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Int. J. Environ. Res. Public Health, Volume 23, Issue 8 (August 2026) – 94 articles

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16 pages, 1110 KB  
Article
Radiation Exposure and Cancer Mortality in Populations Living Around the Semipalatinsk Nuclear Test Site in Kazakhstan
by Altay Dyussupov, Rauan Kissina, Nailya Chaizhunussova, Dariya Shabdarbayeva, Andrey Orekhov, Zhanargul Smailova, Meruyert Massabayeva, Assel Baibussinova, Alexandra Lipikhina, Yulia Brait, Alexey Klivenko, Saulesh Apbassova, Gulnara Batenova, Murat Lepesbayev, Saule Kozhanova, Asset Izdenov, Raushan Dosmagambetova and Lyudmila Pivina
Int. J. Environ. Res. Public Health 2026, 23(8), 1037; https://doi.org/10.3390/ijerph23081037 (registering DOI) - 9 Aug 2026
Abstract
Introduction. Mortality rates from malignant neoplasms can be considered a key marker of adverse environmental impacts. The aim of this study was to assess the association between exposure to ionizing radiation and the risk of mortality from malignant neoplasms among the population of [...] Read more.
Introduction. Mortality rates from malignant neoplasms can be considered a key marker of adverse environmental impacts. The aim of this study was to assess the association between exposure to ionizing radiation and the risk of mortality from malignant neoplasms among the population of Kazakhstan living in areas adjacent to the Semipalatinsk Nuclear Test Site (SNTS). Materials and Methods. The main source of data used in this study was the mortality sub-register of the population living in territories adjacent to the Semipalatinsk Nuclear Test Site (SNTS). The main study group included residents of the Abay District (n = 1300) and Beskaragay District (n = 414). In total, 478 residents of the Kokpekty District, where the radiation dose was minimal, were included in the control group. The median effective radiation dose was 864 mSv for the population of the exposed group, whereas in the control group, it was 67 mSv. Results. The highest RR values were observed in the periods 1965–1969 (RR = 6.14; 95% CI: 4.04–9.34) and 1970–1974 (RR = 6.14; 95% CI: 4.19–8.99). Age-standardized mortality rates (ASMR) in the study group were significantly higher than those in the control group. A dose–response relationship was established: with each 10.0 mSv increase in radiation dose, the risk of cancer mortality increased by 0.9% (OR = 1.009; 95% CI: 1.008–1.010; p <0.001). Conclusion. The obtained results indicate a significant association between long-term exposure to ionizing radiation due to testing at the Semipalatinsk Nuclear Test Site and increased cancer mortality among the population of adjacent territories. Full article
(This article belongs to the Topic Disease Risks from Environmental Radiological Exposure)
24 pages, 2669 KB  
Systematic Review
Antibiotic Resistance Genes in Dust from Kindergarten Environments: A Systematic Review of Occurrence, Diversity, Determinants, and Exposure Implications
by Prasert Makkaew, Apirak Bumyut, Ni Luh Ayu Megasari and Nopadol Precha
Int. J. Environ. Res. Public Health 2026, 23(8), 1036; https://doi.org/10.3390/ijerph23081036 (registering DOI) - 9 Aug 2026
Abstract
Kindergarten environments combine high microbial exposure with increased immunological vulnerability, yet antibiotic resistance genes (ARGs) in kindergarten dust remain poorly characterized. This systematic review synthesized evidence on the occurrence and potential health relevance of ARGs in kindergarten dust. Following PRISMA 2020 guidelines, PubMed, [...] Read more.
Kindergarten environments combine high microbial exposure with increased immunological vulnerability, yet antibiotic resistance genes (ARGs) in kindergarten dust remain poorly characterized. This systematic review synthesized evidence on the occurrence and potential health relevance of ARGs in kindergarten dust. Following PRISMA 2020 guidelines, PubMed, Scopus, and Web of Science were searched. Four studies from China, Hong Kong, and Norway (2018–2024) met the inclusion criteria. ARGs were detected in all kindergarten dust samples, indicating that dust is a consistent reservoir of antibiotic resistance determinants. A consensus resistome (classes detected in ≥2 studies) encompassed sulfonamide, macrolide–lincosamide–streptogramin B (MLSB), tetracycline, beta-lactam, aminoglycoside, and multidrug resistance genes; beta-lactam resistance genes were the only class reported in all four studies. Clinically important ARGs associated with last-resort antibiotics, including mecA, vanA, blaNDM, and mcr-5, were reported in three studies. Class 1 integron-integrase genes (intI1) frequently co-occurred with ARGs, suggesting potential horizontal gene transfer. Limited evidence indicated higher ARG abundance in urban and winter samples. One study reported antibiotic-resistant bacteria carrying resistance markers concordant with those in kindergarten dust in the urine of children attending the same facilities; however, this cross-sectional, single-site evidence is consistent with, but not sufficient to establish, a dust-to-child exposure pathway. The available evidence supports the plausibility that kindergarten dust may contribute to children’s exposure to ARGs and ARG-carrying bacteria, but current studies do not establish causal transmission from dust to child colonization or infection. Standardized monitoring and longitudinal studies are needed to assess health risks and guide mitigation strategies in early childhood educational settings. Full article
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13 pages, 290 KB  
Article
Walkable Intelligent Parks: Can a Large Language Model Turn Urban Park Audit Findings into Actionable Recommendations?
by Md. Sabbir Hossain Khan, Mohammad Javad Koohsari, Jiuling Li, Jing Zhao, Yufeng Luo, Akitomo Yasunaga, Koichiro Oka and Andrew T. Kaczynski
Int. J. Environ. Res. Public Health 2026, 23(8), 1035; https://doi.org/10.3390/ijerph23081035 (registering DOI) - 8 Aug 2026
Abstract
Park audits can inform neighbourhood-scale urban design strategies that support health. However, interpreting park audit data is time-consuming and requires specialised expertise. Recent advances in large language models suggest potential for assisting with structured data interpretation, but their application to park audits remains [...] Read more.
Park audits can inform neighbourhood-scale urban design strategies that support health. However, interpreting park audit data is time-consuming and requires specialised expertise. Recent advances in large language models suggest potential for assisting with structured data interpretation, but their application to park audits remains unexplored. This study examined whether a large language model (ChatGPT-5) can assist in interpreting park audit data from public parks in Dhaka City, Bangladesh. Using a modified park audit tool, 59 parks were audited, of which 26 met the predefined completeness threshold and were included in the analysis. ChatGPT-5 and human experts received identical park audit datasets and instructions for interpretation. Outputs were evaluated using content analysis and a pre-defined scoring framework to assess accuracy and comprehensiveness. Paired t-tests compared ChatGPT-5 outputs with the expert benchmark. ChatGPT-5 showed no statistically significant difference from the expert benchmark in overall accuracy in this sample (p = 0.13). The unadjusted analysis showed a higher recommendation-match count for ChatGPT-5 (p < 0.05), but this result should be interpreted as exploratory because multiple criteria were tested. No statistically significant differences were detected across accuracy domains or other comprehensiveness criteria. These findings suggest that ChatGPT-5 may assist with preliminary interpretation of structured park audit data. However, the results do not establish equivalence with expert assessment. Expert review remains necessary to assess feasibility, contextual relevance, and alignment with local planning standards. Full article
30 pages, 1977 KB  
Article
Changes in Kitchen Thermal Exposure Following the Introduction of Electric Cooking: A Before-and-After Case Study of Three Kampala Kitchens
by Rihab Khalid, Agnes Naluwagga, Jimmy Agaba, Adrian Okorio and Charles Kayemba
Int. J. Environ. Res. Public Health 2026, 23(8), 1034; https://doi.org/10.3390/ijerph23081034 - 7 Aug 2026
Abstract
Institutional and commercial cooks may experience sustained heat exposure from combustion-based cooking, yet field evidence on thermal conditions following the introduction of electric cooking remains limited. This exploratory before-and-after case study examined three purposively selected kitchens in Kampala, Uganda, combining five-minute temperature and [...] Read more.
Institutional and commercial cooks may experience sustained heat exposure from combustion-based cooking, yet field evidence on thermal conditions following the introduction of electric cooking remains limited. This exploratory before-and-after case study examined three purposively selected kitchens in Kampala, Uganda, combining five-minute temperature and relative humidity monitoring at three spatial positions with cooking diaries, repeated thermal comfort and sensation votes, and enumerator observations. Heat Index (HI) was used as a temperature–humidity screening proxy, and Kampala weather data were used to calculate weather-adjusted differences. On documented active e-cooking days, mean hourly near-stove HI fell from 33.26 °C to 26.00 °C at Site A, 31.35 °C to 29.55 °C at Site B, and 31.71 °C to 27.50 °C at Site C. Time in the Safe HI category increased from 23.5% to 67.8%, 17.0% to 33.3%, and 25.4% to 53.0%, respectively. Day-level tests and a sensitivity analysis using all weather-matched intervention period logger days showed the same overall direction. Raw cooking durations declined for several meals, although, after normalisation by the number of people served, the reductions remained statistically detectable only for Site B breakfast and lunch. The results provide exploratory evidence of lower environmental thermal exposure under documented active e-cooking conditions. Sequential timing, purposive sampling, workload differences, incomplete intervention records and the absence of radiant, air speed and physiological measurements prevent causal interpretation as reduced occupational heat strain. Full article
(This article belongs to the Section Environmental Health)
20 pages, 3579 KB  
Article
Exploratory Spatial and Temporal Analysis of the Territorial Coexistence of Undernutrition and Excess Weight Among Children Under Five Years of Age in Peru, 2014–2024
by Jaime Cesar Prieto-Luna, Luis Alberto Holgado-Apaza, Mixel Luigui Corrido-Ninahuaman, Nestor Antonio Gallegos Ramos, Nelly Jacqueline Ulloa-Gallardo, Dany Dorian Isuiza-Perez, Roxana Madueño-Portilla, Pierre Vidaurre-Rojas and Miguel Angel Valles-Coral
Int. J. Environ. Res. Public Health 2026, 23(8), 1033; https://doi.org/10.3390/ijerph23081033 - 7 Aug 2026
Abstract
The coexistence of undernutrition and excess weight is an important child public health challenge. This study described temporal trends and departmental spatial configurations of wasting, stunting, overweight, and obesity among children under five years of age in Peru during 2014–2024. Analyses used anthropometric [...] Read more.
The coexistence of undernutrition and excess weight is an important child public health challenge. This study described temporal trends and departmental spatial configurations of wasting, stunting, overweight, and obesity among children under five years of age in Peru during 2014–2024. Analyses used anthropometric assessment records from the Nutritional Status Information System (SIEN), collected in public healthcare facilities and aggregated by department and year. Annual Percentage Change summarized average temporal trends, while observed prevalence maps, Global Moran’s I, Local Indicators of Spatial Association (LISA), and a median-based bivariate classification were applied independently to 2014, 2019, and 2024. Queen contiguity was the primary spatial specification, along with KNN-4 sensitivity analysis. Wasting and obesity increased on average, stunting decreased, and overweight showed no significant long-term trend. Global autocorrelation was most consistent for wasting, whereas findings for excess-weight indicators were sensitive to the weights matrix. LISA identified local spatial classifications at nominal p < 0.05; however, these findings were exploratory because no multiple-testing correction was applied. The bivariate classification identified two, four, and three departments with concurrent high relative undernutrition and excess-weight scores in 2014, 2019, and 2024, respectively. These record-based findings show territorial heterogeneity within SIEN but do not represent population prevalence, causal geographic effects, or an integrated spatiotemporal process. Full article
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22 pages, 2756 KB  
Article
It’s Not Really the Words; It’s How They Land: Lived Experience Perspectives on the Use of Language and Labels in Mental Health
by Anna Foxcroft, Craig Allen, Julia Dray, Amelia Gulliver, Dianna Smith, Grenville Rose, Bridget Berry and Michelle Banfield
Int. J. Environ. Res. Public Health 2026, 23(8), 1032; https://doi.org/10.3390/ijerph23081032 - 7 Aug 2026
Abstract
The language used to describe and discuss mental ill-health continues to evolve and improve, driven by advocacy and commitment to reducing the harmful effects of stigma. However, from a lived experience perspective, room for improvement remains. This project aimed to explore the use [...] Read more.
The language used to describe and discuss mental ill-health continues to evolve and improve, driven by advocacy and commitment to reducing the harmful effects of stigma. However, from a lived experience perspective, room for improvement remains. This project aimed to explore the use of language and labels within the mental health sector and its impact on people with lived experience of mental ill-health. Interviews were conducted with mental health consumers and/or carers (n = 15), and co-researchers with lived experience of mental ill-health contributed researcher positionality to the research. Six themes were generated using reflexive thematic analysis; they accented how participants expressed complex and nuanced experiences of language and labels, and the overlapping themes highlight the ‘blurry edges’ when people with lived experience discuss language, with the individual at the centre. Responses reflected the nature of inclusive and exclusive language in the medical system and the community. Central to experiences of exclusion were times when people felt dismissed and misunderstood due to the language and labels others use and how the words are delivered. These negative experiences reflect the influence of stigma. Positive language provides validation, understanding and a sense of hope. Health professionals may have opportunities to apply more personalised communication approaches, which could improve outcomes for the people they support. Full article
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20 pages, 4311 KB  
Systematic Review
Navigating the Threshold: Barriers and Facilitators to Accessing Primary Care Among People Living with Dementia—A Systematic Review and Meta-Synthesis
by I Gede Juanamasta, Rapin Polsook, Bootan Ahmed, Yupin Aungsuroch, Ni Made Ratih Comala Dewi, I Gede Griya Suparta and Ferry Efendi
Int. J. Environ. Res. Public Health 2026, 23(8), 1031; https://doi.org/10.3390/ijerph23081031 - 6 Aug 2026
Viewed by 121
Abstract
Background: Dementia is a global health priority affecting more than 55 million people worldwide, with projections indicating this figure will rise to 139 million by 2050. People living with dementia (PLWD) face profound difficulties accessing primary care services—the critical gateway to dementia diagnosis, [...] Read more.
Background: Dementia is a global health priority affecting more than 55 million people worldwide, with projections indicating this figure will rise to 139 million by 2050. People living with dementia (PLWD) face profound difficulties accessing primary care services—the critical gateway to dementia diagnosis, ongoing management, and coordinated specialist referral. Despite growing evidence on individual barriers, a comprehensive synthesis integrating patient, caregiver, and system-level perspectives is lacking. Objectives: This systematic review and meta-synthesis aimed to identify, appraise, and synthesize evidence on the barriers and facilitators experienced by PLWD and their caregivers when accessing primary care services, and to propose evidence-based recommendations to address inequities. Methods: A systematic search was conducted to identify relevant articles in six electronic databases: PubMed, MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Library, and Web of Science from January 2000 to December 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Qualitative, quantitative, and mixed-methods studies reporting barriers or facilitators to primary care access for PLWD were included. A convergent integrated synthesis and thematic meta-synthesis approach was applied. Quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Results: Forty-three studies from 18 countries met inclusion criteria. Barriers were categorized across five domains: (1) patient-level factors (stigma, denial, symptom normalization, and limited health literacy); (2) caregiver-level factors (burden, late symptom recognition, and cultural barriers); (3) provider-level factors (insufficient training, therapeutic nihilism, and time constraints); (4) system-level factors (fragmented care pathways, long waiting times, and poor care coordination); and (5) structural and societal factors (rurality, poverty, and ethnic minority status). Facilitators included caregiver advocacy, strong patient–GP relationships, dementia literacy campaigns, availability of memory clinics, and integrated care models. Disparities were consistently greater for ethnic minority groups, rural populations, and those with lower socioeconomic status. Conclusions: Barriers to primary care access in dementia are complex, overlapping, and mutually reinforcing. Effective strategies require multi-level interventions addressing individual, relational, provider, and system dimensions simultaneously. Full article
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21 pages, 793 KB  
Article
Supporting Sustainable Return to Work in Large Organizations: A Cluster Randomised Feasibility Trial of a Multi-Level Intervention
by Fehmidah Munir, Alice Sinclair, Oliver Davis, Jeremy Dawson, Lizzie Degerdon, Jaime Delgadillo, Umesh Kadam and Joanna Yarker
Int. J. Environ. Res. Public Health 2026, 23(8), 1030; https://doi.org/10.3390/ijerph23081030 - 6 Aug 2026
Viewed by 128
Abstract
Long-term sickness absence is a growing public health issue, reducing workforce participation and widening health inequalities. Effective interventions must address both health and workplace factors to enable not only return-to-work but sustained employment. This study evaluated the feasibility of a multi-level workplace intervention [...] Read more.
Long-term sickness absence is a growing public health issue, reducing workforce participation and widening health inequalities. Effective interventions must address both health and workplace factors to enable not only return-to-work but sustained employment. This study evaluated the feasibility of a multi-level workplace intervention to support sustainable RTW in large organizations. A two-arm cluster randomised feasibility trial was conducted in nine UK organizations (≥600 employees). Participants included senior leaders and HR professionals (n = 91), workers on long-term sick leave (n = 112), and line managers (n = 83). The IGLOo intervention combined e-learning for leaders/HR with structured toolkits for workers and managers to support RTW before and after return. Feasibility outcomes included recruitment, retention, engagement, acceptability, and usability. Secondary outcomes included RTW timing, sustained participation, mental health, and workplace factors. A mixed methods process evaluation explored implementation and context. Retention, acceptability, and usability met targets, but recruitment and engagement were lower than expected. Potential mechanisms included improved confidence, communication, and self-management. Organizational systems and pressures affected delivery. Exploratory analyses suggested different patterns of return-to-work trajectories across trial arms. Overall, the intervention was acceptable to participants who engaged with it, but recruitment barriers and organizational constraints require substantial modification before any future efficacy trial. Full article
(This article belongs to the Section Behavioral and Mental Health)
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12 pages, 1169 KB  
Article
A Longitudinal Study of Psychosocial and Behavioral Adaptations to Continuous Community Violence in Culiacán, Sinaloa, México
by Ángel Radamés Rábago-Monzón, Karyme Mylenia Alemán-Villa, Emiliano Terán, Javier Abednego Magaña-Gómez, Verónica Judith Picos-Cárdenas, Beatriz Kazuko De la Herrán-Arita, Loranda Calderón-Zamora and Alberto Kousuke De la Herrán-Arita
Int. J. Environ. Res. Public Health 2026, 23(8), 1029; https://doi.org/10.3390/ijerph23081029 - 6 Aug 2026
Viewed by 166
Abstract
This study examined how residents of Culiacán, México, adapted over time to prolonged community violence and perceived insecurity. We evaluated a two-speed adaptation theory, which proposes that indicators of acute psychological distress and economic strain decline over time, whereas protective behavioral responses persist [...] Read more.
This study examined how residents of Culiacán, México, adapted over time to prolonged community violence and perceived insecurity. We evaluated a two-speed adaptation theory, which proposes that indicators of acute psychological distress and economic strain decline over time, whereas protective behavioral responses persist as a state of chronic vigilance. A mixed-longitudinal design was employed, consisting of a baseline survey of 1163 residents conducted in October 2024 and a longitudinal cohort of 100 participants followed in February and June 2025. Longitudinal changes were evaluated using Cochran’s Q tests with exact McNemar post hoc comparisons, proportions were reported with 95% Clopper–Pearson confidence intervals, and multivariable logistic regression was used to examine predictors of migration intent. Pharmacologic treatment utilization declined significantly from 36% to 20%, and reported economic strain decreased from 62% to 35% over the study period. In contrast, behavioral routine modifications remained persistently high, decreasing only from 95% to 88%, with no statistically significant longitudinal change. These findings are consistent with the proposed theory, suggesting that while acute psychosocial and economic impacts may diminish over time, protective behavioral adaptations remain comparatively stable. Regarding migration intent, individual economic strain was not significantly associated with the intention to leave the city. Instead, participants who attributed insecurity primarily to social contract collapse, conceptualized as the perceived erosion of community trust, institutional legitimacy, social polarization, and the breakdown of social order, had substantially greater odds of reporting migration intent than those primarily concerned with economic factors (OR = 11.56, 95% CI 1.55–85.98). Overall, these findings suggest that prolonged community violence produces distinct trajectories of psychosocial adaptation, in which acute distress decreases while chronic vigilance persists. Furthermore, migration intentions appear to be more strongly associated with perceived deterioration of the social environment than with individual economic hardship, highlighting the importance of restoring community trust and institutional legitimacy alongside traditional public health and economic interventions. Full article
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20 pages, 6753 KB  
Perspective
Sustainable Healthcare: A Perspective on the Current Landscape, Frameworks, Barriers, and Implementation Model in a Quaternary Hospital System
by Hubert Tuyishime, Carole Lin, Amandeep Chawla, Bryan Khoo and Kevin G. Shea
Int. J. Environ. Res. Public Health 2026, 23(8), 1028; https://doi.org/10.3390/ijerph23081028 - 6 Aug 2026
Viewed by 174
Abstract
Healthcare services account for approximately 4–5% of global greenhouse gas emissions worldwide, and nearly 10% of emissions in the United States are primarily from general hospital operations, surgical and anesthetic care, and pharmaceutical and medical device supply chains. Healthcare services and operations also [...] Read more.
Healthcare services account for approximately 4–5% of global greenhouse gas emissions worldwide, and nearly 10% of emissions in the United States are primarily from general hospital operations, surgical and anesthetic care, and pharmaceutical and medical device supply chains. Healthcare services and operations also generate substantial plastic and chemical waste that pollute the environment and disproportionately affect vulnerable communities. Although global and national organizations have introduced decarbonization frameworks, adoption remains hindered by limited leadership engagement, competing institutional priorities, and insufficient regulatory accountability. This article synthesizes the published literature on the current landscape of healthcare sustainability, summarizes key policy frameworks, and identifies major barriers to implementation; these findings are then illustrated through sustainability initiatives at Stanford Medicine, a quaternary hospital system. These efforts are presented as implementation examples that other institutions may adapt to their own resources and contexts, to reduce emissions and ensure more sustainable healthcare delivery. Full article
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17 pages, 631 KB  
Review
Understanding HPV Vaccine Uptake Among American Indian and Alaska Native College Students: A Scoping Review
by Vanessa Wright, Katy Fisher-Cunningham, Brayton Amidon and Shari Clifton
Int. J. Environ. Res. Public Health 2026, 23(8), 1027; https://doi.org/10.3390/ijerph23081027 - 6 Aug 2026
Viewed by 149
Abstract
American Indian and Alaska Native (AI/AN) communities experience disproportionate rates of HPV-associated cancers, yet vaccination uptake remains low. This scoping review mapped research on HPV vaccination among AI/AN college students aged 18–26, including vaccine uptake, knowledge, perceptions, and barriers. Using Joanna Briggs Institute [...] Read more.
American Indian and Alaska Native (AI/AN) communities experience disproportionate rates of HPV-associated cancers, yet vaccination uptake remains low. This scoping review mapped research on HPV vaccination among AI/AN college students aged 18–26, including vaccine uptake, knowledge, perceptions, and barriers. Using Joanna Briggs Institute scoping review methodology and the PRISMA-ScR checklist, MEDLINE (Ovid), CINAHL Ultimate, Embase (Ovid), ERIC (Ovid), Scopus, and Web of Science Core Collection were searched with no restrictions on publication year. Eligible studies included AI/AN college students aged 18–26 and examined factors influencing HPV vaccine uptake; studies that did not disaggregate AI/AN data were excluded. Of 911 abstracts identified, three publications met inclusion criteria; all included studies drew exclusively on American Indian samples and did not include Alaska Native participants. The findings reveal low HPV knowledge, limited perceived risk, gender differences in attitudes, and barriers including stigma, access challenges, and mistrust of healthcare systems. The near absence of contemporary research reflects ongoing data invisibility and structural factors affecting AI/AN young adults. AI/AN college students represent a critical yet overlooked population for catch-up HPV vaccination, requiring community-engaged strategies to advance cancer equity. Full article
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16 pages, 296 KB  
Article
Evaluation of a Reduced Work Schedule and Housing Authority Employee Wellbeing
by Morgan A. Valley, Katie McMahon, Aurora Koren and Lorann Stallones
Int. J. Environ. Res. Public Health 2026, 23(8), 1026; https://doi.org/10.3390/ijerph23081026 - 6 Aug 2026
Viewed by 126
Abstract
Background: Public housing employees work in challenging conditions with many stressors. A Colorado housing authority requested an evaluation of its voluntary reduced work schedule pilot program and its association with employee wellbeing. Previous research has shown promising short-term improvements in employee productivity and [...] Read more.
Background: Public housing employees work in challenging conditions with many stressors. A Colorado housing authority requested an evaluation of its voluntary reduced work schedule pilot program and its association with employee wellbeing. Previous research has shown promising short-term improvements in employee productivity and morale from reduced schedule programs, but researchers have questioned whether impacts on wellbeing could be sustained. The study aimed to evaluate if program participants and non-participants reported differences in wellbeing measures over 18 months post-implementation. Methods: A longitudinal survey based on the NIOSH WellBQ over three timepoints and a series of four focus groups were conducted with program participants and non-participants. Linear mixed modeling was used to test for differences between participant and non-participant wellbeing outcomes over time. Deductive thematic analysis was used to analyze focus group data. Results: Program participants reported significantly lower work overload than non-participants; differences in work stress and work-to-non-work conflict were smaller and did not reach statistical significance. There was no evidence that the magnitude of these differences changed across timepoints, although limited statistical power constrains interpretation of this finding. Qualitative findings demonstrated that participants perceived benefits for work–life integration and decreased work stress and work overload, which participants attributed to the program. Conclusions: Findings suggest that reduced work schedules may be associated with differences in employee wellbeing over the study period, particularly reduced work overload. Full article
(This article belongs to the Special Issue Health and Safety Promotion at the Workplace)
19 pages, 886 KB  
Article
Nutritional Status, Abdominal Obesity, and Predictors of BMI Categories Among Community-Dwelling Older Adults in Southern Thailand: A Cross-Sectional Study
by Urai Jaraeprapal, Pornchanuch Chumpunuch, Arthit Boonrodchu, Uraiwan Pantong and Ladda Thiamwong
Int. J. Environ. Res. Public Health 2026, 23(8), 1025; https://doi.org/10.3390/ijerph23081025 - 5 Aug 2026
Viewed by 260
Abstract
Geriatric nutritional problems are increasingly characterized by the co-existence of undernutrition and obesity, yet community-level evidence from Southern Thailand remains limited. Grounded in the social determinants of health (SDH) framework, this cross-sectional study examines the prevalence and independent predictors of BMI categories and [...] Read more.
Geriatric nutritional problems are increasingly characterized by the co-existence of undernutrition and obesity, yet community-level evidence from Southern Thailand remains limited. Grounded in the social determinants of health (SDH) framework, this cross-sectional study examines the prevalence and independent predictors of BMI categories and abdominal obesity among 13,458 community-dwelling older adults across 20 sub-districts in Southern Thailand. Anthropometric measurements and structured interview data were analyzed using chi-square tests and multinomial logistic regression, with normal weight as the reference category. Overall, 50.3% of participants were overweight or obese, 40.5% had abdominal obesity, and 7.7% were underweight. Advancing age, continued employment, and asthma were independently associated with higher odds of underweight, whereas abdominal obesity was the strongest predictor of elevated BMI categories, increasing the odds of overweight, obesity Class I, and obesity Class II. Female sex, literacy, dyslipidemia, hypertension, and diabetes were also associated with excess BMI categories. Moderate, regular physical activity was a protective factor. These findings support risk-stratified community interventions that integrate BMI with WC screening and address regional occupational, behavioral, clinical, and food culture determinants of nutritional health in older adults. Full article
(This article belongs to the Special Issue The Management of Nutrition and Obesity: Second Edition)
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18 pages, 686 KB  
Article
Racial Differences in Social Capital Volunteer Activities: A Mixed-Methods Longitudinal Study of How Race and Place Influence Opportunities
by Ester Villalonga-Olives, Abdolvahab Khademi, Alisha A. Crump, Christopher M. Amissah, Inez Adams, Candace Hall, Yun-Yi Pan and Yusuf Ransome
Int. J. Environ. Res. Public Health 2026, 23(8), 1024; https://doi.org/10.3390/ijerph23081024 - 5 Aug 2026
Viewed by 209
Abstract
Volunteering is a key component of social capital associated with improved health outcomes. However, it remains unclear how volunteer patterns differ by race and education and whether standard measures adequately capture racial and contextual differences in how volunteering is understood and reported. This [...] Read more.
Volunteering is a key component of social capital associated with improved health outcomes. However, it remains unclear how volunteer patterns differ by race and education and whether standard measures adequately capture racial and contextual differences in how volunteering is understood and reported. This mixed-methods study examined racial and educational differences in volunteer activities over time and evaluated how individuals from different racial backgrounds define, engage in, and value volunteering. This study used a mixed-methods longitudinal design combining secondary analysis of the Midlife in the United States (MIDUS) study (1995–2016; n = 5921) with qualitative interviews (n = 47) in the United States. The quantitative outcome was the number of self-reported volunteer hours per month across four domains: healthcare, youth-related, political, and other organizations. Linear mixed-effects models were used to examine differences by race, volunteer context, and time, adjusting for age, gender, and educational attainment. Qualitative interviews used MIDUS item probes and open-ended questions to examine participants’ interpretations of volunteer work, unpaid activities, and forms of engagement. Black participants reported significantly higher volunteer hours than White participants (β = 0.97, p = 0.007). Volunteering varied by context, with higher engagement in school and youth-related (β = 1.12, p < 0.001) and other organizational activities (β = 2.80, p < 0.001) and lower engagement in political contexts (β = −0.45, p < 0.001), relative to healthcare settings. Volunteering increased modestly over time (Wave 2: β = 0.45, p < 0.001; Wave 3: β = 0.39, p < 0.001). Interaction analyses indicated that racial differences varied across contexts, with a significantly smaller increase in volunteering within “other” organizations among Black participants relative to White participants (β = −1.29, p = 0.006). Qualitative findings indicated that Black participants more often engaged in community-based and informal activities, including work within community organizations, whereas White participants more frequently participated in formal volunteering. Urban residents reported more flexible engagement compared with suburban residents’ structured participation. Volunteering is shaped by structural and contextual factors. Public health research and interventions should adopt more inclusive measures to better capture diverse forms of civic engagement. Full article
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15 pages, 634 KB  
Article
Childhood Trauma and Subjective Symptoms of Inflammatory Bowel Disease Health-Related Quality of Life in the General Population: The Mediating Roles of Emotional Suppression and Cognitive Control
by Lisa Roque, Lorelei Van Hees, Bebiana Leonardo, Teresa Santos and Paulo Ferrajão
Int. J. Environ. Res. Public Health 2026, 23(8), 1023; https://doi.org/10.3390/ijerph23081023 - 5 Aug 2026
Viewed by 181
Abstract
Background: Inflammatory bowel disease (IBD) affects millions worldwide, imposing substantial clinical consequences and mental health implications. This burden leads to reduced quality of life (QoL) and growing pressure on healthcare systems and economies. This cross-sectional study examined the effects of childhood trauma on [...] Read more.
Background: Inflammatory bowel disease (IBD) affects millions worldwide, imposing substantial clinical consequences and mental health implications. This burden leads to reduced quality of life (QoL) and growing pressure on healthcare systems and economies. This cross-sectional study examined the effects of childhood trauma on subjective symptoms of IBD health-related QoL, focusing on the mediating roles of emotional suppression and cognitive control, providing an integrative model for the general population. Methods: A sample of 402 Portuguese adults completed self-report measures, including the Childhood Trauma Questionnaire, the Emotion Regulation Questionnaire, the Cognitive Control and Flexibility Questionnaire, and the Short IBD Questionnaire. Multiple-step mediation analyses with bootstrapped confidence intervals tested indirect effects. Results: The two-step mediation effects indicated that childhood trauma was associated with subjective symptoms of IBD health-related QoL through both expressive suppression and cognitive control. Conclusions: These findings highlight the pivotal role of developmental, emotional and cognitive factors in understanding IBD health-related QoL in the general population, offering an opportunity to capture undiagnosed, mild, atypical, or intermittent cases, often discarded from most clinical studies. General-population-based data collection on IBD, beyond clinical settings, is vital for informed resource allocation and the design of effective screening, prevention and public health interventions that capture both diagnosed and undiagnosed cases. Full article
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21 pages, 6122 KB  
Article
Social Determinants Associated with Health Care Empowerment Among University Students: A Cross-Sectional Pilot Study
by Miluska Vega-Guevara, Felipe Aguirre-Chávez, Rosa Millones Rivalles and Vicenta Irene Tafur Anzualdo
Int. J. Environ. Res. Public Health 2026, 23(8), 1022; https://doi.org/10.3390/ijerph23081022 - 4 Aug 2026
Viewed by 147
Abstract
Health care empowerment is essential for self-care, informed decision-making, and appropriate use of health services among university students. This cross-sectional pilot study examined the association between selected social determinants of health and health care empowerment among university students in Peru. A sample of [...] Read more.
Health care empowerment is essential for self-care, informed decision-making, and appropriate use of health services among university students. This cross-sectional pilot study examined the association between selected social determinants of health and health care empowerment among university students in Peru. A sample of 336 undergraduate and graduate students from six universities completed an online survey that included the Empowerment Scale for Health Care Empowerment in University Students (ECSU). The instrument demonstrated adequate psychometric properties (Cronbach’s α = 0.859; McDonald’s ω = 0.835). Descriptive analyses and ordinal logistic regression were conducted to identify factors associated with health care empowerment and its dimensions. Income level, family type, and housing situation were associated with overall empowerment. Lower income levels and extended family structures were associated with lower empowerment levels, while university type and educational level were associated with specific dimensions related to decision-making and the ability to empower others. The explanatory capacity of the models was modest (pseudo-R2 = 5.0–12.8%). These findings provide preliminary evidence on the relationship between social determinants and health care empowerment in university students. However, results should be interpreted with caution due to the cross-sectional design and convenience sampling. Future studies using probabilistic sampling and longitudinal designs are needed to confirm these associations. Full article
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25 pages, 704 KB  
Review
Structural Inequalities in Ambulatory Care: A Scoping Review of Access and Quality and the Neglected Dimension of Patient Safety
by Andreas Müller, Eitan Bronschtein and Ferdinand Sasváry
Int. J. Environ. Res. Public Health 2026, 23(8), 1021; https://doi.org/10.3390/ijerph23081021 - 4 Aug 2026
Viewed by 148
Abstract
(1) Background: Ambulatory services are the main interface between populations and health systems, yet their benefits are unevenly distributed due to structural inequalities—systemic differences rooted in the social, economic, and political organisation of society. Inequities in access and quality are well documented, but [...] Read more.
(1) Background: Ambulatory services are the main interface between populations and health systems, yet their benefits are unevenly distributed due to structural inequalities—systemic differences rooted in the social, economic, and political organisation of society. Inequities in access and quality are well documented, but patient safety remains the least examined. (2) Methods: Following Joanna Briggs Institute methodology and PRISMA-ScR guidelines, PubMed/MEDLINE and Scopus were searched for studies published from 2010 to 2026. In total, 44 studies were included, predominantly from the USA (n = 31), and synthesised narratively. (3) Results: Inequalities operated through geographic maldistribution, financial barriers, exclusionary institutional cultures, and market-driven practices. Access and quality were each addressed by 17 studies, whereas only four examined patient safety directly; the limited safety evidence indicated disproportionate diagnostic errors, medication-safety failures, and care-coordination breakdowns among vulnerable groups. Evidence was concentrated in the USA. (4) Conclusions: Structural inequalities are well documented for access and quality but are markedly under-studied for patient safety—the principal evidence gap identified. Patient safety warrants treatment as an equity outcome, measured with stratification by structural disadvantage and addressed through system-level interventions. Full article
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14 pages, 297 KB  
Article
Associations of Happiness, Ikigai, and Enjoyment of Daily Life with Frequency of Forest Walking in a Japanese General Population: The Japan Multi-Institutional Collaborative Cohort Daiko Study
by Emi Morita, Sayo Kawai, Tae Sasakabe, Rieko Okada, Yoko Kubo, Yoko Mitsuda, Yasufumi Kato, Takashi Matsunaga, Mako Nagayoshi, Takashi Tamura and Kenji Wakai
Int. J. Environ. Res. Public Health 2026, 23(8), 1020; https://doi.org/10.3390/ijerph23081020 - 4 Aug 2026
Viewed by 111
Abstract
A number of studies have examined the acute effects of shinrin-yoku (forest bathing), or forest walking; however, only a limited number of epidemiological studies have examined the association between habitual forest walking and daily health. The aim of this study was to examine [...] Read more.
A number of studies have examined the acute effects of shinrin-yoku (forest bathing), or forest walking; however, only a limited number of epidemiological studies have examined the association between habitual forest walking and daily health. The aim of this study was to examine the association of daily happiness, the Japanese concept of ikigai, and enjoyment of daily life with the frequency of forest walking. We used data from the secondary survey of the Japan Multi-Institutional Collaborative Cohort (J-MICC) Daiko study for this cross-sectional study. A total of 3472 participants (2518 women) were included in the analysis. Logistic regression analysis showed that the aORs for frequency of feeling happy, degree of happiness, ikigai, and daily life enjoyment were 1.72 (95% confidence interval [CI]: 1.29–2.28), 1.54 (95% CI: 1.14–2.09), 1.65 (95% CI: 1.25–2.20), and 2.38 (95% CI: 1.60–3.35), respectively, for those who reported going for forest walks at least once per month when those who reported rarely engaging in this practice served as the reference. This study found that the frequency of forest walking was associated with daily happiness, ikigai, and enjoyment of daily life, suggesting that occasional forest bathing may lead to improved well-being and quality of life. Full article
21 pages, 1769 KB  
Article
Systematic Co-Design of Artificial Intelligence-Enabled Innovations for Healthy Aging: A Demonstration Study Involving Socially Assistive Robots for Dementia Care
by Sajay Arthanat, Jing Wang, Dain LaRoche, Heather Fritz, Rosanne DiZazzo-Miller, Mostafa Hussein, Ola Ghattas, Moniruzzaman Akash and Momotaz Begum
Int. J. Environ. Res. Public Health 2026, 23(8), 1019; https://doi.org/10.3390/ijerph23081019 - 4 Aug 2026
Viewed by 143
Abstract
Artificial intelligence-enabled technologies offer new opportunities to support healthy aging and the long-term care needs of older adults. However, inclusive practices are paramount to ensuring that accessibility, usability, privacy, and equitable use are factored into the design and deployment of these emerging technologies. [...] Read more.
Artificial intelligence-enabled technologies offer new opportunities to support healthy aging and the long-term care needs of older adults. However, inclusive practices are paramount to ensuring that accessibility, usability, privacy, and equitable use are factored into the design and deployment of these emerging technologies. This article explores the role of co-design in health technology development and highlights the application of three methodological tools—the NIH Stage Model for Behavioral Intervention Development, the Unified Theory of Acceptance and Use of Technology, and Goal Attainment Scaling—to create a smart-home-based socially assistive robot (SAR) for the care of individuals living with Alzheimer’s disease and related dementias (ADRD). Ten participants (five caregiver–care recipient dyads) from an ongoing mixed-methods pilot feasibility study trialed the SAR in their homes for 1–6 months, with the robot personalized to their daily functioning, home layout, and caregiving needs. Qualitative analysis of monthly interviews derived themes pertaining to technical design, care protocol design, training management, and complementary care. These themes, combined with goal attainment analysis, offered several insights that allowed us to iteratively scale and refine the technology tailored to ADRD care. The study offers a practical framework for future co-design efforts aimed at enhancing the adoption of AI-enabled health technologies among older adults. Full article
(This article belongs to the Special Issue New Trends in Health Status and Care Needs Among Older Adults)
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23 pages, 330 KB  
Article
Problems, Causes, Impact, and Preventive Measures for Addressing Violence Faced by Nurses in Healthcare Settings in Thailand
by Nithinan Mahawan, Rachadaporn Jantasuwan and Hasanah Pairoh
Int. J. Environ. Res. Public Health 2026, 23(8), 1018; https://doi.org/10.3390/ijerph23081018 - 4 Aug 2026
Viewed by 239
Abstract
Workplace violence (WPV) is a major occupational hazard for nurses in Thailand, negatively affecting psychological well-being, professional confidence, and patient care. In this quantitative cross-sectional analytic study involving 415 nurses, 43.61% reported experiencing at least one incident of WPV during the previous 12 [...] Read more.
Workplace violence (WPV) is a major occupational hazard for nurses in Thailand, negatively affecting psychological well-being, professional confidence, and patient care. In this quantitative cross-sectional analytic study involving 415 nurses, 43.61% reported experiencing at least one incident of WPV during the previous 12 months. Verbal abuse (41.20%) and physical violence (13.25%) were the most frequently reported forms, with a higher prevalence observed in urban hospitals than in rural hospitals (53.66% vs. 33.81%). Higher WPV risk was associated with working in medical wards (adjusted incidence rate ratio [Adj IRR] 3.33) and emergency departments (Adj IRR 2.47), caring for male-only patients (Adj IRR 1.87), younger age (Adj IRR 3.31), divorced or separated status (Adj IRR 3.05), rotating day and night shifts (Adj IRR 2.03), and extreme concern about WPV (Adj IRR 4.57). The psychological impact was considerable. Hypervigilance was the most common response (66.30%), especially following physical violence (76.36%). More than 41% of affected nurses reported intentions to resign or transfer and reduced professional confidence. Reporting incidents was often perceived as ineffective, contributing to underreporting. Nurses identified clear disciplinary measures, increased staffing, improved workplace environments, stronger security systems, and organizational support as key prevention priorities. These findings highlight the urgent need for context-specific interventions, targeted staff training, and organizational strategies to protect nurse well-being, strengthen workforce resilience, and maintain quality patient care. Full article
(This article belongs to the Section Health Care Sciences)
9 pages, 259 KB  
Article
The Right to Be Counted: Unmasking First Nations and Métis Population Undercounts in Winnipeg, Manitoba
by Lisa Avery, Marcie Snyder, Monica Cyr, Della Herrera, Leona Star, Stephanie Sinclair, Janet Smylie and Michael Rotondi
Int. J. Environ. Res. Public Health 2026, 23(8), 1017; https://doi.org/10.3390/ijerph23081017 - 4 Aug 2026
Viewed by 640
Abstract
Background: Evidence of systematic under-counting of First Nations, Inuit, and Métis (FNIM) populations living in urban centres in Canada has been documented for the previous three census rounds (2012, 2016, 2021). Methods: In partnership with Aboriginal Health and Wellness Centre of Winnipeg, Inc. [...] Read more.
Background: Evidence of systematic under-counting of First Nations, Inuit, and Métis (FNIM) populations living in urban centres in Canada has been documented for the previous three census rounds (2012, 2016, 2021). Methods: In partnership with Aboriginal Health and Wellness Centre of Winnipeg, Inc. and the First Nations Health and Social Secretariat of Manitoba, a respondent-driven sampling survey of First Nations and Métis peoples living in Winnipeg was conducted and the population living in Winnipeg was estimated using the multiplier method in conjunction with participants’ responses to census participation. Results: We estimated a population of 300,000 (95% CI 248,000 to 379,000) First Nations and Métis people living in Winnipeg, three times higher than the 2021 Census count of 90,535. Interpretation: The Canadian census continues to systematically undercount Indigenous peoples living in urban centres. Improving the accuracy and precision of Indigenous population enumeration is required for equitable health services funding and delivery. Partnerships with FNIM governing and health service organizations, addition of Indigenous identity to the short form-census participation and coverage, and improved collection methods for people living in collective dwellings or experiencing housing insecurity are recommended. Full article
(This article belongs to the Section Global Health)
18 pages, 1362 KB  
Article
Looking up to Look Within: Preliminary Findings of the Restorative Effects of Astronomical Retreats in South Africa
by Dominic Gregory Vertue, Nicole Thomas, Therese Fish, Charles Takalana, Kevin Govender, Sally Ann Macfarlane and Lynn Hendricks
Int. J. Environ. Res. Public Health 2026, 23(8), 1016; https://doi.org/10.3390/ijerph23081016 - 4 Aug 2026
Viewed by 367
Abstract
Depression, anxiety, and stress-related disorders continue to rise globally, with South Africa’s burden intensified by structural inequalities and a 91% mental health treatment gap, making accessible complementary interventions urgently needed. This exploratory mixed-methods pilot study examined the feasibility and acceptability of astronomy-based mental [...] Read more.
Depression, anxiety, and stress-related disorders continue to rise globally, with South Africa’s burden intensified by structural inequalities and a 91% mental health treatment gap, making accessible complementary interventions urgently needed. This exploratory mixed-methods pilot study examined the feasibility and acceptability of astronomy-based mental health support grounded in Attention Restoration Theory and awe research and sought a preliminary signal of change in psychological well-being. Two sequential retreat iterations combined guided naked-eye and telescope-based stargazing with nature immersion: a proof-of-concept peer camp (n = 19, Glencairn) and a family-focused retreat (n = 22 across nine family groups, Sutherland). The Depression Anxiety Stress Scale (DASS-21) was administered before (T1) and after (T2) the Glencairn retreat; qualitative data comprised the Most Significant Change focus groups (Glencairn) and asynchronous text-based interviews (Sutherland). Mean depression, anxiety and stress scores were lower at T2 than at T1. Because questionnaires were completed anonymously, individual T1 and T2 responses could not be linked. A valid paired analysis was therefore not possible, and inferential significance testing was not undertaken. These results represent descriptive cohort level patterns and should not be interpreted as evidence of within person change. Qualitative findings across both settings indicated calm, perspective shifts, and relational connection, while environmental novelty and family dynamics introduced competing cognitive demands at Sutherland. These preliminary findings suggest that astronomy-based interventions may support short-term psychological well-being and highlight three design considerations for implementation in African contexts, offered as provisional insights rather than established implementation principles with the design considerations being: cognitive spaciousness, contextual onboarding and relational anchoring. Full article
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21 pages, 1365 KB  
Article
Co-Designing a Consumer-Centred Educational Resource to Assist Australian Farmers with the Management of Persistent Pain
by Indika Koralegedera, Felicity A. Braithwaite, G. Lorimer Moseley, Gemma Skaczkowski and Kate M. Gunn
Int. J. Environ. Res. Public Health 2026, 23(8), 1015; https://doi.org/10.3390/ijerph23081015 - 3 Aug 2026
Viewed by 263
Abstract
Persistent pain is a major health issue that interferes with farmers’ ability to work more commonly than for the general working population. Farmers also like to self-manage pain but evidence-based pain management educational resources that are relevant to their way of life are [...] Read more.
Persistent pain is a major health issue that interferes with farmers’ ability to work more commonly than for the general working population. Farmers also like to self-manage pain but evidence-based pain management educational resources that are relevant to their way of life are limited. This study utilised a participatory co-design approach with farmers, pain clinicians and pain researchers to develop a tailored persistent pain management education resource for farmers. Key, transferable learnings include: the value of information provision in both printed and digital formats, the use of straightforward language, farmer-themed metaphors, imagery, humour and case studies/quotes, as well as reflection and goal-setting activities that focus on function. Co-designers highlighted the importance of materials being easily accessible, sharable and distributed by those who can demonstrate an understanding of farming, to reassure farmers of the resources’ relevance. Including information that is applicable across farmers’ typical pain journeys (pain onset, frustration and resignation stages as described in the paper) is another important consideration. Findings have informed the development of a pain management education resource that was considered relevant, relatable and accessible by co-designers. Lessons are applicable to the development of future health-related educational resources for this unique and at-risk group. Full article
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17 pages, 1150 KB  
Article
The Relationship Between Loneliness and Sleep Disturbances: The Roles of Community Resilience, Social Support, Anxiety, and Substance Use Coping
by Hwanseok Winston Choi, Michelle Brazeal and Joohee Lee
Int. J. Environ. Res. Public Health 2026, 23(8), 1014; https://doi.org/10.3390/ijerph23081014 - 3 Aug 2026
Viewed by 147
Abstract
This study examined the relationship between loneliness and sleep disturbances and explored the roles of community resilience and psychosocial factors (social support, anxiety, and substance use coping) in shaping this relationship. A spatially stratified random sampling approach was applied to select households between [...] Read more.
This study examined the relationship between loneliness and sleep disturbances and explored the roles of community resilience and psychosocial factors (social support, anxiety, and substance use coping) in shaping this relationship. A spatially stratified random sampling approach was applied to select households between Interstate 10 and the Gulf of Mexico coastline across three Mississippi counties: Hancock, Harrison, and Jackson. Amos version 30 was used to analyze the proposed structural equation model (SEM) based on responses from 310 participants (mean age = 50.47 years, SD = 17.57; 53.3% female). Data were collected using validated self-report instruments, including the Communities Advancing Resilience Toolkit (CART), the Multidimensional Scale of Perceived Social Support (MSPSS), the UCLA 3-item Loneliness Scale, the GAD-2, and the Brief COPE. Results revealed that initially, a significant association was observed between loneliness and sleep disturbances. However, this direct association was non-significant upon the inclusion of anxiety and substance use coping, showing instead a statistically significant indirect association operating through anxiety symptoms. Higher levels of loneliness were associated with increased anxiety symptoms, which in turn were associated with higher sleep disturbances. No indirect relationship between loneliness and sleep disturbances through substance use coping was found. The results also found that higher levels of community resilience and social support were associated with lower levels of loneliness. These findings highlight the need for multilevel strategies to improve sleep quality, which creates a nested system in which community strengths and individual support systems are jointly positioned as upstream correlates of lower individual isolation. Full article
(This article belongs to the Section Behavioral and Mental Health)
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29 pages, 819 KB  
Systematic Review
Exploring Determinants of Community Flood Resilience in Southeast Asia: A Systematic Review
by Nan Ei Moh Moh Kyi, Muhammad Naeem Rashid, Shun Lae Lae Aung, Tipsuda Pintakham and Anurak Wongta
Int. J. Environ. Res. Public Health 2026, 23(8), 1013; https://doi.org/10.3390/ijerph23081013 - 2 Aug 2026
Viewed by 347
Abstract
Flooding is the most devastating natural disaster in Southeast Asia, disproportionately affecting vulnerable communities and posing substantial public health challenges. This PRISMA 2020 systematic review, registered with PROSPERO, aimed to synthesize the determinants influencing community flood resilience among flood-affected communities in Southeast Asia. [...] Read more.
Flooding is the most devastating natural disaster in Southeast Asia, disproportionately affecting vulnerable communities and posing substantial public health challenges. This PRISMA 2020 systematic review, registered with PROSPERO, aimed to synthesize the determinants influencing community flood resilience among flood-affected communities in Southeast Asia. Five electronic databases and Google Scholar were searched for empirical peer-reviewed studies published between January 2015 and January 2026. Methodological quality was independently assessed using the Kmet standard quality assessment tool, and a convergent integrated synthesis design was applied for the synthesis. Eighteen studies (nine quantitative, six qualitative, and three mixed methods) from Indonesia, Thailand, Malaysia, Cambodia, Myanmar, and Vietnam met acceptable quality thresholds. Seven determinant domains were identified: (1) sociodemographic, (2) flood exposure, (3) socioeconomic, (4) socio-cultural, (5) environmental, (6) physical, and (7) psychological factors. Synthesized evidence revealed that community flood resilience is shaped by dynamic interactions among structural, social, environmental, and psychological determinants that collectively influence resilience capacities. Psychological factors, particularly risk perception and anxiety, served as cross-cutting influences on adaptive behavior, while vulnerability remained concentrated among older adults, women, low-income households, informal settlements, and rural agricultural communities. These findings highlight the importance of integrated and equity-oriented resilience strategies that strengthen community adaptation and improve public health outcomes in the region. Full article
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16 pages, 5895 KB  
Review
Green Surgery: Current Evidence, Challenges, and Future Directions
by Aikaterini Mastoraki, Maximos Frountzas, Foivos-Konstantinos Stamatis, Maria Batagianni, Emmanouil I. Kapetanakis, Panagiotis Sakarellos, Paraskevas Stamopoulos, Napoleon Moulavasilis, Evangelos Fragkiadis and Dimitrios Schizas
Int. J. Environ. Res. Public Health 2026, 23(8), 1012; https://doi.org/10.3390/ijerph23081012 - 2 Aug 2026
Viewed by 244
Abstract
Climate change has been identified by the World Health Organization (WHO) as “the single greatest health threat to humanity”. To investigate this subject, we conducted a narrative review of the literature about sustainability in the OR, with the aim of exploring the existing [...] Read more.
Climate change has been identified by the World Health Organization (WHO) as “the single greatest health threat to humanity”. To investigate this subject, we conducted a narrative review of the literature about sustainability in the OR, with the aim of exploring the existing knowledge and identifying prevailing challenges in the field. A combined automated and manual database search of the literature was performed using Medline (PubMed), Scopus, Ovid, and the Cochrane Library, covering publications available up to and including 21 May 2025. The significance of environmental sustainability is recognized across all healthcare systems. To fulfil the United Nations Sustainable Development Goals, the healthcare sector must undergo a transformation towards more eco-friendly practices, which will also affect clinical decision-making. Net-zero is an internationally agreed goal for avoiding worsening global heating in the second half of the 21st century, as it aims to balance the quantities of greenhouse gases released into and removed from the atmosphere, achieving carbon neutrality. Nevertheless, the operating room (OR) is among the most significant contributors to environmental pollution, with the major carbon hotspots determined by the use of energy, procurement and disposal of consumables and the waste of water. In response to this challenge, leading medical societies, surgical teams, government bodies, and industry stakeholders endorse Green Surgery (GS) by taking steps to address healthcare sustainability and its impact on climate change. Therefore, a movement toward “greening” healthcare, or improving the environmental footprint of healthcare has been built. Full article
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20 pages, 346 KB  
Article
Austere and Burnt Offerings: Countering the Material and Symbolic Othering Within School Meals in Aotearoa New Zealand with a Community Psychology Lens
by Kimberly Mary Jackson
Int. J. Environ. Res. Public Health 2026, 23(8), 1011; https://doi.org/10.3390/ijerph23081011 - 2 Aug 2026
Viewed by 226
Abstract
Globally, school meals have formed a social safety net for improving children’s nutrition, health, and educational attainment. In Aotearoa New Zealand, government funded lunches for children attending schools in low-income neighbourhoods were introduced in 2020, amidst rising poverty levels and consequent household food [...] Read more.
Globally, school meals have formed a social safety net for improving children’s nutrition, health, and educational attainment. In Aotearoa New Zealand, government funded lunches for children attending schools in low-income neighbourhoods were introduced in 2020, amidst rising poverty levels and consequent household food insecurity. The aspirations encapsulated within the scheme’s indigenous Māori name, ‘Ka Ora, Ka Ako’ (‘to be well, healthy and safe; to be ready to learn’) have lost focus since reforms to the lunches in 2024 prioritised cost savings, resulting in widely publicised quality issues. This present study draws from a critical multi-level investigation into the issue of hungry children in New Zealand schools, prior to the introduction of ‘Ka Ora, Ka Ako’. Narrative analysis identified how food in schools has been conceptualised within the context of a settler colonial charity model and neoliberal austerity. Applying a critical community psychology lens highlights how burnt and meagre lunches offered to children from food insecure households are a concrete product of historically grounded, unequal relations between groups. A community psychology approach reimagines state-funded food in schools as a public good, arguing for equitable rights to nutrition, including recognition of Māori rights to food sovereignty. Full article
(This article belongs to the Special Issue Social Equalities and Wellbeing in Community Health)
16 pages, 3985 KB  
Article
Temperature-Defined Heat-Alert-Threshold Days and Acute Myocardial Infarction Admissions and Mortality: A Nationwide Hungarian Registry-Based Cohort Study
by Csaba Bálint, Ali Abbas Rahi Al-Murshedi, Ammar Mahmood Jaber, Annamária Pakai and Zsófia Verzár
Int. J. Environ. Res. Public Health 2026, 23(8), 1010; https://doi.org/10.3390/ijerph23081010 - 2 Aug 2026
Viewed by 195
Abstract
Background: Although extreme heat is associated with adverse cardiovascular outcomes, the relationship between heat-alert-threshold days, acute myocardial infarction (AMI) admissions, and post-AMI mortality remains uncertain. We aimed to evaluate the association between temperature-defined heat-alert-threshold days and (i) daily AMI admissions and (ii) cumulative [...] Read more.
Background: Although extreme heat is associated with adverse cardiovascular outcomes, the relationship between heat-alert-threshold days, acute myocardial infarction (AMI) admissions, and post-AMI mortality remains uncertain. We aimed to evaluate the association between temperature-defined heat-alert-threshold days and (i) daily AMI admissions and (ii) cumulative all-cause mortality after hospitalized AMI in Hungary. Methods: We conducted a nationwide registry-based study using data from the Hungarian Myocardial Infarction Registry (HMR). All AMI admissions between 1 January 2018 and 31 December 2019 were eligible, with mortality follow-up through 16 June 2021. Heat-alert-threshold days were defined using the temperature criterion applied in the Hungarian national heat-health action plan (daily mean temperature ≥25 °C). AMI admissions were analyzed using adjusted quasi-Poisson regression models and cumulative mortality using stratified Cox proportional hazards models. This operational temperature threshold was used as the exposure definition and does not represent linkage to administrative heat-alert declarations. Results: The cohort included 30,883 AMI events from 29,596 unique patients (mean age, 67.2 [SD 12.8] years; 60.3% male). Patients admitted on heat-alert-threshold days had baseline clinical characteristics similar to those admitted on non-alert days (all standardized mean differences <0.10). Heat-alert-threshold days were associated with fewer recorded AMI admissions during summer (adjusted incidence rate ratio [aIRR] 0.93, 95% CI 0.90–0.97). In contrast, no association was observed between heat-alert-threshold exposure and subsequent all-cause mortality after AMI hospitalization (adjusted hazard ratio [aHR] 0.96, 95% CI 0.87–1.05). These findings remained consistent across sensitivity analyses. Conclusions: In this nationwide Hungarian registry-based study, temperature-defined heat-alert-threshold days were associated with fewer recorded AMI admissions during summer but not with differences in post-AMI mortality among hospitalized patients. The observed inverse association should not be interpreted as evidence of a protective effect of heat exposure. Alternative explanations include behavioral adaptation, delayed care-seeking, exposure misclassification, residual confounding, and the possibility of unmeasured out-of-hospital cardiovascular events, which were not captured by the registry. Because administrative heat-alert declarations were not linked to the analytic dataset, the findings should be interpreted as associations with temperature-defined heat-alert-threshold days rather than evaluations of the effectiveness of the Hungarian heat-alert system. Full article
(This article belongs to the Section Environmental Health)
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17 pages, 1145 KB  
Article
Dietary Risk of Neonicotinoids and Other Pesticides in Mexican Children Residing in Agroindustrial Zones
by Irma Aidé García Villegas, Silvia Lizette Ramos de Robles and Claudia Alvarado Osuna
Int. J. Environ. Res. Public Health 2026, 23(8), 1009; https://doi.org/10.3390/ijerph23081009 - 1 Aug 2026
Viewed by 262
Abstract
Dietary pesticide exposure is a growing public health concern, particularly for children in agricultural regions. This study assessed the occurrence and concentration of neonicotinoids and other pesticide residues in foods frequently consumed by preschool children (4–5 years) in an agroindustrial zone of Jalisco, [...] Read more.
Dietary pesticide exposure is a growing public health concern, particularly for children in agricultural regions. This study assessed the occurrence and concentration of neonicotinoids and other pesticide residues in foods frequently consumed by preschool children (4–5 years) in an agroindustrial zone of Jalisco, Mexico, and estimated their weekly dietary exposure (DE). Thirty-one food samples representing 18 items were collected from retail sites identified through seven-day dietary records completed by 23 families. Samples were analyzed by LC/ESI-MS/MS covering 236 compounds; exposure was estimated considering raw and cooked consumption patterns and processing factors. Residues were detected in 87% of samples, yielding 34 distinct compounds, including 5 neonicotinoids; imidacloprid was the most frequently detected. Strawberry, raspberry, apple, grape, and tomato showed the highest residue loads; seven samples exceeded MRLs set by the EU, USA, or Mexico. Raw food consumption accounted for 96% of total estimated exposure, with pyrimethanil, boscalid, propamocarb, and imidacloprid as principal contributors. These findings confirm that children in this population face repeated, simultaneous exposure to multiple pesticides through diet, underscoring the need for stronger food safety monitoring, harmonized regulatory limits, and cumulative risk assessment frameworks for vulnerable populations. Full article
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19 pages, 1102 KB  
Article
Secondhand Smoke Exposure Among University Students in the United Arab Emirates: Knowledge as a Correlate of Protective Behavior—A Cross-Sectional Study
by Tania Santina, Marwa Alahmed, Aiysha Faraj, Asma Arif, Jawaher Muhammed, Shayma Haidar, Wedad Almuaini, Nour Kawam and Abdallah Saab
Int. J. Environ. Res. Public Health 2026, 23(8), 1008; https://doi.org/10.3390/ijerph23081008 - 31 Jul 2026
Viewed by 323
Abstract
Secondhand smoke exposure (SHSE) remains a major environmental health risk among university students, particularly in socially shared settings. In the United Arab Emirates, culturally embedded practices such as shisha and midwakh use, combined with variable policy enforcement, sustain persistent exposure. This cross-sectional study [...] Read more.
Secondhand smoke exposure (SHSE) remains a major environmental health risk among university students, particularly in socially shared settings. In the United Arab Emirates, culturally embedded practices such as shisha and midwakh use, combined with variable policy enforcement, sustain persistent exposure. This cross-sectional study examined SHSE-related knowledge and protective health behaviors among 360 university students and their sociodemographic correlates, using a self-report questionnaire with documented internal consistency in comparable populations. Data were analyzed using SPSS version 28. SHSE was highly prevalent, occurring mainly in public and university settings; knowledge was moderate and protective behavior varied. Knowledge emerged as a moderate-to-strong correlate of protective behavior (r = 0.70, p < 0.001, R2 = 0.49). Age, employment, marital status, and number of children were associated with knowledge; age, gender, marital status, and income, but not employment, remained associated with behavior after adjusting for knowledge. Confirmatory factor analysis showed poor absolute fit for both the one- and two-factor solutions, and the behavioral-response factor did not satisfy the Fornell–Larcker criterion (√AVE = 0.750 < latent r = 0.836), providing only partial support for the empirical distinctiveness of the two constructs. Bootstrapped mediation analysis shows that knowledge partially mediated the employment–behavior association (~62% of the total effect); employment status was not, however, independently associated with behavior once knowledge was included, so this pathway is reported as hypothesis-generating. Still, more than a quarter of participants reported poor protective behavior, suggesting that unmeasured social and environmental factors, and possible overlap between the two constructs, may influence this relationship. Findings support integrated interventions combining health education, policy enforcement, and culturally tailored strategies. Full article
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