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International Journal of Environmental Research and Public Health

International Journal of Environmental Research and Public Health is a transdisciplinary, peer-reviewed, open access journal published monthly online by MDPI. It covers Global Health, Healthcare Sciences, Behavioral and Mental Health, Infectious Diseases, Chronic Diseases and Disease Prevention, Exercise and Health Related Quality of Life, Environmental Health and Environmental Sciences. The International Society Doctors for the Environment (ISDE), Italian Society of Environmental Medicine (SIMA) and Environmental Health Association of Québec (ASEQ‑EHAQ) are affiliated with IJERPH and their members receive a discount on the article processing charges.

Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
High Visibility: indexed within Scopus, PubMed, MEDLINE, PMC, Embase, GEOBASE, CAPlus / SciFinder, and other databases.
Journal Rank: CiteScore - Q1 (Public Health, Environmental and Occupational Health)
Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 27.8 days after submission; acceptance to publication is undertaken in 3.9 days (median values for papers published in this journal in the first half of 2025).
Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.
Testimonials: See what our editors and authors say about IJERPH.
Sections: published in 7 topical sections.
Companion journal: Air.
Journal Cluster of Healthcare Sciences and Services: Geriatrics, Journal of Ageing and Longevity, Healthcare, Hospitals, Hygiene, International Journal of Environmental Research and Public Health and Nursing Reports.

Imprint Information Journal Flyer Open Access ISSN: 1660-4601

Latest Articles

13 pages, 295 KiB

Open AccessArticle

The Relationship Between Healthy Lifestyle Behaviours and Levels of Health Literacy of University Students in Mogadishu, Somalia

by Simay Akyuz, Elif Donmez, Betülay Kılıç, Nasra Alı Jama and Hasan Hüseyin Eker

Int. J. Environ. Res. Public Health 2025, 22(8), 1259; https://doi.org/10.3390/ijerph22081259 - 11 Aug 2025

According to the WHO, health problems in Somalia are reported to be at an alarming level today and in the future. Objective: The aim of this study was to determine the relationship between healthy lifestyle behaviours and the levels of health literacy of [...] Read more.

According to the WHO, health problems in Somalia are reported to be at an alarming level today and in the future. Objective: The aim of this study was to determine the relationship between healthy lifestyle behaviours and the levels of health literacy of university students receiving health sciences education in Mogadishu, Somalia. Methods: This descriptive, cross-sectional study was conducted in April 2024 in a university delivering education in Turkish in Mogadishu. The study sample comprised 219 health sciences students. The data collection tools used were a demographic data form, the Healthy Lifestyle Behaviours Scale II (HLBS-II) and the Turkish version of the European Health Literacy Scale (HLS-EU-TR). Results: A total of 219 students participated, with 86.3% identifying as female and 13.7% as male, and the average age was 20.91 ± 2.2 years. The mean of the total scores obtained for the HLBS II was found to be 127.54 ± 23.46 and the mean of the total scores obtained for HLS-EU-TR was 30.33 ± 8.17, while scores across all dimensions of the HLS-EU-TR indicated a problematic−borderline level. Analysis showed that with each advancing year of study, there was a statistically significant increase in health responsibility, physical activity, nutrition and total HLBS scores (p < 0.05). A positive correlation was observed between healthy lifestyle behaviours and HLS-EU-TR total scores, with correlation coefficients as follows: r = 0.230, p = 0.001; r = 0.215, p = 0.001; r = 0.193, p = 0.004; r = 0.308, p < 0.001; r = 0.247, p < 0.001; r = 0.284, p < 0.001; r = 0.313, p < 0.001. Furthermore, 13.1% of the change in healthy lifestyle behaviours was explained by the HLS-EU-TR Treatment and Services subdimension and grade level (R² = 0.131). The HLS-EU-TR Treatment and Services subdimension and grade level positively contributed to the level of healthy lifestyle behaviours (ß = 0.373; ß = 0.164). Conclusion: It can be concluded that the identification of a positive correlation between health literacy and healthy lifestyle behaviours indicates that health literacy significantly influences healthy lifestyle choices. This correlation suggests that as students progress through their educational journey, their knowledge and behaviours toward health improve, highlighting that increased educational attainment equips individuals with the skills necessary to engage more effectively in the healthcare system and to translate acquired knowledge into behaviour. These findings underscore the critical role of ongoing health education initiated from an early age. Full article

(This article belongs to the Special Issue The Role of Health Literacy in Health Promotion and Disease Prevention)

17 pages, 747 KiB

Open AccessArticle

Bridging the Gap Between Climate and Health Systems: The Value of Resilience in Facing Extreme Weather Events

by Eloïse Dagneau, Sophie Marie Ehgartner and Gabriel Gulis

Int. J. Environ. Res. Public Health 2025, 22(8), 1258; https://doi.org/10.3390/ijerph22081258 - 11 Aug 2025

With the rise in climate emergencies come complex challenges for the field of health systems that require equally complex strategies. Acknowledgement of the pressures experienced by health systems in relation to CC is increasing, but it remains understudied. This article aims to strengthen [...] Read more.

With the rise in climate emergencies come complex challenges for the field of health systems that require equally complex strategies. Acknowledgement of the pressures experienced by health systems in relation to CC is increasing, but it remains understudied. This article aims to strengthen the link between climate and health systems by examining how health systems can incorporate resilience strategies to better respond to extreme weather events. Framed by an explorative literature search, the policy analysis dives into the content of the Health National Adaptation plans of both Fiji and Tanzania in relation to the WHO Operational Framework for building a climate-resilient health system. Our findings suggest updating the WHO Framework by adding additional elements under each component and by adding new components, namely human mobility and humanitarian aid. We recommend following a step-by-step ‘system approach’ to facilitate the integration of resilience building within health systems and to acknowledge the iterative aspect of this process. Full article

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16 pages, 1674 KiB

Open AccessArticle

A Resistance Training Program on Patients with Liver Cirrhosis: A Randomized Clinical Trial

by Amanda Brown, Ingrid Dias, Jefferson da Silva Novaes, Leandro Sant’Ana, Bruno Perez Felix, Fabio Cahuê, Anderson Azevedo Brito, Michel Silva Reis, Agnaldo José Lopes, Verônica Salerno, Roberto Simão, Estêvão Rios Monteiro and Renata de Mello Perez

Int. J. Environ. Res. Public Health 2025, 22(8), 1257; https://doi.org/10.3390/ijerph22081257 - 11 Aug 2025

Background: Cirrhosis represents an advanced stage of hepatic fibrosis, and the metabolic changes resulting from liver dysfunction can cause impairment in physical capacity and quality of life. This study aimed to evaluate the effect of 12 weeks of resistance exercise on inflammatory markers, [...] Read more.

Background: Cirrhosis represents an advanced stage of hepatic fibrosis, and the metabolic changes resulting from liver dysfunction can cause impairment in physical capacity and quality of life. This study aimed to evaluate the effect of 12 weeks of resistance exercise on inflammatory markers, oxidative stress, physical conditioning, and quality of life in patients with liver cirrhosis. Methods: A total of 38 patients paired in the exercise (EG) and control (CG) groups participated in this study. The EG submitted to two weekly sessions of a program composed of resistance exercises. We evaluated the inflammatory markers (IL-6, IL-10, and TNF-α), oxidative stress (carbonylated protein, total thiols, enzyme superoxide dismutase, and catalase activity), body composition, handgrip strength (HGS), total volume of training, cardiorespiratory capacity (VO₂, VCO₂, and VE_peak), exercise capacity, and quality of life. Results: Regarding the EG, when comparing the follow-up period to the baseline, significant differences (p < 0.05) were found in BMI, HGS, total training volume, cardiorespiratory capacity variables, the 6 min walk test, and quality of life. Improvements were observed, without significant differences, in the inflammatory profile, oxidative stress, and one of the markers of liver function. The CG showed a significant decrease (p < 0.05) in HGS and cardiorespiratory capacity after the intervention. Conclusions: In patients with liver cirrhosis, a resistance exercise program improved physical fitness and quality of life, without adverse events. In addition, it seems that this type of training can bring some benefit to the inflammatory profile and oxidative stress of this population. Full article

(This article belongs to the Special Issue Public Health Perspectives on Physical Exercise for Adults and Older People)

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12 pages, 1208 KiB

Open AccessArticle

Declining Outdoor Recreation and Increased Use of Fitness Centers Among Norwegian Adolescents, 2010–2019

by Solveig Sandaker Liland and Vidar Sandsaunet Ulset

Int. J. Environ. Res. Public Health 2025, 22(8), 1256; https://doi.org/10.3390/ijerph22081256 - 11 Aug 2025

Adolescents’ physical activity patterns appear to be changing, with indications of a shift from nature-based activities toward more structured, indoor forms of exercise. However, it remains unclear how participation in outdoor recreation and fitness center use has developed in parallel over time, and [...] Read more.

Adolescents’ physical activity patterns appear to be changing, with indications of a shift from nature-based activities toward more structured, indoor forms of exercise. However, it remains unclear how participation in outdoor recreation and fitness center use has developed in parallel over time, and whether these trends vary by degree of urbanization. The aim of the present study was to examine the trends in adolescents’ engagement in outdoor recreation and use of fitness centers across Norwegian municipalities between 2010 and 2019 and to assess how these patterns relate to individual and contextual factors. Repeated cross-sectional data were drawn from the Ungdata survey (N = 67,554), and multilevel linear models were applied to estimate time trends and test interactions with municipal population density. Analyses were adjusted for depressive symptoms, gender, school grade, and vegetation density (NDVI). The results indicated a significant decline in outdoor recreation during the period, particularly in more urban municipalities, alongside a marked increase in fitness center use. The two activity types were positively associated but not mutually exclusive. The findings point to a broader shift in adolescent activity preferences that may reflect changing environmental and sociocultural conditions. These patterns underline the need for public health approaches that recognize diverse forms of youth engagement in physical activity. Full article

(This article belongs to the Section Environmental Health)

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17 pages, 540 KiB

Open AccessArticle

Meanings and Practices of Preceptorship in Pediatric Nursing and Their Implications for Public Health: A Grounded Theory Study

by Thiago Privado da Silva, Flávia Souza Soares, Italo Rodolfo Silva, Sabrina da Costa Machado Duarte, Laura Johanson da Silva and Jessica Renata Bastos Depianti

Int. J. Environ. Res. Public Health 2025, 22(8), 1255; https://doi.org/10.3390/ijerph22081255 - 11 Aug 2025

Strengthening the education of health professionals is imperative to effectively address contemporary public health challenges. Preceptorship, by integrating teaching and care within service settings, stands out as a relevant strategy for developing clinical, ethical, and relational competencies. This study aimed to construct a [...] Read more.

Strengthening the education of health professionals is imperative to effectively address contemporary public health challenges. Preceptorship, by integrating teaching and care within service settings, stands out as a relevant strategy for developing clinical, ethical, and relational competencies. This study aimed to construct a theoretical model based on the meanings attributed by nurse preceptors to preceptorship in pediatric nursing within the context of hospital-based training at a referral institute specializing in rare and complex diseases in Rio de Janeiro, Brazil. The study used Grounded Theory and Symbolic Interactionism as its methodological and theoretical frameworks, respectively, and involved interviews with 14 preceptors. The resulting model characterizes preceptorship as an interactive process materialized in pedagogical practices that integrate technical skill, empathy, responsibility, and creativity into the daily routine of care. The findings offer valuable insights for strengthening professional training programs in health and contribute to public policies that recognize preceptorship as a component of interprofessional education and of workforce development, with a focus on humanization, safety, and contextualized care. Full article

(This article belongs to the Special Issue Challenges and Advances in Nursing Practice in Latin America)

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1 pages, 177 KiB

Open AccessRetraction

RETRACTED: Yuan et al. Green Remanufacturer’s Mixed Collection Channel Strategy Considering Enterprise’s Environmental Responsibility and the Fairness Concern in Reverse Green Supply Chain. Int. J. Environ. Res. Public Health 2021, 18, 3405

by Xigang Yuan, Fei Tang, Dalin Zhang and Xiaoqing Zhang

Int. J. Environ. Res. Public Health 2025, 22(8), 1254; https://doi.org/10.3390/ijerph22081254 - 11 Aug 2025

The journal retracts the article “Green Remanufacturer’s Mixed Collection Channel Strategy Considering Enterprise’s Environmental Responsibility and the Fairness Concern in Reverse Green Supply Chain” [...] Full article

19 pages, 567 KiB

Open AccessArticle

What’s in Your Heart? Development of a Culturally Grounded and Trauma-Informed Parenting Support Program with a Pacific Northwest Tribe

by Sara F. Waters, Meenakshi Richardson, Alvina Marris, Fawn Harris and Myra Parker

Int. J. Environ. Res. Public Health 2025, 22(8), 1253; https://doi.org/10.3390/ijerph22081253 - 10 Aug 2025

The aims of the current study included gathering cultural knowledge and stories regarding parenting young children within a Tribal community and learning community members’ perspectives on key components of a promising parenting prevention program. Qualitative data were drawn from a focus group including [...] Read more.

The aims of the current study included gathering cultural knowledge and stories regarding parenting young children within a Tribal community and learning community members’ perspectives on key components of a promising parenting prevention program. Qualitative data were drawn from a focus group including seven participants and semi-structured phone interviews with 21 additional participants, all of whom were parenting children in the community. Hybrid coding and applied thematic analysis revealed five themes: (1) Desire to Learn and Gain Parenting Skills; (2) Relationships and the Caregiver Role; (3) Culture and Caregiving, which included subthemes of Diversity Among Tribal Bands, Intergenerational Knowledge Sharing, and Reconnection and Revitalization; (4) Historical Trauma and Behavioral Health; and (5) Curriculum Terminology Considerations. The information gathered collectively informed the development of the culturally grounded stim’ aspuʔús (What’s in Your Heart?) parenting program. This addresses the great need for culturally grounded interventions to support trauma healing within Indigenous families. The development process and implications for program development by and for Indigenous communities is discussed. Full article

(This article belongs to the Special Issue Health Promotion and Interventions for Marginalized Mothers and Children)

18 pages, 1071 KiB

Open AccessArticle

A Nature-Based Vocational Training Programme for Migrants and Swedes: Impacts on the Five Ways to Wellbeing

by Liz O’Brien, Ann Dolling, Marcus Hedblom and Anna María Pálsdóttir

Int. J. Environ. Res. Public Health 2025, 22(8), 1252; https://doi.org/10.3390/ijerph22081252 (registering DOI) - 10 Aug 2025

Nature-based interventions are increasingly used to support human wellbeing, and more recently to integrate migrants into host countries. In this research, we focused on a nature-based vocational training programme led by a partnership of three Swedish public organisations. In the programme, long-term unemployed [...] Read more.

Nature-based interventions are increasingly used to support human wellbeing, and more recently to integrate migrants into host countries. In this research, we focused on a nature-based vocational training programme led by a partnership of three Swedish public organisations. In the programme, long-term unemployed Swedes worked with migrants in various nature conservation and nature management tasks as part of an employment programme. We undertook interviews with nineteen participants and carried out observations ‘in situ’ to explore the impact of the programme on participants’ wellbeing. Using the ‘five ways to wellbeing’ as a conceptual framework, we found that the programme connected participants to nature, helped them take notice of the forests and nature they worked in, and connected participants across cultures. The participants learned new conservation skills and migrants had a chance to improve their Swedish language skills. The activities within the programme were physical and the majority found this was important for their overall wellbeing. Migrants were younger and keener to learn new employable skills than Swedes who were closer to pension age. The groups were more similar when it came to identifying the impact of the programme on their wellbeing. Nature-based vocational training programmes not only allow participants to gain skills for employment but can have a significant impact on wellbeing. Full article

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19 pages, 324 KiB

Open AccessArticle

Examining the Effect of SNAP-Multibehaviours on Multimorbidity Risk: A Cross-Sectional Study in Three General Practices’ Electronic Health Records

by Konstantinos Spyropoulos, Naomi J. Ellis and Christopher J. Gidlow

Int. J. Environ. Res. Public Health 2025, 22(8), 1251; https://doi.org/10.3390/ijerph22081251 - 10 Aug 2025

Background: The growing challenge of multimorbidity for healthcare systems worldwide demands a dual prevention framework, targeting both primary and secondary prevention. Multimorbidity–multibehaviours can provide such a theoretical and clinical framework to explore new aetiological evidence for multimorbidity risk. While the role of single [...] Read more.

Background: The growing challenge of multimorbidity for healthcare systems worldwide demands a dual prevention framework, targeting both primary and secondary prevention. Multimorbidity–multibehaviours can provide such a theoretical and clinical framework to explore new aetiological evidence for multimorbidity risk. While the role of single health risk behaviours, such as smoking, nutrition, alcohol, and physical activity (SNAP), in chronic disease prevention is well-documented, their synergistic effect on multimorbidity has received relatively little attention. Methods: Using retrospective observational data from electronic health records of 21,079 patients from a convenience sample of three general practices in Staffordshire, UK (2015–2018), we examined the association between SNAP-multibehaviours and multimorbidity risk, defined as follows: MM2+ (≥2 morbidities), MM3+ (≥3 morbidities), and complex multimorbidity (accumulated morbidities affecting ≥3 body systems). Multiple logistic regression models, stratified by sex and adjusted for age and area, were applied to analyse the associations between both combined and accumulative SNAP-health risk behaviours (HRBs) and all multimorbidity operational definitions. Results: A dose–response association was observed, indicating increased multimorbidity risk with greater accumulation of SNAP-HRBs. Additionally, sex-specific patterns were identified, which varied according to the operational definitions of multimorbidity. These findings underscored both the clinical significance of the identified outcomes for promoting tailored multimorbidity guidelines and the need for further sex-sensitive research. Conclusion: These findings support the importance of transcending traditional silos in healthcare and public health research by integrating preventive and curative medicines under a multimorbidity–multibehaviour framework. Embracing the complexity of coexisting morbidities and health risk behaviours, healthcare systems can move beyond disease-specific and behaviour-specific paradigms. This approach has the potential to enhance clinical outcomes and to address the complex needs of individuals with multimorbidity in real-world healthcare settings. Full article

(This article belongs to the Section Health Care Sciences)

32 pages, 1280 KiB

Open AccessReview

Effectiveness of Technology-Based Interventions in Promoting Lung Cancer Screening Uptake and Decision-Making Among Patients

by Safa Elkefi, Nelson Gaillard and Rongyi Wu

Int. J. Environ. Res. Public Health 2025, 22(8), 1250; https://doi.org/10.3390/ijerph22081250 - 9 Aug 2025

This study reviews how technology-based interventions have been designed and implemented to promote lung cancer screening (LCS), support shared decision-making, and enhance patient engagement. A systematic search of six databases in February 2025 identified 28 eligible studies published between 2014 and 2025. Most [...] Read more.

This study reviews how technology-based interventions have been designed and implemented to promote lung cancer screening (LCS), support shared decision-making, and enhance patient engagement. A systematic search of six databases in February 2025 identified 28 eligible studies published between 2014 and 2025. Most interventions were home-based and self-guided, including videos, websites, mobile apps, telehealth, and patient portal messages. Common features included risk calculators, multimedia content, simplified navigation, and integration with electronic medical records. These tools aim to raise awareness, improve informed decision-making, and support smoking cessation. While 82% of studies reported positive effects on knowledge and decision-making confidence, only some showed an increased screening uptake. Key barriers included limited internet access, low digital literacy, provider time constraints, fear or anxiety, and concerns about radiation or cost. Despite these challenges, digital tools show promise in advancing LCS promotion. Their effectiveness, however, depends on thoughtful design, integration into clinical workflows, and equitable access. Future work should address structural and contextual challenges to scale digital health solutions and reduce disparities in screening participation. This review identifies both the potential and limitations of current interventions and offers guidance for enhancing impact through targeted, accessible, and user-informed approaches. Full article

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

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18 pages, 326 KiB

Open AccessArticle

Mental Health and Cognitive Outcomes in Patients Six Months After Testing Positive Compared with Matched Patients Testing Negative for COVID-19 in a Non-Hospitalized Sample: A Matched Retrospective Cohort Study

by Brooklyn Ward, Nicole E. Edgar, Chloe Ahluwalia, Eileen Huang, Daniel Corsi, D. William Cameron, Ian Colman, Mark Kaluzienski, Heather Orpana, Sarah E. MacLean and Simon Hatcher

Int. J. Environ. Res. Public Health 2025, 22(8), 1249; https://doi.org/10.3390/ijerph22081249 - 9 Aug 2025

We aimed to determine the mental health and cognitive outcomes at six months in people who had not been hospitalized with COVID-19 and who had tested positive or negative for COVID-19 in Eastern Ontario, Canada. Participants were matched 1:1 six months following their [...] Read more.

We aimed to determine the mental health and cognitive outcomes at six months in people who had not been hospitalized with COVID-19 and who had tested positive or negative for COVID-19 in Eastern Ontario, Canada. Participants were matched 1:1 six months following their COVID-19 polymerase chain reaction test. X2, t-test, and Mann–Whitney U tests were conducted to compare self-report and observer-rated mental health and cognitive outcomes between the two groups. We also conducted an age and gender-adjusted logistic regression analysis to explore risk factors associated with depression, anxiety, and cognitive impairment among those who had tested positive for COVID-19. A total of 324 participants were enrolled (n = 162 per arm). Overall, 40.7% of those in the COVID-positive group were men, with an average age of 37.9 (SD 13.2) years. In the COVID-negative group, 41.4% were men, with an average age of 36.7 (SD 12.8). There were no statistically significant differences in mental health outcomes between the groups. On cognitive testing, while 21% of the COVID-positive participants and 14% of the COVID-negative participants had scores indicating significant cognitive impairment, the difference between groups was not significant, though this warrants further investigation in future research. In non-hospitalized patients who have tested positive for COVID-19, there is no evidence of an increase in mental health disorders compared to people who tested negative. Any increases in mental health disorders during the pandemic may be the effect of social changes rather than an effect of the virus itself. The exception may be the cognitive changes in those who tested positive. Full article

19 pages, 1099 KiB

Open AccessArticle

Generators of Inequality and Inequity Affecting Dental Patient Safety: A Grounded Theory Approach

by Diego A. Gil-Alzate, Isabel C. Posada-Zapata and Andrés A. Agudelo-Suárez

Int. J. Environ. Res. Public Health 2025, 22(8), 1248; https://doi.org/10.3390/ijerph22081248 - 9 Aug 2025

This study aimed to understand, through the voices of patients, the factors that contribute to inequality and inequity in oral healthcare and their implications for patient safety. A qualitative study was performed using a Grounded Theory approach (GT) through 13 in-depth interviews with [...] Read more.

This study aimed to understand, through the voices of patients, the factors that contribute to inequality and inequity in oral healthcare and their implications for patient safety. A qualitative study was performed using a Grounded Theory approach (GT) through 13 in-depth interviews with a flexible design, recorded and transcribed verbatim for study purposes. Open and axial coding and analysis categories were generated, and a conceptual and explicative framework was established. Ethical approval was obtained. The main findings highlighted how individual, social, and contextual factors significantly influence the materialization of risks and failures in oral healthcare, ultimately affecting patient safety in dental practice. These factors include individual factors, the relationship between professionals and patients, and failures in healthcare service provision. Participants’ discourses showed examples of inequities, such as gender, socioeconomic gradient, educative level, type of healthcare system, discrimination, stigmatization, and othering-otherness, and their effect on dental care and dentistry safety. Health inequities should be tackled in a preventive and proactive manner through the effective integration of intersectoral policies and strategies. This approach would enhance oral health, make patient safety a fundamental pillar of dental care, uphold human dignity, and strengthen trust in the healthcare system. Full article

(This article belongs to the Special Issue Oral Health Surveillance and Care)

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19 pages, 302 KiB

Open AccessArticle

Resettlement Workforce Perspectives on Mental Health Care of Refugees

by Bibhuti K. Sar, Lesley M. Harris, Adrian J. Archuleta, Susan H. Rhema, Nicole B. Adams, Eva Nyerges and Doroty Sato

Int. J. Environ. Res. Public Health 2025, 22(8), 1247; https://doi.org/10.3390/ijerph22081247 - 9 Aug 2025

Background: To identify the mental health care needs of resettled refugees, researchers have studied the perspectives of mental health service providers but have paid limited attention to the perspectives of individuals who work directly in resettlement agencies or in agencies that exclusively provide [...] Read more.

Background: To identify the mental health care needs of resettled refugees, researchers have studied the perspectives of mental health service providers but have paid limited attention to the perspectives of individuals who work directly in resettlement agencies or in agencies that exclusively provide services to promote refugees’ self-sufficiency and integration—the refugee resettlement workforce—who routinely provide support, make referrals, and coordinate mental health care. To better inform programming and service delivery, this qualitative case study focuses on the perspectives of the resettlement workforce. Methods: Focus group interviews conducted with 48 refugee resettlement workforce members were analyzed for their perspectives on refugee mental health needs and care. Results: Thematic analysis revealed that their perspectives centered on barriers to (i.e., resettlement challenges, notions about mental illness, stigma associated with mental illness, inadequate access to mental health care, and limited technology literacy) and facilitators of (i.e., promoting mental health literacy, addressing stigma, providing specific and targeted training, mental health coordination, allies, and building programming capacity) refugee mental health care. A set of recommendations to minimize barriers and promote facilitators is presented. Conclusions: These findings corroborate previous research and inform the practices, programs, and policies that should be developed and implemented to support refugees’ mental health wellbeing, self-sufficiency, and community integration post-resettlement. Full article

9 pages, 438 KiB

Open AccessArticle

Maternal Satisfaction with Perinatal Care and Breastfeeding at 6 Months Postpartum

by Caitlin M. Dressler, Karina M. Shreffler, Ingrid R. Wilhelm, Jameca R. Price and Karen P. Gold

Int. J. Environ. Res. Public Health 2025, 22(8), 1246; https://doi.org/10.3390/ijerph22081246 - 9 Aug 2025

Positive childbirth experiences increase breastfeeding in the early postpartum period. Using a diverse, clinic-based sample of predominately low-income women (n = 118) recruited at their first prenatal appointment in 2017–2018 and followed through six months postpartum, binary logistic regression analyses were used to [...] Read more.

Positive childbirth experiences increase breastfeeding in the early postpartum period. Using a diverse, clinic-based sample of predominately low-income women (n = 118) recruited at their first prenatal appointment in 2017–2018 and followed through six months postpartum, binary logistic regression analyses were used to examine the association between maternal satisfaction with perinatal care measured two weeks postpartum and breastfeeding at six months postpartum. Participants reported high satisfaction with perinatal care overall (mean = 25.7; range of 6–30), and 25% of participants reported breastfeeding at six months postpartum. Regression results found that greater satisfaction with perinatal care is associated with higher odds of breastfeeding at six months postpartum (OR = 1.19; p < 0.05), controlling for sociodemographic characteristics. These findings that have important implications for providers as they identify a group at risk for shorter breastfeeding duration: those who are less satisfied with their perinatal care. More research is needed to identify methods providers can use to increase satisfaction with care as well as to successfully encourage and assist mothers with breastfeeding despite challenges that might arise during pregnancy or childbirth that are associated with low satisfaction. Full article

(This article belongs to the Special Issue Advances in Maternal and Family Mental Health: Relational, Clinical, and Systemic Approaches Across the Reproductive and Perinatal Spectrum)

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15 pages, 1221 KiB

Open AccessArticle

Benefits of Multimodal Exercise Intervention for BDNF and Cytokines Levels, Cognitive Function, and Motor Functionality in Alzheimer’s Disease: A Preliminary Study

by Emmanuel Dias de Sousa Lopes, Flávia Gomes de Melo Coelho, Sheilla Tribess, Jonatas da Silva Catarino, Bruno Naves Ferreira, Marina de Melo Reis, Antônio Ribeiro Neto, Carlo José Freire Oliveira and Jair Sindra Virtuoso Júnior

Int. J. Environ. Res. Public Health 2025, 22(8), 1245; https://doi.org/10.3390/ijerph22081245 - 9 Aug 2025

Background: Physical exercise has been linked to improvements in motor and cognitive functions as well as to the modulation of neurotrophic and inflammatory factors, particularly in older adults. This aim of this study was to investigate the effects of a 12-week multimodal exercise [...] Read more.

Background: Physical exercise has been linked to improvements in motor and cognitive functions as well as to the modulation of neurotrophic and inflammatory factors, particularly in older adults. This aim of this study was to investigate the effects of a 12-week multimodal exercise program on cognitive function, motor performance, and plasma levels of brain-derived neurotrophic factor (BDNF) and cytokines in elderly individuals with Alzheimer’s disease (AD). Methods: A non-randomized controlled trial design was employed, involving 23 participants aged 62 to 85 years diagnosed with mild to moderate AD. The intervention group (n = 7) attended 60-minute sessions three times per week, incorporating aerobic, strength, flexibility, and motor coordination exercises, while the control group (n = 8) maintained usual activities. Methods: A non-randomized controlled trial design was used, involving 23 participants aged 62 to 85 years. Of these, 15 had a clinical diagnosis of mild to moderate AD and were allocated to either an intervention group (n = 7) or and AD control group (n = 8). The remaining eight participants were cognitively healthy and formed a control group matched for age and sex, used exclusively for baseline comparisons. The intervention group participated in 60-minute sessions three times per week, including aerobic, strength, flexibility, and motor coordination exercises. The AD control group (n = 8) maintained their usual daily routines. Results: Compared to baseline, the intervention group demonstrated significant improvements in executive and attentional functions, as measured by the Frontal Assessment Battery (FAB) and Clock Drawing Test (CDT); mobility, balance, gait speed, and lower limb strength also improved (p < 0.05). Additionally, plasma BDNF levels increased significantly, and interleukin-2 (IL-2) levels decreased. Conclusions: In conclusion, the multimodal exercise program resulted in cognitive and motor benefits and positively modulated biomarkers related to neuroplasticity and inflammation, supporting its potential as a complementary intervention in elderly individuals with AD. Full article

(This article belongs to the Special Issue Physical Activity Promotion and Exercise Intervention for Persons with Chronic Disease)

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22 pages, 812 KiB

Open AccessReview

Use of the Hypertension Self-Care Profile: A Scoping Review

by Hae-Ra Han, Chitchanok Benjasirisan, Faith E. Metlock, Yordanos Tesfai and Yvonne Commodore-Mensah

Int. J. Environ. Res. Public Health 2025, 22(8), 1244; https://doi.org/10.3390/ijerph22081244 - 8 Aug 2025

Self-care is a critical component of chronic disease management and is linked to better health outcomes. The Hypertension Self-Care Profile (HBP SCP) is one of the few validated instruments designed to assess not only behaviors but also self-efficacy and motivation in HBP self-care. [...] Read more.

Self-care is a critical component of chronic disease management and is linked to better health outcomes. The Hypertension Self-Care Profile (HBP SCP) is one of the few validated instruments designed to assess not only behaviors but also self-efficacy and motivation in HBP self-care. This scoping review synthesized published research using the HBP SCP to examine its scope and utility across diverse populations. A total of 48 studies were reviewed—34 non-validation studies and 14 validation studies—spanning regions including Asia, the Middle East, and the Americas. The HBP SCP showed strong psychometric performance across multiple cultural adaptations, with Cronbach’s alpha values ranging from 0.73 to 0.99. Several correlates of HBP self-care emerged, including self-efficacy, social support, health literacy, and education. Findings also revealed that HBP self-care remains suboptimal, particularly among rural populations and low- and middle-income countries. The HBP SCP has proven to be a versatile and culturally adaptable instrument for evaluating HBP self-care behaviors, self-efficacy, and motivation. Its consistently demonstrated validity and reliability across diverse contexts, combined with its responsiveness in randomized controlled trials, affirm its value as both a clinical assessment tool and a research outcome measure in interventions aimed at improving cardiovascular health. Full article

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18 pages, 1342 KiB

Open AccessArticle

Residential Outdoor Environments for Individuals with Multiple Chemical Sensitivity (MCS)

by Emilia Danuta Lausen, Marina Bergen Jensen and Victoria Linn Lygum

Int. J. Environ. Res. Public Health 2025, 22(8), 1243; https://doi.org/10.3390/ijerph22081243 - 8 Aug 2025

Severe sensitivity to various environmental chemicals affects an increasing number of people—a condition referred to as Multiple Chemical Sensitivity (MCS). The responses are both physical and psychological, where avoidance of chemical triggers can lead to social isolation, thereby increasing the level of disability. [...] Read more.

Severe sensitivity to various environmental chemicals affects an increasing number of people—a condition referred to as Multiple Chemical Sensitivity (MCS). The responses are both physical and psychological, where avoidance of chemical triggers can lead to social isolation, thereby increasing the level of disability. There is a need for user supportive environments where people with MCS can thrive, both indoors and outdoors. The study resulted in three principles for designing outdoor housing areas: (1) using spatial analysis to create a site layout that minimizes exposure to external and confounding triggers (e.g., noise, visual disturbances); (2) using zoning to clearly delineate private from semi-private areas; and (3) selecting vegetation and materials carefully to avoid triggers. The principles were developed in an iterative process based on existing research combined with a survey involving 58 MCS respondents. Full article

(This article belongs to the Special Issue Healthy and Resilient Cities: Urban Spatial Planning, Design and Governance)

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19 pages, 322 KiB

Open AccessArticle

Health Inequalities in Primary Care: A Comparative Analysis of Climate Change-Induced Expansion of Waterborne and Vector-Borne Diseases in the SADC Region

by Charles Musarurwa, Jane M. Kaifa, Mildred Ziweya, Annah Moyo, Wilfred Lunga and Olivia Kunguma

Int. J. Environ. Res. Public Health 2025, 22(8), 1242; https://doi.org/10.3390/ijerph22081242 - 8 Aug 2025

Climate change has magnified health disparities across the Southern African Development Community (SADC) region by destabilizing the critical natural systems, which include water security, food production, and disease ecology. The IPCC (2007) underscores the disproportionate impact on low-income populations characterized by limited adaptive [...] Read more.

Climate change has magnified health disparities across the Southern African Development Community (SADC) region by destabilizing the critical natural systems, which include water security, food production, and disease ecology. The IPCC (2007) underscores the disproportionate impact on low-income populations characterized by limited adaptive capacity, exacerbating existing vulnerabilities. Rising temperatures, erratic precipitation patterns, and increased frequency of extreme weather events ranging from prolonged droughts to catastrophic floods have created favourable conditions for the spread of waterborne diseases such as cholera, dysentery, and typhoid, as well as the expansion of vector-borne diseases zone also characterized by warmer and wetter conditions where diseases like malaria thrives. This study employed a comparative analysis of climate and health data across Malawi, Zimbabwe, Mozambique, and South Africa examining the interplay between climatic shifts and disease patterns. Through reviews of national surveillance reports, adaptation policies, and outbreak records, the analysis reveals the existence of critical gaps in preparedness and response. Zimbabwe’s Matabeleland region experienced a doubling of diarrheal diseases in 2019 due to drought-driven water shortages, forcing communities to rely on unsafe alternatives. Mozambique faced a similar crisis following Cyclone Idai in 2019, where floodwaters precipitated a threefold surge in cholera cases, predominantly affecting children under five. In Malawi, Cyclone Ana’s catastrophic flooding in 2022 contaminated water sources, leading to a devastating cholera outbreak that claimed over 1200 lives. Meanwhile, in South Africa, inadequate sanitation in KwaZulu-Natal’s informal settlements amplified cholera transmission during the 2023 rainy season. Malaria incidence has also risen in these regions, with warmer temperatures extending the geographic range of Anopheles mosquitoes and lengthening the transmission seasons. The findings underscore an urgent need for integrated, multisectoral interventions. Strengthening disease surveillance systems to incorporate climate data could enhance early warning capabilities, while national adaptation plans must prioritize health resilience by bridging gaps between water, agriculture, and infrastructure policies. Community-level interventions, such as water purification programs and targeted vector control, are essential to reduce outbreaks in high-risk areas. Beyond these findings, there is a critical need to invest in longitudinal research so as to elucidate the causal pathways between climate change and disease burden, particularly for understudied linkages like malaria expansion and urbanization. Without coordinated action, climate-related health inequalities will continue to widen, leaving marginalized populations increasingly vulnerable to preventable diseases. The SADC region must adopt evidence-based, equity-centred strategies to mitigate these growing threats and safeguard public health in a warming world. Full article

(This article belongs to the Special Issue Health Inequalities in Primary Care)

31 pages, 513 KiB

Open AccessReview

The Intersection of Socioeconomic and Environmental Factors in Aging: Insights from a Narrative Review

by Shelby Vereecke, Kalia Bennett, Stephanie Schrempft, Michael Kobor, Michael Brauer and Silvia Stringhini

Int. J. Environ. Res. Public Health 2025, 22(8), 1241; https://doi.org/10.3390/ijerph22081241 - 8 Aug 2025

(1) Background: Socioeconomic conditions and environmental exposures are well-established determinants of health and aging, yet the pathways through which they influence the aging process remain insufficiently understood. Clarifying these mechanisms is critical for developing effective, equity-focused public health interventions to support healthy aging; [...] Read more.

(1) Background: Socioeconomic conditions and environmental exposures are well-established determinants of health and aging, yet the pathways through which they influence the aging process remain insufficiently understood. Clarifying these mechanisms is critical for developing effective, equity-focused public health interventions to support healthy aging; (2) Methods: We conducted a narrative review examining the relationships between socioeconomic conditions, environmental exposures, and aging-related health outcomes. While the scope was intentionally broad to capture diverse exposures and outcomes, we applied a systematic search strategy to identify relevant peer-reviewed studies; (3) Results: The search populated over 4000 articles; 33 relevant papers were selected. The evidence suggests that environmental exposures may mediate or modify the effects of socioeconomic disadvantage on aging. Conversely, socioeconomic conditions can alter the association between environmental factors and aging outcomes. Disadvantaged populations consistently face higher environmental burdens and exhibit poorer aging outcomes, including accelerated biological aging and increased risk of age-related disease; (4) Conclusions: The complex interplay between social and environmental factors contributes to disparities in aging. Our integrative approach highlights the need for more intersectional, longitudinal research to inform interventions that address the social and environmental determinants of healthy aging. Full article

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9 pages, 266 KiB

Open AccessArticle

Residential and School Food Swamps and Overweight in Children and Adolescents: A Cross-Sectional Analysis in Urban Brazil

by Ingrid Werneck Linhares, Paula Martins Horta, Ariene Silva do Carmo, Luana Lara Rocha, Mariana Zogbi Jardim, Olivia Souza Honório and Larissa Loures Mendes

Int. J. Environ. Res. Public Health 2025, 22(8), 1240; https://doi.org/10.3390/ijerph22081240 - 8 Aug 2025

The community food environment, which encompasses residential and school neighborhoods, is an important determinant of overweight in children and adolescents. This study aimed to investigate the relationship between the co-occurrence of food swamps in residential and school environments and overweight status. This cross-sectional [...] Read more.

The community food environment, which encompasses residential and school neighborhoods, is an important determinant of overweight in children and adolescents. This study aimed to investigate the relationship between the co-occurrence of food swamps in residential and school environments and overweight status. This cross-sectional study included 2601 children and adolescents (aged 5–14 years) from 47 schools in a medium-sized municipality in Brazil. The outcome was overweight status, defined as body mass index for age exceeding the mean by at least one z-score. Food swamps in residential and school surroundings were defined as buffers of 250 m with four or more establishments selling ultra-processed foods. The prevalence of being overweight was 30.4%. Food swamps were present in 22.5% and 22% of the residential and school areas, respectively, and 16.2% of the participants were exposed to food swamps in both residential and school environments. Children and adolescents simultaneously exposed to food swamps in both residential and school areas had a higher likelihood of being overweight (odds ratio: 1.22; 95% confidence interval: 1.02–1.45). The simultaneous presence of food swamps in residential and school environments is associated with overweight in children and adolescents. Full article

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