International Journal of Environmental Research and Public Health

19 pages, 344 KiB

Open AccessArticle

Attachment Style During a Partner’s Deployment with the United States Navy: Associations with Relational Satisfaction, Stress, and Changes over Time

by Alaina M. Hansom and Laura K. Guerrero

Int. J. Environ. Res. Public Health 2025, 22(7), 1056; https://doi.org/10.3390/ijerph22071056 - 30 Jun 2025

Abstract

Separation from a loved one can trigger the attachment system and cause stress, especially for those with insecure attachment styles. The present study investigates how attachment style relates to the degree of stress and relational satisfaction individuals experience during one such situation—that of [...] Read more.

Separation from a loved one can trigger the attachment system and cause stress, especially for those with insecure attachment styles. The present study investigates how attachment style relates to the degree of stress and relational satisfaction individuals experience during one such situation—that of being separated from a partner who is on military deployment. Findings from a questionnaire distributed while participants’ partners were deployed show that secure attachment is positively related to relational satisfaction, whereas preoccupied and fearful attachment are negatively related to satisfaction. In addition, having a preoccupied or fearful attachment style is positively associated with experiencing deployment stress, whereas having a secure or dismissive style is negatively related to experiencing deployment stress. This study also addressed whether attachment style might change over the course of deployment and if affectionate writing would lead people to report becoming less insecure. Results from a quasi-experiment using a pre-test–post-test design showed that those who engaged in affectionate writing (versus innocuous writing or no writing) reported less preoccupied attachment over time. Both affectionate and innocuous writing led to less fearful attachment over time in comparison to a no-writing condition. Thus, communicating via writing may be an important tool for reducing attachment insecurity during military deployments. Full article

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

15 pages, 279 KiB

Open AccessReview

Moral Injury Among Medical Personnel and First Responders Across Different Healthcare and Emergency Response Settings: A Narrative Review

by Amit Rimon and Leah Shelef

Int. J. Environ. Res. Public Health 2025, 22(7), 1055; https://doi.org/10.3390/ijerph22071055 - 30 Jun 2025

Abstract

Moral injury is increasingly recognized as a significant concern among medical personnel and first responders, particularly in high-stress healthcare and emergency settings. This review aims to synthesize current evidence on the prevalence, risk factors, and outcomes of moral injury among medical personnel and [...] Read more.

Moral injury is increasingly recognized as a significant concern among medical personnel and first responders, particularly in high-stress healthcare and emergency settings. This review aims to synthesize current evidence on the prevalence, risk factors, and outcomes of moral injury among medical personnel and first responders across diverse healthcare and emergency response environments. We included peer-reviewed studies reporting on moral injury among medical personnel or first responders in any healthcare or emergency response setting, excluding studies that did not report original data or focused solely on military populations. We systematically searched PubMed, Google Scholar, and Central, up to April 2025. Risk of bias was assessed directly from the manuscripts. Data were synthesized narratively and, where possible, pooled using random-effects meta-analysis. A total of 41 studies involving 14,500 participants were included. The prevalence of moral injury ranged from 4.1% to 69.44% across settings. Key risk factors identified included exposure to traumatic events, organizational constraints, and lack of support. Meta-analysis indicated a significant association between moral injury and symptoms of PTSD. The evidence is limited by heterogeneity in measurement tools and study designs, as well as a moderate risk of bias in several included studies. In conclusion, moral injury is prevalent among medical personnel and first responders, with important implications for mental health interventions and organizational policy. This review was not funded externally, and is registered in PROSPERO (CRD420251019492). Full article

28 pages, 617 KiB

Open AccessReview

Unveiling the Impact: A Scoping Review of the COVID-19 Pandemic’s Effects on Racialized Populations in Canada

by Menna Komeiha, Iryna Artyukh, Oluwasegun J. Ogundele, Q. Jane Zhao, Notisha Massaquoi, Sharon Straus, Fahad Razak, Benita Hosseini, Navindra Persaud, Sharmistha Mishra, Azza Eissa, Mathieu Isabel and Andrew D. Pinto

Int. J. Environ. Res. Public Health 2025, 22(7), 1054; https://doi.org/10.3390/ijerph22071054 - 30 Jun 2025

Abstract

Objectives: The objective of this study was to examine the impact of the COVID-19 pandemic on racialized communities and individuals in Canada. Methods: This review followed the Joanna Briggs Institute (JBI) methodology and the PRISMA-ScR guidance on reporting scoping reviews. Ovid MEDLINE ALL, [...] Read more.

Objectives: The objective of this study was to examine the impact of the COVID-19 pandemic on racialized communities and individuals in Canada. Methods: This review followed the Joanna Briggs Institute (JBI) methodology and the PRISMA-ScR guidance on reporting scoping reviews. Ovid MEDLINE ALL, Embase Classic + Embase, CINAHL (Ebsco platform), PsycINFO, and Cochrane were searched for documents that were published after March 2020 and that reported on the social and economic impacts and health outcomes of the COVID-19 pandemic on generally healthy racialized populations that reside in Canada. Synthesis: A total of 39 documents were included in this review. Our results show racialized communities faced greater social, economic, and health impacts from the pandemic. These impacts were manifested in the form of high COVID-19 morbidity and mortality rates, increased discrimination, worsening mental health, difficulty in accessing healthcare, and challenges related to accessing food and basic necessities. Conclusion: Canadian racialized groups have been inequitably affected by the COVID-19 pandemic due to pre-existing inequalities and emerging discrimination. Responsive policy action and robust pandemic preparedness efforts are indispensable in adopting a proactive stance to prevent racialized populations from bearing a disproportionate burden of negative health crises in the future. This necessitates addressing pre-existing disparities and targeting social and economic vulnerability areas. By doing so, we can mitigate the reported social, economic, and health impacts experienced by racialized groups, including challenges related to accessing basic necessities, deteriorating mental health, and barriers to healthcare access. Full article

20 pages, 758 KiB

Open AccessReview

Adjustment Criteria for Air-Quality Standards by Altitude: A Scoping Review with Regulatory Overview

by Lenin Vladimir Rueda-Torres, Julio Warthon-Ascarza and Sergio Pacsi-Valdivia

Int. J. Environ. Res. Public Health 2025, 22(7), 1053; https://doi.org/10.3390/ijerph22071053 - 30 Jun 2025

Abstract

Air-quality standards (AQS) are key regulatory tools to protect public health by setting pollutant thresholds. However, most are based on sea-level data. High-altitude (HA) environments differ in atmospheric conditions, influencing pollutant behavior and human vulnerability. These differences have prompted proposals for altitude-specific AQS [...] Read more.

Air-quality standards (AQS) are key regulatory tools to protect public health by setting pollutant thresholds. However, most are based on sea-level data. High-altitude (HA) environments differ in atmospheric conditions, influencing pollutant behavior and human vulnerability. These differences have prompted proposals for altitude-specific AQS adjustments. This systematic review identifies models and criteria supporting such adaptations and examines regulatory air-quality frameworks in countries with substantial populations living at very high altitudes (VHA). This review follows PRISMA-P guidelines, focusing on studies examining AQS adjustment approaches based on altitude. The Population/Concept/Context (PCC) framework was used to define search terms: population (AQS), concept (air pollutants), and context (altitude), with equivalents. The literature was retrieved from PubMed, Scopus, Web of Science, and Gale OneFile: Environmental Studies and Policy. A total of 2974 articles were identified, with 2093 remaining after duplicate removal. Following title and abstract screening, 2081 papers were excluded, leaving 12 for full-text evaluation. Ultimately, six studies met the eligibility criteria. Three studies focused on adjustment models based on atmospheric conditions, such as temperature and pressure changes, while the other three examined human physiological responses, particularly the increased inhaled air volume. China, Peru, and Bolivia have the largest populations living above 3500 m a.s.l., yet none of these countries have specific air-quality regulations tailored to HA conditions. The review underscores the necessity for tailored AQS in HA environments, highlighting specific criteria related to both atmospheric conditions and human physiological responses. Full article

(This article belongs to the Special Issue Air Pollution Exposure and Its Impact on Human Health)

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16 pages, 3509 KiB

Open AccessArticle

Forecasting the Regional Demand for Medical Workers in Kazakhstan: The Functional Principal Component Analysis Approach

by Berik Koichubekov, Bauyrzhan Omarkulov, Nazgul Omarbekova, Khamida Abdikadirova, Azamat Kharin and Alisher Amirbek

Int. J. Environ. Res. Public Health 2025, 22(7), 1052; https://doi.org/10.3390/ijerph22071052 - 30 Jun 2025

Abstract

The distribution of the health workforce affects the availability of health service delivery to the public. In practice, the demographic and geographic maldistribution of the health workforce is a long-standing national crisis. In this study, we present an approach based on Functional Principal [...] Read more.

The distribution of the health workforce affects the availability of health service delivery to the public. In practice, the demographic and geographic maldistribution of the health workforce is a long-standing national crisis. In this study, we present an approach based on Functional Principal Component Analysis (FPCA) of data to identify patterns in the availability of health workers across different regions of Kazakhstan in order to forecast their needs up to 2033. FPCA was applied to the data to reduce dimensionality and capture common patterns across regions. To evaluate the forecasting performance of the model, we employed rolling origin cross-validation with an expanding window. The resulting scores were forecasted one year ahead using Autoregressive Integrated Moving Average (ARIMA) and Long Short-Term Memory (LSTM) methods. LSTM showed higher accuracy compared to ARIMA. The use of the FPCA method allowed us to identify national and regional trends in the dynamics of the number of doctors. We identified regions with different growth rates, highlighting where the most and least intensive growth is taking place. Based on the FPSA, we have predicted the need for doctors in each region in the period up to 2033. Our results show that the FPCA can serve as a significant tool for analyzing the situation relating to human resources in healthcare and be used for an approximate assessment of future needs for medical personnel. Full article

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

11 pages, 391 KiB

Open AccessArticle

Parental Low Level of Education and Single-Parent Families as Predictors of Poor Control of Type 1 Diabetes in Children Followed in French Guiana

by Christelle Boyom Samou-Fantcho, Falucar Njuieyon, Nadjia Aigoun and Narcisse Elenga

Int. J. Environ. Res. Public Health 2025, 22(7), 1051; https://doi.org/10.3390/ijerph22071051 - 30 Jun 2025

Abstract

This study aimed to determine the prevalence of type 1 diabetes mellitus (T1DM) in French Guiana and describe the social profiles of the patients. We conducted a multicenter cross-sectional study of children under 18 years who were diagnosed with type 1 diabetes and [...] Read more.

This study aimed to determine the prevalence of type 1 diabetes mellitus (T1DM) in French Guiana and describe the social profiles of the patients. We conducted a multicenter cross-sectional study of children under 18 years who were diagnosed with type 1 diabetes and followed up from 2002 to 2021. Over a 20-year period, 48 children under 18 years with type 1 diabetes living in French Guiana were included in the study, out of a total of 59 cases. There were 26 girls and 22 boys. The median age at diagnosis was 8.52 years [IQR 6–12]. The incidence rate was 5.9 per 100,000 people in children aged 0–18 years. The 5–9-year age group was the most affected (43.7% (95% CI 38–51%). Of these children, 56.2% (95% confidence interval 40–70%) lived in single-parent households, and 35% (95% CI 23–57%) of the parents had a primary education. Of the children, 29% (95% CI 21–42%) were from families with no resources. Diabetes was diagnosed by ketoacidosis in 56% (95% CI 38–74%) of the patients. Forty percent (95% CI 35–66%) of the patients had an HbA1c > 9%. There was an imbalance in the prevalence of children with higher Hba1c (>9%), with 18.7% (95% CI 10–29%, p < 0.001) of children whose parents had a low level of education having an Hba1c > 9% compared with only 6% (95% CI 3–10%) of children whose parents had a university degree, and a marked imbalance in the prevalence of children with High Hba1c (>9%) among children from single-parent families (22.9%, 95% CI 17–30%) compared with children whose parents lived in couples (8%%, 95% CI 5–12%). The 10–14-year age group (18.7%, 95% CI 11–25%) had the highest imbalance in the prevalence of poor diabetes control between children whose parents had lower versus higher education levels. Diabetic retinopathy and diabetic nephropathy were the only reported complications. The multivariate analysis showed that a low level of parental education (Odds ratio 2.9 [95% CI 2.1–4.5], p < 0.001) and single-parent families (Odds ratio 3.1 [95% CI 2.6–4.3], p < 0.001) were predictors of poor control of T1DM. However, the lack of social insurance coverage at diagnosis was not associated with poor T1DM control (p = 0.4). In conclusion, these sociodemographic factors should be considered when caring for children with T1DM in French Guiana. Full article

6 pages, 237 KiB

Open AccessReply

Reply to Sussman et al. Comment on “Svarch-Pérez et al. Methods for a Non-Targeted Qualitative Analysis and Quantification of Benzene, Toluene, and Xylenes by Gas Chromatography-Mass Spectrometry of E-Liquids and Aerosols in Commercially Available Electronic Cigarettes in Mexico. Int. J. Environ. Res. Public Health 2024, 21, 1308”

by Alejandro Svarch-Pérez, María Vanessa Paz-González, Carlota Ruiz-Juárez, Juan C. Olvera-Chacón, Angelina Larios-Solís, Santiago Castro-Gaytán, Eugenia Aldeco-Pérez and Jorge Carlos Alcocer-Varela

Int. J. Environ. Res. Public Health 2025, 22(7), 1050; https://doi.org/10.3390/ijerph22071050 - 30 Jun 2025

Abstract

The paper titled “Methods for a Non-Targeted Qualitative Analysis and Quantification of Benzene, Toluene, and Xylenes by Gas Chromatography-Mass Spectrometry of E-Liquids and Aerosols in Commercially Available Electronic Cigarettes in Mexico” was submitted in compliance with all the requirements of the editorial and [...] Read more.

The paper titled “Methods for a Non-Targeted Qualitative Analysis and Quantification of Benzene, Toluene, and Xylenes by Gas Chromatography-Mass Spectrometry of E-Liquids and Aerosols in Commercially Available Electronic Cigarettes in Mexico” was submitted in compliance with all the requirements of the editorial and journal in question, as evidenced by the dates and the respective backup documentation [...] Full article

4 pages, 214 KiB

Open AccessComment

Comment on Svarch-Pérez et al. Methods for a Non-Targeted Qualitative Analysis and Quantification of Benzene, Toluene, and Xylenes by Gas Chromatography-Mass Spectrometry of E-Liquids and Aerosols in Commercially Available Electronic Cigarettes in Mexico. Int. J. Environ. Res. Public Health 2024, 21, 1308

by Roberto A. Sussman, Humberto Gómez-Ruiz and Konstantinos Farsalinos

Int. J. Environ. Res. Public Health 2025, 22(7), 1049; https://doi.org/10.3390/ijerph22071049 - 30 Jun 2025

Abstract

The authors of a study recently published in IJERPH quantified levels of benzene, toluene and xylenes (BTXs) in e-liquids and aerosols in a sample of 20 disposable e-cigarettes collected in Mexico City [...] Full article

15 pages, 252 KiB

Open AccessArticle

Lived Challenges Contributing to Mental Illness Relapse and Coping Strategies Used by Teachers in Limpopo Province

by Thembi Nkomo, Mokoko Percy Kekana and Mabitsela Hezekiel Mphasha

Int. J. Environ. Res. Public Health 2025, 22(7), 1048; https://doi.org/10.3390/ijerph22071048 - 30 Jun 2025

Abstract

Mental illness relapse among teachers presents a growing public health concern, particularly in under-resourced settings, where social and structural factors often go unaddressed. This study aimed to explore challenges outside the workplace that contribute to mental illness relapse among public school teachers in [...] Read more.

Mental illness relapse among teachers presents a growing public health concern, particularly in under-resourced settings, where social and structural factors often go unaddressed. This study aimed to explore challenges outside the workplace that contribute to mental illness relapse among public school teachers in Limpopo Province and how they cope with them. Guided by the Stress-Vulnerability Model, a qualitative explorative phenomenological design was employed. Fourteen participants with a documented history of existing mental illness and mental illness relapse were purposively selected across four different hospitals. The data were collected through in-depth, face-to-face semi-structured interviews until data saturation was reached. The interviews were audio-recorded, transcribed verbatim, and analysed using Tesch’s open coding method. The findings revealed unstable home environments, community-level stigma, inadequate institutional support, and systemic barriers to mental healthcare access. Moreover, the participants rely on family members for support and on spiritual practices to cope, highlighting gaps in formal support systems. Addressing these overlooked challenges is critical to reducing relapse resulting from social and systematic challenges, promoting mental health equity, and sustaining teacher resilience in underserved communities. This study calls for collaborative efforts from policymakers, educational institutions, healthcare providers, and community leaders, including faith-based organisations, to develop integrated mental health strategies. Such strategies can promote mental health equity, reduce stigma, and support sustainable teacher well-being in vulnerable communities. Full article

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

15 pages, 538 KiB

Open AccessReview

Personalised Nutrition Approaches in the Prevention and Management of Type 2 Diabetes: A Narrative Review of Evidence and Practice

by Mabitsela Mphasha and Tebogo Mothiba

Int. J. Environ. Res. Public Health 2025, 22(7), 1047; https://doi.org/10.3390/ijerph22071047 - 30 Jun 2025

Abstract

Type 2 diabetes mellitus (T2DM) remains a significant global public health concern, largely driven by poor dietary habits, physical inactivity, and rising obesity rates. In recent years, personalised nutrition (PN) emerged as a promising approach to T2DM prevention and management. This narrative review [...] Read more.

Type 2 diabetes mellitus (T2DM) remains a significant global public health concern, largely driven by poor dietary habits, physical inactivity, and rising obesity rates. In recent years, personalised nutrition (PN) emerged as a promising approach to T2DM prevention and management. This narrative review synthesises current evidence on tailored dietary strategies, including the glycaemic index (GI), glycaemic load (GL), food insulin index (FII), and precision nutrition tools. It further explores their impact on glycaemic control, insulin sensitivity, and adherence to dietary interventions. A structured review of peer-reviewed and grey literature was conducted, taking into account behavioural, cultural, and systemic implementation factors. Although evidence supports the efficacy of PN in improving metabolic outcomes, implementation in low- and middle-income countries (LMICs) remains limited due to infrastructural, financial, and contextual challenges. This review emphasises the need for context-specific, scalable solutions integrated into primary healthcare systems. Full article

(This article belongs to the Special Issue Nutrition and Diabetes: Advances in Prevention and Management)

15 pages, 285 KiB

Open AccessArticle

A Quasi-Experimental Study: Social Support in Group Prenatal Care’s Impact on Postpartum Depression in Black and Hispanic Women

by Keisha A. Robinson, Tarnisha Ebony Hemphill and Robert O. Atlas

Int. J. Environ. Res. Public Health 2025, 22(7), 1046; https://doi.org/10.3390/ijerph22071046 - 30 Jun 2025

Abstract

Depression is a widespread mental health condition that affects millions of women globally. In the United States (U.S.), more than half of maternal mental health-related deaths occur during the postpartum period, making it the leading cause of mortality during this time. This urban [...] Read more.

Depression is a widespread mental health condition that affects millions of women globally. In the United States (U.S.), more than half of maternal mental health-related deaths occur during the postpartum period, making it the leading cause of mortality during this time. This urban U.S. single-site quasi-experimental study aimed to evaluate the effectiveness of social support integrated into group prenatal care as an intervention for postpartum depression. The study employed a dual methodological approach, combining prospective participant recruitment with a retrospective analysis of medical records. It compared the Edinburgh Postnatal Depression Scale (EPDS) scores from group prenatal care to those from traditional individualized prenatal care, specifically focusing on Black and Hispanic women. In all, 200 postpartum women participated in the study, comprising (n = 100) group prenatal care and (n = 100) traditional individualized care. Most participants were Black (97%), with an average age of 26.8 years (SD = 5.9). At six weeks postpartum, 97% of the participants underwent depression screening, which indicated a mean EPDS score of 3.79 (SD = 4.7). Among the participants, 25% exhibited mild to moderate postpartum depression, while 3% experienced severe depression. No significant differences were observed between the models of care in terms of total scores (T = 2.0, p = 0.46) or score ranges (χ² = 5.8, p = 0.12). It is noteworthy that no severe cases of depression were identified within the group prenatal care model. Suggesting group prenatal care may still benefit Black and Hispanic women in urban areas with a history of anxiety or depression. Full article

(This article belongs to the Special Issue Improving the Quality of Maternity Care)

33 pages, 1978 KiB

Open AccessSystematic Review

Effectiveness and Efficacy of Long-Lasting Insecticidal Nets for Malaria Control in Africa: Systematic Review and Meta-Analysis of Randomized Controlled Trials

by Dereje Bayisa Demissie, Getahun Fetensa, Tilahun Desta and Firew Tiruneh Tiyare

Int. J. Environ. Res. Public Health 2025, 22(7), 1045; https://doi.org/10.3390/ijerph22071045 - 30 Jun 2025

Abstract

Background: Long-lasting insecticidal nets (LLINs) have significantly reduced the malaria burden in recent decades, and this malaria prevalence reduction has been achieved through the upgrading of pyrethroid long-lasting insecticidal nets. However, this reduction has stalled due to many factors, including rapidly developing [...] Read more.

Background: Long-lasting insecticidal nets (LLINs) have significantly reduced the malaria burden in recent decades, and this malaria prevalence reduction has been achieved through the upgrading of pyrethroid long-lasting insecticidal nets. However, this reduction has stalled due to many factors, including rapidly developing pyrethroid resistance. Method: The protocol was registered in PROSPERO, and we used Cochrane methodology to assess bias and evidence quality. Three reviewers extracted data from individual studies, and a meta-analysis was performed using Excel and STATA version 17, expressing the data as a risk ratio. Result: A study involving 21,916 households from 11 randomized controlled trials showed that the chlorfenapyr treatment group had a 10% reduction in malaria infection risk, with a pooled overall prevalence of 25.96 per 100 children in the chlorfenapyr group and 32.38 per 100 children in the piperonyl butoxide group, compared to 41.60 per 100 children in the control (pyrethroid-only) group. This meta-analysis determined that the entomological outcomes of effectiveness and efficacy showed that these treatments effectively reduced vector density per household per night and mean inoculation rates, with a 23% reduction in chlorfenapyr, a 7% reduction in pyrethroid-only treatments, and a 12% reduction in piperonyl-butoxide-treated groups. This study shows that chlorfenapyr (CFP) and pyriproxyfen (PPF) LLINs are highly effective and more efficacious in reducing malaria infection, case incidence, and anemia among children, as well as in reducing mean indoor vector density, mean entomological inoculation rate, and sporozoite rate, compared to pyriproxyfen (PPF) LLINs in Africa. Conclusions: This study found that chlorfenapyr (CFP) LLINs are highly effective and more efficacious in reducing malaria infection, case incidence, and anemia among children in Africa. Therefore, policymakers and health planners should place strong emphasis on addressing the effectiveness, efficacy, and resistance management of LLINs as part of their current public health agenda to eliminate malaria. Full article

(This article belongs to the Special Issue SDG 3 in Sub-Saharan Africa: Emerging Public Health Issues)

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18 pages, 805 KiB

Open AccessArticle

Psychosocial Aspects of Injuries Among Professional Folk Dancers

by Csilla Almásy and Anita R. Fedor

Int. J. Environ. Res. Public Health 2025, 22(7), 1044; https://doi.org/10.3390/ijerph22071044 - 30 Jun 2025

Abstract

Injury or fear of injury can cause stress for everyone. This is especially true for dancers, whose careers can be ruined by a serious injury. Stress or various psychological problems can play a role in the development of injury. Our research aims to [...] Read more.

Injury or fear of injury can cause stress for everyone. This is especially true for dancers, whose careers can be ruined by a serious injury. Stress or various psychological problems can play a role in the development of injury. Our research aims to explore the psychosocial patterns associated with injuries among Hungarian professional folk dancers. A cross-sectional study was carried out with 96 professional dancers (47.9% male, 52.1% female, mean age 29.9 years). Data was collected through an online questionnaire survey. Among psychological factors, perceived stress (using the Perceived Stress Scale), burnout (using the Athletic Burnout Questionnaire), coping skills (using the Athletic Coping Skills Inventory), relationship with the leader (using the Coaching Behaviour Questionnaire) and perceived social support (using the Multidimensional Scale of Perceived Social Support) were examined among injured and non-injured dancers. The two groups were compared along psychological subscales using Multivariate Analysis of Variance (MANOVA) followed by a post hoc ANOVA and Mann–Whitney test regarding social support. Our results showed a significant correlation between psychosocial factors and injuries sustained during the study period. Positive correlation was found between injuries and perceived stress (p < 0.001) and burnout (reduced sense of accomplishment p = 0.021; dance devaluation p < 0.001). Factors reflecting dancer’s behavior and coping skills also correlated with injuries, such as a decrease in coachability (p = 0.007), less concern (p = 0.029), and negative reactions to the leader’s behavior (p = 0.019). In addition, perceived social support from family also negatively correlates with injury (p = 0.019). Our findings suggest a multidirectional relationship between physical injuries and the mental state of dancers. Further investigation of the causal relationships is recommended, with the aim of using psychosocial support tools during the prevention and treatment of injuries by the professionals dealing with dance artists. It is also recommended to investigate whether individual psychological factors are directly related to injuries or interact with each other. It would also be useful to introduce prevention programs that help dancers manage their emotions related to injuries. Full article

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

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14 pages, 712 KiB

Open AccessArticle

The Need for Culturally Responsive Nutritional Counselling for Pregnant Aboriginal and Torres Strait Islander Women in Australia

by Lina Jalloub, Stephanie Gilbert, Clare Collins, Marc T. P. Adam, Mieka Thorogood, Tahlia Smith, Janinne Gliddon, Serena St Clair, Nicole Turner, Rhonda Marriott, Roz Walker, Kym M. Rae and on behalf of Deadly Diets Indigenous Steering Committee

Int. J. Environ. Res. Public Health 2025, 22(7), 1043; https://doi.org/10.3390/ijerph22071043 - 30 Jun 2025

Abstract

Access to high-quality, culturally responsive nutrition advice during pregnancy is necessary for optimal health outcomes for mothers and babies. Evidence indicates that age, education and access to trained healthcare practitioners have a positive correlation with healthy food intake and positive outcomes. There are [...] Read more.

Access to high-quality, culturally responsive nutrition advice during pregnancy is necessary for optimal health outcomes for mothers and babies. Evidence indicates that age, education and access to trained healthcare practitioners have a positive correlation with healthy food intake and positive outcomes. There are limited studies that discuss the importance of providing culturally responsive nutrition advice to pregnant Indigenous women. Therefore, this paper investigates the sources from which Indigenous women access nutrition information, assesses its adequacy in meeting needs, and identifies the effective ways to deliver this information. This study took place in Queensland (QLD), New South Wales (NSW), and Western Australia (WA), which were chosen to represent diverse cultural communities. A total of 103 participants were recruited, including Indigenous women and healthcare practitioners. Focus groups were audio-recorded, transcribed and analysed. Participants indicated that pregnant women are highly interested in improving their nutrition knowledge during pregnancy and actively seek information from their healthcare practitioners and dietitians. Findings suggested dissatisfaction with the information received, as it failed to address their needs. Results of this paper call for an urgent increased presence of community dietitians in antenatal clinics dedicated to Indigenous pregnant women as an additional way to provide families with the information they need for healthy pregnancies. Full article

(This article belongs to the Special Issue Advancing Health Equity: Challenges and Opportunities)

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19 pages, 1289 KiB

Open AccessArticle

Upholding the Right to Health in Contexts of Displacement: A Whole-of-Route Policy Analysis in South Africa, Kenya, Somalia, and the Democratic Republic of Congo

by Rebecca Walker, Jo Vearey, Ahmed Said Bile and Genèse Lobukulu Lolimo

Int. J. Environ. Res. Public Health 2025, 22(7), 1042; https://doi.org/10.3390/ijerph22071042 - 30 Jun 2025

Abstract

The Sustainable Development Goals commit states to Universal Health Coverage (UHC) for all; yet displaced populations—including asylum seekers, refugees, internally displaced persons (IDPs), and undocumented migrants—remain systematically excluded from national health systems across southern and eastern Africa. This paper applies a whole-of-route, rights-based [...] Read more.

The Sustainable Development Goals commit states to Universal Health Coverage (UHC) for all; yet displaced populations—including asylum seekers, refugees, internally displaced persons (IDPs), and undocumented migrants—remain systematically excluded from national health systems across southern and eastern Africa. This paper applies a whole-of-route, rights-based framework to examine how legal status, policy implementation, and structural governance shape healthcare access for displaced populations across South Africa, Kenya, Somalia, and the Democratic Republic of Congo (DRC). Drawing on 70 key informant interviews and policy analysis conducted between 2020 and 2025, the study finds that despite formal commitments to health equity, access remains constrained by restrictive legal regimes, administrative discretion, and fragmented service delivery models. Critical gaps persist in migration-sensitive planning, gender-responsive care, and mental health integration. The findings highlight the limitations of rights-based rhetoric in the absence of legal coherence, intersectoral coordination, and political will. To realise UHC in displacement contexts, health systems must move beyond citizen-centric models and embed migration-aware, inclusive, and sustainable approaches across all stages of displacement. Without such structural reforms, displaced populations will remain at the margins of national health agendas—and the promise of health for all will remain unmet. Full article

(This article belongs to the Special Issue SDG 3 in Sub-Saharan Africa: Emerging Public Health Issues)

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11 pages, 265 KiB

Open AccessArticle

Exploring the Psycho-Social Well-Being of Young Adults in Rural South Africa During the COVID-19 Lockdown: A Qualitative Study from Lonely Park, Mafikeng

by Dineo J. Melamu, Wandile F. Tsabedze, Caroll Hermann and Thabile S. Manengela

Int. J. Environ. Res. Public Health 2025, 22(7), 1041; https://doi.org/10.3390/ijerph22071041 - 30 Jun 2025

Abstract

The COVID-19 pandemic and its associated lockdowns had widespread psycho-social implications globally. However, the unique experiences of young adults in under-researched rural communities, such as Lonely Park in South Africa’s North West Province, remain poorly documented. This study explores the psycho-social well-being of [...] Read more.

The COVID-19 pandemic and its associated lockdowns had widespread psycho-social implications globally. However, the unique experiences of young adults in under-researched rural communities, such as Lonely Park in South Africa’s North West Province, remain poorly documented. This study explores the psycho-social well-being of young adults aged 18–24 in the Lonely Park community during the national COVID-19 lockdown from 23 March 2020 to 30 April 2020, with a particular focus on their emotional, psychological, and social experiences. Using a qualitative, phenomenological design rooted in Bronfenbrenner’s Ecological Systems Theory (EST), data were collected from 14 purposively sampled participants through two focus group discussions. Thematic analysis was conducted following Braun and Clarke’s six-phase framework. Ethical clearance was obtained from the Health Research Ethics Committee, and participants provided informed consent. Two main themes emerged, (1) psychological and (2) social well-being. Six sub-themes were identified: (1) negative emotions linked to lockdown, (2) fear of COVID-19 and its consequences, (3) rumination and anxiety, (4) disruption of social and educational routines, (5) coping strategies, and (6) structural limitations of healthcare and support systems. Participants experienced intense fear, boredom, isolation, and a sense of helplessness. Yet, coping mechanisms such as communication, spirituality, exercise, and adherence to public health regulations provided resilience. Some reported depression and financial strain due to job loss and school disruptions. The findings highlight the complex interplay of psychological, emotional, and social stressors in rural young adults during the pandemic. Policymakers and mental health practitioners must prioritise targeted psycho-social interventions for youth in under-resourced rural settings. A call is made for culturally responsive mental health programmes that incorporate local voices, especially in rural African contexts. Full article

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

11 pages, 285 KiB

Open AccessArticle

The Nicotine Metabolite Ratio and Response to Smoking Cessation Treatment Among People Living with HIV Who Smoke in South Africa

by Chukwudi Keke, Limakatso Lebina, Katlego Motlhaoleng, Raymond Niaura, David Abrams, Ebrahim Variava, Nikhil Gupte, Jonathan E. Golub, Neil A. Martinson and Jessica L. Elf

Int. J. Environ. Res. Public Health 2025, 22(7), 1040; https://doi.org/10.3390/ijerph22071040 - 30 Jun 2025

Abstract

The nicotine metabolite ratio (NMR) has been informative in selecting treatment choices for nicotine dependence and increasing treatment efficacy in Western settings; however, the clinical utility of the NMR among smokers in low-resource settings remains unclear. Prospective analysis was conducted using data from [...] Read more.

The nicotine metabolite ratio (NMR) has been informative in selecting treatment choices for nicotine dependence and increasing treatment efficacy in Western settings; however, the clinical utility of the NMR among smokers in low-resource settings remains unclear. Prospective analysis was conducted using data from a randomized controlled trial of smoking cessation among adults living with HIV, to examine the association between the NMR and response to smoking cessation treatment. NMR was assessed using bio-banked urine samples collected at baseline. Self-reported smoking at 6 months was verified using a urine cotinine test and exhaled breath carbon monoxide (CO). We found no associations between the NMR and smoking abstinence (adjusted risk ratio (aRR) = 0.82; 95% CI: 0.45, 1.49; p = 0.53). No evidence of effect modification by treatment conditions was observed on the multiplicative scale (aRR = 1.17; 95% CI: 0.32, 4.30; p = 0.81) or additive scale (adjusted relative excess risk due to interaction (aRERI) = 0.10; 95% CI: −1.16, 1.36; p = 0.44). Our results suggest that the NMR may not be a viable approach for selecting smoking cessation treatment in this setting, given the minimal variability in our sample and racial/ethnic makeup of this population. Full article

14 pages, 537 KiB

Open AccessArticle

Patient Reflections on Participation in a Randomised Controlled Multimodal Prehabilitation Trial Before Ventral Hernia Repair

by Sofie Anne-Marie Skovbo Jensen, Siv Fonnes, Jacob Rosenberg, Hanne Tønnesen and Susanne Vahr Lauridsen

Int. J. Environ. Res. Public Health 2025, 22(7), 1039; https://doi.org/10.3390/ijerph22071039 - 30 Jun 2025

Abstract

Background: The aim was to explore patients’ reflections related to their choice of participating or not in a multimodal prehabilitation randomised controlled trial (RCT) in relation to minor surgery. Methods: A qualitative study with 22 semi-structured in-depth interviews on patients awaiting ventral hernia [...] Read more.

Background: The aim was to explore patients’ reflections related to their choice of participating or not in a multimodal prehabilitation randomised controlled trial (RCT) in relation to minor surgery. Methods: A qualitative study with 22 semi-structured in-depth interviews on patients awaiting ventral hernia repair was conducted between March and May 2024 and reported according to the COREQ guideline. All were eligible to participate in a prehabilitation RCT; twelve had accepted, and ten had declined. The interviews were analysed using Kirsti Malterud’s method of systematic text condensation, resulting in themes. Results: Five global themes were identified: “time commitment”, “research participation for the general good”, “personal benefits of RCT participation”, “ambivalence of own health and lifestyle”, and “complications after surgery”. All participants found the RCT and its prehabilitation programme a positive initiative. Those who had accepted to participate in the RCT emphasised personal benefits and contributing to research, while those who had declined expressed more ambivalence regarding lifestyle change, the extent of personal advantage, and prioritising of time. Conclusions: Those who declined RCT participation generally had more elaborate and ambivalent reflections than those who had accepted. Addressing ambivalence regarding lifestyle change, personal benefits, and prioritising time might be a relevant focus point for increasing inclusion rates in prehabilitation RCTs and in clinical practice to increase patients’ readiness for lifestyle change. Full article

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14 pages, 552 KiB

Open AccessArticle

A Cross-Cultural Study of Social Support from Family, Friends, and Significant Others and Mental Health Among Italian, Spanish, and Portuguese Gay and Lesbian Young Adults

by Nicola Picone, Pedro Alexandre Costa, Marta Evelia Aparicio-García and Gaetana Affuso

Int. J. Environ. Res. Public Health 2025, 22(7), 1038; https://doi.org/10.3390/ijerph22071038 - 29 Jun 2025

Abstract

Gay and lesbian young adults report worse mental health than their heterosexual counterparts due to social stigma. Nonetheless, factors such as social support may protect them against the negative effects of stigma. The current study compares Italian, Spanish, and Portuguese gay and lesbian [...] Read more.

Gay and lesbian young adults report worse mental health than their heterosexual counterparts due to social stigma. Nonetheless, factors such as social support may protect them against the negative effects of stigma. The current study compares Italian, Spanish, and Portuguese gay and lesbian young adults on three dimensions of social support (family, friends, and significant others) and on mental health indicators (depression and anxiety). It also explores the associations between social support and mental health among the three countries. To this end, a sample of 687 gay and lesbian young adults filled out an online questionnaire: 345 from Italy (M_age = 25.24, SD = 4.39), 193 from Spain (M_age = 27.44, SD = 5.05), and 149 from Portugal (M_age = 24.45, SD = 5.15). Italian participants reported lower levels of social support from family and friends than Spanish participants. Moreover, Portuguese participants reported higher levels of anxiety than Italian participants. The results of the survey further indicate that only social support from family was significantly and negatively associated with depression and anxiety in the three countries. Overall, the findings suggest that the mental health of gay and lesbian young adults can be improved through non-stigmatising cultures as well as family education. Full article

(This article belongs to the Special Issue Mental Health Challenges Affecting LGBTQ+ Individuals and Communities)

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