for equitable healthcare access. The findings provide a foundational map and a structured agenda to consolidate this nascent field. Full article

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22 pages, 844 KB

Open AccessArticle

The Mediating Role of Alcohol Use Between Adverse Childhood Experiences and Delinquency Among Youth in the Legal System

by Akemi E. Mii, Johanna B. Folk, Brandon D. L. Marshall, Kathleen Kemp, Sophia Garcia-Meza and Marina Tolou-Shams

Int. J. Environ. Res. Public Health 2026, 23(1), 95; https://doi.org/10.3390/ijerph23010095 - 9 Jan 2026

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Abstract

Rates of alcohol use and exposure to adverse childhood experiences (ACEs) are elevated among youth in the legal system (YILS) compared to their non-legally involved peers. Exposure to ACEs has been associated with later alcohol use and delinquency, and YILS often engage in [...] Read more.

Rates of alcohol use and exposure to adverse childhood experiences (ACEs) are elevated among youth in the legal system (YILS) compared to their non-legally involved peers. Exposure to ACEs has been associated with later alcohol use and delinquency, and YILS often engage in delinquent behavior while under the influence of alcohol. The associations between ACEs, alcohol use, and delinquency among YILS are complex and multidirectional; research has yet to explore how these experiences and behaviors influence each other over time, or whether they differ based upon the reason for legal system involvement (status or delinquent petition). This study examined whether YILS’ ACEs were prospectively associated with self-reported delinquent behaviors, and whether self-reported recent alcohol use was an explanatory mechanism for this association. Multigroup mediation analyses were utilized to examine if these pathways differed based on youth’s court petition type. Results indicated that YILS report high rates of ACEs. Frequency of recent alcohol use mediated the associations between ACEs and subsequent delinquency for youth with a delinquent, but not status, petition. Concurrent assessment of trauma exposure and alcohol use when youth first enter the legal system is imperative to inform early intervention needs to reduce the likelihood of continued system involvement. Full article

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

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23 pages, 399 KB

Open AccessArticle

Maternal Mortality Among Black Women in Brazil: A Retrospective Cohort Study

by Gustavo Gonçalves dos Santos, Anuli Njoku, Reginaldo Roque Mafetoni, Clara Fróes de Oliveira Sanfelice, Ana Izabel Oliveira Nicolau, Patrícia Wottrich Parenti, Cely de Oliveira, Leticia López-Pedraza, Ricardo José Oliveira Mouta, Karina Franco Zihlmann, Cindy Ferreira Lima, Cícero Ricarte Beserra Júnior, Cláudia de Azevedo Aguiar, Cesar Henrique Rodrigues Reis, Júlia Maria das Neves Carvalho, Ana Cristina Ribeiro da Fonseca Dias, Maria Luísa Santos Bettencourt, Mónica Alexandra Pinho da Silva, Maria João Jacinto Guerra and Giovana Aparecida Gonçalves Vidotti

Int. J. Environ. Res. Public Health 2026, 23(1), 94; https://doi.org/10.3390/ijerph23010094 - 9 Jan 2026

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Abstract

Background: Maternal mortality in Brazil remains a critical indicator of social and racial inequalities, reflecting structural failures in access to and quality of obstetric care. Black women, particularly those categorized as black or brown, are at a higher risk of dying during pregnancy, [...] Read more.

Background: Maternal mortality in Brazil remains a critical indicator of social and racial inequalities, reflecting structural failures in access to and quality of obstetric care. Black women, particularly those categorized as black or brown, are at a higher risk of dying during pregnancy, childbirth, or the postpartum period. This is the result of the intersection of institutional racism, poverty, and social vulnerabilities. This study aimed to analyze trends and associated factors of maternal mortality among black women in Brazil from 2000 to 2020. Methods: This is a retrospective cohort analytical study using data from the Brazilian Mortality Information System. The sample included women aged 10 to 49 years whose underlying cause of death was classified under ICD-10 codes O00–O99. Descriptive and bivariate analyses were conducted, as well as Poisson and multinomial logistic regressions to estimate adjusted risk ratios according to skin color, education, region, type, and place of death. Results: A total of 40,907 maternal deaths were identified, with 59.2% occurring among black women. The maternal mortality ratio was 39% higher among black women compared to white women and more than double among Indigenous women. Low education, residence in the North and Northeast regions, deaths outside hospital settings, and lack of formal investigation were independently associated with increased risk. Direct obstetric causes accounted for most deaths, with hypertensive disorders and puerperal complications being the leading conditions. Conclusions: Maternal mortality among black women in Brazil reveals deep structural inequalities. Urgent public policies that incorporate an intersectional perspective, addressing race, gender, and class, are necessary to reduce disparities and ensure equitable and dignified maternal healthcare. Full article

(This article belongs to the Special Issue Discrimination as a Social Determinant of Health and Healthcare Inequities)

16 pages, 301 KB

Open AccessArticle

Impact of Social Drivers of Health, Self-Efficacy, and Substance Use on COVID-19 Preventative Behaviors Among Persons Who Inject Drugs with Hepatitis C: The HERO Study

by Snehal S. Lopes, Irene Pericot-Valverde, Paula J. Lum, Lynn E. Taylor, Shruti H. Mehta, Judith I. Tsui, Judith Feinberg, Arthur Y. Kim, Brianna L. Norton, Kimberly Page, Cristina Murray-Krezan, Jessica Anderson, Alison Karasz, Julia Arnsten, Phillip Moschella, Moonseong Heo, Alain H. Litwin and the HERO Study Group

Int. J. Environ. Res. Public Health 2026, 23(1), 93; https://doi.org/10.3390/ijerph23010093 - 9 Jan 2026

Viewed by 115

Abstract

Background: Personal protective measures help prevent infection and disease transmission during health crises such as Coronavirus disease 2019 (COVID-19). Populations facing barriers to adhering to these measures are more vulnerable to the health crisis. This study investigated the association of social drivers of [...] Read more.

Background: Personal protective measures help prevent infection and disease transmission during health crises such as Coronavirus disease 2019 (COVID-19). Populations facing barriers to adhering to these measures are more vulnerable to the health crisis. This study investigated the association of social drivers of health (SDoH), self-efficacy, and adverse substance use behavior changes with ability to practice COVID-19 personal protective behaviors among persons who inject drugs (PWID) with hepatitis C virus (HCV) infection history. Methods: This study used the Hepatitis C Real Options (HERO) study’s COVID-19 survey data (n = 157). The association of inability to practice COVID-19 personal protective behaviors (hand washing, social distancing, etc.) with (a) SDoH difficulties (employment, housing, etc.); (b) adverse substance use behavior change (overdose, injecting behavior, etc.); and (c) self-efficacy was tested using logistic regression. Results: Inability to practice any personal protective behaviors was more likely among those experiencing any vs. no SDoH difficulties [adjusted odds ratio (aOR) (95% confidence interval (CI))] = 4.57 (1.57, 16.40); p = 0.003] but less likely for those with higher overall self-efficacy [aOR (95% CI) = 0.55 (0.32, 0.93); p = 0.025] and self-efficacy for setting goals [aOR (95% CI) = 0.63 (0.40, 0.96); p = 0.031]. The association between adverse substance use behavior changes and the outcome was not significant. Conclusions: Greater SDoH difficulties and lower self-efficacy were associated with greater inability to practice COVID-19 personal protective behaviors. Interventions to meet SDoH-related challenges and increase self-efficacy could help encourage practice of personal protective behaviors and economically reduce disease burden during health crises. Full article

(This article belongs to the Special Issue Substance Use Disorders: Etiology, Epidemiology, Prevention, Treatment and Recovery)

32 pages, 713 KB

Open AccessReview

A Scoping Review of Refugee Children’s Health Conditions, Outcomes, and Measures Used in Refugee-Serving Public Health Centres/Clinics in Canada

by Augustine Botwe, Nour Armoush, Cheryl Poth, Sophie Yohani and Rebecca Gokiert

Int. J. Environ. Res. Public Health 2026, 23(1), 92; https://doi.org/10.3390/ijerph23010092 - 9 Jan 2026

Viewed by 248

Abstract

Refugee-serving primary health centres/clinics (PHCs) provide culturally safe, integrated care for refugee children, yet little is known about how their health conditions and outcomes are assessed. This scoping review examines the current literature on the health conditions and outcomes of refugee children aged [...] Read more.

Refugee-serving primary health centres/clinics (PHCs) provide culturally safe, integrated care for refugee children, yet little is known about how their health conditions and outcomes are assessed. This scoping review examines the current literature on the health conditions and outcomes of refugee children aged 0–5 years and how they are measured in refugee-serving PHCs in Canada. In partnership with the New Canadians Health Centre and guided by Joanna Briggs Institute methodological guidelines, we systematically searched Medline, CINAHL, Scopus, and Embase. Included studies focused on refugee children in Canada and reported health conditions, outcomes, and their measurements within PHCs. Twenty-five studies (2008–2024) met the inclusion criteria, most from Ontario (n = 11), followed by Alberta and Saskatchewan (n = 4 each). Reported health conditions or outcomes (n = 24) spanned the physical (n = 19), developmental, and mental health domains (n = 5). Communicable (e.g., gastrointestinal infections, hepatitis) and non-communicable conditions (e.g., malnutrition, vitamin D deficiency) were mostly reported. Although some standardized approaches were used, substantial variability exists across provinces and conditions or outcomes measured. Findings reveal a disproportionate focus on physical health and notable variability and gaps in child health measures, limited cultural adaptation, and lack of longitudinal data. Standardized, culturally responsive, and age-appropriate measurement approaches are needed to enhance health equity and inform evidence-based policy for refugee children in Canada. Full article

(This article belongs to the Special Issue Reducing Disparities in Health Care Access of Refugees and Migrants)

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26 pages, 694 KB

Open AccessReview

Shelter to Survival: Unpacking the Health Impacts of Housing Insecurity Across the Life Course

by Gordane V. Calloo, Mavis Odei Boateng, Eyram A. Agbe and Godfred O. Boateng

Int. J. Environ. Res. Public Health 2026, 23(1), 91; https://doi.org/10.3390/ijerph23010091 - 9 Jan 2026

Viewed by 233

Abstract

Housing insecurity is a growing public health concern linked to adverse health outcomes and lifelong vulnerability. Although housing is a well-established social determinant of health, this review employs a life-course framework to explain how housing insecurity contributes to the accumulation of health inequities [...] Read more.

Housing insecurity is a growing public health concern linked to adverse health outcomes and lifelong vulnerability. Although housing is a well-established social determinant of health, this review employs a life-course framework to explain how housing insecurity contributes to the accumulation of health inequities and chronic disparities across the different stages of human development. A rapid review was conducted across PubMed, Google Scholar, SCOPUS, and Web of Science, focusing on peer-reviewed studies published between 1991 and 2025. Studies were screened using predefined eligibility criteria, and the selection process was documented through a PRISMA flow diagram. Fifty-five studies met the inclusion criteria. Housing insecurity was consistently associated with adverse health outcomes across pregnancy, infancy, childhood, adolescence, adulthood, and older age. Each life stage presents distinct vulnerabilities shaped by environmental and social conditions, which are manifested through physiological and psychosocial pathways. While physical health effects were most frequently reported, developmental and mental health impacts accumulated over time, amplifying overall burden. The findings demonstrate a clear life-course pathway linking housing insecurity to immediate and long-term health risks. Early-life disadvantages create lasting, preventable consequences, underscoring the urgent need for policies that embed housing stability within broader public health planning. Full article

(This article belongs to the Special Issue Health Impacts of Resource Insecurity on Vulnerable Populations)

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13 pages, 474 KB

Open AccessOpinion

Environmental Health Practice: An Identity in Crisis

by Jason Barnes

Int. J. Environ. Res. Public Health 2026, 23(1), 90; https://doi.org/10.3390/ijerph23010090 - 9 Jan 2026

Viewed by 202

Abstract

Environmental health practice is facing an identity crisis. Not because our work lacks impact, but because our work lacks a coherent narrative. Environmental health practice needs a brand that speaks our truth and secures our place in the future of health protection. The [...] Read more.

Environmental health practice is facing an identity crisis. Not because our work lacks impact, but because our work lacks a coherent narrative. Environmental health practice needs a brand that speaks our truth and secures our place in the future of health protection. The brand of environmental health practice must be more than a label. It needs to be an asset that our industry can leverage to build identity, recognisability, credibility, relevance and a unique value proposition. A strong brand will allow us to express the unique impact of our role and thus, it needs to capture the most central component of our work that unmistakably differentiates it from anything else. A rapid review of the literature was performed using systematic methods to discern a coherent narrative capturing the essence of environmental health practice. Through application of a critical lens shaped through professional experience, a novel narrative was synthesized of the key defining component of our work. This narrative establishes the work of environmental health practitioners as a unique value proposition and forms the basis for a brand that we can fearlessly project and reverberate. It represents the makings for an unmistakable identity. The future of environmental health practice depends on environmental health practitioners establishing a brand by building awareness of the unique value of our work. Full article

(This article belongs to the Section Environmental Health)

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19 pages, 538 KB

Open AccessArticle

Validity and Applicability of the Eating Motivation Survey (TEMS) in a University Population in the Western Brazilian Amazon

by Flávia S. B. Dias, Wanderson Roberto da Silva, Mônica da Silva-Nunes and Alanderson Alves Ramalho

Int. J. Environ. Res. Public Health 2026, 23(1), 89; https://doi.org/10.3390/ijerph23010089 - 9 Jan 2026

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Abstract

This study aimed to test the factorial structure of the Eating Motivation Survey (TEMS) using Confirmatory Factor Analysis (CFA) in a sample of 632 university students from the Western Brazilian Amazon. A cross-sectional study was conducted between December 2022 and April 2023 with [...] Read more.

This study aimed to test the factorial structure of the Eating Motivation Survey (TEMS) using Confirmatory Factor Analysis (CFA) in a sample of 632 university students from the Western Brazilian Amazon. A cross-sectional study was conducted between December 2022 and April 2023 with participants of both sexes, aged 18 or older. In addition to CFA, psychometric analyses were performed, and a Structural Equation Model was developed to examine the relationships between individual characteristics (age, sex, and Body Mass Index (BMI)) and the TEMS constructs. The results showed that 58.3% of participants were female, with a mean age of 25.29 years. The CFA supported an eight-factor model (health, natural concerns, socialization, price, visual appeal, weight control, emotional control, and social image) with 24 items, presenting good validity and reliability indices. Older individuals and those with lower BMIs prioritized health, natural concerns, and weight control, while younger participants, women, and those with higher BMIs were more influenced by emotional control. The findings contribute to understanding eating motivations in culturally diverse contexts and may support strategies aimed at promoting healthier dietary behaviors and preventing diet-related chronic diseases. Full article

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19 pages, 408 KB

Open AccessArticle

Expanding Diabetes Self-Management Education to Address Health-Related Social Needs: A Qualitative Feasibility Study

by Niko Verdecias-Pellum, Gianna D’Apolito, Abby M. Lohr, Aliria M. Rascón and Kelly N. B. Palmer

Int. J. Environ. Res. Public Health 2026, 23(1), 88; https://doi.org/10.3390/ijerph23010088 - 8 Jan 2026

Viewed by 181

Abstract

Diabetes self-management education (DSME) programs are evidence-based interventions that improve glycemic control and self-care behaviors, yet their effectiveness may be limited by unaddressed health-related social needs (HRSN) (e.g., food insecurity, housing or utility instability, transportation barriers). This qualitative multiple case study examined the [...] Read more.

Diabetes self-management education (DSME) programs are evidence-based interventions that improve glycemic control and self-care behaviors, yet their effectiveness may be limited by unaddressed health-related social needs (HRSN) (e.g., food insecurity, housing or utility instability, transportation barriers). This qualitative multiple case study examined the feasibility of integrating HRSN assessments into DSME delivery within three community-based organizations (CBOs) across urban and rural U.S. settings. Guided by the Consolidated Framework for Implementation Research, semi-structured interviews were conducted with 15 DSME facilitators and program leadership to identify contextual factors influencing implementation. Findings revealed that while DSME’s structured, manualized design promotes fidelity and client autonomy, it constrains responsiveness to the client’s HRSN. Facilitators expressed openness to integrating HRSN screening, particularly during intake, yet cited limited infrastructure, role clarity, and training as key barriers. CBOs were recognized as trusted, accessible spaces for holistic care, but growing expectations to address HRSN without adequate resources for referral created sustainability concerns. Participants recommended a parallel support model involving navigators or community health workers to manage HRSN screening and referrals alongside DSME sessions. Integrating HRSN assessment processes into DSME may enhance engagement, reduce attrition, and extend the reach of diabetes education to populations most affected by HRSN. However, successful implementation requires dedicated funding, workforce development, and cross-sector coordination. Findings underscore the importance of supporting CBOs as critical partners in bridging diabetes education and social care to advance whole-person, chronic disease management. Full article

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

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15 pages, 1324 KB

Open AccessArticle

Context-Based Development to Promote Physical Activity Among Working-Age Populations: Participatory Action Research and Pilot Test

by Kamlai Somrak, Poramet Hemarachatanon, Saranrat Manunyanon, Kiattisak Pechpan, Phiphat Khlongdi, Sanhapan Wattanapisit, Apichat Photia and Apichai Wattanapisit

Int. J. Environ. Res. Public Health 2026, 23(1), 87; https://doi.org/10.3390/ijerph23010087 - 8 Jan 2026

Viewed by 242

Abstract

Insufficient physical activity (PA) is a significant health challenge among working-age populations. This study aimed to develop context-specific processes to promote PA among adults aged 35–60 years. A participatory action research approach was conducted across seven provinces in upper southern Thailand. The study [...] Read more.

Insufficient physical activity (PA) is a significant health challenge among working-age populations. This study aimed to develop context-specific processes to promote PA among adults aged 35–60 years. A participatory action research approach was conducted across seven provinces in upper southern Thailand. The study consisted of three phases: (1) preparation and situation analysis, (2) development and implementation of PA promotion programs, and (3) program evaluation and lessons learned. In Phase 1, the working-age population was categorized into four groups: Group 1: PA occupation and exercise; Group 2: PA occupation but non-exercise; Group 3: non-PA occupation but exercise; Group 4: non-PA occupation and non-exercise. In Phase 2, an exercise program and PA tracking guide were developed and implemented over a 6-month period. In Phase 3, based on the complete-case analysis, 175 participants enrolled, with 101 (57.7%) and 100 (57.1%) remaining at 3 and 6 months, respectively. Based on the last observation carried forward analysis (n = 175 across the 6 months), the proportion achieving global recommended PA levels and time spent in weekly moderate- to vigorous-intensity PA increased significantly in the non-exercise groups (Groups 2 and 4). All participants in the exercise groups (Groups 1 and 3) met the recommended PA level at baseline; however, this level was not maintained at the endpoint. The context-based PA promotion programs improved PA participation among non-exercise working-age adults. Future research should identify strategies to enhance program uptake and sustain engagement. Full article

(This article belongs to the Special Issue Adherence to Physical Activity and Its Role in Health Promotion)

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18 pages, 2406 KB

Open AccessArticle

Global Research Trends in Community-Based Strategies for Reducing Risky Alcohol Consumption and Promoting Health

by Kristijan Breznik, Andreja Hrovat Bukovšek and Tamara Štemberger Kolnik

Int. J. Environ. Res. Public Health 2026, 23(1), 86; https://doi.org/10.3390/ijerph23010086 - 8 Jan 2026

Viewed by 184

Abstract

The aim of this study was to map global research on community-based strategies to reduce risky alcohol consumption and promote health, aiming to clarify growth, leading contributors, thematic structure, and integration with public-health frameworks. Using a PubMed corpus, we analyzed production, authorship, and [...] Read more.

The aim of this study was to map global research on community-based strategies to reduce risky alcohol consumption and promote health, aiming to clarify growth, leading contributors, thematic structure, and integration with public-health frameworks. Using a PubMed corpus, we analyzed production, authorship, and collaboration indicators, built a thematic map (centrality/density) to identify core topics, and applied Multiple Correspondence Analysis to assess conceptual proximity between alcohol-specific and broader prevention domains. The dataset comprised 2607 documents across 916 sources, with output led by the USA, with substantial contributions from Australia, Canada, the UK, and rising activity in sub-Saharan Africa. The thematic map showed a mature core centered on adolescents and pregnancy, cross-cutting foundations in health education and sexual behavior with substance-related disorders, measurement-oriented niches at the periphery, and emerging work linking family planning. The Multiple Correspondence Analysis positioned alcohol-prevention terms close to health promotion, primary prevention, and epidemiology, with maternal–child health bridging community programs and clinical prevention. Overall, community-based alcohol prevention is expanding, globally distributed, and embedded in mainstream public-health practice. Limitations include the absence of citation data in PubMed, and future work should integrate citation-enabled databases and compare patterns across income groups. Full article

(This article belongs to the Special Issue Risk Reduction for Health Prevention)

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29 pages, 904 KB

Open AccessReview

Risks Associated with Dietary Exposure to Contaminants from Foods Obtained from Marine and Fresh Water, Including Aquaculture

by Martin Rose

Int. J. Environ. Res. Public Health 2026, 23(1), 85; https://doi.org/10.3390/ijerph23010085 - 7 Jan 2026

Viewed by 279

Abstract

Aquatic environments have been a critical source of nutrition for millennia, with wild fisheries supplying protein and nutrients to populations worldwide. A notable shift has occurred in recent decades with the expansion of aquaculture, now representing a fast-growing sector in food production. Aquaculture [...] Read more.

Aquatic environments have been a critical source of nutrition for millennia, with wild fisheries supplying protein and nutrients to populations worldwide. A notable shift has occurred in recent decades with the expansion of aquaculture, now representing a fast-growing sector in food production. Aquaculture plays a key role in mitigating the depletion of wild fish stocks and addressing issues related to overfishing. Despite its potential benefits, the sustainability of both wild and farmed aquatic food systems is challenged by anthropogenic pollution. Contaminants from agricultural runoff, industrial discharges, and domestic effluents enter freshwater systems and eventually reach marine environments, where they may be transported globally through ocean currents. Maintaining water quality is paramount to food safety, environmental integrity, and long-term food security. In addition to conventional seafood products such as fish and shellfish, foods such as those derived from microalgae are gaining attention in Western markets for their high nutritional value and potential functional properties. These organisms have been consumed in Asia for generations and are now being explored as sustainable foods and ingredients as an alternative source of protein. Contaminants in aquatic food products include residues of agrochemicals, persistent organic pollutants (POPs) such as dioxins, polychlorinated biphenyls (PCBs), and per- and polyfluoroalkyl substances (PFASs), as well as brominated flame retardants and heavy metals. Public and scientific attention has intensified around plastic pollution, particularly microplastics and nanoplastics, which are increasingly detected in aquatic organisms and are the subject of ongoing toxicological and ecological risk assessments. While the presence of these hazards necessitates robust risk assessment and regulatory oversight, it is important to balance these concerns against the health benefits of aquatic foods, which are rich in omega-3 fatty acids, high-quality proteins, vitamins, and trace elements. Furthermore, beyond direct human health implications, the environmental impact of pollutant sources must be addressed through integrated management approaches to ensure the long-term sustainability of aquatic ecosystems and the food systems they support. This review covers regulatory frameworks, risk assessments, and management issues relating to aquatic environments, including the impact of climate change. It aims to serve as a comprehensive resource for researchers, policymakers, food businesses who harvest food from aquatic systems and other stakeholders. Full article

(This article belongs to the Special Issue Health Impacts Associated with Dietary Exposure to Chemical Contaminants and Residues)

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34 pages, 1111 KB

Open AccessSystematic Review

A Systematic Review of Ecological Momentary Assessment Procedures of Self-Harm (With and Without Suicidal Intent) Studies in Adolescents and Young Adults

by Bethany Martin, Susan Rasmussen, Kirsten Russell, Megan Crawford, Spence Whittaker, Scott Thomson and Abbie Greenwood

Int. J. Environ. Res. Public Health 2026, 23(1), 84; https://doi.org/10.3390/ijerph23010084 - 7 Jan 2026

Viewed by 334

Abstract

Ecological momentary assessment (EMA) captures real-time data on thoughts, emotions, and behaviours within individuals’ natural environments. Although EMA has been increasingly used to examine self-harm, existing reviews have not focused specifically on adolescents. This systematic review examines EMA research on adolescent self-harm, focusing [...] Read more.

Ecological momentary assessment (EMA) captures real-time data on thoughts, emotions, and behaviours within individuals’ natural environments. Although EMA has been increasingly used to examine self-harm, existing reviews have not focused specifically on adolescents. This systematic review examines EMA research on adolescent self-harm, focusing on methodological considerations and key risk and protective factors for self-harm. Five databases, plus pre-print, unpublished and grey literature sources, were searched up to 30 January 2024. Studies were included if published in English, used EMA methodology, included adolescents aged 10–24 years and measured suicidal ideation, suicidal behaviours, or self-harm. The review included 79 studies, published from 2009 to the present. Self-harm was associated with numerous risk factors, including negative affect, stress, interpersonal influences and sleep. EMA was generally well-accepted by adolescent participants, with high compliance rates. The findings highlight the value of EMA in capturing real-time fluctuations in self-harm and associated risk factors among adolescents. EMA demonstrates strong potential for improving understanding and prediction of self-harm; yet challenges remain, including variability in study designs and a lack of clear reporting of the methodologies. Future research should focus on standardising methodologies, increasing participant diversity, and exploring the clinical utility of EMA in early intervention and prevention strategies. Full article

(This article belongs to the Special Issue Understanding Self-Harm Among Young People)

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21 pages, 456 KB

Open AccessArticle

Changes in Dietary Patterns and Environmental Footprints Among University Students: A Retrospective Study

by Gordana Kenđel Jovanović, Greta Krešić, Elena Dujmić, Mihaela Sabljak and Sandra Pavičić Žeželj

Int. J. Environ. Res. Public Health 2026, 23(1), 83; https://doi.org/10.3390/ijerph23010083 - 7 Jan 2026

Viewed by 164

Abstract

Background: University students are often exposed to environments that encourage unhealthy eating, but universities can promote better health and sustainability by making sustainable food options more accessible. Methods: Temporal changes in dietary patterns and environmental footprints of 1684 students at the University of [...] Read more.

Background: University students are often exposed to environments that encourage unhealthy eating, but universities can promote better health and sustainability by making sustainable food options more accessible. Methods: Temporal changes in dietary patterns and environmental footprints of 1684 students at the University of Rijeka, Croatia, over a 16-year period (2009–2025) were retrospectively analyzed using data from 3 cross-sectional studies. Results: A significant transition toward less sustainable diets, increased consumption of animal-based foods, and proinflammatory eating habits was observed (both p < 0.001). Adherence to the Mediterranean and Planetary Health Diet declined over time (p < 0.001), followed by increased prevalence of overweight and obesity. Three dietary patterns were identified: high fruit and vegetable intake, consistently high milk and dairy consumption, and lower-to-moderate intake of all other food groups with temporal variation. Consumption of most food groups increased, leading to higher water and ecological footprints. Only the intake of fruits, vegetables, whole grains, and fish declined, which corresponded with reduced carbon footprints for these and a few other food groups, while the environmental impact of other foods significantly increased (all p < 0.001). Gender, diet quality, and a proinflammatory diet were significant predictors of dietary environmental footprints. Conclusions: The findings underscore the need for systemic changes and addressing barriers at the university level to support sustainable eating behaviors. This study offers valuable insights for policymakers, educators, and researchers, which aim to help students become health-conscious and environmentally responsible consumers. Further research is needed to explore the broader factors influencing dietary choices and the long-term impact of future institutional interventions. Full article

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12 pages, 303 KB

Open AccessArticle

The Protective Role of Social Support Against Depression, Anxiety, and Stress in Physiotherapy Students

by Latifah Alenezi, Maath Alhaddad, Shareefah Almutairi and Fareedah Almohri

Int. J. Environ. Res. Public Health 2026, 23(1), 82; https://doi.org/10.3390/ijerph23010082 - 7 Jan 2026

Viewed by 180

Abstract

Background: Physiotherapy University students frequently experience psychological challenges such as depression, anxiety, and stress. These issues are shaped by various individual, health-related, and social factors. Understanding these influences is essential for identifying vulnerable subgroups and guiding effective support strategies. Aim and Objectives: This [...] Read more.

Background: Physiotherapy University students frequently experience psychological challenges such as depression, anxiety, and stress. These issues are shaped by various individual, health-related, and social factors. Understanding these influences is essential for identifying vulnerable subgroups and guiding effective support strategies. Aim and Objectives: This study aims to assess the prevalence and severity of depression, anxiety, and stress among physiotherapy students. Specific objectives include (1) analyzing mental health variations across demographic variables such as gender, nationality, marital status, and year of study; (2) evaluating the impact of physical and mental health conditions on psychological distress; and (3) investigating the protective role of perceived social support from family, friends, and faculty. Methods: A cross-sectional study was conducted among 282 physiotherapy students at Kuwait University, focusing on students from the Physical Therapy Department in the College of Allied Health Sciences, of whom 89% were aged 18–22 years and 10% were aged 23–27 years. Participants were selected through purposive and convenience sampling, including second-, third-, and fourth-year students. Data were collected using the DASS-21 scale along with demographic, health, and social support information. Descriptive statistics and ANOVA tests were used to analyze associations between psychological outcomes and the studied variables. Results: Anxiety was the most prevalent condition, with 39.4% of students reporting extremely severe levels. Depression and stress affected 14.2% and 11.3% of students at the same severity level, respectively. Gender differences were examined among the participants (259 females and 23 males), with female students showing significantly higher stress levels than males and second-year students reporting greater depression and stress compared to their senior peers. Students who received support from family and friends exhibited lower levels of psychological distress. Conclusions: This is the first study in Kuwait to examine mental health among physiotherapy students, revealing a high prevalence of depression, anxiety, and stress in this group. The findings highlight the unique academic and clinical pressures faced by physiotherapy students, including intensive coursework, frequent assessments, physically demanding clinical placements, close patient interaction, and the need to integrate theoretical knowledge with hands-on clinical practice, while also emphasizing the protective role of social support. These insights call for targeted mental health strategies and support systems within physiotherapy education to promote student well-being and foster a healthier learning environment. Full article

21 pages, 449 KB

Open AccessReview

LLM-Assisted Scoping Review of Artificial Intelligence in Brazilian Public Health: Lessons from Transfer and Federated Learning for Resource-Constrained Settings

by Fabiano Tonaco Borges, Gabriela do Manco Machado, Maíra Araújo de Santana, Karla Amorim Sancho, Giovanny Vinícius Araújo de França, Wellington Pinheiro dos Santos and Carlos Eduardo Gomes Siqueira

Int. J. Environ. Res. Public Health 2026, 23(1), 81; https://doi.org/10.3390/ijerph23010081 - 7 Jan 2026

Viewed by 162

Abstract

Artificial intelligence (AI) has become a strategic technology for global health, with increasing relevance amid the climate emergency and persistent digital inequalities. This study examines how AI has been applied in Brazilian healthcare through a scoping review with an in-depth methodological synthesis, focusing [...] Read more.

Artificial intelligence (AI) has become a strategic technology for global health, with increasing relevance amid the climate emergency and persistent digital inequalities. This study examines how AI has been applied in Brazilian healthcare through a scoping review with an in-depth methodological synthesis, focusing on Transfer Learning (TL) and Federated Learning (FL) as approaches to address data scarcity, privacy, and technological dependence. We searched PubMed, SciELO, and the CNPq Theses and Dissertations Repository for peer-reviewed studies on AI applications in Brazil, screened titles using AI-assisted tools with manual validation, and analyzed thematic patterns across methodological and infrastructural dimensions. Among 349 studies retrieved, six explicitly used TL or FL. These techniques were frequently implemented through multi-country research consortia, demonstrating scalability and feasibility for collaborative model training under privacy constraints. However, they remain marginal in mainstream practice despite their ability to deploy AI solutions with limited computational resources while preserving data sovereignty. The findings indicate an emerging yet uneven integration of resource-aware AI in Brazil, underscoring its potential to advance equitable innovation and digital autonomy in health systems of the Global South. Full article

(This article belongs to the Section Global Health)

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12 pages, 3029 KB

Open AccessArticle

Zoonotic Helminths in the Southern Peruvian Altiplano: A Four-Year Sero-Epidemiological Study and One Health Policy Implications

by Polan Ferro-Gonzales, Pompeyo Ferro, Patricia Matilde Huallpa Quispe, Euclides Ticona, Jorge Bautista Nuñez and Ana Lucia Ferró-Gonzáles

Int. J. Environ. Res. Public Health 2026, 23(1), 80; https://doi.org/10.3390/ijerph23010080 - 6 Jan 2026

Viewed by 179

Abstract

We assessed the prevalence of three helminthic zoonoses—echinococcosis, fasciolosis and the taeniosis/cysticercosis complex—among residents of the Chucuito Health Network (Puno Health Region, Peru) over four years (2018–2021). Sera (n = 910) were analysed by ELISA to detect pathogen-specific antibodies, following national protocols. [...] Read more.

We assessed the prevalence of three helminthic zoonoses—echinococcosis, fasciolosis and the taeniosis/cysticercosis complex—among residents of the Chucuito Health Network (Puno Health Region, Peru) over four years (2018–2021). Sera (n = 910) were analysed by ELISA to detect pathogen-specific antibodies, following national protocols. Echinococcosis predominated, whereas fasciolosis and taeniosis/cysticercosis occurred at comparatively low levels. Prevalence ranged from 4.4–9.2% for echinococcosis, 1.1–4.9% for fasciolosis, and 1.1–2.7% for taeniosis/cysticercosis across the four years. Prevalence varied significantly between years, with a notable upsurge in echinococcosis in 2021. These findings underscore the need for integrated control and prevention measures grounded in a One Health framework that recognises the interconnections between human, animal and environmental health. Priority actions include strengthened health education programmes, improved hygiene and sanitation practices, and enhanced rural health infrastructure, alongside coordinated epidemiological surveillance and environmental management. Such measures are essential to mitigate the burden of zoonotic disease in vulnerable high-Andean communities. Full article

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26 pages, 1294 KB

Open AccessArticle

Health Benefits of Cycling as a Form of Active Travel: A Pilot Empirical Study

by Mehrnaz Zargarzadeh, Anabela Salgueiro Narciso Ribeiro, Amândio Manuel Cupido Santos and Rafael Nogueira Rodrigues

Int. J. Environ. Res. Public Health 2026, 23(1), 79; https://doi.org/10.3390/ijerph23010079 - 6 Jan 2026

Viewed by 205

Abstract

Integrating physical activity into daily routines through walking and cycling supports health while promoting sustainable mobility. This assumption aligns with SDGs 3, 5 and 11. This study assessed the feasibility and health impacts of cycling within a university setting. As part of the [...] Read more.

Integrating physical activity into daily routines through walking and cycling supports health while promoting sustainable mobility. This assumption aligns with SDGs 3, 5 and 11. This study assessed the feasibility and health impacts of cycling within a university setting. As part of the UCicletas program at Coimbra University, sixteen participants (8 males, 8 females) used conventional or pedal-assist bicycles for eight weeks. Descriptive analyses, t-tests, and Spearman correlations were applied to anthropometric and cardiorespiratory measurements collected before and after the intervention. Weekly cycling distance was obtained through self-reported odometer values. After eight weeks, notable health improvements were observed. Body fat decreased by 1.8% overall, with a significant reduction in females (p < 0.05). VO_2max increased by 13.79% in males (p = 0.02) and 12.21% in females (p = 0.03). The Ruffier Index decreased by 18.87% in males (p < 0.05) and 14.73% in females (p = 0.03). Gender differences were evident in correlations: male BMI showed a strong negative association with respiratory recovery (ρ = −0.867, p = 0.005), whereas the female association was weak (ρ = 0.371). Correlations between cycling distance and health outcomes were weak and non-significant. Overall, the findings confirm that modest daily cycling improves health outcomes. Full article

(This article belongs to the Section Exercise and Health-Related Quality of Life)

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Int. J. Environ. Res. Public Health, Volume 23, Issue 1 (January 2026) – 108 articles

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