International Journal of Environmental Research and Public Health

16 pages, 309 KB

Open AccessArticle

Baseline Predictors of Informal Breast Health Promotion Among Participants Overdue for Screening

by Ezra Belfiore Wright, Garth H. Rauscher, John Dziak, Jocelyn Perez-Ahlgrain, Tatiana Lopez, Mariana Tellez, Heidi Parra, Emely Moreno, Monica J. Padilla, Karyme Huerta, Viviana Bahena, Sheryl Lawrence, Irlanda Maneli Estrada Sanchez, Carolina Bujanda, Paola Torres, Elizabeth de la Paz, Juanita Arroyo, Silvia Montoya, Araceli Lucio, Pamela Ganschow, Kristin Andersen, Maria J. Perez, Nathan Stackhouse, Marc S. Atkins, Erin I. Neuschler, Candyce H. Kroenke, Jennifer Watling Neal and Yamilé Molina Show full author list Hide full author list

Int. J. Environ. Res. Public Health 2026, 23(9), 1216; https://doi.org/10.3390/ijerph23091216 (registering DOI) - 15 Sep 2026

Abstract

To address underutilization of breast cancer screening among Latines, one solution may be to identify participants, at baseline, who are likely to promote breast health after participation. We sought to (1) describe breast health promotion at baseline and (2) examine relevant predictors, using [...] Read more.

To address underutilization of breast cancer screening among Latines, one solution may be to identify participants, at baseline, who are likely to promote breast health after participation. We sought to (1) describe breast health promotion at baseline and (2) examine relevant predictors, using self-report data from 400 Latine participants. Breast health and mammography promotion were binary outcomes and validated with environmental data (message, modality, time). Predictors were measured with validated instruments, including (1) acceptability of breast health promotion (Likert items); (2) breast cancer screening knowledge (count); (3) limited cultural misconceptions (count); (4) knowing a health advocate/professional (binary); and (5) non-health volunteerism history (binary). About 35% of participants had promoted breast health, and 14% had promoted mammography. Modified Poisson regressions found that perceived acceptability predicted breast health (PR = 1.53, 95% CI [1.17, 1.99], p = 0.002) and mammography promotion (PR = 1.61, 95% CI [1.02, 2.55], p = 0.04), after accounting for age, nativity, education, income, and mammography history. Knowing a health advocate/professional also predicted breast health promotion (PR = 1.53, 95% CI [1.18, 1.98], p = 0.001). Our findings highlight potential factors to consider for future interventions to train participants to promote breast health. Full article

(This article belongs to the Special Issue Advancing Breast Health and Breast Cancer Prevention Through Policy, Community, System and Technological Change)

23 pages, 3894 KB

Open AccessArticle

What Happens When Work Is Not Restricted to a Single Work Location? Development and Validation of the E-Work Well-Being (EWW) Scale

by Maria Charalampous, Christine A. Grant and Carlo Tramontano

Int. J. Environ. Res. Public Health 2026, 23(9), 1215; https://doi.org/10.3390/ijerph23091215 - 15 Sep 2026

Abstract

The paradox of the modern workplace lies in the coexistence of location-flexible work and a growing trend of return-to-office mandates introduced by organisations. This paper presents the E-Work Well-being (EWW) scale, a measure assessing the impact of remote (including hybrid) working on well-being. [...] Read more.

The paradox of the modern workplace lies in the coexistence of location-flexible work and a growing trend of return-to-office mandates introduced by organisations. This paper presents the E-Work Well-being (EWW) scale, a measure assessing the impact of remote (including hybrid) working on well-being. The EWW scale was developed and framed within a multi-dimensional work well-being model, offering a more nuanced and holistic understanding of remote workers’ well-being at work. Three studies were conducted using independent samples (N1 = 202; N2 = 399; N3 = 366) of UK. remote workers. The final scale consists of 69 items assessing 13 first-order well-being factors and three second-order factors. These comprise: individual factors of well-being (i.e., emotions, job satisfaction, emotional exhaustion, and cognitive well-being), interaction between the individual and the organisation (i.e., organisational commitment, relationships with colleagues and supervisors, social isolation, autonomy, competence, and career development), and physical health (i.e., musculoskeletal symptoms and fatigue). The scale demonstrated face, content, convergent, and criterion-related validity and showed internal reliability. This multi-dimensional scale elucidates the complex effects of remote and hybrid work arrangements. It can be employed by line managers, organisations, workplace health practitioners, and researchers to gain comprehensive assessments of remote workers’ well-being at work, identify psychosocial risk factors, and inform targeted workplace interventions. Full article

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

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13 pages, 290 KB

Open AccessArticle

Evaluation of Share Tables in U.S. Elementary School Lunchrooms, from Waste to Rescue

by Jean Pierre Enriquez, Esther U. Adaji, Crystal Momii and Sabina Malik

Int. J. Environ. Res. Public Health 2026, 23(9), 1214; https://doi.org/10.3390/ijerph23091214 - 15 Sep 2026

Abstract

Background: Food insecurity and food waste are persistent challenges in the U.S. Nevada’s largest school district serves a population in which approximately 20% of children live in food-insecure households. Share Tables (ST), where students can place unwanted, unopened school food for access by [...] Read more.

Background: Food insecurity and food waste are persistent challenges in the U.S. Nevada’s largest school district serves a population in which approximately 20% of children live in food-insecure households. Share Tables (ST), where students can place unwanted, unopened school food for access by other students, offer a potential strategy to increase food access while reducing food waste and stigma. This study examined ST utilization and explored strategies to support their implementation in school cafeterias. Methods: Food service staff from 11 schools completed a brief e-survey and responses were analyzed using descriptive coding. A 17-item lunchroom atmosphere assessment evaluated practical, low-cost strategies supporting healthy eating environments. Schools received coaching to enhance their lunchroom atmosphere, with pre-post changes assessed using the Wilcoxon test. ST utilization was observed at three schools and evaluated using an estimated utilization formula. Results: While 72.1% of respondents reported high ST utilization, qualitative analysis revealed promotion and utility as distinct prominent themes. Following coaching, promotion strategies increased significantly (p < 0.05) among 11 elementary schools. Across the three schools where the observational phase was conducted, the average ST utilization rate was 79.6% (range: 71–100%). Conclusions: ST may provide a feasible, low-cost approach to reducing food waste and promoting food redistribution in elementary schools. Staff engagement, education, promotion, and structural support may strengthen implementation. Best-practice guidance can support sustainable ST programs. Full article

17 pages, 1265 KB

Open AccessViewpoint

The FIT–FRAIL–DISABLE Framework: A Multidimensional CGA-Based Model for Proportional Treatment of Older Adults Across Speciality Care

by Crescenzo Testa, Francesco Palmese, Grazia Daniela Femminella, Marco Domenicali, Marcello Giuseppe Maggio and Fulvio Lauretani

Int. J. Environ. Res. Public Health 2026, 23(9), 1213; https://doi.org/10.3390/ijerph23091213 - 14 Sep 2026

Abstract

Frailty, cognitive impairment, depression, functional dependency, low physical performance, and undernutrition are highly prevalent in older adults referred for cancer treatment, cardiovascular interventions, neurological therapies, and orthopaedic surgery, and each independently predicts treatment toxicity, post-procedural complications, and mortality. Comprehensive Geriatric Assessment (CGA) is [...] Read more.

Frailty, cognitive impairment, depression, functional dependency, low physical performance, and undernutrition are highly prevalent in older adults referred for cancer treatment, cardiovascular interventions, neurological therapies, and orthopaedic surgery, and each independently predicts treatment toxicity, post-procedural complications, and mortality. Comprehensive Geriatric Assessment (CGA) is the most accurate predictor of treatment outcomes in older patients, yet it remains structurally absent from most speciality pathways, contributing to overtreatment of biologically frail patients and undertreatment of biologically robust ones. In this Viewpoint, we propose and operationalise the FIT–FRAIL–DISABLE multidimensional geriatric stratification model as a conceptual framework for translating CGA findings into proportional, speciality-specific treatment recommendations across oncology, cardiology, neurogeriatrics, and orthogeriatrics. The model integrates six validated CGA instruments—the Mini-Mental State Examination (MMSE), the 15-item Geriatric Depression Scale (GDS-15), basic and instrumental Activities of Daily Living (ADL, IADL), the Short Physical Performance Battery (SPPB), and the Mini Nutritional Assessment Short Form (MNA-SF)—into three actionable categories (FIT, FRAIL, DISABLE) aligned with full-intensity, risk-adapted, and symptom-focused care, and is explicitly positioned in relation to the deficit-based frailty paradigm and the WHO Intrinsic Capacity (ICOPE) framework, which it complements rather than replaces. We specify a provisional, a priori decision rule for combining domain scores and describe how each stratification category should inform—but not dictate—goal-concordant treatment intensity within a shared decision-making process. FIT–FRAIL–DISABLE is presented as a proposed, hypothesis-generating framework: its composite thresholds and domain weighting have not yet been empirically derived, and the model has not undergone prospective validation. Retrospective calibration on existing CGA cohorts and prospective multicentre validation are being designed within the GERIA-NET research consortium. If validated, the framework has the potential to reduce both overtreatment-related harm and undertreatment-related therapeutic deprivation in older adults undergoing active treatment. Full article

(This article belongs to the Section Global Health)

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20 pages, 586 KB

Open AccessArticle

Growth Trajectories of 2 to 6-Year-Old Children Infected with or Exposed to HIV: A 9-Month Follow-Up

by Anita Elizabeth Pienaar and Jo-Anne Elizabeth Botha

Int. J. Environ. Res. Public Health 2026, 23(9), 1212; https://doi.org/10.3390/ijerph23091212 - 14 Sep 2026

Abstract

Background/Objectives: HIV infection is associated with growth faltering, including stunting, wasting, and malnutrition, particularly during early childhood. However, limited longitudinal evidence exists regarding growth trajectories in such vulnerable populations. This study examined the growth trajectories of South African children aged 2–6 years who [...] Read more.

Background/Objectives: HIV infection is associated with growth faltering, including stunting, wasting, and malnutrition, particularly during early childhood. However, limited longitudinal evidence exists regarding growth trajectories in such vulnerable populations. This study examined the growth trajectories of South African children aged 2–6 years who were HIV-infected or exposed to HIV (HEU) over a nine-month period while comparing them with HIV-unexposed, uninfected (HU) children. Method: HIV-infected (n = 16; mean age, 4.63 years), HIV-exposed uninfected (HEU) (n = 11; mean age, 3.90 years), and HIV-unexposed uninfected (HU) (n = 11; mean age, 4.34 years) children participated in the study. Height, weight, upper-arm circumference, and skinfold thickness were obtained, while body mass index (BMI), stunting, and wasting indicators were calculated. Assessments were conducted at baseline and every 3 months over 9 months. Frequency distributions across groups were analysed against CDC growth percentiles using repeated-measures ANOVA with Bonferroni post hoc tests in Statistica for Windows to assess changes over time. Results: Linear growth vulnerability persisted among HIV-infected and HEU children despite improvements in weight-related indicators. Both HIV-infected and HEU children exhibited stunting (<−2 SD), while the HIV-infected group was underweight (<−2 SD) at baseline. HEU children showed weight gains but exhibited distinct growth patterns, indicating a continued risk of suboptimal growth outcomes compared with HU children. Conclusions: The observed growth trajectories indicate persistent linear growth vulnerability among HIV-infected and HEU children, despite improvements in weight-related indicators. Regular and early growth monitoring and timely and sustained nutritional support remain essential in paediatric HIV care, as improvements in weight do not necessarily translate into optimal linear growth among children affected by HIV. Full article

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

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20 pages, 355 KB

Open AccessArticle

Uptake and Determinants of Community-Based HIV Testing Services Amongst Key Populations in Ekiti State, South-West Nigeria: A Cross-Sectional Mixed-Methods Study

by Chukwudike Maraizu Aku, James Robson Sunday, Oluwaseun Kingsley Ogunla, Best Ordinioha and Christian Kosisochukwu Anumudu

Int. J. Environ. Res. Public Health 2026, 23(9), 1211; https://doi.org/10.3390/ijerph23091211 - 14 Sep 2026

Abstract

Key populations (KPs), including female sex workers (FSWs), men who have sex with men (MSM), people who inject drugs (PWID), and transgender (TG) individuals, bear a disproportionate HIV burden in Nigeria, yet sub-national evidence on community-based HIV testing services (HTS) uptake remains limited, [...] Read more.

Key populations (KPs), including female sex workers (FSWs), men who have sex with men (MSM), people who inject drugs (PWID), and transgender (TG) individuals, bear a disproportionate HIV burden in Nigeria, yet sub-national evidence on community-based HIV testing services (HTS) uptake remains limited, particularly in culturally conservative settings such as Ekiti State. This study assessed knowledge, attitudes, and uptake of community-based HTS among KPs in Ekiti State and examined associated sociodemographic and psychosocial factors. A cross-sectional mixed-methods study was conducted from April to June 2025 among 424 KPs recruited through purposive selection of nine high-burden Local Government Areas and exponential non-discriminatory snowball sampling. Quantitative data were collected using an interviewer-administered questionnaire, while qualitative data comprised one focus group discussion (n = 8) and one key informant interview. Descriptive statistics summarised knowledge, attitudes, and community-based HTS uptake; Pearson’s chi-square and Fisher–Freeman–Halton exact tests assessed associations between explanatory variables and HTS uptake status (never tested, previously tested, or tested within the preceding 12 months). Awareness of community-based HTS was high (90.6%), and attitudes were predominantly positive (88.7%), yet recent community-based HTS uptake, defined as HIV testing through a community-based modality within the preceding 12 months, was 64.2%. Recent uptake was lowest among MSM (58.9%) and FSWs (63.6%) and highest among PWID (78.6%) and transgender individuals (100.0%). Ever community-based HTS uptake was higher, at 72.6%. Bivariate analysis showed statistically significant associations between HTS uptake status and knowledge (Fisher–Freeman–Halton exact p < 0.001), attitude (Fisher–Freeman–Halton exact p < 0.001), sex (Fisher–Freeman–Halton exact p = 0.024), age (Fisher–Freeman–Halton exact test, p = 0.002), educational level (Fisher–Freeman–Halton exact test, p = 0.001), religion (Fisher–Freeman–Halton exact test, p < 0.001), and KP typology (Fisher–Freeman–Halton exact p < 0.001). Marital status was not significantly associated with uptake (Fisher–Freeman–Halton exact p = 0.484). Qualitative findings complemented and contextualised the quantitative patterns, identifying trust in peer-led testers, affordability, and flexible outreach as facilitators, while stigma, self-stigmatisation, and funding constraints emerged as barriers. Despite high awareness of community-based HTS (90.6%) and predominantly favourable attitudes, recent uptake remained lower, suggesting that recent uptake reflected not only individual-level factors but also social and health-system conditions, including stigma, social barriers, and constraints affecting the availability, accessibility, and continuity of services. Peer-led delivery models, strengthened confidentiality protections, and sustained programme financing are needed to close this gap and advance Nigeria’s progress toward the UNAIDS 95-95-95 targets. Full article

(This article belongs to the Special Issue Public Health Strategies for HIV/AIDS Prevention and Treatment)

13 pages, 7408 KB

Open AccessArticle

Association Between Biomarkers of Environmental Enteric Dysfunction and Early Child Development Amongst Infants in Rural Central Java, Indonesia

by Callum Lowe, Tony Arjuna, Mubasysyir Hasanbasri, Haribondhu Sarma, I Nyoman Sutarsa, Severine Navarro, Darren Gray and Matthew Kelly

Int. J. Environ. Res. Public Health 2026, 23(9), 1210; https://doi.org/10.3390/ijerph23091210 - 14 Sep 2026

Abstract

Environmental enteric dysfunction (EED) may be associated with poor cognitive and overall early child development (ECD) independent of linear growth. This may serve as an opportunity to improve ECD with water, sanitation, and hygiene (WASH) interventions. This study aimed to measure the association [...] Read more.

Environmental enteric dysfunction (EED) may be associated with poor cognitive and overall early child development (ECD) independent of linear growth. This may serve as an opportunity to improve ECD with water, sanitation, and hygiene (WASH) interventions. This study aimed to measure the association between EED and ECD amongst 119 infants aged 11–24 months from five villages in rural Wonosobo, Indonesia. Data collection at baseline (September–October 2024) and follow-up (February–March 2025) involved a quantitative questionnaire, anthropometric measurements, measurement of three EED stool biomarkers, alpha-1-antitrypsin (AAT), neopterin (NEO), and myeloperoxidase (MPO), and assessment of ECD using the Caregiver Reported Early Development Instruments (CREDI) z-scores for the cognitive and overall category performed at follow-up. Linear regression modelled the association between EED biomarkers and CREDI cognitive and overall z-score. The associations between MPO and ECD were generally weak and insignificant. MPO above the 75th percentile at baseline was associated with lower cognitive z-score (β = −0.63, 95% CI = −0.99 to −0.26, p < 0.001) but, at follow-up, was associated with higher cognitive z-score (β = 0.41, 95% CI = 0.03 to 0.79, p < 0.05). Associations between AAT and NEO with cognitive and development z-scores were not statistically significant. These findings show that the relationships between EED and early child development are complex and weakly explained by these biomarkers. Full article

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19 pages, 743 KB

Open AccessArticle

Nutritional Status, Eating Habits and Association with In-Hospital Mortality in Older Hospitalized Patients

by Carlotta Franchi, Sara Mandelli, Alessandro Nobili, Pier Mannuccio Mannucci, Ilaria Ardoino and REPOSI Investigators

Int. J. Environ. Res. Public Health 2026, 23(9), 1209; https://doi.org/10.3390/ijerph23091209 - 12 Sep 2026

Abstract

Background: Malnutrition in older adults commonly takes the form of undernutrition and is often associated with adverse health outcomes. This study aimed to evaluate the nutritional profile and eating habits, and their association with in-hospital mortality, in a large cohort of hospitalized older [...] Read more.

Background: Malnutrition in older adults commonly takes the form of undernutrition and is often associated with adverse health outcomes. This study aimed to evaluate the nutritional profile and eating habits, and their association with in-hospital mortality, in a large cohort of hospitalized older patients. Methods: The REPOSI (Registro POliterapie SIMI) register collected clinical and pharmacological data on patients aged 65 years and more hospitalized in a network of Italian internal medicine and geriatric wards. From January 2025, we added to the registered dataset the collection of data on dietary habits data through a Food Frequency Questionnaire, as well as on the non-dietary determinants of nutritional status. We employed the Mini Nutritional Assessment (MNA) to evaluate the nutritional status and the Medi-Lite and the MedQ-Sus MD tools to evaluate adherence to the Mediterranean Diet (MD). Results: Of the 1008 patients enrolled, 787 were assessable for this study. The MNA identified a high prevalence of nutritional impairment: 10.1% of cases were malnourished and 44.9% at risk of malnutrition. Adherence to MD was generally poor, with only 22.4% of participants showing a high adherence according to the Medi-Lite, and much lower according to the MedQ-Sus MD (7.9%). Increasing age, and lower MD adherence were associated with poorer nutritional status. Nutritional impairment was associated with higher in-hospital mortality (HR = 6.36, 95% CI: 1.90–21.24). Conclusions: Malnutrition in hospitalized older patients is often unrecognized, despite affecting nearly half of this cohort and being associated with in-hospital mortality. This highlights the need for preventive strategies and intensive follow-up. Full article

(This article belongs to the Section Health Care Sciences)

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15 pages, 273 KB

Open AccessReview

Social Support, Organizational Resources and Professional Sustainability in Child Protection Social Work: A Focused Integrative Review

by Nuzha Allassad Alhuzail

Int. J. Environ. Res. Public Health 2026, 23(9), 1208; https://doi.org/10.3390/ijerph23091208 - 12 Sep 2026

Abstract

Child protection officers (CPOs) and social workers operate under sustained emotional, organizational, and relational pressure. This is especially salient in minoritized and conflict-affected settings where statutory authority may coexist with community mistrust, cultural obligations, and limited resources. The earlier version of this article [...] Read more.

Child protection officers (CPOs) and social workers operate under sustained emotional, organizational, and relational pressure. This is especially salient in minoritized and conflict-affected settings where statutory authority may coexist with community mistrust, cultural obligations, and limited resources. The earlier version of this article relied primarily on four qualitative studies of Arab and Bedouin CPOs in Israel that were led by this article’s author., The present study is a focused integrative review of 21 peer-reviewed articles, comprising four related author-led studies and 17 independently authored external studies.. The review is purposive and transparent rather than systematic or meta-analytic. Published methods, findings, and discussions were analyzed within a matrix that distinguished direct support constructs (emotional, collegial, supervisory, informational, instrumental, organizational, and relational legitimacy support) from demands and contextual conditions (caseload, trauma exposure, threats, role conflict, and service scarcity). The four author-led papers were treated as one related contextual research cluster, not as independent replications or a pooled participant sample. Across the corpus, support emerged as a multi-level and conditional resource. Organizational climate, supervisor and peer relations, practical resources, and reflective space were repeatedly associated with wellbeing, resilience, job satisfaction, and retention-related outcomes, yet support did not substitute for safe staffing, manageable workload, adequate service capacity, or protection from violence. The Arab and Bedouin studies made visible a further dimension that is less developed in the wider literature: family and community relationships can confer legitimacy and cultural knowledge while also generating surveillance, stigma, confidentiality risks, and gendered pressure. This review therefore advances a cautious proposition that professional sustainability depends on the alignment of relational, organizational, and structural conditions rather than individual coping alone. This conclusion is context-bound and requires independent comparative and longitudinal evaluation. Full article

(This article belongs to the Special Issue Social Support for Social Services: Addressing the Well-Being of Social Workers)

28 pages, 1182 KB

Open AccessArticle

Developmental Trajectories of Psychosis and Internalising and Externalising Disorders Among Young People with Varying Levels of Child Protection Involvement: A Population-Level Linked Data Study

by Fadzai Chikwava, Reinie Cordier, Anna Ferrante and Melissa O’Donnell

Int. J. Environ. Res. Public Health 2026, 23(9), 1207; https://doi.org/10.3390/ijerph23091207 - 11 Sep 2026

Viewed by 104

Abstract

Despite extensive research on the risks faced by young people in out-of-home care, population-level evidence on how mental disorders develop and diverge through childhood, adolescence, and early adulthood remains limited. This study addresses this gap by modelling developmental trajectories across internalising, externalising, and [...] Read more.

Despite extensive research on the risks faced by young people in out-of-home care, population-level evidence on how mental disorders develop and diverge through childhood, adolescence, and early adulthood remains limited. This study addresses this gap by modelling developmental trajectories across internalising, externalising, and psychotic domains. This retrospective population-based study examined developmental trajectories of internalising, externalising, and psychotic disorders among 414,746 young people born in Western Australia between 1993 and 2008. Using linked administrative data, group-based trajectory modelling was applied to compare young people with out-of-home care (OHC) experience, those with child protection (CP) contact but no OHC experience, and those with no CP contact. Two distinct trajectory groups were identified across all mental disorder types, based on participants with at least one recorded mental health episode. Most young people followed low stable mental disorder trajectories, while a smaller subgroup (fewer than 10% or slightly above 10% for psychotic disorders) showed elevated, increasing trajectories over time, with more pronounced escalation among those with OHC exposure, reflecting concentrated and complex developmental risk. These higher-risk trajectories reflected developmental variation in timing and severity, including earlier escalation of internalising and externalising disorders and later emergence of psychotic disorders. Factors associated with higher-risk trajectories included socio-demographic disadvantage, placement characteristics, and substance misuse. These findings indicate that mental health risk among young people with child protection involvement is not uniform but concentrated within particular model-derived developmental trajectory groups. Population-level linked data can enhance understanding of developmental mental health risk and support timelier, targeted, and integrated child protection, mental health, housing, and substance misuse responses. Full article

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

21 pages, 2171 KB

Open AccessArticle

Bridging the Knowledge–Behavior Gap: A Cross-Sectional Study on Food Safety and Pesticide Exposure Among Migrant Workers in Chiang Mai

by Nan Ei Moh Moh Kyi, Tipsuda Pintakham, Muhammad Samar, Muhammad Naeem Rashid, Surat Hongsibsong, Kanokwan Kulprachakarn and Anurak Wongta

Int. J. Environ. Res. Public Health 2026, 23(9), 1206; https://doi.org/10.3390/ijerph23091206 - 11 Sep 2026

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Abstract

Pesticide contamination in fruits and vegetables remains a critical food safety concern in Northern Thailand, posing risks to environmental and human health. Improving knowledge, attitude, and behavior (KAB) in food safety is essential for reducing pesticide exposure, particularly among migrant workers. This cross-sectional [...] Read more.

Pesticide contamination in fruits and vegetables remains a critical food safety concern in Northern Thailand, posing risks to environmental and human health. Improving knowledge, attitude, and behavior (KAB) in food safety is essential for reducing pesticide exposure, particularly among migrant workers. This cross-sectional study evaluates food safety knowledge, attitude, behavior, and pesticide exposure among Myanmar migrant workers in Chiang Mai Province. Face-to-face interviews were conducted with 137 participants between August and September 2025 in Mueang, Mae Rim, and San Sai districts. Mann–Whitney U test and linear regression were used to explore demographic differences and associated factors of knowledge, attitude, and safety behavior. Most participants demonstrated adequate knowledge (65.7%) and positive attitude (80.3); however, 78.1% reported only moderate safety behavior. Higher knowledge and more favorable attitudes were observed among non-Shan ethnic groups and participants with higher education (p < 0.001). Women and non-farming workers exhibited significantly safer behavior (p < 0.05). Knowledge and attitude were strongly correlated (ρ = 0.556, p < 0.01), but neither was associated with safety behavior. Most participants had cholinesterase activity within the normal reference range (73.0% cellular AChE; 81.0% plasma BChE). Low enzyme activity was observed in 13.9% and 6.6% of participants, respectively. Enzyme activity did not differ significantly by occupation, sex, or ethnicity and was not significantly associated with KAB scores. Linear regression analyses identified ethnicity as significantly associated with knowledge and attitude; whereas, sex and occupation were significantly associated with safety behavior. These findings suggest that individual-level knowledge and attitude may not be sufficient to drive protective behavior among migrant workers, though the cross-sectional study design limits causal inference and generalizability. Full article

(This article belongs to the Section Environmental Health)

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19 pages, 2177 KB

Open AccessArticle

Association Between Nutritional Status, Body Mass Index, and Oral Health Among Older Adults in Primary Health Care

by Cleomar Ana de Souza Valentim, Ademir Alves de Melo, Thiago Costa Florentino, André Silva Valentim and Marília Jesus Batista

Int. J. Environ. Res. Public Health 2026, 23(9), 1205; https://doi.org/10.3390/ijerph23091205 - 11 Sep 2026

Viewed by 154

Abstract

Objective: We aimed to analyze factors associated with body mass index and nutritional status, including oral health, among older adults in Primary Health Care. Methods: We conducted a cross-sectional study of community-dwelling older adults aged ≥ 60 years, selected from five Health Units [...] Read more.

Objective: We aimed to analyze factors associated with body mass index and nutritional status, including oral health, among older adults in Primary Health Care. Methods: We conducted a cross-sectional study of community-dwelling older adults aged ≥ 60 years, selected from five Health Units in a Brazilian city. A questionnaire was applied to collect the following data: sociodemographic data, anthropometric status assessed by Body Mass Index (BMI) (weight and height), oral health (number of teeth and self-perceived chewing ability: good, fair, or poor), cognition assessed using the 10-Point Cognitive Screener (10-CS), nutritional status using the Mini Nutritional Assessment (MNA), health literacy using the 14-item Health Literacy Scale (HLS-14), sarcopenia risk using the SARC-F questionnaire plus calf circumference (SARC-F + CC), and frailty using the Clinical Functional Vulnerability Index-20 (CFVI-20). The outcomes were Body Mass Index (BMI)-defined anthropometric status, dichotomized as non-excess weight (underweight/normal weight) vs. excess weight (overweight/obese), and nutritional status assessed by the Mini Nutritional Assessment (MNA), dichotomized into normal nutritional status vs. nutritional risk or malnutrition. Descriptive, bivariate (Chi-square test), and multiple binary logistic regression analyses were performed for each outcome (p < 0.05). Results: A total of 211 older adults participated in the study. The sample was 72% female, with a mean age of 70.41 (±7.45) years. In the adjusted regression analysis, the use of four or more medications (OR = 2.12; 95% CI: 1.08–4.17), sedentary behavior (OR = 3.09; 95% CI: 1.58–6.04), and absence of sarcopenia risk (OR = 4.99; 95% CI: 2.02–12.34) were associated with higher odds of overweight/obesity. Conversely, usual attendance at the neighborhood PHC unit (OR = 0.23; 95% CI: 0.07–0.72) and possible cognitive impairment (OR = 0.30; 95% CI: 0.08–0.98) were inversely associated with overweight/obesity. Nutritional risk or malnutrition was associated with edentulism (OR = 2.10; 95% CI: 1.05–4.23), poor chewing ability (OR = 2.48; 95% CI: 1.06–5.82), fair chewing ability (OR = 2.88; 95% CI: 1.29–6.47), and the presence of feelings of discouragement, sadness, or hopelessness (OR = 3.52; 95% CI: 1.78–6.96). Among participants with overweight/obesity, 28.4% were also classified as being at nutritional risk or malnourished according to the MNA. Conclusions: Among older adults in Primary Health Care, nutritional risk or malnutrition was associated with oral health and psychosocial characteristics, whereas overweight/obesity was associated with distinct clinical, healthcare-use, behavioral, cognitive, and functional characteristics, even after adjustment for sociodemographic, clinical, functional, and psychosocial characteristics. These findings support the importance of comprehensive multidisciplinary assessment and care to address the heterogeneous and coexisting nutritional challenges of aging. Full article

(This article belongs to the Special Issue The Impact of Social Inequalities on the Oral Health of Vulnerable Populations)

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18 pages, 311 KB

Open AccessArticle

Seeing the Same Challenges Differently: A Comparative Qualitative Analysis of Adolescent and Guidance and Counseling Coordinator Perspectives on School-Based Mental Health in Northern Ghana

by Claudia L. Leung, Priscilla Kukua Goka, Ishmael Adu, Barnabas Atangongo, Rashid Atchulo, Mansur Mohammed Musah Bingle, Laud Boateng, Keng-Yen Huang, Neda Laiteerapong, Anna Volerman, Peter Mintir Amadu and William Frank Hill Koomson

Int. J. Environ. Res. Public Health 2026, 23(9), 1204; https://doi.org/10.3390/ijerph23091204 - 11 Sep 2026

Viewed by 154

Abstract

Adolescent mental health is a high priority in low- and middle-income countries (LMICs), yet perspectives may differ among youth and adult providers responsible for supporting mental health within schools. These differences may create challenges for designing contextually appropriate school-based preventive strategies. This qualitative [...] Read more.

Adolescent mental health is a high priority in low- and middle-income countries (LMICs), yet perspectives may differ among youth and adult providers responsible for supporting mental health within schools. These differences may create challenges for designing contextually appropriate school-based preventive strategies. This qualitative study compared adolescent and school guidance and counseling coordinator (GCC) perspectives on factors influencing adolescent mental health and support in all 12 public senior high schools in Tamale, Ghana. GCC data were collected through semi-structured interviews informed by the Consolidated Framework for Implementation Research, and adolescent data was through human-centered design workshops. Data were analyzed using rapid qualitative analysis and organized using the Social Ecological Model. At the individual level, adolescents linked emotional distress, stress, and substance use to mental health challenges, whereas GCCs more commonly framed these as behavioral or academic challenges. At the interpersonal level, both groups identified peer relationships and confidentiality as important influences on help-seeking; adolescents emphasized trusted peer relationships, while GCCs described challenges implementing peer counseling approaches within schools. At the organizational level, adolescents emphasized teacher attitudes and punitive school responses to student distress, while GCCs emphasized staffing shortages, limited infrastructure, and insufficient institutional support. At the community level, both groups identified stigma and gendered social norms as barriers to mental health support. Adolescents and GCCs identified similar concerns but differed in how they understood adolescent mental health and support within schools. Integrating both youth and provider perspectives may strengthen multilevel school-based preventive strategies in resource-constrained settings. Full article

(This article belongs to the Special Issue Health Promotion in Childhood and Adolescence)

15 pages, 7414 KB

Open AccessArticle

The HIV/AIDS Epidemic in Minas Gerais, Brazil, 2009–2022: An Analysis of Geographic, Demographic, and Temporal Factors of Health Macroregions

by Pedro Stringelli-Brandão, Fabrício Anibal Corradini, Gilberto de Araújo Pereira, Wellington Roberto Gomes de Carvalho and Sybelle de Souza Castro

Int. J. Environ. Res. Public Health 2026, 23(9), 1203; https://doi.org/10.3390/ijerph23091203 - 11 Sep 2026

Viewed by 136

Abstract

This study assessed the geographic, demographic, and temporal factors underlying the evolution of the HIV/AIDS epidemic across the health macroregions of Minas Gerais, Brazil, comparing the periods before (2009–2014) and after (2015–2022) the implementation of universal HIV notification and immediate antiretroviral therapy (ART). [...] Read more.

This study assessed the geographic, demographic, and temporal factors underlying the evolution of the HIV/AIDS epidemic across the health macroregions of Minas Gerais, Brazil, comparing the periods before (2009–2014) and after (2015–2022) the implementation of universal HIV notification and immediate antiretroviral therapy (ART). An ecological study was conducted using statewide surveillance and clinical monitoring databases. Epidemiological indicators, including HIV detection, AIDS incidence, AIDS-related mortality, ART coverage, and sustained viral suppression (SVS), were analyzed according to sex and health macroregion using generalized linear models with negative binomial regression and spatial analysis. HIV detection increased markedly following the expansion of mandatory notification, while ART coverage and SVS also increased significantly. In contrast, AIDS incidence and AIDS-related mortality declined during the later period. Substantial heterogeneity was observed across macroregions, with important differences in epidemiological indicators and HIV care cascade performance. These findings demonstrate that the benefits of expanded HIV detection and universal ART have not been distributed uniformly across the state. Regional disparities in access to diagnosis, treatment, and long-term care remain important barriers to HIV control, highlighting the need for targeted, region-specific public health strategies to reduce territorial inequalities and strengthen the HIV care cascade. Full article

(This article belongs to the Special Issue Spatial and Spatiotemporal Epidemiology of HIV/AIDS Prevalence)

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19 pages, 2396 KB

Open AccessArticle

Co-Creating a Culturally Responsive Parenting Program for Families of a Disabled Child in Aotearoa New Zealand

by Rebekah Graham, Louise Were, Marcia Ranginui Charlton and Trisha Benge

Int. J. Environ. Res. Public Health 2026, 23(9), 1202; https://doi.org/10.3390/ijerph23091202 - 11 Sep 2026

Viewed by 167

Abstract

Parenting programs in Aotearoa New Zealand are typically designed by and for non-Indigenous parents of non-disabled children, yet are routinely promoted to all families, including Māori (the Indigenous people of Aotearoa) and families of disabled children, despite limited cultural relevance. This paper describes [...] Read more.

Parenting programs in Aotearoa New Zealand are typically designed by and for non-Indigenous parents of non-disabled children, yet are routinely promoted to all families, including Māori (the Indigenous people of Aotearoa) and families of disabled children, despite limited cultural relevance. This paper describes and discusses the co-creation of a culturally responsive program for whānau (families) of a disabled child, undertaken over three years using a participatory, culturally informed approach. Drawing on key practices from te Ao Māori (the Māori worldview)—including whakawhanaungatanga (relationship building), tuakana-teina (peer-to-peer support), and koha atu koha mai (reciprocity)—the team developed and iteratively tested a wānanga-style program across three stages of development (foundation building, program drafting, and program testing). Evaluation data was collected from participants (n = 16), facilitators (n = 3), and authors, using anonymous online surveys (participants, facilitators), in-person discussion (facilitators), and reflective observation (authors). Data analysis was pragmatic and participatory in design, prioritizing collective sense-making. Findings indicate that whānau highly valued dedicated time for wellbeing reflection, culturally grounded content (particularly the Whiti Te Rā wellbeing model), peer connection, and practical supports such as on-site childcare. The paper reflects on the intentionality required for working together, including the need to center Māori knowledge, flatten power dynamics, and slow down program development to prioritize relationship over output. This work contributes to community psychology and public health scholarship as an example of decolonial, anti-racist practice in community health program design. This paper offers a template for how culturally responsive, co-created program design and delivery can work in practice. Full article

(This article belongs to the Section Global Health)

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21 pages, 3642 KB

Open AccessArticle

by Nipakorn Nanta, Pongthorn Chanlearn, Kriengkrai Srithanaviboonchai, Arunrat Tangmunkongvorakul, Suchada Thaweesit, Sulaiporn Chonwilai, Niwat Suwanphatthana, Karoline Soerensen, Patchara Benjarattanaporn and Lucy R. Stackpool-Moore

Int. J. Environ. Res. Public Health 2026, 23(9), 1201; https://doi.org/10.3390/ijerph23091201 - 10 Sep 2026

Viewed by 186

Abstract

Background: HIV-related stigma and discrimination remain barriers to equitable HIV prevention, treatment, and well-being in Thailand despite their longstanding inclusion in the national HIV response. This study examined contemporary experiences of stigma and discrimination among people living with HIV. Methods: The people living [...] Read more.

Background: HIV-related stigma and discrimination remain barriers to equitable HIV prevention, treatment, and well-being in Thailand despite their longstanding inclusion in the national HIV response. This study examined contemporary experiences of stigma and discrimination among people living with HIV. Methods: The people living with HIV Stigma Index 2.0 was a community-led mixed-methods study conducted from August 2022 to January 2023. The quantitative survey enrolled 2508 people living with HIV from 24 provinces covering all 13 health regions, including general adults living with HIV, four key population groups, migrant workers, and young people. A nested qualitative study included 174 in-depth interviews across six population groups. Results: Sixteen percent of participants reported HIV-related discrimination in healthcare services in the previous 12 months, 4.7% reported community stigma in the past 12 months, 39.0% reported internalized stigma, and 2.7% experienced rights abuse in the past 12 months. Younger people living with HIV reported significantly higher levels of healthcare discrimination, community stigma, internalized stigma, and rights abuse than older participants and the general people living with HIV reference group. Compared with general people living with HIV, sex workers and people who use drugs reported significantly higher levels of community stigma; men who have sex with men, sex workers, people who use drugs, and migrant workers reported significantly higher internalized stigma; and transgender people and sex workers reported significantly higher levels of rights abuse. Qualitative findings highlighted anticipated and enacted stigma, confidentiality concerns, internalized stigma, intersecting identities, rights violations, and resilience. Conclusions: HIV-related stigma remains evident in healthcare, community, and personal domains. Younger people living with HIV and key populations were particularly vulnerable to HIV-related stigma, discrimination, and rights abuse. Responses should combine updated public communication, stigma-free and person-centered healthcare, protection of privacy and rights, support for internalized stigma and mental well-being, and sustained leadership of people living with HIV. Full article

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17 pages, 450 KB

Open AccessReview

Opening a Rural Maternity Care Center Amid Nationwide Closures: A Case Study of Implementation and Opportunities

by Dana Iglesias, Jesus Ruiz, Emily C. Sheffield and Margaret R. Helton

Int. J. Environ. Res. Public Health 2026, 23(9), 1200; https://doi.org/10.3390/ijerph23091200 - 10 Sep 2026

Viewed by 121

Abstract

Rural maternity care in the United States faces an unprecedented crisis. As of 2022, more than half of rural hospitals lacked obstetric services, leaving many rural communities without local maternity care. This descriptive case study documents the implementation of maternity services at a [...] Read more.

Rural maternity care in the United States faces an unprecedented crisis. As of 2022, more than half of rural hospitals lacked obstetric services, leaving many rural communities without local maternity care. This descriptive case study documents the implementation of maternity services at a 25-bed rural critical access hospital in North Carolina. We reviewed and coded data derived from the following sources from 2020–2025: institutional planning documents, clinical protocols, standard workflows, operational procedures, administrative records, meeting minutes, presentations and summaries, and published commentaries, manuscripts and articles related to the new maternity unit. We identified six critical domains for sustainability: (1) hospital and community engagement, (2) stable multidisciplinary staffing models, (3) emergency preparedness, (4) anesthesia service delivery, (5) financial sustainability, and (6) risk-appropriate scope of care. Successful implementation required integrated approaches across organizational dimensions facilitated by committed institutional leadership; community advocacy; innovative staffing models with family physicians, certified nurse-midwives, and certified registered nurse anesthetists; competency-based emergency training; Medicaid-based financial sustainability; and explicit risk stratification with clear interfacility communication protocols. Workforce sustainability emerged as the most significant ongoing challenge. Rural maternity service sustainability requires multifaceted, evidence-based approaches integrating workforce development, organizational infrastructure, financial mechanisms, and clear scope definitions. This case study demonstrates a model of perinatal regionalized and risk-appropriate care with replicable strategies that can inform efforts to address maternal health equity and strengthen rural health care systems. Full article

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

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33 pages, 842 KB

Open AccessReview

Teacher Burnout and Burnout-Related Outcomes in Educational Settings: A Scoping Review of Mental Health Promotion and Prevention Interventions

by Szergej Malhazjan and Bettina F. Piko

Int. J. Environ. Res. Public Health 2026, 23(9), 1199; https://doi.org/10.3390/ijerph23091199 - 10 Sep 2026

Viewed by 118

Abstract

This scoping review aimed to map empirical interventions in teacher and educator populations in which burnout or burnout-related outcomes were evaluated from a broad mental health promotion and prevention perspective. Searches were conducted in Scopus, ERIC, PubMed/MEDLINE, and Web of Science. The search [...] Read more.

This scoping review aimed to map empirical interventions in teacher and educator populations in which burnout or burnout-related outcomes were evaluated from a broad mental health promotion and prevention perspective. Searches were conducted in Scopus, ERIC, PubMed/MEDLINE, and Web of Science. The search strategy was broadened to improve sensitivity by removing the mandatory study-design block and expanding intervention-related terminology. A structured evidence map was used to chart reports by intervention category, population, intervention level, study design, burnout-related outcome, follow-up, and research gaps, following PRISMA-ScR reporting principles and established scoping review methodological guidance. The final evidence base comprised 123 eligible reports. Interventions spanned cognitive-behavioral and rational-emotive approaches, mindfulness and mind–body programs, compassion- and emotion-focused interventions, social–emotional and trauma-informed approaches, professional development, classroom-management and instructional-practice interventions, and broader occupational or organizational approaches. Emotional exhaustion was the most frequently represented burnout-related dimension, although substantial heterogeneity was evident in intervention content, design, measurement, and follow-up. No formal risk-of-bias or methodological quality assessment was conducted. The evidence base is substantial but heterogeneous, and future research should more directly evaluate sustained, context-sensitive, organizational, and multilevel approaches alongside individual- and classroom/practice-level interventions. Full article

19 pages, 352 KB

Open AccessArticle

Exploring Awareness, Beliefs, and Perceptions of HPV and Cervical Cancer Prevention Among Cape Verdean Immigrant Mothers in Massachusetts, United States: A Qualitative Study

by Ana Cristina Lindsay, Monica Pereira, Celestina V. Antunes, Aysha G. Pires and Denise Lima Nogueira

Int. J. Environ. Res. Public Health 2026, 23(9), 1198; https://doi.org/10.3390/ijerph23091198 - 10 Sep 2026

Viewed by 87

Abstract

Cape Verdean immigrants are a growing yet understudied population in the United States (U.S.), with limited data on HPV and cervical cancer prevention knowledge. This descriptive qualitative study explored awareness, knowledge, beliefs, and perceptions related to HPV and cervical cancer prevention among Cape [...] Read more.

Cape Verdean immigrants are a growing yet understudied population in the United States (U.S.), with limited data on HPV and cervical cancer prevention knowledge. This descriptive qualitative study explored awareness, knowledge, beliefs, and perceptions related to HPV and cervical cancer prevention among Cape Verdean immigrant mothers of children aged 11–17 residing in Massachusetts, a state in the northeastern U.S. A qualitative descriptive design was used. Semi-structured interviews were conducted with 27 Cape Verdean immigrant mothers of adolescents aged 11–17 residing in the study area. Interviews were transcribed, translated, and analyzed thematically using inductive and deductive approaches guided by the literature and emergent narratives. MAXQDA was used for data management, and coding reliability was established through independent review by bilingual researchers. Participants demonstrated varying levels of awareness, ranging from comprehensive understanding to limited knowledge. Two major themes emerged: (1) knowledge and beliefs about cervical cancer and (2) knowledge and beliefs about HPV. Findings revealed fragmented knowledge, misconceptions about screening and transmission, and gendered perceptions of HPV as a “women’s issue.” While many mothers valued prevention and recognized HPV’s link to cervical cancer, uncertainties remained regarding vaccination, screening recommendations, and vaccine effectiveness. Findings highlight the need for culturally and linguistically tailored interventions addressing HPV misinformation, strengthening parental confidence, and supporting Cape Verdean mothers as informed health decision-makers to improve HPV vaccination and cervical cancer prevention. Full article

(This article belongs to the Special Issue HPV Infection in Minoritized Populations: Addressing Challenges in Prevalence, Transmission, and Prevention)

20 pages, 315 KB

Open AccessArticle

Development and Validation of a Psychometric Questionnaire to Measure Knowledge and Attitudes Towards Traditional Male Circumcision and the Links with HIV Transmission in Indonesia

by Gregorius Abanit Asa, Nelsensius Klau Fauk, Hailay Abrha Gesesew and Paul R. Ward

Int. J. Environ. Res. Public Health 2026, 23(9), 1197; https://doi.org/10.3390/ijerph23091197 - 10 Sep 2026

Viewed by 84

Abstract

Traditional male circumcision (TMC) is viewed as a rite of passage from childhood to manhood. In the Atoni Meto tribe in Indonesia, this practice requires initiates to engage in unprotected sexual intercourse with unrelated women following circumcision, thereby exposing both men and women [...] Read more.

Traditional male circumcision (TMC) is viewed as a rite of passage from childhood to manhood. In the Atoni Meto tribe in Indonesia, this practice requires initiates to engage in unprotected sexual intercourse with unrelated women following circumcision, thereby exposing both men and women to the risk of HIV transmission. However, there is a lack of validated questionnaires in Indonesia to measure knowledge and attitudes towards TMC and the associated risk of HIV transmission. This study aimed to develop and validate a questionnaire aimed at measuring the knowledge and attitudes of men aged 18 to 49 years in West Timor, Indonesia, regarding TMC and the risk of HIV transmission linked to the practice and subsequent sexual intercourse. A series of validations was conducted, including content validity, face validity, test-retest reliability, exploratory factor analysis, and inter-item correlation. The EFA was conducted with 140 participants. The Kaiser–Meyer–Olkin test for the knowledge factor was 0.759, and the attitudes factor was 0.797, with Bartlett’s test of sphericity p-value < 0.001 indicating that the data were suitable to proceed with further factor analysis. Cronbach’s alpha values for knowledge and attitudes were 0.861 and 0.824, respectively, suggesting good internal consistency. The questionnaire provides preliminary evidence of its validity and reliability in assessing Indonesian men’s knowledge and attitudes on TMC and HIV transmission. Full article

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

17 pages, 328 KB

Open AccessArticle

Daily Sitting Time and Musculoskeletal Symptoms Are Associated with Poorer Health-Related Quality of Life Among University Employees

by Jakeline López Rodríguez, Josué Prieto Prieto, Eduardo Mateos Martín and Carlos Moreno Pascual

Int. J. Environ. Res. Public Health 2026, 23(9), 1196; https://doi.org/10.3390/ijerph23091196 - 10 Sep 2026

Viewed by 150

Abstract

University employees are increasingly exposed to prolonged sitting, yet the relationships between daily sitting time, musculoskeletal symptoms (MSS), and health-related quality of life (HRQoL) in this occupational population remain insufficiently understood. This study aimed to estimate the prevalence, anatomical distribution, and chronicity of [...] Read more.

University employees are increasingly exposed to prolonged sitting, yet the relationships between daily sitting time, musculoskeletal symptoms (MSS), and health-related quality of life (HRQoL) in this occupational population remain insufficiently understood. This study aimed to estimate the prevalence, anatomical distribution, and chronicity of MSS among university employees and to explore their associations with daily sitting time and sociodemographic, occupational, and behavioural factors, as well as the relationships of these factors and MSS with HRQoL. A cross-sectional study was conducted among 893 academic and non-academic employees at a Spanish university. Participants completed an online questionnaire including sociodemographic and occupational characteristics, the Nordic Musculoskeletal Questionnaire, the 12-item Short Form Health Survey (SF-12), and the International Physical Activity Questionnaire. Multivariable logistic and linear regression models were used to examine factors associated with MSS and HRQoL. Female sex (OR = 1.58; 95% CI: 1.07–2.32), younger age (OR = 0.98; 95% CI: 0.96–0.99), and longer daily sitting time (OR = 1.001; 95% CI: 1.000–1.002) were associated with MSS after mutual adjustment. Overall, 82.8% of participants reported MSS during the previous 12 months, most frequently affecting the back (58.8%) and neck (49.2%). Daily sitting time was also associated with poorer mental HRQoL after mutual adjustment, whereas duration of work limitation due to MSS showed the strongest association with poorer physical HRQoL. Symptom prevalence was similar in academic and non-academic staff, although non-academic employees reported greater symptom chronicity and treatment use. MSS are highly prevalent among university employees and are associated with poorer HRQoL. Daily sitting time represents a potentially modifiable behavioural factor that should be considered in health promotion strategies within higher education institutions. Full article

(This article belongs to the Special Issue Advancing Workplace Health Management: Strategies, Challenges and Future Directions)

19 pages, 651 KB

Open AccessArticle

Exploring Healthcare Students’ Perspectives on Physical Activity: A Qualitative Study of Habits, Barriers and Facilitators, Academic Self-Efficacy, and Their Role as Future Health Promoters

by Lāsma Spundiņa, Una Veseta and Agita Abele

Int. J. Environ. Res. Public Health 2026, 23(9), 1195; https://doi.org/10.3390/ijerph23091195 - 10 Sep 2026

Viewed by 199

Abstract

PA is an important determinant of health and well-being; however, many university students, including healthcare students, do not achieve recommended activity levels despite their future role in health promotion. This study aimed to explore healthcare students’ perspectives on physical activity, including their habits, [...] Read more.

PA is an important determinant of health and well-being; however, many university students, including healthcare students, do not achieve recommended activity levels despite their future role in health promotion. This study aimed to explore healthcare students’ perspectives on physical activity, including their habits, perceived barriers and facilitators, the relationship between physical activity and academic self-efficacy, and its role in their future professional identity. A qualitative descriptive design was applied using semi-structured individual interviews with 15 healthcare students. Data were analyzed using Braun and Clarke’s six-phase reflexive thematic analysis approach. Five interrelated themes were identified: physical activity as a resource for health, well-being, and academic functioning; academic demands shaping physical activity behavior; physical activity strengthening academic self-efficacy; physical activity as part of professional identity; and the university environment as a facilitator of physical activity. Students perceived physical activity as supporting physical and mental well-being, stress management, concentration, and daily functioning. Academic workload, limited time, fatigue, financial constraints, and motivational challenges were identified as barriers, whereas institutional support and flexible opportunities facilitated participation. Students also viewed physical activity as contributing to confidence, discipline, and their perceived credibility as future healthcare professionals. Supportive university environments may help healthcare students maintain active lifestyles and support the development of their role as health-promoting professionals. Full article

(This article belongs to the Special Issue Physical Activity and Its Association with Health in University Students)

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10 pages, 253 KB

Open AccessArticle

Exploring the Impact of Occupational Hazards on the Mental Health of Farmworkers: A Qualitative Study in Maruleng, Limpopo Province

by Letladi Kamogelo Moagi, Mokoko Percy Kekana and Bonelwa Sidumo

Int. J. Environ. Res. Public Health 2026, 23(9), 1194; https://doi.org/10.3390/ijerph23091194 - 10 Sep 2026

Viewed by 139

Abstract

Mental health encompasses emotional, psychological, and social well-being, influencing how individuals’ function and cope with life events. In the agricultural industry, the use of machinery and chemicals to increase productivity exposes farmworkers to a range of occupational hazards. These hazards often create unsafe [...] Read more.

Mental health encompasses emotional, psychological, and social well-being, influencing how individuals’ function and cope with life events. In the agricultural industry, the use of machinery and chemicals to increase productivity exposes farmworkers to a range of occupational hazards. These hazards often create unsafe working conditions that can contribute to mental health problems, including anxiety and depression. This study explored the impact of the occupational hazards on the mental health of the farmworkers at Maruleng, Limpopo Province. A qualitative research approach and phenomenological research design were adopted. In-depth individual, semi-structured interviews were conducted with 15 farmworkers. The interviews were guided by a central question. Data were audio-recorded, transcribed and analysed using Tesch’s eight-step of open-coding method. The findings indicate that farmworkers in Maruleng are exposed to a range of occupational hazards that adversely affect their mental health. Participants reported experiencing significant psychological strain associated with unsafe working conditions on the farms. Employers were found to inadequately protect workers, as evidenced by poor maintenance of farm machinery, insufficient pesticides handling training, and the lack of appropriate and adequate personal protective equipment (PPE). The study concludes that limited institutional support and inadequate access to mental health services exacerbate risks to the health and safety of farmworkers in Maruleng. To address these challenges, mental health support should be strengthened through the implementation of employee assistance programmes on the farms and other relevant services. In addition, regular monitoring of machinery maintenance, working conditions and safety protocol practices on the farms is essential to ensure compliance with occupational health and safety standards. Full article

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

17 pages, 658 KB

Open AccessArticle

Healthcare Access for Adults with Multiple Chemical Sensitivity in Canada: A Descriptive Online Cross-Sectional Survey

by Nene A. Diallo, John Molot, Riina Bray, Adrianna Trifunovski and Rohini Peris

Int. J. Environ. Res. Public Health 2026, 23(9), 1193; https://doi.org/10.3390/ijerph23091193 - 10 Sep 2026

Viewed by 187

Abstract

Multiple chemical sensitivity (MCS) is a chronic condition characterized by adverse multisystem reactions triggered by chemical exposures, including at low levels. The use of fragranced and disinfectant products within healthcare institutions was frequently reported by individuals with MCS as a challenge to accessing [...] Read more.

Multiple chemical sensitivity (MCS) is a chronic condition characterized by adverse multisystem reactions triggered by chemical exposures, including at low levels. The use of fragranced and disinfectant products within healthcare institutions was frequently reported by individuals with MCS as a challenge to accessing healthcare. This study was conducted during the COVID-19 pandemic, when infection control measures may have intensified the pre-existing chemical-exposure barriers for people with MCS. This study examines healthcare access among adults with MCS in Canada, including access to diagnosis and physicians and satisfaction with in-person and virtual care. A national cross-sectional online survey was conducted between January and February 2021 among adults living with MCS for at least one year prior to the pandemic. Quantitative and open-ended questions captured experiences related to diagnosis, access to physicians, and satisfaction with virtual and in-person healthcare. Of the 119 participants who completed the survey, most reported having a formal diagnosis of MCS (78.2%, n = 93, 95% CI 69.9–84.6). Among those who could not obtain an MCS diagnosis (N = 26), common barriers included obtaining any other diagnosis but MCS (61.5%, n = 16; 42.5–77.6), and the belief among medical professionals that MCS does not exist (57.7%, n = 15; 38.9–74.5). Among participants who gave reasons for dissatisfaction with virtual care (n = 32), 87.5% (71.9–95.0) cited the clinician’s lack of understanding of the condition, whereas technical problems were rarely reported (12.5%, 5.0–28.1). Among participants who reported dissatisfaction with in-person care (n = 41), 85.4% (71.6–93.1) cited the clinician’s lack of understanding of the condition, and 85.4% (71.6–93.1) cited chemical exposures, including scented disinfectants, soaps or sanitizers, while 80.5% (66.0–89.8) cited cleaning products on surfaces. Participants’ responses suggest that pandemic-related public health responses intensified pre-existing barriers to care for people with MCS by increasing chemical exposures and constraining access to knowledgeable providers. These findings highlight the need for healthcare systems and emergency preparedness frameworks that integrate chemical safety, disability inclusion, and provider education to ensure equitable access, including during public health crises. Full article

(This article belongs to the Special Issue Understanding Multiple Chemical Sensitivity (MCS): Interdisciplinary Insights into Science, Policy, and Lived Experience)

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10 pages, 265 KB

Open AccessArticle

Psychological Distress and Perceived Burden Among Informal Caregivers of Individuals with Intellectual Disabilities in Mongolia

by Delgermaa Sendmaa, Namuun Ganbaatar, Erdenetuul Nuden, Enkhtuul Chuluun, Anudari Batsukh, Sundui-Yanjmaa Luvsangenden, Khishigsuren Zuunnast, Myagmartseren Dashtseren, Naranbaatar Nyam, Orgilmaa Regzedmaa and Oyungoo Badamdorj

Int. J. Environ. Res. Public Health 2026, 23(9), 1192; https://doi.org/10.3390/ijerph23091192 - 10 Sep 2026

Viewed by 385

Abstract

Background: Informal caregiving for individuals with intellectual disabilities can involve sustained psychological and social demands. This study assessed caregiver burden and psychological distress among informal caregivers of individuals with intellectual disabilities in Mongolia and examined their associations with caregiver and care-recipient characteristics. Methods: [...] Read more.

Background: Informal caregiving for individuals with intellectual disabilities can involve sustained psychological and social demands. This study assessed caregiver burden and psychological distress among informal caregivers of individuals with intellectual disabilities in Mongolia and examined their associations with caregiver and care-recipient characteristics. Methods: This descriptive cross-sectional study included 642 informal caregivers recruited from primary health care centers and the National Center for Mental Health in Ulaanbaatar. Psychological distress was assessed with the 42-item Depression Anxiety Stress Scales (DASS-42), and caregiver burden with the Zarit Burden Interview (ZBI). Results: The mean ZBI score was 39.03 ± 14.68, and 48.9% of caregivers had moderate-to-severe or severe burden. Severe or extremely severe symptoms were observed in 25.9% of participants for depression, 49.5% for anxiety, and 15.2% for stress. ZBI scores correlated positively with depression (r = 0.537), anxiety (r = 0.519), and stress (r = 0.584) (all p < 0.001). In multivariable models, higher ZBI scores remained associated with higher depression (β = 0.313), anxiety (β = 0.306), and stress scores (β = 0.355) (all p < 0.001). Conclusions: Caregiver burden and psychological distress were common and closely associated in this sample. Routine assessment of caregiver mental health, together with caregiver-focused psychosocial and community support, should be considered in services for individuals with intellectual disabilities. Full article

(This article belongs to the Special Issue Mental Health Services in Primary Care Settings: Challenges, Opportunities and Best Practices)

13 pages, 1112 KB

Open AccessArticle

Effect of a LINE-Application-Based “PASS” Program on Depression in Myanmar Migrant Factory Workers: A Randomized Controlled Trial

by Nanda Win, Pankaew Tantirattanakulchai, Win Myint Thu and Worapath Kratoo

Int. J. Environ. Res. Public Health 2026, 23(9), 1191; https://doi.org/10.3390/ijerph23091191 - 9 Sep 2026

Viewed by 255

Abstract

Depression is a common mental health issue among migrant workers. This study was designed to investigate the effectiveness of a LINE-application-based PASS program on depression scores among Myanmar migrant factory workers in Samut Prakan, Thailand. This randomized controlled trial was conducted in nine [...] Read more.

Depression is a common mental health issue among migrant workers. This study was designed to investigate the effectiveness of a LINE-application-based PASS program on depression scores among Myanmar migrant factory workers in Samut Prakan, Thailand. This randomized controlled trial was conducted in nine factories in Samut Prakan, Thailand. One hundred and forty-four factory workers were randomly allocated between the intervention and control groups (72 participants in each group). The PASS program was implemented in the intervention group. A self-administered method was used at three time points—baseline, immediately after the intervention, and at the three-month follow-up. The generalized linear mixed model was used for statistical analysis. There were no statistically significant between-group differences in sociodemographic characteristics or depression at baseline. According to the generalized linear mixed model, the intervention group demonstrated a significantly greater reduction in depression scores than the control group (p < 0.001). The PASS program intervention significantly reduced depression scores, with sustained effects at three months. It also provides a suggestion for stakeholders, particularly public health organizations, that they need to implement measures to reduce depression and to prevent more serious psychological health issues among Myanmar migrant factory workers in the future. Full article

(This article belongs to the Special Issue Psychological Well‑Being and Psychosocial Risks in Evolving Workplaces and Communities)

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19 pages, 952 KB

Open AccessReview

Texting Support for Mental Health Care: A Scoping Review

by Fatima Tuz Zehra, Amjad Junaid Bin Faidh, Dougal Nolan and Abraham Rudnick

Int. J. Environ. Res. Public Health 2026, 23(9), 1190; https://doi.org/10.3390/ijerph23091190 - 9 Sep 2026

Viewed by 192

Abstract

Introduction: Mobile phone text messaging (Short Message Service; SMS) interventions are digital health strategies that may support mental health care. This scoping review examined related study designs, outcomes, and gaps across the literature. Methods: Systematic searches identified 38 eligible studies from 1542 abstracts. [...] Read more.

Introduction: Mobile phone text messaging (Short Message Service; SMS) interventions are digital health strategies that may support mental health care. This scoping review examined related study designs, outcomes, and gaps across the literature. Methods: Systematic searches identified 38 eligible studies from 1542 abstracts. Data were extracted and thematically analyzed to identify trends and outcomes. Texting interventions were categorized as cognitive, motivational, instrumental/practical, or combined approaches. Results: Study design included randomized controlled trials (RCTs), quasi-experimental pilots and systematic reviews, with RCTs providing the strongest evidence for improvements in adherence and relapse prevention. Outcomes included behavioral measures (e.g., medication adherence, therapy homework completion, and reduced non-attendance) alongside clinical measures (e.g., symptom reduction and relapse prevention). Cognitive reminders that were most common reduced non-attendance and improved adherence, particularly for medication and appointments, although they were less effective in severe depression. Motivational and combined interventions demonstrated higher acceptability and engagement, particularly in adolescents and high-risk individuals. Success was influenced by diagnosis, age, gender, and social status, including adherence at baseline. Conclusions: Overall, text-based interventions were generally acceptable, accessible, and cost-effective for improving mental health engagement. Limitations included lack of long-term evaluations, technological barriers, and lack of personalization. Future research should address these gaps and include underrepresented populations. Full article

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

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40 pages, 2723 KB

Open AccessArticle

“I Wish We Could Have Done More”: A Narrative Case Study of Emerging Volunteer Engagement During COVID-19

by Edward Pontius, Richard Lewis, Susan Peixotto and Paula Connor-Crouch

Int. J. Environ. Res. Public Health 2026, 23(9), 1189; https://doi.org/10.3390/ijerph23091189 - 9 Sep 2026

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Abstract

The COVID-19 pandemic placed prolonged, multi-year demands on the systems supporting frontline workers in healthcare, public safety, and education. In response, approximately 150 licensed behavioral-health professionals and credentialed educators, trained in Psychological First Aid (PFA), built and staffed the Maine FrontLine WarmLine (MFLWL) [...] Read more.

The COVID-19 pandemic placed prolonged, multi-year demands on the systems supporting frontline workers in healthcare, public safety, and education. In response, approximately 150 licensed behavioral-health professionals and credentialed educators, trained in Psychological First Aid (PFA), built and staffed the Maine FrontLine WarmLine (MFLWL) as unpaid Volunteers from 21 March 2020 through 31 May 2021 and began fielding calls in April 2020, contributing approximately 33,000 h of service. Although the MFLWL fielded 100 calls in aggregate, engagement persisted and expanded into Community Outreach, reaching approximately 250 frontline workers. To understand that paradox, this narrative case study analyzed two waves of open-ended Volunteer surveys (n = 22; n = 20) using consensus-based thematic analysis. Four themes emerged: a specific COVID-19 frontline focus; personal and professional Calling; an intentionally cultivated Culture of self-care and relational support; and stakeholder relationships marked by experienced systemic betrayal and moral injury. Low call volume, rather than eroding engagement, appears to have activated Volunteers’ sense of Calling, converting frustrated readiness into new capability and new avenues of service. From these findings, we derive Emerging Volunteer Engagement (EVE), a values-and-process framework situated within Disaster Ecology that positions Volunteers as principal drivers of disaster response rather than interchangeable resources, with implications for Volunteer organization, support, and liability policy in future disasters. Full article

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Open AccessArticle

Reminiscence Therapy to Improve Self-Esteem, Loneliness, and Stress in Rural Thai Older Adults: A Quasi-Experimental Study

by Yaowaluck Meebunmak, Kannika Kitnopkiat and Parinyaporn Thanaboonpuang

Int. J. Environ. Res. Public Health 2026, 23(9), 1188; https://doi.org/10.3390/ijerph23091188 - 9 Sep 2026

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Abstract

Background: Loneliness, psychological stress, and low self-esteem are important mental health concerns among community-dwelling older adults and may negatively affect healthy ageing and quality of life. This study examined psychosocial outcomes associated with participation in a 4-week Hybrid Happy Reminiscence Program among community-dwelling [...] Read more.

Background: Loneliness, psychological stress, and low self-esteem are important mental health concerns among community-dwelling older adults and may negatively affect healthy ageing and quality of life. This study examined psychosocial outcomes associated with participation in a 4-week Hybrid Happy Reminiscence Program among community-dwelling older adults. Methods: A quasi-experimental pretest–posttest control group study was conducted between September and November 2025 among community-dwelling older adults in Don Tako Subdistrict, Ratchaburi Province, Thailand. Participants were recruited using purposive sampling based on predefined eligibility criteria and were subsequently assigned to either an experimental group (n = 30), which received the Hybrid Happy Reminiscence Program combining bi-weekly face-to-face group sessions with a digital intervention delivered through the LINE application, or a control group (n = 30), which received routine community care. No statistically significant between-group differences were detected in the measured baseline demographic characteristics (all p > 0.05). Primary outcomes included self-esteem, loneliness, and psychological stress. Results: Within the experimental group, self-esteem increased from baseline to posttest (t(29) = −8.07, p < 0.001), while loneliness (t(29) = 5.11, p < 0.001, Cohen’s d = 0.93) and psychological stress (t(29) = 6.59, p < 0.001, Cohen’s d = 1.20) decreased. At posttest, the experimental group had higher self-esteem than the control group (mean difference = 4.73, 95% CI: 3.23–6.23, t(58) = 6.32, p < 0.001) and lower loneliness scores (mean difference = −2.13, 95% CI: −3.27 to −1.00, t(58) = −3.78, p < 0.001). For psychological stress, the experimental group also had a lower mean score than the control group at posttest, although the confidence interval included zero (mean difference = −0.73, 95% CI: −1.51 to 0.04, t(58) = −1.89, p = 0.063). Conclusions: Participants receiving the Hybrid Happy Reminiscence Program showed greater post-intervention self-esteem and lower loneliness scores than those receiving routine community care. Although psychological stress decreased within the intervention group, the post-intervention between-group difference was not statistically significant. Given the quasi-experimental design and the non-random allocation procedure, these findings should be interpreted as group differences consistent with a possible beneficial effect of the program rather than definitive evidence of causality. Larger randomized controlled studies with longer follow-up periods are needed to confirm these findings and to distinguish intervention-specific effects from non-specific influences. Full article

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

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20 pages, 349 KB

Open AccessReview

Organizational Approaches Supporting Remote and Decentralized Kidney Replacement Therapy Across Geographically Isolated, Rural, Underserved, and Resource-Limited Settings

by Dinmuhamed Tazhdinov, Nurlan Dzhainakbaev, Akimzhan Zaynalov, Abay Shepetov, Ibrahim Aliosmanoglu, Adilkhan Tokpanov and Aray Aidarova

Int. J. Environ. Res. Public Health 2026, 23(9), 1187; https://doi.org/10.3390/ijerph23091187 - 9 Sep 2026

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Abstract

Background: Equitable access to kidney replacement therapy (KRT) remains a major challenge for patients living in geographically isolated, rural, and underserved settings. Organizational approaches, including tele-nephrology, remote patient monitoring, decentralized dialysis services, home dialysis support, rural outreach programs, and emergency preparedness strategies, have [...] Read more.

Background: Equitable access to kidney replacement therapy (KRT) remains a major challenge for patients living in geographically isolated, rural, and underserved settings. Organizational approaches, including tele-nephrology, remote patient monitoring, decentralized dialysis services, home dialysis support, rural outreach programs, and emergency preparedness strategies, have been increasingly used to address geographic and organizational barriers to KRT delivery. This review summarizes the available evidence on organizational approaches supporting remote and decentralized KRT delivery and examines their reported implications for healthcare accessibility, continuity of care, and service delivery. Methods: A structured literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science Core Collection, and the Cochrane Library for studies published between January 2016 and January 2026. Publications considered relevant addressed organizational, healthcare delivery, implementation, or health-system approaches supporting KRT accessibility, continuity, or delivery in geographically isolated, rural, underserved, disaster-affected, humanitarian, or resource-limited settings. Studies describing conventional facility-based dialysis without an organizational or healthcare delivery component were excluded. Relevant information on study characteristics, KRT modality, organizational approaches, implementation components, healthcare accessibility, continuity of care, and reported barriers and outcomes was extracted and narratively synthesized. Results: A total of 749 records were identified, and 12 publications were retained for detailed synthesis. The publications addressed tele-nephrology, remote monitoring, home dialysis support, rural outreach, decentralized and community-based dialysis, and emergency preparedness. Study designs, settings, organizational models, and outcomes varied substantially. Reported findings concerned specialist access, home and decentralized dialysis pathways, dialysis continuity, healthcare utilization, and implementation feasibility. Most publications were observational, pilot, implementation-based, or qualitative, limiting causal inference and direct comparison across settings. Conclusions: The literature describes organizational approaches that may address specific barriers to KRT access and continuity. However, heterogeneous and predominantly non-comparative evidence is insufficient to establish causal effectiveness or superiority of any specific model. Multicenter comparative studies with standardized organizational, patient-centered, and economic outcomes are needed to assess effectiveness, scalability, and sustainability. Full article

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Int. J. Environ. Res. Public Health, Volume 23, Issue 9 (September 2026) – 125 articles

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