International Journal of Environmental Research and Public Health

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 (registering DOI) - 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 (registering DOI) - 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, 2690 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 (registering DOI) - 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 (registering DOI) - 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 (registering DOI) - 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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15 pages, 311 KB

Open AccessArticle

Knowledge-Sharing Practices Among Dentists, Pharmacists, and Allied Health Professionals: A Cross-Sectional Study in Eastern Cape Public Hospitals, South Africa

by Nombulelo Chitha, Linda Sobekwa, Ziyanda Ngcobo, Ruth Tshabalala, Ntiyiso V. Khosa and Onke R. Mnyaka

Int. J. Environ. Res. Public Health 2026, 23(1), 66; https://doi.org/10.3390/ijerph23010066 - 31 Dec 2025

Abstract

Knowledge-sharing is a deliberate exchange of information to enhance accessibility and reuse which is critical for improving healthcare delivery. This study assessed knowledge-sharing practices among dentists, pharmacists, and allied health professionals (AHPs) in nine public hospitals in South Africa’s Eastern Cape Province. A [...] Read more.

Knowledge-sharing is a deliberate exchange of information to enhance accessibility and reuse which is critical for improving healthcare delivery. This study assessed knowledge-sharing practices among dentists, pharmacists, and allied health professionals (AHPs) in nine public hospitals in South Africa’s Eastern Cape Province. A cross-sectional survey was conducted using purposive and stratified random sampling to recruit 99 participants. Data were collected via a validated questionnaire and analysed with SPSS v.22.0 using descriptive statistics. Respondents were predominantly female (77.6%) and aged 21–35 years (63.6%); AHPs comprised 65.7% of the sample. The results show a statistically significant association between profession and encouragement to adopt a global perspective (p = 0.017), while significant differences were observed between profession and encouragement to seek inter-team solutions (p = 0.020), and access to leadership-driven opportunities for interdisciplinary knowledge-sharing (p = 0.016). Despite observable patterns in the descriptive results, no other statistically significant differences by profession were observed for all other items. Collaboration with external communities and leadership-driven knowledge-sharing opportunities were also highest among dentists but limited overall. Adoption of information systems for knowledge exchange was low, particularly among pharmacists and AHPs. Participation in professional development and recognition of long-term knowledge-sharing strategies followed similar patterns. These findings highlight the need to strengthen leadership-driven opportunities for interdisciplinary knowledge-sharing and to develop targeted interventions to address specific gaps between professions. Full article

14 pages, 483 KB

Open AccessStudy Protocol

Climate Change Policies and Social Inequalities in the Transport, Infrastructure and Health Sectors: A Scoping Review Protocol

by Estefania Martinez Esguerra, Marie-Claude Laferrière, Anouk Bérubé, Pierre Paul Audate and Thierno Diallo

Int. J. Environ. Res. Public Health 2026, 23(1), 65; https://doi.org/10.3390/ijerph23010065 - 31 Dec 2025

Abstract

Climate action has been deemed as fundamental to counteract the impacts of rising global temperatures on health which will disproportionately affect low-income populations, racial and ethnic minorities, women, and other historically marginalized groups. Along with poverty reduction, inequality mitigation, gender equality promotion, and [...] Read more.

Climate action has been deemed as fundamental to counteract the impacts of rising global temperatures on health which will disproportionately affect low-income populations, racial and ethnic minorities, women, and other historically marginalized groups. Along with poverty reduction, inequality mitigation, gender equality promotion, and public health protection, climate action has been recognized as a fundamental goal for achieving Sustainable Development Goals (SDGs). However, despite growing recognition of the need to align climate action with development goals, there is a knowledge gap regarding how the implementation of climate change mitigation and adaptation policies impacts social inequalities. To address this knowledge gap, this document proposes a scoping review protocol aimed at identifying and synthesizing research that examines the impacts of climate policies on inequalities at the subnational scales, within the transport, infrastructure and health. The objective of this review is to map existing evidence, identify conceptual and empirical gaps and inform policy strategies that promote climate action in line with values of social justice and equality. Full article

16 pages, 596 KB

Open AccessArticle

Sleep Quality in Shift-Working Nurses: Subjective and Objective Evaluation

by Željka Dujmić, Štefica Mikšić, Ivana Barać, Josip Samardžić, Lea Maršić, Petar Samardžić, Zvjezdana Gvozdanović, Ivana Jelinčić, Blaženka Kljajić Bukvić, Marija Barišić, Davorka Čavar-Lovrić, Ružica Mrkonjić, Ivica Mihaljević and Nikolina Farčić

Int. J. Environ. Res. Public Health 2026, 23(1), 64; https://doi.org/10.3390/ijerph23010064 - 31 Dec 2025

Abstract

Background: It is well-known that rotating shift work disrupts the circadian rhythm and sleep quality in nurses. With this study, we aimed to compare subjectively and objectively measured sleep quality in nurses, specifically focusing on any differences that arose in relation to shift [...] Read more.

Background: It is well-known that rotating shift work disrupts the circadian rhythm and sleep quality in nurses. With this study, we aimed to compare subjectively and objectively measured sleep quality in nurses, specifically focusing on any differences that arose in relation to shift work. Methods: This prospective, observational, cross-sectional study was conducted in 2025 in Croatia; a total of 140 nurses participated. Sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI) and FitBit Charge 3 smartwatch, which monitored sleep over an eight-day period. Results: Most nurses rated their sleep as good or very good, but according to the PSQI questionnaire, all participants were classified as poor sleepers (PSQI > 5). Objective smartwatch measurements showed that nurses working only day shifts had higher sleep scores (median 77, IQR 75–80 vs. 73, IQR 68–76; p < 0.001), significantly longer total sleep duration (median 6.4, IQR 6.3–7.1 vs. 5.5, IQR 5.2–6.2 h; p < 0.001), and longer durations of all sleep stages compared with those working rotating shifts. Conclusions: Most nurses subjectively rated their sleep as good or very good; however, according to the PSQI questionnaire results, all were classified as poor sleepers, with no significant difference related to shift work. Objective measurements using the smartwatch indicated that rotating shift work is associated with significantly poorer sleep quality. Full article

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

26 pages, 836 KB

Open AccessReview

Home Visiting Interventions and Their Impact on Mental Health, Psychosocial, and Parenting Practice Outcomes of Vulnerable Caregivers: A Systematic Review and Meta-Analysis

by Sara Cibralic, Wengtong Wu, Bright Opoku Ahinkorah, Christa Lam-Cassettari, Susan Woolfenden, Jane Kohlhoff, Rebekah Grace, Lynn Kemp, Patrice Johnson, Elisabeth Murphy, April Deering, Shanti Raman and Valsamma Eapen

Int. J. Environ. Res. Public Health 2026, 23(1), 63; https://doi.org/10.3390/ijerph23010063 - 31 Dec 2025

Abstract

Past reviews have found home visiting interventions to be successful at improving caregiver outcomes. Though, no review has looked specifically at the effect of home visiting interventions on caregivers with high vulnerability and complex needs. This review aimed to examine and synthesis the [...] Read more.

Past reviews have found home visiting interventions to be successful at improving caregiver outcomes. Though, no review has looked specifically at the effect of home visiting interventions on caregivers with high vulnerability and complex needs. This review aimed to examine and synthesis the literature on the impact of home visiting programs administered to caregivers with young children, high vulnerability and complex needs by professionals/paraprofessionals. Interdisciplinary databases, reference lists, and the Home Visiting Evidence of Effectiveness database were searched for articles that fit the inclusion criteria. Together searches resulted in a total of 623 articles, 34 of these articles were included in the final review, all from high-income countries. Twenty-five interventions were implemented across the 34 studies. Findings showed that these interventions were effective at improving a range of mental health, parenting, and family violence outcomes in caregivers with high vulnerability and complex needs. However, weighted mean standardized effect sizes ranged from 0.01–0.24 (small effect), with only one (i.e., practical parenting skills) of the five significantly different from 0 (standardized mean difference 0.24; 95% CI: 0.10, 0.38; z = 3.39, p = 0.00) and results favoring the control group. Missing information together with considerable variation in interventions, meant that identifying a clear pattern in treatment components that lead to effective verses non-effective interventions was not possible. Further research is therefore needed to assess the effectiveness of these interventions. Trial registration: The University of York Centre for Reviews and Dissemination (PROSPERO) registration number CRD42023460366. Full article

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

14 pages, 289 KB

Open AccessArticle

Perceptions of Youth Substance Users on Substance Use Relapse Prevention: A Qualitative Study in Lobatse, Botswana

by Wada Gaolaolwe, Miriam Mmamphamo Moagi, Gaotswake Patience Kovane and Leepile Alfred Sehularo

Int. J. Environ. Res. Public Health 2026, 23(1), 62; https://doi.org/10.3390/ijerph23010062 - 31 Dec 2025

Abstract

Background: Substance use relapse is a significant obstacle that hinders the success of addiction treatment and recovery for youths struggling with substance use challenges. The economic and social impacts of substance use and relapse in young people are a cause of concern [...] Read more.

Background: Substance use relapse is a significant obstacle that hinders the success of addiction treatment and recovery for youths struggling with substance use challenges. The economic and social impacts of substance use and relapse in young people are a cause of concern worldwide; Botswana is not an exception. Objective: The study aimed to explore and describe the perceptions of youth substance users regarding the prevention of relapse in Lobatse, Botswana. Methods: A qualitative study was conducted, following an exploratory, descriptive, and contextual research design. In total, 15 participants were selected using a purposive sampling technique. Data were collected using semi-structured questions, and thematic analysis was used to analyse the data. Results: Data analysis yielded two themes and subthemes. The first theme was on the perceptions of youth substance users on the causes of substance use relapse. The second theme was on the perceptions of youth substance users on the prevention of substance use relapse. Conclusion: The study showed that substance use relapse can be caused by psychological challenges, social problems, societal issues, and healthcare barriers. Our study suggests that to abate relapses to substances, interventions should encompass individual, social, and community dimensions of a substance user’s life. Furthermore, there should be healthcare interventions geared towards relapse prevention. Full article

(This article belongs to the Special Issue Substance Misuse and Mental Health Among Young Adults)

21 pages, 542 KB

Open AccessArticle

Evaluating Knowledge, Attitudes and Practices Related to Water, Sanitation and Hygiene (WASH): A Case Study of Durban High Schools in South Africa

by Magareth Thulisile Ngcongo and Memory Tekere

Int. J. Environ. Res. Public Health 2026, 23(1), 61; https://doi.org/10.3390/ijerph23010061 - 31 Dec 2025

Abstract

Inadequate hygiene knowledge and poor sanitation practices remain key challenges to safe learning environments in South Africa, with 462 million learners attending schools without basic handwashing facilities and many schools failing to meet sanitation standards. Although national policies and infrastructure investments have improved [...] Read more.

Inadequate hygiene knowledge and poor sanitation practices remain key challenges to safe learning environments in South Africa, with 462 million learners attending schools without basic handwashing facilities and many schools failing to meet sanitation standards. Although national policies and infrastructure investments have improved water, sanitation, and hygiene (WASH) services in some schools, access and behaviours remain uneven across socio-economic contexts. This study evaluated knowledge, attitudes, and practices (KAP) related to WASH among 1200 learners from 40 high schools in Durban using a cross-sectional design and interviewer-administered questionnaires. Data were analysed using descriptive statistics, Pearson correlations, ANOVA, and multiple regression. The study addressed the research question: To what extent do learners’ knowledge and attitudes predict hygiene practices across socio-economic contexts? It was hypothesised that higher knowledge and more positive attitudes would significantly predict improved hygiene practices. Results showed that while 74.6% reported handwashing after toilet use, only 39.3% consistently used soap. Knowledge of disease transmission through unsafe water was 35.4%, although overall attitudes were positive. Learners from higher-quintile schools had significantly better KAP scores than those from lower quintiles (p < 0.001). Both knowledge (β = 0.232, p < 0.001) and attitudes (β = 0.266, p < 0.001) were significant predictors of learners’ hygiene practices. Significant group differences were also observed by gender (t = 18.032, p = 0.001) and district (t = −3.895, p = 0.001). These findings highlight persistent WASH gaps and inequities across schools, underscoring the need for integrated interventions that strengthen both hygiene education and school infrastructure to achieve Sustainable Development Goal 6. Full article

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25 pages, 1312 KB

Open AccessArticle

Knowledge, Perceptions, and Practices of Traffic Police Officers Towards Air Pollution in Addis Ababa, Ethiopia: An Exploratory Study

by Andualem Ayele, Andualem Mekonnen, Eyale Bayable, Marc N. Fiddler, George Stone and Solomon Bililign

Int. J. Environ. Res. Public Health 2026, 23(1), 60; https://doi.org/10.3390/ijerph23010060 - 31 Dec 2025

Abstract

Traffic police officers represent a critical occupational group with high vulnerability to vehicular air pollution, a severe environmental health threat in rapidly urbanizing metropolises such as Addis Ababa. This cross-sectional study explored occupational exposure, protective practices, health risks, perceptions, and awareness of air-quality-associated [...] Read more.

Traffic police officers represent a critical occupational group with high vulnerability to vehicular air pollution, a severe environmental health threat in rapidly urbanizing metropolises such as Addis Ababa. This cross-sectional study explored occupational exposure, protective practices, health risks, perceptions, and awareness of air-quality-associated health risks among 120 traffic police officers in Addis Ababa. The officers were mostly male (80%) and married (93.3%), with the majority (62.6%) having served for more than ten years. While vehicle emissions were consistently recognized as the main source of air pollution, critical knowledge gaps were identified, i.e., only 24.2% had received pollution-related training, fewer than half (45.8%) were aware of government policies, and just 9.2% reported collaboration with environmental authorities. Awareness of the Air Quality Index (AQI) was generally low, and regular monitoring of AQI was limited. Self-reported health symptoms were highly prevalent among participants, with cough (75.0%), eye irritation (61.7%), sneezing (58.3%), and runny nose (55.8%) being the most frequently reported. Notably, sneezing, runny nose, eye irritation, and psychological stress showed significant association with perceived pollution levels at the workplace (p < 0.05), while blood pressure, cough, difficulty concentrating, and sleep loss were not significantly associated (p > 0.05). A higher prevalence of symptoms was generally observed in groups experiencing moderate-to-very high levels of pollution. Protective measures were applied inconsistently; while 63.3% of participants reported using masks, their beliefs about the effectiveness of using masks varied. Relocation (60%) and use of face covers/glasses (13.3%) were less commonly practiced. Overall, traffic police officers are exposed to occupational air pollution, which is associated with various health symptoms. These findings highlight the need for enhanced training, clearer communication of policies, stronger institutional engagement, the provision of standardized protective masks, and the promotion of AQI utilization to reduce occupational health risks and safeguard the wellbeing of traffic police officers in Addis Ababa. Full article

(This article belongs to the Section Environmental Health)

13 pages, 1078 KB

Open AccessArticle

Venous Thromboembolism Risk Assessment and Prophylaxis in Trauma Patients

by Parichat Tanmit, Patharat Singthong, Phati Angkasith, Panu Teeratakulpisarn, Narongchai Wongkonkitsin, Supatcha Prasertcharoensuk and Chaiyut Thanapaisal

Int. J. Environ. Res. Public Health 2026, 23(1), 59; https://doi.org/10.3390/ijerph23010059 - 31 Dec 2025

Abstract

Background: Venous thromboembolism (VTE) is associated with high morbidity and mortality. The activation of multiple pathways of venous thrombosis occurs after an injury. A prophylaxis protocol is necessary to prevent early and late venous thrombotic complications. Methods: This study aimed to evaluate the [...] Read more.

Background: Venous thromboembolism (VTE) is associated with high morbidity and mortality. The activation of multiple pathways of venous thrombosis occurs after an injury. A prophylaxis protocol is necessary to prevent early and late venous thrombotic complications. Methods: This study aimed to evaluate the outcomes of venous thromboembolism using the Greenfield risk assessment profile score and its association with bleeding complications. This was a retrospective cohort study conducted on trauma cases who were aged 15 years or older. The study was conducted from January 2020 through December 2022. Patients who were admitted to hospital for less than 24 h or those who died during resuscitation or treatment in an emergency room were excluded from this study. Results: We enrolled 580 cases. Among them, 46.6% were categorized as high-risk for developing venous thromboembolism, and 30.4% of these high-risk patients received pharmaco-mechanical thromboprophylaxis. All VTE cases were high risk according to the Greenfield risk assessment profile, accounting for 3% of the entire group and 1.4% of all enrolled cases. All major bleeding complications occurred with a previously diagnosed large subdural hematoma. Conclusions: Assessing VTE risk was crucial for optimal management of prophylaxis. Proper use of pharmacological prophylaxis had to be balanced against the risk of bleeding complications. Full article

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

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13 pages, 830 KB

Open AccessArticle

Ability to Detect Digital Risks: Effects of an Educational Intervention and Dementia Risk Level

by Ricardo de Oliveira Ferreira, Isabella Gomes de Oliveira Karnikowski, Emmanuely Nunes Costa, Aline Gomes de Oliveira, Mariana Sodário Cruz, Iolanda Bezerra dos Santos Brandão and Margô Gomes de Oliveira Karnikowski

Int. J. Environ. Res. Public Health 2026, 23(1), 58; https://doi.org/10.3390/ijerph23010058 - 31 Dec 2025

Abstract

Introduction: Several studies have been conducted in the field of education for older adults, with an emphasis on teaching and learning processes related to the use of digital technologies. Among the relevant aspects to be considered in this context is the cognitive vulnerability [...] Read more.

Introduction: Several studies have been conducted in the field of education for older adults, with an emphasis on teaching and learning processes related to the use of digital technologies. Among the relevant aspects to be considered in this context is the cognitive vulnerability of this age group in terms of digital security. Objective: The aim of this study was to analyze the relationship between cognitive aspects of older adults and their ability to identify digital risks, before and after participating in an educational intervention, as well as the effect of the intervention on cognition in this age group. Methodology: Analyses were conducted according to the educational intervention and control groups, further stratified by digital risk (SJT) and dementia risk, according to the ACE-R test. The Mann–Whitney test was used to identify possible differences in the likelihood of falling for digital scams, considering the dimensions generated by the simulations (SJT). Results: Overall, the educational intervention was effective for the media education dimension (delta −0.5), regardless of dementia risk. More specifically, a particular effect was observed in the post-intervention stage. Conclusions: The educational intervention was able to promote cognitive gains and reduce digital risks among older adults, particularly in the identification of misinformation, underscoring the importance of continuous and adapted programs to promote digital security in this population. Full article

(This article belongs to the Topic Healthy, Safe and Active Aging, 2nd Edition)

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14 pages, 672 KB

Open AccessArticle

Socioeconomic Factors and Depressive Symptoms Among Caregivers of Visually Impaired Individuals in South Africa

by Dimakatso Given Mashala, Hlupheka Lawrence Sithole and Eric Maimela

Int. J. Environ. Res. Public Health 2026, 23(1), 57; https://doi.org/10.3390/ijerph23010057 - 31 Dec 2025

Abstract

Caregiving for visually impaired individuals imposes substantial psychological, social, and financial burdens. This study examined depressive symptoms among family caregivers in rural Limpopo, South Africa, and their associations with sociodemographic and socioeconomic factors. A cross-sectional survey was conducted among 253 informal caregivers (response [...] Read more.

Caregiving for visually impaired individuals imposes substantial psychological, social, and financial burdens. This study examined depressive symptoms among family caregivers in rural Limpopo, South Africa, and their associations with sociodemographic and socioeconomic factors. A cross-sectional survey was conducted among 253 informal caregivers (response rate: 85.5%). Data on age, gender, marital status, education, employment, income, and socioeconomic status were collected. Depressive symptoms were assessed using the full 20-item Centre for Epidemiologic Studies Depression Scale (CES-D), and associations were analysed using chi-square tests, Cramer’s V, and logistic regression. Moderate-to-severe depressive symptoms were reported by 29.2% of caregivers, with 28.1% experiencing mild-to-moderate symptoms. Male caregivers were less likely to report minimal symptoms (OR = 0.3; 95% CI: 0.12–0.65). Caregivers aged 50–59 years were more likely to report lower depressive symptoms (OR = 1.3). Unmarried caregivers had higher odds of depressive symptoms compared with married caregivers (OR = 2.3). Education was protective: secondary education was associated with lower odds of severe symptoms, while primary education significantly increased risk (OR = 18.1). Lower-income caregivers tended to report higher depressive symptoms. Depressive symptoms among caregivers are influenced by gender, age, marital status, education, and income. Interventions such as psychosocial support, financial assistance, and community-based respite services are essential to reduce caregiver burden. Full article

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

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22 pages, 329 KB

Open AccessArticle

A Dyadic Approach to Cancer Care: Examining the Feasibility and Preliminary Effectiveness of a Partner-Based Exercise Intervention for Caregivers and Their Care Recipients

by Melanie R. Keats, Thomas Christensen, Scott A. Grandy, Ross Mason, Cory A. Munroe, Stephanie Snow, Lori Wood and Christopher Blanchard

Int. J. Environ. Res. Public Health 2026, 23(1), 56; https://doi.org/10.3390/ijerph23010056 - 31 Dec 2025

Abstract

Despite being key partners in the supportive care of the cancer patient, family caregivers are often inadequately prepared for or supported to take on this critical role, subsequently putting their own wellbeing at risk and, by extension, that of the patient. Exercise interventions [...] Read more.

Despite being key partners in the supportive care of the cancer patient, family caregivers are often inadequately prepared for or supported to take on this critical role, subsequently putting their own wellbeing at risk and, by extension, that of the patient. Exercise interventions show promise in mitigating caregiver burden and improving health outcomes for both caregivers and patients; however, the interrelationship between family caregiver and care recipient has gone largely unexplored. Thus, we conducted a single-group pilot study to examine the feasibility and preliminary effectiveness of a 12-week dyadic exercise intervention. Of the 27 caregiver–patient dyads who consented, 21 (77.8%) completed the study, with participants completing an average of 23.1 (96.3%) of the prescribed exercise sessions, suggesting good adherence and study retention. All participants reported higher post-intervention levels of strenuous physical activity (p = 0.017), improved sit-to-stand repetitions (p = 0.004), and social functioning (p = 0.030) compared to baseline. Of note, caregivers reported higher post-intervention scores on the burden in relationship subscale of the Zarit Burden Interview relative to baseline (p = 0.043), suggesting an increase in perceived caregiver burden following the intervention. Overall, dyadic exercise interventions appear feasible and may confer certain physical and psychosocial benefits for both family caregivers and care recipients. However, such programs may also unintentionally exacerbate certain aspects of caregiver burden. Future research should aim to identify factors within dyadic exercise interventions that may contribute to increased caregiver burden, as well as strategies to help mitigate these effects. Full article

18 pages, 316 KB

Open AccessArticle

Reasons for Participating in the EDS-HEART Program: Holistic and Performative Within a Supportive Community

by Maria Kosma, Nick Erickson, Ashley L. Hinerman and Ira A. Anderson III

Int. J. Environ. Res. Public Health 2026, 23(1), 55; https://doi.org/10.3390/ijerph23010055 - 31 Dec 2025

Abstract

Background: Hypermobile Ehlers–Danlos Syndrome (hEDS) results in multiple, complex health-related risks and associated fear of movement (kinesiophobia). Therefore, the purpose of this research study was to examine how a holistic, embodied, and performative movement program (EDS-HEART) can affect body schema, physical and [...] Read more.

Background: Hypermobile Ehlers–Danlos Syndrome (hEDS) results in multiple, complex health-related risks and associated fear of movement (kinesiophobia). Therefore, the purpose of this research study was to examine how a holistic, embodied, and performative movement program (EDS-HEART) can affect body schema, physical and mental health, and lifestyle, which contribute to the joy of movement and physical activity participation among adult women with hEDS. Methods: This was a hermeneutic, phenomenological, quasi-experimental, and community-based research study among six women with hEDS, who participated in the EDS-HEART movement program at a local physical therapy clinic. The seven-week program incorporated stretching and strength training activities as well as performative-thematic movement sequences. Results: Based on the qualitative analysis, three themes emerged regarding reasons for the joy of the EDS-HEART program: (a) improved body schema: body awareness, confidence, posture, and proprioception; (b) highly motivating program: holistic, embodied, performative, pleasant, and safe; and (c) psychosocial reasons: supportive setting, sense of pleasure and euphoria, and freed from social comparisons and the fear of movement. Conclusions: Based on the study results, public health experts should develop and implement easily accessible and holistic movement programs among people with hEDS and similar conditions to improve physical health, psychosocial health, and the joy of movement. Full article

(This article belongs to the Special Issue Public Health Policies to Promote Physical Activity Among People with Disabilities and Clinical Conditions)

17 pages, 4569 KB

Open AccessArticle

Association of Military Aircraft Noise Exposure with Mental Well-Being and Sleep Disturbance near a Military Air Base in Okinawa, Japan: An Ecological Study

by Yuka Maekawa, Daisuke Nonaka, Sae Kawamoto, Yukako Maeda and Yuko Toyama

Int. J. Environ. Res. Public Health 2026, 23(1), 54; https://doi.org/10.3390/ijerph23010054 - 31 Dec 2025

Abstract

A considerable number of people are exposed to noise from military aircraft daily, but its health effects have not been sufficiently examined. This study assessed the association of exposure to such noise with mental well-being and sleep disturbance among people living in Okinawa [...] Read more.

A considerable number of people are exposed to noise from military aircraft daily, but its health effects have not been sufficiently examined. This study assessed the association of exposure to such noise with mental well-being and sleep disturbance among people living in Okinawa prefecture, where there are two U.S. military air bases. In 2024, data were collected from 394 residents in high-, low-, and no-exposure communities using the WHO-5 Well-being Index and the Athens Insomnia Scale. Among respondents, 55.8% were female; the largest age groups were 70’s (25.4%) and 60’s (23.6%). Poor mental well-being and sleep disturbance were most prevalent in the high-exposure community (poor mental well-being: 38.2%, sleep disturbance: 46.6%), followed by low-exposure (36.1%, 46.3%) and no-exposure (21.9%, 29.0%) communities. Multivariate logistic regression analyses showed that compared to no-exposure community, the high-exposure and low-exposure communities were significantly more likely to have poor mental well-being (odds ratio (OR): 1.84, 95% confidence interval (CI): 1.05–3.23; OR: 1.94, 95% CI: 1.05–3.56), as well as sleep disturbance (OR: 1.98, 95% CI: 1.17–3.35; OR: 2.04; 95% CI: 1.16–3.59, respectively). The results suggest that there is a substantial need to address the noise from military aircraft in Okinawa. Full article

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8 pages, 537 KB

Open AccessArticle

Seasonal, Monthly, and Holiday Patterns in Self-Monitored Step Counts Among Individuals with Prediabetes and Type 2 Diabetes: A Two-Year Analysis

by Yohannes Woldamanuel, Philip von Rosen, Patrick Bergman, Unn-Britt Johansson, Maria Hagströmer and Jenny Rossen

Int. J. Environ. Res. Public Health 2026, 23(1), 53; https://doi.org/10.3390/ijerph23010053 - 31 Dec 2025

Abstract

Background: There is a limited amount of evidence concerning the association between seasonal variation and the level of physical activity in individuals with chronic disease. This longitudinal observational study aimed to explore seasonal, monthly, and holiday variations in self-monitored step counts over two [...] Read more.

Background: There is a limited amount of evidence concerning the association between seasonal variation and the level of physical activity in individuals with chronic disease. This longitudinal observational study aimed to explore seasonal, monthly, and holiday variations in self-monitored step counts over two years among adults with prediabetes and type 2 diabetes in Sweden. Methods: Participants were recruited at primary care centers from 2013 to 2018 to take part in a physical activity intervention. Inclusion criteria included the following: an age of 40–80 years, having prediabetes or type 2 diabetes (≥1 year), and the ability to communicate in Swedish. Individuals with recent myocardial infarction, impaired renal function, diabetic ulcers, a limited capacity for physical activity, insulin onset (<6 months), recurrent or severe hypoglycemia, a high baseline for physical activity, or no internet access were excluded. In total, 120 participants wore step counters and recorded daily steps for two years. Linear mixed models adjusted for sex, age, and body mass index were applied. Results: Mean (95% CI) step counts were statistically significantly higher in summer (7825 [7762, 7889]) and spring (7805 [7757, 7853]) compared to winter (7098 [7052, 7145]) and fall (7422 [7349, 7490]). Highest step counts were registered in May (7993 [7904, 8071]), followed by June (7968 [7895, 8063]), and the lowest in January (6944 [6856, 7034]) and November (7208 [7113, 7289]). Step counts during holiday periods were statistically significantly lower than non-holiday periods across all seasons. Conclusion: Self-monitored daily steps varied over the seasons in this sample of individuals with prediabetes and type 2 diabetes. Declined physical activity levels in months with unfavorable weather conditions require attention in consultations and research. Full article

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

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