International Journal of Environmental Research and Public Health

16 pages, 499 KB

Open AccessArticle

The Mediating Role of Burnout and Secondary Traumatic Stress in the Relationship Between Perceived Stress and Quality of Life Among Nurses

by Marin Mamić, Tihomir Jovanović, Božica Lovrić, Gabriela Katharina Pomper, Ivana Mamić, Ivana Barać, Robert Lovrić, Goranka Rafaj, Danijela Kumpović and Ivan Vukoja

Int. J. Environ. Res. Public Health 2026, 23(4), 540; https://doi.org/10.3390/ijerph23040540 (registering DOI) - 21 Apr 2026

Abstract

(1) Background: Nurses are exposed to occupational stressors that may impair their well-being and quality of life. This study examined whether burnout and secondary traumatic stress mediate the relationship between perceived stress and physical and psychological quality of life. (2) Methods: A cross-sectional [...] Read more.

(1) Background: Nurses are exposed to occupational stressors that may impair their well-being and quality of life. This study examined whether burnout and secondary traumatic stress mediate the relationship between perceived stress and physical and psychological quality of life. (2) Methods: A cross-sectional study included 294 nurses employed at the Clinical Hospital Center Osijek, Croatia. Data were collected using the Perceived Stress Scale (PSS-10), the Burnout and Secondary Traumatic Stress subscales of the Professional Quality of Life Scale (ProQOL-5), and the physical and psychological domains of the WHOQOL-BREF. Pearson correlations and path analysis were used. (3) Results: Perceived stress showed significant negative effects on physical (β = −0.291; p < 0.001) and psychological quality of life (β = −0.217; p < 0.001), and positive effects on burnout (β = 0.230; p < 0.001) and secondary traumatic stress (β = 0.171; p = 0.002). Burnout significantly mediated both relationships, while secondary traumatic stress did not. The model explained 20.8% and 19.3% of variance in physical and psychological quality of life. (4) Conclusions: Burnout represents an important pathway linking perceived stress with poorer quality of life among nurses. Full article

(This article belongs to the Special Issue Exploring Quality of Life in Nursing and Patient Care)

11 pages, 254 KB

Open AccessArticle

Postpartum OGTT Non-Adherence in Regional and Rural Australia: A Longitudinal Study

by Michelle Culhane, Shelley Jedrisko, Joanne Harris, Michelle Johnson, Nourah Lababidi and Christina Aggar

Int. J. Environ. Res. Public Health 2026, 23(4), 539; https://doi.org/10.3390/ijerph23040539 (registering DOI) - 21 Apr 2026

Abstract

Background: Postpartum oral glucose tolerance test (OGTT) screening after gestational diabetes mellitus (GDM) enables early detection and prevention of type 2 diabetes, yet adherence is suboptimal, particularly in regional and rural areas. This study examined lifestyle behaviour and health-related quality-of-life factors associated with [...] Read more.

Background: Postpartum oral glucose tolerance test (OGTT) screening after gestational diabetes mellitus (GDM) enables early detection and prevention of type 2 diabetes, yet adherence is suboptimal, particularly in regional and rural areas. This study examined lifestyle behaviour and health-related quality-of-life factors associated with OGTT non-adherence over time. Methods: A longitudinal cohort study of women with prior GDM in regional and rural New South Wales, Australia, was conducted. Binary logistic regression models examined associations between lifestyle behaviours, health-related quality of life, and OGTT non-adherence at 3, 18, and 36 months postpartum. Results: OGTT non-adherence increased over time. Multivariable models were not statistically significant at any timepoint. At 3 months postpartum, several lifestyle and health-related quality-of-life variables were associated with non-adherence; however, these associations were not sustained at later timepoints. No consistent predictors of non-adherence were identified across follow-up. Conclusions: All women with prior GDM remain at risk of missed postpartum screening, with engagement declining over time. Findings should be interpreted as exploratory, reflecting time-specific patterns rather than stable predictors. Early postpartum represents a critical window for intervention, while longer-term strategies require flexible, integrated, and accessible models of care to support sustained diabetes prevention, particularly in regional and rural populations. Full article

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

19 pages, 2897 KB

Open AccessArticle

Oral Function, Frailty and Mortality in Older Adults: Evidence from the Chilean National Health Survey 2016–2017

by Gustavo Sáenz-Ravello, Mauricio Baeza, Laura Sáenz-Ravello, Carol Guarnizo-Herreño and Jorge Gamonal

Int. J. Environ. Res. Public Health 2026, 23(4), 538; https://doi.org/10.3390/ijerph23040538 (registering DOI) - 21 Apr 2026

Abstract

Background: Oral health is an often-overlooked component of healthy ageing, as a sign of cumulative functional decline. This study explored the association between oral functional status and all-cause mortality. Methods: This was a secondary analysis of the 2016–2017 Chilean National Health Survey linked [...] Read more.

Background: Oral health is an often-overlooked component of healthy ageing, as a sign of cumulative functional decline. This study explored the association between oral functional status and all-cause mortality. Methods: This was a secondary analysis of the 2016–2017 Chilean National Health Survey linked to mortality records through December 31, 2022. In total, 223 participants aged ≥ 60 years were included (N = 1,016,557). Minimum dentition (MD) was defined as ≥10 teeth, prosthesis use was self-reported, and frailty was assessed using a modified Fried phenotype. Survey-weighted Cox models estimated associations with all-cause mortality, adjusting for age, sex, area, education, frailty, diabetes, and hypertension. Results: In the survey-weighted Cox model, each category representing MD and/or prosthesis use was associated with lower mortality hazards compared with the reference group (<10 teeth and no prostheses): prostheses only (HR 0.17, 95% CI 0.05–0.61), MD only (HR 0.16, 95% CI 0.04–0.74), and MD with prostheses (HR 0.08, 95% CI 0.01–0.46). Increasing age and rural residence were associated with higher mortality hazards, whereas estimates for sex, education, frailty, diabetes and hypertension were imprecise and generally compatible with no clear association. Conclusions: These findings are hypothesis-generating and support further evaluation of oral functional status as a marker of broader health vulnerability in aged Chileans. Full article

(This article belongs to the Special Issue Improving Oral Health for Older Adults)

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14 pages, 294 KB

Open AccessArticle

Urban Homelessness in California: A Multicity Analysis of Structural Constraints and Policy Implementation

by Peter G. Kreysa

Int. J. Environ. Res. Public Health 2026, 23(4), 537; https://doi.org/10.3390/ijerph23040537 (registering DOI) - 21 Apr 2026

Abstract

Across California, the seven largest cities—Los Angeles, San Diego, San Jose, San Francisco, Fresno, Sacramento, and Long Beach—carry a disproportionate share of the state’s homelessness crisis, even though they operate under the same statewide policy framework. Each city’s homelessness system reflects its own [...] Read more.

Across California, the seven largest cities—Los Angeles, San Diego, San Jose, San Francisco, Fresno, Sacramento, and Long Beach—carry a disproportionate share of the state’s homelessness crisis, even though they operate under the same statewide policy framework. Each city’s homelessness system reflects its own history, political climate, and housing market conditions, and this study shows that a common set of structural forces especially severe housing scarcity, fragmented behavioral–health systems, and uneven local capacity shapes homelessness across these urban areas while producing different outcomes on the ground. Drawing on multidisciplinary research, statewide policy analyses, and municipal data, the analysis compares how cities interpret and implement key interventions, including permanent supportive housing, interim shelter expansion, prevention strategies, and enforcement-oriented responses. The findings make clear that California’s homelessness crisis cannot be reduced to a single cause; instead, understanding it requires a systems-oriented perspective that accounts for the intertwined economic, social, and policy forces shaping conditions in each community. By situating city-level strategies within broader statewide patterns, the study identifies points of convergence and divergence, as well as persistent structural constraints that limit the effectiveness of current responses, underscoring the need for coordinated, scalable, and context-responsive policy solutions. Full article

1 pages, 177 KB

Open AccessRetraction

RETRACTED: Choi, H.-S.; Lee, B.-M. A Complex Intervention Integrating Prism Adaptation and Neck Vibration for Unilateral Neglect in Patients of Chronic Stroke: A Randomised Controlled Trial. Int. J. Environ. Res. Public Health 2022, 19, 13479

by Hyun-Se Choi and Bo-Min Lee

Int. J. Environ. Res. Public Health 2026, 23(4), 536; https://doi.org/10.3390/ijerph23040536 (registering DOI) - 21 Apr 2026

Abstract

The journal retracts the article titled “A Complex Intervention Integrating Prism Adaptation and Neck Vibration for Unilateral Neglect in Patients of Chronic Stroke: A Randomised Controlled Trial” [...] Full article

19 pages, 494 KB

Open AccessArticle

Diet Cost and Affordability in Queensland: A Two-Year Cross-Sectional Study

by Renae Earle, Tessa Kenney, Kora Uhlmann, Meron Lewis, Nicola Malone, Martin O’Flaherty and Simone Nalatu

Int. J. Environ. Res. Public Health 2026, 23(4), 535; https://doi.org/10.3390/ijerph23040535 - 20 Apr 2026

Abstract

Diet affordability is a critical determinant of food security, health and wellbeing. However, the cost and affordability of diets have not been routinely measured in Queensland (Australia) in over a decade. This study assessed the cost and affordability of healthy (based on national [...] Read more.

Diet affordability is a critical determinant of food security, health and wellbeing. However, the cost and affordability of diets have not been routinely measured in Queensland (Australia) in over a decade. This study assessed the cost and affordability of healthy (based on national healthy eating guidelines) and habitual (less healthy, based on national reported intake) diets across six Queensland regions. Data were collected in 35 communities, over two years (2023 and 2024), using the evidence-based Healthy Diets Australian Standardised Affordability and Pricing protocol. Data were analyzed relative to a six-person intergenerational Aboriginal and Torres Strait Islander reference household. Results indicate that, across Queensland, healthy diet costs are above the threshold for food stress in Aboriginal and Torres Strait Islander households. On average, healthy diets were 30% cheaper than the habitual diet (which include alcohol and takeaway foods) but cost at least 26% of household income (above the 25% threshold for food stress). In 2023, healthy diets were on average 31% more expensive in remote communities compared to urban and regional centers. In 2024, the cost of a healthy diet in remote communities decreased significantly by 24%, narrowing diet cost differences between remote and non-remote regions. This shift could be associated with the implementation of a freight subsidy in remote Queensland, or other influences on remote food pricing. Findings highlight diet-related cost-of-living challenges for Aboriginal and Torres Strait Islander families, underscore the need for ongoing monitoring and provide insight for policy interventions (such as targeted subsidies) to improve diet affordability and reduce nutrition-related health inequity. Full article

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14 pages, 278 KB

Open AccessArticle

Out of Sight: Sex Differences in Public and Semi-Public Drug Use Settings Among People Who Use Opioids in Baltimore, Maryland

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

Int. J. Environ. Res. Public Health 2026, 23(4), 534; https://doi.org/10.3390/ijerph23040534 - 20 Apr 2026

Abstract

Background: Drug use settings are critical determinants of overdose risk and other drug-related harms. Although sex differences in drug use patterns are well documented, less is known about sex differences in the types of locations where people use drugs. This study examined sex [...] Read more.

Background: Drug use settings are critical determinants of overdose risk and other drug-related harms. Although sex differences in drug use patterns are well documented, less is known about sex differences in the types of locations where people use drugs. This study examined sex differences in drug use settings among people who use opioids. Methods: Data were from the baseline survey of the OASIS project, a community-based study conducted in Baltimore, Maryland (N = 869), focusing on 9 specific types of locations where participants reported drug use in the past 30 days: their own residence, someone else’s residence, street, alley, park, abandoned building, public restroom, car, and other locations. Bivariate and multivariable logistic regression models examined associations between sex and drug use settings, adjusting for age, race, education, homelessness, and frequency of drug use. Results: The sample included 346 women and 523 men. In adjusted models, women had significantly lower odds than men of using drugs on the street (aOR = 0.49, 95% CI 0.35–0.70), in alleys (aOR = 0.50, 95% CI 0.35–0.69), parks (aOR = 0.57, 95% CI 0.42–0.78), abandoned buildings (aOR = 0.53, 95% CI 0.38–0.75), cars (aOR = 0.55, 95% CI 0.41–0.73), and other locations (aOR = 0.59, 95% CI 0.37–0.94). Sex was not significantly associated with drug use at one’s own residence or someone else’s residence. Conclusions: Women who use opioids were significantly less likely than men to use drugs in public and semi-public settings, which may reflect gendered patterns of stigma, interpersonal violence, and safety concerns. Harm reduction programs should focus on making current drug use settings safer and developing additional safer settings with an emphasis on addressing barriers for women to access harm reduction services, including women-centered overdose prevention centers and household-based overdose response training. Full article

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

2 pages, 178 KB

Open AccessRetraction

RETRACTED: Khalil-ur-Rehman et al. Impact of Substantive Staging and Communicative Staging of Sustainable Servicescape on Behavioral Intentions of Hotel Customers through Overall Perceived Image: A Case of Boutique Hotels. Int. J. Environ. Res. Public Health 2021, 18, 9123

by Khalil-ur-Rehman, Mohammad Adnan, Naveed Ahmad, Miklas Scholz, Muhammad Khalique, Rana Tahir Naveed and Heesup Han

Int. J. Environ. Res. Public Health 2026, 23(4), 533; https://doi.org/10.3390/ijerph23040533 - 20 Apr 2026

Abstract

The journal retracts the article titled “Impact of Substantive Staging and Communicative Staging of Sustainable Servicescape on Behavioral Intentions of Hotel Customers through Overall Perceived Image: A Case of Boutique Hotels” [...] Full article

16 pages, 608 KB

Open AccessArticle

Evaluation of a National Breast Cancer Screening Program in a Middle-Income Country: The Case of Kazakhstan

by Yuliya Semenova, Zhandos Burkitbayev, Sanzhar Shalekenov, Oxana Shatkovskaya, Gauhar Dunenova, Alma Zhylkaidarova, Azat Chinaliyev, Baurzhan Anapiya, Asel Sadvakassova, Ayan Yerekesh, Zhadyra Karashutova, Almira Manatova and Lyudmila Pivina

Int. J. Environ. Res. Public Health 2026, 23(4), 532; https://doi.org/10.3390/ijerph23040532 - 19 Apr 2026

Abstract

Breast cancer (BC) is the most common cancer in Kazakhstan, and a population-based breast cancer screening program was introduced in 2008, initially targeting women aged 50–60 years. It was subsequently expanded in 2018 to include women aged 40–70 years. This study evaluates the [...] Read more.

Breast cancer (BC) is the most common cancer in Kazakhstan, and a population-based breast cancer screening program was introduced in 2008, initially targeting women aged 50–60 years. It was subsequently expanded in 2018 to include women aged 40–70 years. This study evaluates the national BC screening program from its introduction in 2008 onward, focusing on program outputs, outcomes, and associated expenditures. Several administrative datasets and official sources were analyzed, including the legislative acts database, analytical reports on cancer screening programs, and cancer reporting forms. Trends in key indicators were summarized using the average annual percent change (AAPC). From the program’s inception, the absolute number of women screened increased steadily, with an AAPC of 6.23%. In contrast, the proportion of eligible women covered by screening declined over time, particularly following the expansion of the target age groups in 2018. Stage I BC detected through screening accounted for only about 50% of all stage I BC cases diagnosed nationwide, while the contribution of screening to stage II cancers was below 30%. Neither the introduction nor the subsequent expansion of the BC screening program was associated with statistically significant immediate or trend changes in national BC incidence or mortality rates. These findings may inform evidence-based discussions on potential refinements to BC screening policy and practice in Kazakhstan. Full article

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

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48 pages, 543 KB

Open AccessSystematic Review

The Influence of Social Determinants of Health, Environmental, and Healthcare Resources on Life Expectancy in the Organization of Islamic Cooperation (OIC) Countries: A Systematic Review

by Ruhina Aimaq, Hana AlSumri, Amal S. Malehi, Zainab M. Al-Zadjali, Kouthar S. Al-Alawi, Laila S. Al-Saadi, Rawan Ibrahim, Sumaiya Al Aamri, Rabab Mohammed Bedawi Husien, Anak Agung Bagus Wirayuda and Moon Fai Chan

Int. J. Environ. Res. Public Health 2026, 23(4), 531; https://doi.org/10.3390/ijerph23040531 - 18 Apr 2026

Abstract

Life expectancy (LE) varies widely across Organization of Islamic Cooperation (OIC) countries, reflecting differences in economic, social, environmental, and health-system conditions. This review aimed to synthesize quantitative evidence on determinants of LE at birth in OIC member countries. The study was conducted in [...] Read more.

Life expectancy (LE) varies widely across Organization of Islamic Cooperation (OIC) countries, reflecting differences in economic, social, environmental, and health-system conditions. This review aimed to synthesize quantitative evidence on determinants of LE at birth in OIC member countries. The study was conducted in accordance with the PRISMA guidelines, and a systematic search of electronic databases was performed up to September 2025. After screening 5312 records and assessing full texts, studies were appraised using the Joanna Briggs Institute checklists, with an inclusion threshold of ≥80%. A total of 54 studies, mainly ecological, time-series, and panel analyses using national-level data, were included. Higher gross domestic product per capita, education, employment, and health expenditure were consistently associated with longer LE. In contrast, poverty, income inequality, air pollution, and carbon dioxide emissions were associated with shorter LE. Clear differences were observed across World Bank income groups, with LE being lowest in low-income OIC countries and highest in high-income Gulf Cooperation Council states, where gains were driven more by health-system resources than by income growth. Improving LE in OIC countries requires integrated economic, social, environmental, and health-system policies. Full article

(This article belongs to the Special Issue 4th Edition: Social Determinants of Health)

15 pages, 734 KB

Open AccessArticle

Ecotoxicological Assessment and Biodegradation of Prednisone by Aquatic Microorganisms

by Érika Michelle Miranda, Paula von Randow Cardoso, Carolina Paula de Souza Moreira and Marcos Paulo Gomes Mol

Int. J. Environ. Res. Public Health 2026, 23(4), 530; https://doi.org/10.3390/ijerph23040530 - 18 Apr 2026

Abstract

The increasing consumption of pharmaceuticals associated with global population growth has intensified concerns regarding their release into aquatic environments and potential ecotoxicological effects. In this context, this study evaluated the ecotoxicity and biodegradation of the widely used corticosteroid prednisone. Ecotoxicity assays were performed [...] Read more.

The increasing consumption of pharmaceuticals associated with global population growth has intensified concerns regarding their release into aquatic environments and potential ecotoxicological effects. In this context, this study evaluated the ecotoxicity and biodegradation of the widely used corticosteroid prednisone. Ecotoxicity assays were performed using aquatic organisms representing different trophic levels: Artemia salina (microcrustacean), Aliivibrio fischeri (marine bacterium), and the cyanobacterium Microcystis novacekii. Biodegradation assays were conducted using M. novacekii. Prednisone was tested at concentrations ranging from 5 to 100 mg/L, corresponding to its maximum solubility in water. All experiments were carried out in accordance with standardized protocols (ABNT NBR 16530, ABNT NBR 15411-3, ISO 11348-3, and OECD 201). No toxic effects were observed for prednisone in any of the tested organisms, as responses at all tested concentrations, including the highest, were not significantly different from the control. Therefore, it was not possible to estimate EC50 values within the tested concentration range. According to the Globally Harmonized System of Classification and Labelling of Chemicals (GHS), substances with effect concentrations above 100 mg/L are considered non-toxic to aquatic organisms. During biodegradation assays, a reduction in prednisone concentration was observed during the growth of M. novacekii, which was associated with an increase in the pH of the culture medium. These results suggest that prednisone degradation occurred indirectly through pH changes caused by cyanobacterial growth rather than through direct metabolic pathways. Full article

(This article belongs to the Special Issue Pharmaceutical Pollution in Aquatic Ecosystems: Public Health Risks and Sustainable Solutions)

14 pages, 747 KB

Open AccessArticle

Bridging Gaps in Care: Evaluation of a Mobile Health Model Addressing Social Determinants and Harm Reduction in Eastern Puerto Rico

by Elisa Pujals, Glorimar Caraballo-Correa, Kathia Ocasio Maldonado, Yelanesse Pastrana Gonzalez, Rafael A. Torruella and Luis Román Badenas

Int. J. Environ. Res. Public Health 2026, 23(4), 529; https://doi.org/10.3390/ijerph23040529 - 18 Apr 2026

Abstract

The harms associated with substance use continue to disproportionately affect marginalized populations. This study presents a retrospective program evaluation of a mobile health unit that delivers integrated clinical and harm reduction services to marginalized populations in Eastern Puerto Rico. Methods: A secondary data [...] Read more.

The harms associated with substance use continue to disproportionately affect marginalized populations. This study presents a retrospective program evaluation of a mobile health unit that delivers integrated clinical and harm reduction services to marginalized populations in Eastern Puerto Rico. Methods: A secondary data analysis was conducted using administrative data from a mobile health unit, capturing client encounters, service utilization (e.g., mental health support, health screenings, safe injection counseling, and case management), visit frequency, and demographic characteristics. This study is framed as an implementation-focused program evaluation. Descriptive and exploratory analyses were conducted to assess service delivery, program reach, utilization patterns, and selected program outcomes over a 1.5-year period. Results: Between January 2022 and October 2023, the mobile health unit served 279 participants across eight municipalities. Participants exhibited higher rates of intravenous drug use, mental health disorders, homelessness, and incarceration history compared with previously published estimates for the general Puerto Rican population, although these comparisons are indirect. The program delivered multidisciplinary services and facilitated referrals addressing key social determinants of health, including housing, nutritional assistance, identification services, in-patient treatment, and medication-assisted treatment. Model-based estimates using the Mobile Health Map Impact Tracker tool suggest that, in 2023, mobile health screenings may be associated with a return on investment of approximately 6:1, 259 avoided emergency department visits, 29 life-years saved, and approximately USD 2.4 million in healthcare cost savings. Conclusions: This evaluation demonstrates the feasibility of a mobile health model integrating harm reduction and clinical services to reach highly marginalized populations and facilitate connections to health and social services. Findings reflect program implementation, service reach, and engagement rather than causal effectiveness. Mobile health approaches may represent a feasible and potentially beneficial strategy for expanding access to care, although further research incorporating patient-level outcomes is needed to assess effectiveness. Full article

(This article belongs to the Special Issue Advances and Trends in Mobile Healthcare)

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21 pages, 442 KB

Open AccessArticle

Social Media Addiction, Perceived Stress, Emotional Intelligence, and Cyberbullying Among Thai Adolescents During the Transition from the COVID-19 Pandemic to the Endemic Phase

by Sasicha Rodpet, Tusana Thaweekoon and Wilai Napa

Int. J. Environ. Res. Public Health 2026, 23(4), 528; https://doi.org/10.3390/ijerph23040528 - 18 Apr 2026

Abstract

The COVID-19 pandemic significantly increased adolescent digital engagement, but whether the rise in cyberbullying persists beyond the crisis is not well understood, especially in Southeast Asia. This study examined social media addiction, perceived stress, emotional intelligence, and cyberbullying among 416 Thai secondary students [...] Read more.

The COVID-19 pandemic significantly increased adolescent digital engagement, but whether the rise in cyberbullying persists beyond the crisis is not well understood, especially in Southeast Asia. This study examined social media addiction, perceived stress, emotional intelligence, and cyberbullying among 416 Thai secondary students (grades 7–12) during the pandemic-to-endemic transition (June–October 2023). Participants completed validated Thai-language instruments assessing cyberbullying, social media addiction, perceived stress, and emotional intelligence. Results showed 66.4% of adolescents were involved in cyberbullying, with 32.2% as bully-victims. Social media addiction correlated with cyberbullying perpetration (r_s = 0.33, p < 0.001) and victimization (r_s = 0.22, p < 0.001), as did perceived stress (r_s = 0.20 and 0.29; p < 0.001). Emotional intelligence showed negative correlations with cyberbullying perpetration (r_s = −0.15, p = 0.002) and victimization (r_s = −0.10, p = 0.048). Over one-third (34.4%) were at high risk for social media addiction. These findings indicate that during the pandemic-to-endemic transition, Thai adolescents showed elevated cyberbullying involvement, high social media addiction, and moderate-to-high stress—a profile consistent with sustained digital risk. These results highlight the need for integrated interventions that address digital wellness, stress management, and the development of emotional intelligence among Thai adolescents. Full article

(This article belongs to the Collection Bullying, Cyberbullying, Dating Violence, and Cyber Dating Violence in Adolescence)

15 pages, 729 KB

Open AccessArticle

Developing a Machine Learning Model for Personalized, Predictor-Centric, Adaptive Intervention for Vaping Cessation in Young People: Secondary Data Analysis of Smartphone App Data

by Anasua Kundu, Peter Selby, Daniel Felsky, Theo J. Moraes, Lynn Planinac and Michael Chaiton

Int. J. Environ. Res. Public Health 2026, 23(4), 527; https://doi.org/10.3390/ijerph23040527 - 18 Apr 2026

Abstract

Although increasing numbers of young people are trying to quit e-cigarettes, personalized tools to support vaping cessation remain limited. We aimed to build a machine learning model to predict individual probability of short-term relapses and identify person-specific barriers to successful cessation. Data were [...] Read more.

Although increasing numbers of young people are trying to quit e-cigarettes, personalized tools to support vaping cessation remain limited. We aimed to build a machine learning model to predict individual probability of short-term relapses and identify person-specific barriers to successful cessation. Data were taken from the “Stop Vaping Challenge” smartphone app. We included past 30-day e-cigarette users aged 15–35 years (n = 311) who completed 387 quit challenges. Feature selection minimized number of predictors while maximizing predictive ability. We built multiple GBM survival models with different sets of predictors to predict time to vaping relapse. The five-feature model yielded the best performance (C-index 0.751), thereby was selected as the final model. These five features were: self-confidence in quitting, intention to quit, average e-liquid used per week, time to first vape and mood trend during challenge. We stratified the challenges by the individual relapse risk by 7 days into low-, medium-, and high probability of quit success. This approach can inform tailored quit plans for vaping cessation. SHAP analysis demonstrated individual-level barriers to cessation, which can guide the development of personalized, predictor-centric, adaptive behavioral interventions. However, future research is needed to implement the model in real-world settings and evaluate its effectiveness and generalizability. Full article

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

13 pages, 825 KB

Open AccessArticle

Cost-Effectiveness of a Lifestyle and Behavioral Care Model Targeting Cardiometabolic Disease Progression

by Michelle Alencar, Rachel Sauls and Justin Whetten

Int. J. Environ. Res. Public Health 2026, 23(4), 526; https://doi.org/10.3390/ijerph23040526 - 18 Apr 2026

Abstract

Chronic diseases drive healthcare costs, and employers seek scalable strategies to improve health outcomes and control expenses. Telehealth behavioral care shows promise for managing chronic conditions, but its long-term economic value in employer populations is still unclear. We assessed the cost-effectiveness and ROI [...] Read more.

Chronic diseases drive healthcare costs, and employers seek scalable strategies to improve health outcomes and control expenses. Telehealth behavioral care shows promise for managing chronic conditions, but its long-term economic value in employer populations is still unclear. We assessed the cost-effectiveness and ROI of a behavioral care (LBC) model using a Markov model in a custom analytic tool. The model simulated disease progression, healthcare utilization, and QALYs over five years from the employer perspective. Transition probabilities, costs, and mortality risks were obtained from the InHealth program, national sources, and published literature. Employees in the behavioral care model were compared with a control group receiving usual care. Among 4461 employees aged 40, intervention participants had five-year costs of $41,431, versus $47,834 for controls, saving $6403 per member and $28.6 million overall. Treated members gained 4.7 QALYs compared to 4.6 in controls, equivalent to 36.5 extra days of full health. The program had a ROI of 6.53, showing significant cost savings. Telehealth behavioral care is a cost-effective way to improve health outcomes and provide financial benefits to employers. These results support incorporating behavioral care into value-based benefits and highlight potential long-term savings through prevention and management of lifestyle-related chronic diseases. Full article

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20 pages, 860 KB

Open AccessArticle

The Enforcement of Intimate Image Offences and the Effectiveness of Victim Services in Taiwan: A Qualitative Study Using Reflexive Thematic Analysis

by Wen-Ling Hung

Int. J. Environ. Res. Public Health 2026, 23(4), 525; https://doi.org/10.3390/ijerph23040525 - 18 Apr 2026

Abstract

(1) Background: The non-consensual dissemination of intimate images constitutes a severe form of online gender-based violence (OGBV) that inflicts profound harm on victims’ sexual privacy, psychological well-being, and social functioning. Taiwan enacted comprehensive legislative reforms in 2023—commonly referred to as the “Four Acts [...] Read more.

(1) Background: The non-consensual dissemination of intimate images constitutes a severe form of online gender-based violence (OGBV) that inflicts profound harm on victims’ sexual privacy, psychological well-being, and social functioning. Taiwan enacted comprehensive legislative reforms in 2023—commonly referred to as the “Four Acts on Sexual Violence Prevention”—to strengthen criminal responses and expand victim protection mechanisms. However, the extent to which these reforms have translated into effective frontline practice remains insufficiently examined. (2) Methods: This qualitative study employed reflexive thematic analysis to investigate frontline professionals’ experiences with enforcing intimate image offence legislation and delivering victim support services. Semi-structured, in-depth interviews were conducted with 20 practitioners, including social workers, police officers, prosecutors, and lawyers. (3) Results: Three superordinate themes emerged across macro, meso, and micro structural levels. At the macro level, limited public awareness and persistent victim-blaming attitudes undermine prevention, help-seeking, and reporting. At the meso level, legislative fragmentation, challenges in preserving and analysing digital evidence, and inter-agency coordination gaps constrain enforcement capacity. At the micro level, procedural delays, risks of secondary victimization, and perceived inadequacies in compensation and support mechanisms weaken victims’ trust in institutional responses. (4) Conclusions: While Taiwan’s legislative reforms represent a significant institutional advancement, legal reform alone is insufficient to address digital sexual violence effectively. Comprehensive responses require integrated public education initiatives, enhanced inter-agency coordination, strengthened digital investigation capacity, and trauma-informed victim protection practices across all structural levels. In particular, the findings underscore an urgent public health need to establish rapid digital evidence preservation and takedown mechanisms to limit the proliferation of non-consensual sexual images and mitigate the associated mental health harms among victims. Full article

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20 pages, 429 KB

Open AccessArticle

Working from Home: Hybrid and Predominantly Home-Based Work in Relation to Work Environment, Job Satisfaction, and Health

by Michael Rosander

Int. J. Environ. Res. Public Health 2026, 23(4), 524; https://doi.org/10.3390/ijerph23040524 - 18 Apr 2026

Abstract

Working from home has become an increasingly common feature of contemporary working life. The present study examined how different degrees of working from home relate to employees’ perceptions of the work environment, job satisfaction, and health. The analyses were based on a national [...] Read more.

Working from home has become an increasingly common feature of contemporary working life. The present study examined how different degrees of working from home relate to employees’ perceptions of the work environment, job satisfaction, and health. The analyses were based on a national probability sample of Swedish employees (N = 2331). A multivariate regression model was estimated to examine associations between three working arrangements—office, hybrid, and predominantly home-based work—and multiple employee outcomes. The results showed that hybrid work and predominantly home-based work were associated with different patterns of employee outcomes. Hybrid work was primarily related to higher role ambiguity and lower job satisfaction, whereas predominantly home-based work was associated with a broader set of outcomes, including poorer general health, more sleep problems, lower job satisfaction, higher role ambiguity, and lower perceived workload. Taken together, the findings suggest that patterns of associations differ across working-from-home arrangements rather than simply reflecting the mere presence of remote work. The study highlights the importance of distinguishing between different degrees of working from home when examining how remote work relates to employees’ work experiences and well-being. Full article

17 pages, 1008 KB

Open AccessArticle

Sustainability Consciousness, Green Advocacy, and Work Grit Among Nurses: Implications for Environmentally Sustainable Healthcare and Public Health

by Eman Kamel Hossny, Noura Alsayed Esmeil, Hanan Sayed Younes, Eman Ramadan Abdalfadeel, Ahmed Zinhom Elkady, Hammad S. Alotaibi and Somia Mohamed Abdel Aziz

Int. J. Environ. Res. Public Health 2026, 23(4), 523; https://doi.org/10.3390/ijerph23040523 (registering DOI) - 17 Apr 2026

Abstract

Background: Healthcare systems contribute significantly to environmental pollution, energy consumption, and resource depletion, making sustainability an increasingly important environmental and public health priority. Nurses, as frontline healthcare professionals, play a critical role in promoting environmentally responsible practices and advocating for sustainable healthcare within [...] Read more.

Background: Healthcare systems contribute significantly to environmental pollution, energy consumption, and resource depletion, making sustainability an increasingly important environmental and public health priority. Nurses, as frontline healthcare professionals, play a critical role in promoting environmentally responsible practices and advocating for sustainable healthcare within clinical settings. Objective: The study aimed to examine the associations between nurses’ sustainability consciousness, green advocacy, and work grit in hospital settings. Methods: A descriptive cross-sectional correlational study was conducted among 377 nurses working in two university-affiliated hospitals in Egypt. Data were collected using validated instruments assessing sustainability consciousness, green advocacy, and work grit. Descriptive statistics were calculated to summarize participant characteristics and study variables. Associations among sustainability consciousness, green advocacy, and work grit were examined using Pearson correlation analysis. Multiple linear regression analysis was conducted to identify significant predictors of green advocacy, while noting that the study design allows for identification of associations rather than causal relationships. Results: The findings indicated generally high levels of sustainability consciousness among nurses. Significant positive associations were observed between sustainability consciousness, green advocacy, and work grit (p < 0.01). Multiple linear regression analysis identified sustainability consciousness and work grit as significant predictors of green advocacy, explaining 34.2% of its variance. Conclusions: These findings highlight the interconnected roles of sustainability awareness, advocacy behaviors, and psychological resilience in promoting environmentally sustainable healthcare practices. Strengthening nurses’ sustainability consciousness and work grit may enhance green advocacy and contribute to the development of sustainable healthcare systems, supporting global environmental and public health goals aligned with the United Nations Sustainable Development Goals. Full article

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26 pages, 2624 KB

Open AccessSystematic Review

Daily Steps During Nutritional Lifestyle Modification Programs for Obesity Management: A Systematic Review and Meta-Analysis

by Dana Saadeddine, Matteo Foglia, Elisa Berri, Silvia Raggi, Leila Itani and Marwan El Ghoch

Int. J. Environ. Res. Public Health 2026, 23(4), 522; https://doi.org/10.3390/ijerph23040522 - 17 Apr 2026

Abstract

Background and objectives: Increasing daily steps during weight management programs remains one of the most common recommendations; however, why, when and how many is still unclear. To clarify this, we aim to conduct a systematic review and meta-analysis. Methods: The study was conducted [...] Read more.

Background and objectives: Increasing daily steps during weight management programs remains one of the most common recommendations; however, why, when and how many is still unclear. To clarify this, we aim to conduct a systematic review and meta-analysis. Methods: The study was conducted in adherence to the PRISMA guidelines on randomized controlled trials (RCTs), that included weight loss (WL) interventions based on lifestyle modification programs (LSMs), compared to “as usual care” considered as controls, to whom both daily steps and WL% were reported or retrievable at baseline (Time 0), end of WL phase (Time 1, WL1%), and weight maintenance phase (Time 2, WL2%), for both arms. Results: A total of 18 RCTs met the inclusion criteria and were included in the systematic review. Of those, 14 underwent meta-analysis and five main findings were revealed: (i) at baseline (Time 0), no significant difference was observed in mean daily steps between the LSM and controls (7280 vs. 7180, p = 0.336), reflecting a similar lifestyle between arms; (ii) at Time 1, the mean duration was 7.88 months (range = 3–12 months), and the LSM arm showed a significant increase in daily steps with respect to baseline (8454 vs. 7486 steps, p = 0.017) and a significant WL (WL1% = 4.39%, p < 0.001); (iii) at Time 2, the mean duration was 10.27 months (range = 3–24 months), and the LSM arm maintained the level of daily steps achieved by the end of WL phase (8241 vs. 8454 steps, p > 0.05), and also a significant WL% (WL2% = 3.28%, p = 0.001); (iv) the control arm showed no significant changes in daily steps and weight status at all times of assessment; and (v) the meta-regression showed in the LSM arm a positive relationship between daily steps at Time 1 (β = 1.33, p = 0.03) and Time 2 (β = 1.10, p = 0.02), both with WL2%. Conclusions: Our preliminary study results support that during LSM programs, patients should be encouraged to increase their daily steps during the WL phase, targeting approximately 8500 steps/day and maintaining these levels during the maintenance phase, since this strategy appears to be a useful behavioral approach associated with maintaining significant WL in the long term. Full article

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