International Journal of Environmental Research and Public Health

29 pages, 904 KB

Open AccessReview

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

by Martin Rose

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

Abstract

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

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

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

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34 pages, 1111 KB

Open AccessSystematic Review

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

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

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

Abstract

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

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

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

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21 pages, 456 KB

Open AccessArticle

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

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

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

Abstract

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

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

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12 pages, 303 KB

Open AccessArticle

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

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

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

Abstract

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

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

23 pages, 380 KB

Open AccessReview

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

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

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

Abstract

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

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

(This article belongs to the Section Global Health)

12 pages, 635 KB

Open AccessArticle

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

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

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

Abstract

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

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

26 pages, 1294 KB

Open AccessArticle

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

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

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

Abstract

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

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

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

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16 pages, 523 KB

Open AccessArticle

Perspectives of Community Health Center Employees on Public Bus Transportation in Rural Hawai‘i County

by L. Brooke Keliikoa, Claudia Hartz, Ansley Pontalti, Ke’ōpūlaulani Reelitz, Heidi Hansen Smith, Kiana Otsuka, Lance K. Ching and Meghan D. McGurk

Int. J. Environ. Res. Public Health 2026, 23(1), 78; https://doi.org/10.3390/ijerph23010078 - 6 Jan 2026

Abstract

People living in rural communities are typically underserved by public transportation services and face challenges in accessing healthcare, jobs, stores, and other destinations. Understanding the lived experiences of people who use public transportation in rural communities can help to inform a more equitable [...] Read more.

People living in rural communities are typically underserved by public transportation services and face challenges in accessing healthcare, jobs, stores, and other destinations. Understanding the lived experiences of people who use public transportation in rural communities can help to inform a more equitable transportation system. This qualitative study gathered the perspectives of community health center employees about the public bus system for Hawai‘i Island, a rural county in the United States. Using a community-engaged research approach, the evaluation team interviewed 10 employees through either in-person small group interviews or online individual interviews between April and July 2023. Transcripts were coded and analyzed using a thematic analysis approach. While all study participants were selected for their interest in commuting to work by bus, most believed the bus was not a reliable or convenient option. Participants shared their experiences about not being able to rely on the bus schedule, feeling unsafe while walking to bus stops or waiting for the bus, and other barriers to using the bus system. Participants also shared their insights about how a reliable bus system would benefit community health center patients who needed transportation to more than just their medical appointments, but also to places like pharmacies, laboratory services, and grocery stores. These findings can be used to initiate discussions around the ways that community health centers can further address transportation as a social determinant of health and inform transportation providers about how to best plan and invest in transportation infrastructure and services to meet the needs of rural populations. Full article

(This article belongs to the Special Issue Addressing Disparities in Health and Healthcare Globally)

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10 pages, 1266 KB

Open AccessArticle

An Exploratory Comparative Study of the Influence of Thai Massage on Postural Stability in Children with Overweight and Obesity

by Supapon Kaewsanmung, Vitsarut Buttagat, Ampha Pumpho, Phannarin Suwannarat, Petcharat Keawduangdee, Narongsak Khamnon and Niroat Chartpot

Int. J. Environ. Res. Public Health 2026, 23(1), 77; https://doi.org/10.3390/ijerph23010077 - 6 Jan 2026

Abstract

Background: Prolonged obesity in children can lead to a gradual decline in postural stability due to changes in biomechanics, musculoskeletal function, and neuromuscular control. Early interventions may help address these issues. This exploratory study examined the potential influence of Thai massage on postural [...] Read more.

Background: Prolonged obesity in children can lead to a gradual decline in postural stability due to changes in biomechanics, musculoskeletal function, and neuromuscular control. Early interventions may help address these issues. This exploratory study examined the potential influence of Thai massage on postural stability in children with overweight and obesity. Methods: This study employed a quasi-experimental, comparative design and was conducted at the Pa Tueng Sub-district Health Promoting Hospital, Chiang Rai, Thailand. A total of 58 children meeting the criteria for overweight or obesity were systematically assigned to either the Thai massage group or the control group based on the order in which they were recruited. The Thai massage group received 45 min full-body Thai massage sessions combined with stretching exercises twice a week for six weeks (a total of 12 sessions), while the control group was advised to perform daily stretching exercises at home. Postural stability was assessed by measuring sway path length and sway velocity during double-leg and single-leg stances with eyes closed, both before and after the intervention. Results: While no statistically significant differences were found between the groups, the Thai massage group exhibited a non-significant trend toward reduced sway path length and sway velocity, whereas the control group showed a significant increase in both measures (p < 0.05), indicating a decline in postural stability over time. Conclusions: These findings suggest that Thai massage showed a potential trend toward stabilizing postural stability in children with overweight and obesity; however, the between-group differences were not statistically significant. As an exploratory study, further research with longer intervention durations and follow-up assessments is needed to determine whether clinically meaningful effects can be established. Full article

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25 pages, 768 KB

Open AccessArticle

Emotional Needs in the Face of Climate Change and Barriers for Pro-Environmental Behaviour in Dutch Young Adults: A Qualitative Exploration

by Valesca S. M. Venhof and Bertus F. Jeronimus

Int. J. Environ. Res. Public Health 2026, 23(1), 76; https://doi.org/10.3390/ijerph23010076 - 5 Jan 2026

Abstract

Rapid climate change and its anticipated impacts trigger significant worry and distress among vulnerable groups, including young adults. Little is known about how Dutch young adults experience and cope with climate change within their specific social and environmental context. This study examines Dutch [...] Read more.

Rapid climate change and its anticipated impacts trigger significant worry and distress among vulnerable groups, including young adults. Little is known about how Dutch young adults experience and cope with climate change within their specific social and environmental context. This study examines Dutch young people’s emotional responses to climate change, their perceived emotional and psychological needs arising from these experiences, and the barriers they encounter in engaging in pro-environmental behaviour, with the aim of informing public health strategies to better support and empower this vulnerable group. Data were drawn from a large online survey among a representative sample of 1006 Dutch young adults (16–35 years; 51% women). The questionnaire included fixed-answer sections assessing emotional responses to climate change, as well as two open-ended questions exploring participants’ perceptions of their emotional and psychological needs related to climate change and the barriers they perceive to pro-environmental behaviour. Descriptive statistics were used for the fixed-response items, and thematic analysis was applied to the open-ended responses. Many Dutch young adults reported worry and sadness about climate change and its impacts, with approximately one third experiencing feelings of powerlessness. A large percentage of respondents attributed responsibility to large companies, and nearly half indicated that they still had hope for the future. One third (31%) felt that nothing could make them feel better about climate change, and another third (36%) reported to experience no climate-related emotions. Key emotional needs included more action at personal, community, and governmental levels, and more motivating positive news. Almost half (46%) of young adults said they already lived sustainably, while perceived barriers to pro-environmental behaviour were mainly financial (21%), knowledge-related (8%), and time-related (7%). This exploratory study highlights key practical and emotional barriers to pro-environmental behaviour reported by Dutch young adults 16–35, who expressed diverse emotional needs while coping with climate change. The findings underscore the need for a multi-level public health response to climate-related emotions, that simultaneously addresses emotional needs, structural barriers, and opportunities for meaningful engagement. Lowering barriers to pro-environmental behaviour and fostering supportive environments that enable sustainable action among young adults may enhance wellbeing and strengthen their sense of agency. Public health supports this by reducing barriers to pro-environmental behaviour in young adults, through targeted support, clear information, and enabling social and structural conditions that promote wellbeing and sustained engagement. Full article

(This article belongs to the Special Issue Psychosocial Well-Being and Stress Related to Environmental Disaster and Climate Change)

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29 pages, 14338 KB

Open AccessArticle

Application of a Temporal Fusion Transformer and Long-Term Climate and Disease Data to Assess the Predictive Power and Understand the Drivers for Malaria and Dengue

by Micheal Teron Pillay, Mai Thi Quỳnh Le, Yuki Takamatsu, Tran Vu Phong, Nyakallo Kgalane and Noboru Minakawa

Int. J. Environ. Res. Public Health 2026, 23(1), 75; https://doi.org/10.3390/ijerph23010075 - 5 Jan 2026

Abstract

Vector-borne diseases are strongly influenced by climate, yet the magnitude and temporal variability of climate–disease relationships remain poorly quantified. Outbreaks occur abruptly, and responses are typically delayed, underscoring the need for predictive tools that can support proactive interventions. This study applies Temporal Fusion [...] Read more.

Vector-borne diseases are strongly influenced by climate, yet the magnitude and temporal variability of climate–disease relationships remain poorly quantified. Outbreaks occur abruptly, and responses are typically delayed, underscoring the need for predictive tools that can support proactive interventions. This study applies Temporal Fusion Transformers (TFTs) to long-term, high-resolution climate datasets and to weekly malaria and dengue case records from South Africa and Vietnam to assess predictive performance and identify key environmental drivers. The models incorporated diverse climatic predictors and large-scale climate indices and were trained using multi-horizon forecasting with novel loss functions and physics-based constraints. The best malaria model achieved an R² of 0.95 and an MAE of 4.98, while leading dengue models reached R² values up to 0.90. Variable-importance analyses derived from model-learned weights showed that extreme temperature and rainfall metrics were consistently the strongest predictors, with ENSO (El Niño Southern Oscillation) and IOD (Indian Ocean Dipole) improving longer-range malaria forecasts. Furthermore, climate–disease risk dynamics were explored, revealing specific temperature and rainfall thresholds associated with elevated transmission and highlighting non-stationary relationships across decades. These findings demonstrate accurate, interpretable forecasting offered by TFTs and represent a valuable tool for early warning and understanding of complex climate–disease interactions. Full article

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20 pages, 1429 KB

Open AccessArticle

Character Strengths as Predictors of Mental Health and Well-Being During the COVID-19 Pandemic: A 13-Month Longitudinal Study

by María Luisa Martínez-Martí, Cecilia I. Theirs, David Pascual and Sergio Villar

Int. J. Environ. Res. Public Health 2026, 23(1), 74; https://doi.org/10.3390/ijerph23010074 - 4 Jan 2026

Abstract

The COVID-19 pandemic has posed significant challenges to mental health worldwide, raising the need to identify stable psychological resources that promote sustainable well-being. This longitudinal study examined whether character strengths predict well-being, post-traumatic growth, and mental health over a 13-month period. Participants (N [...] Read more.

The COVID-19 pandemic has posed significant challenges to mental health worldwide, raising the need to identify stable psychological resources that promote sustainable well-being. This longitudinal study examined whether character strengths predict well-being, post-traumatic growth, and mental health over a 13-month period. Participants (N = 146) completed online measures of character strengths, mental health, life satisfaction, affect, and post-traumatic growth at two time points. First, we tested whether a single general factor of character predicted later mental health and whether life satisfaction, affect, and post-traumatic growth mediated this relationship. Then, we repeated this model but with five different character strengths factors as predictors. Results showed that character predicted all mediators and mental health over time, but only the affective components of well-being mediated the relationship between character and mental health, especially positive affect. When looking at the five character strengths factors, although the majority predicted higher well-being and better mental health over time, goodness and interpersonal and fortitude strengths yielded the strongest effects. These findings suggest that character strengths contribute to sustainable well-being by fostering affective resilience in the face of adversity, aligning with the goals of Sustainable Development Goal 3 (Good Health and Well-being). Full article

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

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30 pages, 1801 KB

Open AccessSystematic Review

Systematic Review of Noise Pollution in Morocco: Regulatory Frameworks, Urban Impacts, and Policy Recommendations

by Mohamed El Malki, Ali Khettabi, Felipe A. P. de Figueiredo and Mohammed Serrar

Int. J. Environ. Res. Public Health 2026, 23(1), 73; https://doi.org/10.3390/ijerph23010073 - 4 Jan 2026

Abstract

Background: Driven by rapid urbanization, infrastructural development, socio-economic growth, and population increase, noise pollution has become a major public health and environmental policy challenge in Moroccan cities. However, current legislation and enforcement mechanisms remain insufficient to address rising exposure levels and associated health [...] Read more.

Background: Driven by rapid urbanization, infrastructural development, socio-economic growth, and population increase, noise pollution has become a major public health and environmental policy challenge in Moroccan cities. However, current legislation and enforcement mechanisms remain insufficient to address rising exposure levels and associated health risks. Methods: This systematic review followed PRISMA guidelines to examine urban noise levels, health implications, the regulatory frameworks, and policy actions related to noise pollution in Morocco. Various databases were systematically searched (Scopus, Web of Science, Google Scholar), along with reports from international organizations and government bodies for studies published between 2003 and 2025. Eligible documents included peer-reviewed publications and official reports directly addressing Moroccan noise pollution, legislation, urban impacts, or health outcomes. Results: Twenty-three Moroccan studies and additional regional, European, and legislative sources were included. Findings show that average noise levels in Moroccan urban centers generally exceed international safety thresholds and are associated with cardiovascular risks, sleep disturbances, and psychological stress. The regulatory framework suffers from weak enforcement, limited monitoring protocols, and an absence of noise mapping. Tangier, Béni Mellal, Témara, Marrakech, and Casablanca exhibit significant environmental inequalities, particularly in low-income districts. Conclusions: Morocco’s current noise-management system is inadequate to address the growing health and environmental impacts of urban noise. Urgent actions are needed, including a dedicated noise-control law, systematic monitoring, noise mapping, and integration of public-health considerations into environmental governance. Policy reforms must prioritize vulnerable populations and align with international best practices. Full article

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27 pages, 449 KB

Open AccessReview

Culturally Adapted Mental Health Education Programs for Migrant Populations: A Scoping Review

by Shaima Ahammed Thayyilayil, Sophie Yohani, Lisa Cyuzuzo, Megan Kennedy and Bukola Salami

Int. J. Environ. Res. Public Health 2026, 23(1), 72; https://doi.org/10.3390/ijerph23010072 - 2 Jan 2026

Abstract

Migrant populations drive Canada’s demographic expansion, making their successful integration a national priority. However, research has consistently shown that refugees and immigrants experience declining mental health and encounter significant barriers to accessing culturally appropriate mental health support. This scoping review examined the breadth [...] Read more.

Migrant populations drive Canada’s demographic expansion, making their successful integration a national priority. However, research has consistently shown that refugees and immigrants experience declining mental health and encounter significant barriers to accessing culturally appropriate mental health support. This scoping review examined the breadth of evidence on culturally adapted mental health education (MHE) programs for migrant populations, including those that integrate traditional and complementary healing practices, and their effectiveness. Systematic searches across six databases (Medline, EMBASE, PsycINFO, Global Health, CINAHL, and Scopus) identified 4075 peer-reviewed articles, with 28 studies meeting inclusion criteria. These included mental health education and awareness programs that integrate psychoeducation and skill-building. Inclusion criteria required cultural adaptation of programs through one or more approaches such as language modification, culturally adapted content, community-based delivery, or integration of traditional and complementary healing practices. Thematic analysis of the programs revealed seven key themes characterizing effective MHE programs: cultural adaptation and sensitivity, addressing unique migration-related stressors, integration of traditional and Western approaches, use of theoretical frameworks and evidence-based practices, rigorous evaluation methodologies, application of holistic frameworks, and community-based peer support models. Programs predominantly utilized psychoeducation and culturally adapted interventions, with common theoretical frameworks including cognitive–behavioral therapy and the PRECEDE–PROCEED model. Across the reviewed studies, program evaluations reported positive outcomes including increased mental health literacy, reduced stigma, enhanced coping skills, and decreased depression, anxiety, and PTSD symptoms, suggesting that culturally adapted MHE programs are acceptable and feasible interventions for migrant populations. Full article

(This article belongs to the Special Issue The State of Mental Health Services: Challenges, Trends and Achievements)

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16 pages, 715 KB

Open AccessArticle

Evaluation of Food Offerings for Workers in Commercial Foodservices from the Perspective of Healthiness and Sustainability

by Thaís de Gois Santos Marinho, Maria Luísa Meira Faustino, Maria Izabel de Oliveira Silva, Tatiane de Gois Santos, Ingrid Wilza Leal Bezerra and Priscilla Moura Rolim

Int. J. Environ. Res. Public Health 2026, 23(1), 71; https://doi.org/10.3390/ijerph23010071 - 2 Jan 2026

Abstract

Aims: To evaluate the quality of lunch menus for workers in commercial food services across social, health and environmental sustainability dimensions. Methods: Mixed methods were applied to five restaurants. Data collection included a sociodemographic questionnaire, the Brazilian Food Insecurity Scale (EBIA), workers’ nutritional [...] Read more.

Aims: To evaluate the quality of lunch menus for workers in commercial food services across social, health and environmental sustainability dimensions. Methods: Mixed methods were applied to five restaurants. Data collection included a sociodemographic questionnaire, the Brazilian Food Insecurity Scale (EBIA), workers’ nutritional status, nutritional composition of 111 lunch menus, and environmental footprints. Data triangulation integrated caloric–nutritional adequacy, food insecurity, obesity, protein supply, and environmental footprints. Results: We assessed 261 participants (71.6% male; average age 32.3; 53.5% with a high school education). Food insecurity affected 53.3% and was associated with income, education, household composition, and municipality (p < 0.05). Nutritional status (n = 438) showed 68.3% were overweight/obese; obesity affected 42.7% of women and 30.5% of men. Menu analyses (n = 111) showed adequate energy and protein, but excessive lipids and sodium and reduced carbohydrates. Environmental analyses indicated beef had the highest impact; protein type was more influential than quantity, indicating no simple linear nutrition–impact relationship. Conclusion: Widespread food insecurity and obesity co-occurred with menus characterized by excessive lipids, sodium, and beef-driven impacts. The findings highlight that health and sustainability outcomes depend on both menu quality and social context, necessitating integrated, multidimensional policies. Full article

(This article belongs to the Special Issue Promoting Health and Safety in the Workplace)

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13 pages, 267 KB

Open AccessArticle

Perceptions and Experiences of Xylazine, Disparities in Xylazine Awareness, and Correlates of Xylazine-Attributed Wounds Among People Who Use Opioids

by Carl A. Latkin, Lauren Dayton, Haley Bonneau, Melissa A. Davey-Rothwell, Danielle German, Ananya Bhaktaram and Oluwaseun Falade-Nwulia

Int. J. Environ. Res. Public Health 2026, 23(1), 70; https://doi.org/10.3390/ijerph23010070 - 2 Jan 2026

Abstract

Background: Xylazine, an adulterant in the illicit opioid supply, heightens the risks of overdose, withdrawal severity, and severe wounds among people who use opioids (PWUO). Despite increasing prevalence, gaps remain regarding xylazine awareness in the drug supply and effective harm reduction interventions to [...] Read more.

Background: Xylazine, an adulterant in the illicit opioid supply, heightens the risks of overdose, withdrawal severity, and severe wounds among people who use opioids (PWUO). Despite increasing prevalence, gaps remain regarding xylazine awareness in the drug supply and effective harm reduction interventions to address it. Methods: We conducted a cross-sectional survey of 703 PWUO in Baltimore, MD (2023–2025), to assess xylazine awareness, perceptions, and experiences. Multivariable logistic regression models examined correlates of xylazine awareness and self-reported xylazine-attributed wounds. Results: 84.8% of White participants, 48.6% Black participants, 64.3% of males, and 51.4% females had heard of xylazine. Nearly half (45%) of those who used xylazine reported that it caused more severe withdrawal symptoms. In the multivariable model of xylazine awareness, the largest odds ratios were year of survey administration (2024 vs. 2023: aOR = 4.30, 95% CI = 2.91–6.37; 2025 vs. 2023: aOR = 6.32, 95% CI = 3.31–12.07) and White race (aOR = 3.22, 95% CI = 1.85–5.57). Other significant demographic variables included education and gender. In the multivariable model of xylazine-attributed wounds, survey year 2025 vs. 2023 (aOR = 2.65, 95% CI = 1.06–6.61) and injection drug use in the prior year (aOR = 17.74, 95% CI = 5.58–56.39) were statistically significant. Conclusions: Awareness of xylazine in the drug supply remains incomplete among PWUO, with differences by race, age, and gender. The finding of a strong association of xylazine-attributed wounds and injection drug use should be the focus of future research. These findings underscore the need for enhanced surveillance systems, peer education, and community-based harm reduction strategies. Real-time monitoring and rapid response strategies are essential to protect against health risks of toxic adulterants, such as xylazine, medetomidine, and BTMP, in the drug supply. Full article

23 pages, 2689 KB

Open AccessArticle

Integrating Surveillance and Stakeholder Insights to Predict Influenza Epidemics: A Bayesian Network Study in Queensland, Australia

by Oz Sahin, Hai Phung, Andrea Standke, Mohana Rajmokan, Alex Raulli, Amy York and Patricia Lee

Int. J. Environ. Res. Public Health 2026, 23(1), 69; https://doi.org/10.3390/ijerph23010069 - 1 Jan 2026

Abstract

Seasonal influenza continues to pose a substantial and recurrent public health challenge in Queensland, driven by annual variability in transmission and uncertainty in climatic, demographic, and behavioural determinants. Predictive modelling is constrained by data limitations and parameter uncertainty. In response, this study developed [...] Read more.

Seasonal influenza continues to pose a substantial and recurrent public health challenge in Queensland, driven by annual variability in transmission and uncertainty in climatic, demographic, and behavioural determinants. Predictive modelling is constrained by data limitations and parameter uncertainty. In response, this study developed a Bayesian network (BN) model to estimate the probability of influenza epidemics in Queensland, Australia. The model integrated diverse inputs, including international and local influenza surveillance data, demographic health statistics, and expert and stakeholder insights to capture the complex multifactorial causal relationships underlying epidemic risk. Scenario-based simulations revealed that Southeast Asian viral origin, severe global influenza seasons, peak season timing, increasing international travel, absence of control measures, and low immunisation rates substantially elevate the likelihood of influenza epidemics. Southeast Queensland was identified as particularly vulnerable under high-risk conditions. Model evaluation demonstrated good discriminative performance (AUC = 0.6974, accuracy = 70%) with appropriate uncertainty quantification through credible intervals and sensitivity analysis. Its modular design and capacity for integrating various data sources make it a practical decision-making support tool for public health preparedness and responding to evolving climatic and epidemiological conditions. Full article

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15 pages, 958 KB

Open AccessArticle

Impact of Social Determinants of Health on the Incidence of Tuberculosis in Central Asia

by Assiya Kussainova, Laura Kassym, Almas Kussainov, Ainash Orazalina, Yerbol Smail, Gulmira Derbissalina, Zhanagul Bekbergenova, Ulzhan Kozhakhmetova, Elvira Aitenova and Yuliya Semenova

Int. J. Environ. Res. Public Health 2026, 23(1), 68; https://doi.org/10.3390/ijerph23010068 - 1 Jan 2026

Abstract

Background/Objectives: Tuberculosis (TB) remains a major global health challenge influenced by social determinants of health (SDHs) such as poverty, overcrowding, malnutrition, and limited healthcare access. Although Central Asia (CA) has achieved progress through vaccination, screening, and treatment, the region continues to face severe [...] Read more.

Background/Objectives: Tuberculosis (TB) remains a major global health challenge influenced by social determinants of health (SDHs) such as poverty, overcrowding, malnutrition, and limited healthcare access. Although Central Asia (CA) has achieved progress through vaccination, screening, and treatment, the region continues to face severe disease consequences, unstable incidence patterns, and an escalating challenge of TB resistant to first-line drugs. This study aimed to analyze TB incidence dynamics in Kazakhstan, Tajikistan, the Kyrgyz Republic, Turkmenistan, and Uzbekistan from 2000–2023, forecast trends to 2030, and identify key SDHs shaping the epidemic. Methods: Data on TB incidence were obtained from the World Bank DataBank for 2000–2023. Of 61 socioeconomic, environmental, and health-related indicators, 29 were included in the analysis. Statistical procedures in SPSS (v24.0) involved time-series forecasting through 2030, calculation of average annual percentage change (AAPC), correlation testing, and linear regression, with significance set at p < 0.05. Results: TB incidence generally declined across CA during 2000–2023, though trends varied by country. Forecasts suggest continued decreases in Turkmenistan and Uzbekistan, while Kazakhstan, Tajikistan, and the Kyrgyz Republic display fluctuating or nonsignificant patterns, likely influenced by SDHs. Regression analyses indicated that anemia, undernourishment, and population density showed a positive relationship with TB incidence, while clean fuel access, physician density, and Gross Domestic Product per capita (GDP) were inversely related. Conclusions: The findings highlight the heterogeneous nature of TB dynamics in CA and the possible role of SDHs. Enhanced surveillance, nutritional and social interventions are required to sustain progress toward End TB targets. Full article

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15 pages, 513 KB

Open AccessArticle

Frequent Plastic Usage Behavior and Lack of Microplastic Awareness Correlates with Cognitive Decline: A Cross-Sectional Survey

by Pukovisa Prawiroharjo, Anyelir Nielya Mutiara Putri, Noryanto Ikhromi, Aldithya Fakhri, Elizabeth Divina, Rani Permata, Aileen Gabrielle, Violine Martalia and Agustyno Zulys

Int. J. Environ. Res. Public Health 2026, 23(1), 67; https://doi.org/10.3390/ijerph23010067 - 1 Jan 2026

Abstract

Introduction: Microplastics (MPs) are widespread environmental pollutants with possible neurotoxic effects. Exploring links between plastic use, MP awareness, and cognition is key for assessing public health risks. Objective: To examine correlations between plastic consumption, MP awareness and attitudes, and neurocognitive function among Greater [...] Read more.

Introduction: Microplastics (MPs) are widespread environmental pollutants with possible neurotoxic effects. Exploring links between plastic use, MP awareness, and cognition is key for assessing public health risks. Objective: To examine correlations between plastic consumption, MP awareness and attitudes, and neurocognitive function among Greater Jakarta residents. Methods: A cross-sectional survey of 562 adults used a validated e-questionnaire covering plastic usage, MP knowledge, attitudes, risk perception, and cognition via the Ascertain Dementia 8 (AD-8). Analyses included chi-square, t-tests, and logistic regression. Results: Suspected cognitive impairment (AD-8 ≥ 2) was observed in 44.5% of respondents. High single-use plastic consumption correlated with worse cognition (p = 0.032), while reusable plastic use showed no association (p = 0.605). Awareness of MPs was relatively low, with 19.4% of respondents having never heard of them. Awareness and knowledge also varied significantly by age (p = 0.007), gender (p = 0.004), and education level (p = 0.027). Positive attitudes and higher risk perception aligned with greater awareness (p < 0.001) but not cognitive scores. Risk perception influenced bottled water use (p = 0.009), with low-risk groups consuming more. Conclusions: Frequent single-use plastic consumption is linked to poorer cognition, while MP awareness and risk perception do not directly affect cognitive outcomes. Educational strategies may enhance awareness and reduce exposure. Full article

(This article belongs to the Topic Plastic Contamination (Plastamination): An Environmental and Public Health-Related Concern)

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