International Journal of Environmental Research and Public Health

20 pages, 993 KB

Open AccessArticle

The Impact of Socioeconomic Inequities and Small-Area Deprivation on Child Inpatient Care: Evidence from a Quantitative Study in a Vulnerable Suburban Setting

by Tânia Russo and João Pereira

Int. J. Environ. Res. Public Health 2026, 23(6), 767; https://doi.org/10.3390/ijerph23060767 (registering DOI) - 7 Jun 2026

Abstract

Socioeconomic inequities are associated with longer length of hospital stay (LOS) and clinical severity in children. This retrospective cross-sectional study analyzes health inequalities and area-level deprivation, focusing on hospitalization indicators, in a suburban pediatric population in Portugal. Pediatric admissions to a local general [...] Read more.

Socioeconomic inequities are associated with longer length of hospital stay (LOS) and clinical severity in children. This retrospective cross-sectional study analyzes health inequalities and area-level deprivation, focusing on hospitalization indicators, in a suburban pediatric population in Portugal. Pediatric admissions to a local general hospital were analyzed for LOS and admission to intensive care unit (ICU), as well as their relation to socioeconomic factors, over an 8-year period (2014 to 2021), using population-averaged models. Area-level inequalities were measured for the population ranked by civil parishes’ European Deprivation Index. 8016 admissions were included. Health inequalities associated with socioeconomic deprivation were observed, with concentration curves above the diagonal for LOS and admission to ICU and located in urban and densely populated civil parishes. Neonatal age showed the highest mean LOS ratio (MR = 2.29, 95% CI 1.96; 2.67, p < 0.001) and ICU admission odds (OR = 9.25, 95% CI 4.84; 17.68, p < 0.001). Mean LOS ratio was significantly higher for Black ethnicity (MR = 1.19; 95% CI 1.10; 1.28, p < 0.001) and lower maternal education. Odds of admission to ICU was significantly higher for male gender (OR = 1.25, 95% CI 1.01; 1.55, p = 0.048) and mother’s unskilled occupation (OR = 1.66, 95% CI 1.09; 2.53, p = 0.019). Paternal manual skilled occupation demonstrated 17% higher mean LOS ratio (p < 0.001) and 51% higher odds of admission to ICU (p = 0.019). Public policies must be culturally competent and target socioeconomic and geographical deprivation. Full article

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15 pages, 1562 KB

Open AccessReview

Commercial Determinants of Latinx Health: A Scoping Review of Sugar-Sweetened Beverages in the USA

by Megan M. Patton-Lopez, Mariana Pinto-Alvarez, Elisa Rivero, Julia Ma, Ileana Carrión, Eric Toole and Daniel F. López-Cevallos

Int. J. Environ. Res. Public Health 2026, 23(6), 766; https://doi.org/10.3390/ijerph23060766 (registering DOI) - 6 Jun 2026

Abstract

Commercial determinants of health (CDoHs) describe how corporate practices influence population health. This scoping review aimed to characterize the extant evidence base regarding how CDoH in the sugar-sweetened beverage (SSB) industry affects health and health-related outcomes among Latinx populations in the United States [...] Read more.

Commercial determinants of health (CDoHs) describe how corporate practices influence population health. This scoping review aimed to characterize the extant evidence base regarding how CDoH in the sugar-sweetened beverage (SSB) industry affects health and health-related outcomes among Latinx populations in the United States of America (USA). The present study was conducted in accordance with the JBI methodology for scoping reviews. Overall, 1236 references were identified and imported for screening. After duplicate removal, screening, and full-text eligibility assessment, 33 studies met all inclusion criteria. SSB marketing and advertising was the most frequently examined CDoH (61%), including advertising exposure, messaging strategies, and warning label interventions. SSB taxation studies projected reductions in consumption and obesity prevalence. Outcomes associated with health focused primarily on perceptions of marketing and purchasing intentions (94%). Additional studies examined the impact on knowledge, attitudes, beliefs, and behaviors (e.g., purchasing and consumption of SSBs) (66%), while a few studies included chronic disease (27%) or healthcare outcomes (6%). Evidence highlights several gaps in CDoH research associated with SSBs, with 94% of the included studies focused on understanding marketing exposure, signaling a need to examine other domains of CDoH, SSB industry practices, and impacts on health disparities. Findings suggest that structural policy interventions such as taxation and stronger regulation of commercial practices are necessary to address higher exposure to marketing and consumption of SSBs among Latinx populations in the USA. Full article

(This article belongs to the Special Issue System Approaches to Improving Latino Health)

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12 pages, 284 KB

Open AccessArticle

Indicators of Household Composition Are Associated with Adherence to Fruit and Vegetable Intake Recommendations Among Caretakers Eligible for SNAP with Children

by Kellie McLean, Stefani Wiloejo, Zoya N. Rehman, Pasquale E. Rummo and Angela C. B. Trude

Int. J. Environ. Res. Public Health 2026, 23(6), 765; https://doi.org/10.3390/ijerph23060765 (registering DOI) - 6 Jun 2026

Abstract

Inadequate fruit and vegetable consumption is associated with increased risk of chronic disease. Yet, many individuals consume below the recommended intake according to the Dietary Guidelines for Americans (DGA). This study aimed to examine the association of adherence to the DGA (2020–2025) recommendations [...] Read more.

Inadequate fruit and vegetable consumption is associated with increased risk of chronic disease. Yet, many individuals consume below the recommended intake according to the Dietary Guidelines for Americans (DGA). This study aimed to examine the association of adherence to the DGA (2020–2025) recommendations for fruit and vegetable (FV) intake of 1.5–2 cups of fruits and 2–3 cups of vegetables daily for adults among caretakers with a child(ren) living in households eligible for a Supplemental Nutrition Assistance Program (SNAP). We conducted a cross-sectional analysis of 85 caretakers with children in an urban neighborhood of low-income in the Bronx, New York (NY). Log-binomial regressions demonstrated that having more children (RR 1.36; 95% CI 1.15–1.59), younger children (RR 1.22; 95% CI 1.07–1.39), or children participating in a school lunch program (RR 1.47; 95% CI 1.16–1.85) was positively associated with caretakers’ probability of adhering to the DGA recommendations for FV intake. Our study highlights the eating behaviors of families living with children ≤ 10 years of age, many of whom were participating in a school lunch program, and underscores the dietary benefits associated with these characteristics. Full article

14 pages, 1264 KB

Open AccessReview

Naegleria fowleri and Risk of Primary Amoebic Meningoencephalitis in a Changing Climate: A Scoping Review of Biomedical Literature

by Janette DeFelice

Int. J. Environ. Res. Public Health 2026, 23(6), 764; https://doi.org/10.3390/ijerph23060764 (registering DOI) - 6 Jun 2026

Abstract

Objective: Naegleria fowleri, known as the brain-eating amoeba, is a thermophilic, freshwater amoeba causing primary amoebic meningoencephalitis (PAM), a disease that progresses rapidly from symptom onset to death. Climate change is causing surface water temperatures to increase, providing a hospitable environment [...] Read more.

Objective: Naegleria fowleri, known as the brain-eating amoeba, is a thermophilic, freshwater amoeba causing primary amoebic meningoencephalitis (PAM), a disease that progresses rapidly from symptom onset to death. Climate change is causing surface water temperatures to increase, providing a hospitable environment for N. fowleri, possibly increasing risk factors for PAM. This review synthesizes the peer-reviewed biomedical literature published between January 2012 and December 2025, examining the risk of N. fowleri infection in the context of a warming climate. Methods: A scoping review was conducted searching PubMed, Scopus, and Environment Complete. Data were extracted using a structured coding framework, and risk dimensions were derived inductively during the coding process. Results: Twenty-seven articles met inclusion criteria. Analysis revealed four dimensions of risk (environmental, behavioral, clinical/biological, and infrastructural). The environmental risk dimension highlighted gaps in understanding geographic range expansion and organism ecology. The behavioral dimension identified recreational water exposure, sinus rinsing, and travel as primary risk drivers. The clinical/biological dimension highlighted the need for standards and capacity in diagnosis and treatment, as well as research into pathogenicity. The infrastructural dimension identified gaps in water distribution system surveillance and disinfectant efficacy at high temperatures. Discussion: This review maps environmental, behavioral, clinical/biological, and infrastructural dimensions of N. fowleri disease risk onto a hazard/exposure/vulnerability framework, highlighting major gaps surrounding exposure and vulnerability. Uncertainties remain in hazard habitat favorability factors, human behavior, and water distribution systems. Emphasis should be placed on characterizing the hazard through environmental testing and determining geographic range, and addressing vulnerability by increasing clinician awareness, which serves double duty in both initiating early empiric treatment and efforts to quantify true disease burden. Full article

(This article belongs to the Section Environmental Health)

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12 pages, 521 KB

Open AccessCommunication

On Burden of Diseases, Prevention, Medical Research and Health Service Delivery: Grampian Case Study

by Seshadri S. Vasan, Sudarshan Anand, Miae Lee and Nicholas C. Fluck

Int. J. Environ. Res. Public Health 2026, 23(6), 763; https://doi.org/10.3390/ijerph23060763 (registering DOI) - 5 Jun 2026

Abstract

Burden of diseases measured as disability-adjusted life years (DALYs) per 100,000 people can be mined from public domain data, when they are made available by population health surveillance systems. This can be analysed to allow insightful comparisons with the national average, and to [...] Read more.

Burden of diseases measured as disability-adjusted life years (DALYs) per 100,000 people can be mined from public domain data, when they are made available by population health surveillance systems. This can be analysed to allow insightful comparisons with the national average, and to understand differences in trends between the sexes, age groups, time periods, geographic regions, and sub-regions. In this illustrative case study, we have analysed the Scottish burden of disease database to understand what ailed the population of the Grampian region before the COVID-19 pandemic. We have identified that selected cancers, ischaemic heart disease, Alzheimer’s disease and other dementias are amongst the highest contributors to the burden; that drug use disorders and colorectal cancer are showing worsening trends and require health promotion and disease prevention measures from ages 15 and 25, respectively, especially in Aberdeen City; and that males are more vulnerable to atrial fibrillation and flutter, diabetes mellitus, oesophageal cancer, and self-harm, while females are more vulnerable to cerebrovascular and chronic obstructive pulmonary diseases. We demonstrate the usefulness of our analysis and methodology for the wider health system, allowing targeted medical research investments and coordinated response from public health and health service delivery. We also show the need for up-to-date surveillance data, forecasts, and evidence on the impact of interventions to be made available widely. Full article

(This article belongs to the Section Health Care Sciences)

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Graphical abstract

19 pages, 461 KB

Open AccessArticle

A Qualitative Exploratory Study of Facilitators and Barriers Influencing Organ Donation in Ghana: Insights for Health Policy and Advocacy

by Amoah Kwadwo, Fordjuor Gladys, Lartey Seth, Bonsaana Gilbert Batieka, Abaidoo Benjamin, Tetteh John, Aidam Enam Afi Mana, Darko Kwame Asante, Oteng Kwame, Fuseini Alhassan, Forgah Amanda Evelyn, Quaye Mohammed Alphazaazi, Abdul-Rahaman Lahari Salma, Mamani Amina Ponaa, Boateng Dorcas Baah, Charinga Josiah, Ansing Ida Mbamah, Kusi Lawrence, Asante Adjei Collins, Oduro Awo Yaa Karikari, Wryter Bertha Ellen, Blankson Kojo, Odoi Nafisatu Odokai, Sam-Brew Dora, Krow Mabel Oparebea, Addy James, Oboo-Gyan Michael Gyamera, Berzack Shannan and Nariani Ashiyana Show full author list Hide full author list

Int. J. Environ. Res. Public Health 2026, 23(6), 762; https://doi.org/10.3390/ijerph23060762 (registering DOI) - 5 Jun 2026

Abstract

Background: Organ donation and transplantation are among the greatest scientific discoveries of our time, which have restored hope and life to many. However, several factors influence the global organ donation rate. It is, therefore, important to understand the Ghanaian context of facilitators and [...] Read more.

Background: Organ donation and transplantation are among the greatest scientific discoveries of our time, which have restored hope and life to many. However, several factors influence the global organ donation rate. It is, therefore, important to understand the Ghanaian context of facilitators and barriers to donation to dispel cultural myths and misconceptions about organ donation. This study aims to qualitatively explore the facilitators and barriers influencing organ donation in Ghana. Methods: This was a qualitative exploratory study conducted among health professionals at four major tertiary hospitals in Ghana. Participants were chosen using the purposive sampling technique. Using a structured interview guide, an in-depth interview was conducted to gather qualitative data, which was then tape-recorded and transcribed. Thematic content analysis was used to manually analyze the data. Results: Of the 25 expert participants, the majority (15, 60.0%) were female. The majority (15, 60.0%) were between 40 and 59 years. The mean age was 42.4 ± 8.0 years. The average number of years of work experience was 15.8 ± 7.1 years. Themes identified for facilitators of organ donation included increased awareness and knowledge campaign, societal influence, and legislative support. Themes for barriers were inadequate knowledge, socio-cultural influence, religious beliefs, and ethical concerns. Conclusions: Increased awareness and knowledge campaigns, societal influence, and legislative support are the significant facilitators of organ donation in Ghana, whereas inadequate knowledge, socio-cultural, and religious influence are important barriers to organ donation in Ghana. Full article

(This article belongs to the Section Global Health)

15 pages, 343 KB

Open AccessArticle

Predictors of Moral Distress Among Nurses: A Cross-Sectional Study

by Vladimír Siska, Andrea Sollárová, Zuzana Slezáková, Lukáš Kober, Peter Minárik and Tomáš Forgon

Int. J. Environ. Res. Public Health 2026, 23(6), 761; https://doi.org/10.3390/ijerph23060761 (registering DOI) - 5 Jun 2026

Abstract

Investigating the predictors of moral distress is particularly important for protecting nurses’ mental health and professional satisfaction, thereby preventing burnout and attrition from the profession. The primary aim of this study was to evaluate the predictors of moral distress among nurses. A cross-sectional [...] Read more.

Investigating the predictors of moral distress is particularly important for protecting nurses’ mental health and professional satisfaction, thereby preventing burnout and attrition from the profession. The primary aim of this study was to evaluate the predictors of moral distress among nurses. A cross-sectional study design was used. The sample consisted of 412 nurses from 11 hospitals across Slovakia. The mean age of the respondents was 40.48 years (SD = 10.92). Moral distress was assessed using the Modified Moral Distress Scale. Linear regression analysis was used to evaluate predictors of moral distress. Personal accomplishment, the maladaptive coping strategy of self-distraction, continuous shift operation, and emotional burnout emerged as significant predictors of the frequency of moral distress among nurses (AdjR² = 15.5%; R² = 0.155). Regarding the intensity of moral distress, significant predictors included personal accomplishment, the maladaptive strategy of self-distraction and the adaptive strategy of religiosity and spirituality (AdjR² = 14.0%; R² = 0.140), which appear to function as adaptive coping mechanisms for dealing with the intensity of moral distress. Systematic investigation of predictors of moral distress among nurses may contribute to the development of interventions and programs that support nurses, thereby improving not only their job satisfaction but also the quality of patient care. Full article

11 pages, 674 KB

Open AccessArticle

A Rise in Measles Reporting Two Years After the COVID-19 Pandemic: A Descriptive Analysis of Measles in Iraq in 2023 and Early 2024

by Hanan Abdulghafoor Khaleel, Riyadh Abdulameer Alhilfi and Sabrina Viele Brown

Int. J. Environ. Res. Public Health 2026, 23(6), 760; https://doi.org/10.3390/ijerph23060760 (registering DOI) - 5 Jun 2026

Abstract

Background: The elimination of measles is a public health priority for the World Health Organization. During the COVID-19 pandemic from 2020 to 2022, the number of cases in Iraq decreased. However, a surge in cases started in late 2022. The aims of this [...] Read more.

Background: The elimination of measles is a public health priority for the World Health Organization. During the COVID-19 pandemic from 2020 to 2022, the number of cases in Iraq decreased. However, a surge in cases started in late 2022. The aims of this study are to understand and describe the epidemiology of the surge of measles compared to reported cases in 2018 and 2019. Secondarily, they are to identify high clusters to find possible causes and implement prevention efforts accordingly, and low clusters of measles to identify possible protective factors. Methods: Frequencies were used to describe the univariate characteristics of cases reported each year. The chi-square test of independence was used to test differences by age; p-values less than 0.05 were considered statistically significant. Gi cluster analysis was used to determine where there were high and low clusters of cases in each district. Results: The number of clinically confirmed cases of measles rose dramatically in 2023 (14,301) and early 2024 (33,048) compared to 2018 (1044) and 2019 (4586). Most patients were less than one year to 14 years of age. The percentage of patients aged 5–14 years was higher in 2023 (32.8%) and 2024 (30.0%) than in 2018 (15.9%) and 2019 (22.1%). Males were consistently more prevalent than females throughout all study years. Almost 5% (1545) of patients were vaccinated; the remainder were unvaccinated or had unknown vaccination status. Only 1% reported a history of contact with infected patients. The case fatality ratio was 0.06% in 2023 and 0.2% in early 2024. Despite the recent surge in cases, 27 of the 153 districts (17.4%) had low clustering. Conclusions: The recent surge in measles cases in Iraq was found to be in those below 15 who are commonly associated with the disease. Clusters of high reporting were mainly in the middle of Iraq while clusters of low reporting were mainly in the north. We recommend continuing to study clusters of measles and vaccine coverage to direct prevention efforts. Full article

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

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14 pages, 1268 KB

Open AccessPerspective

The Relationship Between Urban Characteristics and Non-Communicable Diseases—Conceptual Framework of the HORUS Project

by Sven Maričić, Denis Juraga, Tomislav Rukavina, Darko Roviš, Zlatko Trobonjača, Mihaela Marinović Glavić, Lovorka Bilajac and Vanja Vasiljev

Int. J. Environ. Res. Public Health 2026, 23(6), 759; https://doi.org/10.3390/ijerph23060759 (registering DOI) - 5 Jun 2026

Abstract

The HORUS project investigates the interface between urban planning and public health, focusing on the reduction in non-communicable diseases through innovative urban planning and technological integration. Using geographic information systems, the project will develop advanced urban mapping and analysis tools to visualize and [...] Read more.

The HORUS project investigates the interface between urban planning and public health, focusing on the reduction in non-communicable diseases through innovative urban planning and technological integration. Using geographic information systems, the project will develop advanced urban mapping and analysis tools to visualize and tackle health inequalities. The participatory approach of technologies will actively engage communities and empower citizens to shape a healthier urban environment. Through multidimensional methodology, including qualitative research and natural experiments, HORUS will align urban planning with public health needs. The project will target modifiable risk factors (physical inactivity, unhealthy diet and substance use) and will promote behavior change and environmental redesign to reduce the prevalence of non-communicable diseases. The integration of digital technologies will not only improve the assessment of urban health but also facilitate evidence-based interventions tailored to vulnerable populations. HORUS will provide practical applications for policy makers and urban planners by providing actionable frameworks for incorporating health-promoting features into urban design. This holistic approach will help create resilient cities that prioritize public health and shape the future urban environment. The project is an example of the transformative potential of aligning technology, policy and community engagement to effectively address the challenges of urbanization, and non-communicable diseases. Full article

(This article belongs to the Section Environmental Health)

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13 pages, 1112 KB

Open AccessArticle

The Stellate Ganglion Block for PTSD: A Retrospective Clinical Case Series

by Michael Hollifield, Jennifer Lai-Trzebiatowski, Michael Alkire, Tyler C. Smith, Christine J. Eickhoff, Nima Fahimian, Rostam Khoshsar, Rajika Tobey, Staci Becker, Rossean C. Rossel, Sarah Madison, Patrick Wu, Amy Treadwell and Christopher Reist

Int. J. Environ. Res. Public Health 2026, 23(6), 758; https://doi.org/10.3390/ijerph23060758 (registering DOI) - 5 Jun 2026

Abstract

Background/Objectives: Extant data suggest that the Stellate Ganglion Block (SGB) is effective for posttraumatic stress disorder (PTSD). Clinical data from a large healthcare system are lacking. We report data from a clinical project in the Veterans Health Administration. Methods: Retrospective data of PTSD [...] Read more.

Background/Objectives: Extant data suggest that the Stellate Ganglion Block (SGB) is effective for posttraumatic stress disorder (PTSD). Clinical data from a large healthcare system are lacking. We report data from a clinical project in the Veterans Health Administration. Methods: Retrospective data of PTSD and anxiety for 579 patients who received one or more SGBs were analyzed on the full sample and on those who had complete data using general linear models. Results: Receiving the first SGB provided a 36% and 30% reduction in PTSD symptom scores at 1-week and 1-month post-SGB, respectively. Those who received 2–4+ SGBs showed lower pre-SGB PTSD symptom scores and trends for lower scores at 1-week and 1-month post-SGB. Overall, 78% and 71% of patients had a reliable (Δ ≥ −5 points) change and 68% and 60% had a clinically meaningful (Δ ≥ −10 points) change in PTSD symptom scores from pre-SGB to 1-week and 1-month post-SGB, respectively. There were clinically meaningful reductions for anxiety in 51.5% and 48.3% at 1-week and 1-month post-SGB, respectively. Conclusions: These data corroborate existing data about the benefit of SGB for PTSD and anxiety and are unique in showing an association between repeat SGBs and lower PTSD symptoms at subsequent baseline. Full article

(This article belongs to the Special Issue Prevention and Treatment of Trauma-Related Mental Illness)

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21 pages, 331 KB

Open AccessArticle

Prevalence of Burnout and Associated Work-Related Factors Among Intensive Care Unit Nurses at Tertiary Healthcare Setting, Riyadh, Saudi Arabia

by Bridget Ndlovu and Bernard Hope Taderera

Int. J. Environ. Res. Public Health 2026, 23(6), 757; https://doi.org/10.3390/ijerph23060757 - 4 Jun 2026

Abstract

Burnout among intensive care unit (ICU) nurses is an escalating occupational health concern due to the high psychological and physical demands of critical care, with implications for staff well-being, patient safety, and healthcare quality. Despite its importance, limited evidence exists on burnout among [...] Read more.

Burnout among intensive care unit (ICU) nurses is an escalating occupational health concern due to the high psychological and physical demands of critical care, with implications for staff well-being, patient safety, and healthcare quality. Despite its importance, limited evidence exists on burnout among ICU nurses in Saudi Arabian tertiary hospitals. This study investigated the prevalence of burnout, associated factors, and potential interventions to reduce stigma and support mental health among ICU nurses at a tertiary healthcare setting, Saudi Arabia. A quantitative cross-sectional design was employed using the Maslach Burnout Inventory–Human Services Survey (MBI-HSS). Simple random sampling selected 250 registered ICU nurses with at least six months of experience. Data was analysed using SPSS v30 with descriptive statistics, and chi-square tests at a significance level of p < 0.05. Findings indicated a high prevalence of burnout, with 52% of nurses reporting elevated emotional exhaustion. Burnout was significantly associated with overtime hours (χ² = 29.155, df = 12, p = 0.015), nurse-to-patient ratios (χ² = 36.170, df = 20, p = 0.015), shift patterns (day: χ² = 4.931, df = 8, p = 0.765; night: χ² = 263 4.226, df = 8, p = 0.836; rotating: χ² = 3.739, df = 4, p = 0.442), living arrangements ((χ² = 13.153, df = 16, p = 0.662), and perceived impact on patient outcomes. Participants identified mental health education, anonymous support programmes, psychological check-ins, and leadership encouragement as helpful coping strategies. The study concludes that burnout among ICU nurses is influenced by workload, work schedules, and organisational support, underscoring the need for systemic interventions to enhance nurse well-being and sustain healthcare quality. Full article

(This article belongs to the Special Issue 2nd Edition: Workplace Health and Wellbeing Research and Evaluation)

11 pages, 971 KB

Open AccessArticle

Multisite Mobile Addiction Services: Four-Year Outcomes

by Cynthia A. Tschampl, Jennifer J. Wicks, Dominic Hodgkin, Craig Regis, Jadyn Baptista, Brittany P. Chapman, Madeline E. Davies, Kimberly De La Cruz, Karen Peugh, Allyson Pinkhover, Ben Plant, Priya Sarin Gupta, Sarah Mackin, Catherine E. Urquhart, Samantha Walsh, Jessie M. Gaeta, Constance Horgan and Elsie M. Taveras

Int. J. Environ. Res. Public Health 2026, 23(6), 756; https://doi.org/10.3390/ijerph23060756 - 4 Jun 2026

Abstract

First launched in Boston, MA in January 2018, Community Care in Reach^® is a mobile addiction model that uses mobile clinics to deliver harm reduction and clinical services to people at high risk of drug-related morbidity and mortality and who are unhoused [...] Read more.

First launched in Boston, MA in January 2018, Community Care in Reach^® is a mobile addiction model that uses mobile clinics to deliver harm reduction and clinical services to people at high risk of drug-related morbidity and mortality and who are unhoused or at risk of losing housing. Through a public/private partnership, the model has grown to include six programs across Massachusetts. Using the RE-AIM framework, this initial, descriptive evaluation for this multisite project included quantitative and qualitative methods to give insight into reach and performance. From 1 January 2022 to 30 June 2024, there were 17,887 harm reduction encounters and 16,117 clinical encounters providing care to 4645 individuals. Buprenorphine-based treatment (a key medication for opioid use disorder) was initiated among 1227 individuals, of whom 15% remained in buprenorphine-based treatment after 180 days. Evaluation across multiple organizations posed unique challenges; however, results demonstrated universal engagement of hard-to-reach individuals. Full article

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

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15 pages, 670 KB

Open AccessArticle

A Detailed Study on the Public and Health Worker Perception and Level of Knowledge on the Topic of Radiation and Nuclear Energy in Oman

by Hajir Al Hamrashdi, Ismail Al Yahmadi and Fatma Al Ma’mari

Int. J. Environ. Res. Public Health 2026, 23(6), 755; https://doi.org/10.3390/ijerph23060755 - 4 Jun 2026

Abstract

Background radiation and nuclear applications are deeply embedded in modern life. With the continuous advancement in nuclear techniques, daily radiation exposure is commonplace. The level of knowledge within this field among the general public must therefore be assessed to ensure that fundamental and [...] Read more.

Background radiation and nuclear applications are deeply embedded in modern life. With the continuous advancement in nuclear techniques, daily radiation exposure is commonplace. The level of knowledge within this field among the general public must therefore be assessed to ensure that fundamental and essential information on radiation and nuclear energy is attained and to prevent the spread of misinformation. The aim of this study is to evaluate the level of knowledge and awareness of this topic among the general public in Oman. The study was performed using a cross-sectional survey specifically designed to measure the knowledge of different aspects in the field of radiation and nuclear applications. We achieved this aim by assessing the level of knowledge among the general public and medical professionals. Overall, 500 individuals participated in the study, 75 of whom were from the medical field. The results demonstrate varying levels of knowledge on this topic. In general, the public and medical professionals show a high level of confidence in basic information; however, the level of knowledge and confidence decreases to intermediate and, in some cases, low levels with questions at fundamental and intermediate levels of knowledge. This decrease was clearly observed among topics related to the nature of radiation, the origin of radiation, radiation protection, and radiation applications. Our findings demonstrate conclusively that the public and medical professionals in Oman have limited knowledge in this field; therefore, appropriate measures must be implemented. Full article

(This article belongs to the Topic Environmental Exposures, Disasters, and Population Health: Epidemiology and Evaluation)

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13 pages, 353 KB

Open AccessArticle

Frozen and Canned Produce Use and WIC Cash-Value Benefit Redemption in a Tribal Organization

by Emily M. Melnick, Francesco Acciai, Nicole Vaudrin O’Reilly, Mindy Jossefides and Punam Ohri-Vachaspati

Int. J. Environ. Res. Public Health 2026, 23(6), 754; https://doi.org/10.3390/ijerph23060754 - 4 Jun 2026

Abstract

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides monthly cash-value benefits (CVBs) for fruits and vegetables. In addition to fresh produce, WIC agencies may allow households to purchase frozen and canned produce using CVBs. The use of these options [...] Read more.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides monthly cash-value benefits (CVBs) for fruits and vegetables. In addition to fresh produce, WIC agencies may allow households to purchase frozen and canned produce using CVBs. The use of these options may support benefit redemption for households who face inequitable barriers to accessing fresh produce, such as households living on tribal lands. This study examined (1) associations between frozen/canned food CVB purchases and overall CVB redemption and (2) predictors of frozen/canned food purchasing within a Tribal Organization using administrative data collected between November 2024 and April 2025 and a participant survey. Administrative data analyses included 4787 Inter Tribal Council of Arizona WIC-participating households; survey analyses included 1165 respondents. Mixed-effects models showed that households purchasing frozen and canned foods using CVBs, instead of only fresh, redeemed more of their CVBs. Further, higher frozen/canned purchasing predicted higher redemption rates. Households with multiple WIC participants were more likely to purchase frozen and canned foods using CVBs than single-participant households. The most commonly reported reason for purchasing frozen/canned foods in surveys was longer shelf life. Findings indicate that allowing and promoting frozen and canned food options may improve CVB utilization for American Indian families. Full article

(This article belongs to the Special Issue Advances in Indigenous and American Indian and Alaska Native Health and Wellness: 2nd Edition)

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15 pages, 317 KB

Open AccessArticle

Gender Differences in On-Site and Online Gambling Among Finnish Adolescents: Associations with School-, Family-, and Peer-Related Factors and Other Risk Behaviors

by Sari Castrén, Johanna Järvinen-Tassopoulos and Kirsimarja Raitasalo

Int. J. Environ. Res. Public Health 2026, 23(6), 753; https://doi.org/10.3390/ijerph23060753 - 3 Jun 2026

Abstract

Adolescent gambling is a growing public health concern as opportunities expand across both physical and digital environments. This study examined gender differences in on-site and online gambling among Finnish adolescents and assessed associations with school engagement, family context, peer activities, and co-occurring risk [...] Read more.

Adolescent gambling is a growing public health concern as opportunities expand across both physical and digital environments. This study examined gender differences in on-site and online gambling among Finnish adolescents and assessed associations with school engagement, family context, peer activities, and co-occurring risk behaviors. Data were obtained from the European School Survey Project on Alcohol and Other Drugs (ESPAD), collected from Finnish adolescents aged 15–16 in 2024 (boys: n = 1706; girls: n = 1588). Associations with past-12-month gambling were analyzed using Rao–Scott’s chi-square tests, F tests, and multinomial logistic regression, examining gender interactions. Gambling was more common among boys than girls: 7% of boys had gambled on-site only, 3% online only, and 11% both during the past 12 months. Among girls, the corresponding proportions were 0–2%. Skipping school, spending leisure time with friends, risky sexual behavior, and problematic substance use were associated with increased odds of both gambling types, whereas parental control was associated with decreased odds. Problematic social media increased the odds of on-site gambling, while problematic gaming decreased the odds. Several associations with online gambling differed by gender. These findings support multi-level prevention targeting family, school, peer, and behavioral risk factors. Full article

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

13 pages, 289 KB

Open AccessArticle

High Prevalence of Problematic Health Literacy and Its Associated Sociodemographic Factors Among Community-Dwelling Individuals in Northern Thailand: A Cross-Sectional Study

by Uratcha Sadjapong, Nattapon Harnsamut, Patipat Vongruang and Sakesun Thongtip

Int. J. Environ. Res. Public Health 2026, 23(6), 752; https://doi.org/10.3390/ijerph23060752 - 3 Jun 2026

Abstract

Health literacy (HL) is an important factor associated with individuals’ capacity to manage their health effectively. This cross-sectional study assessed HL and its associated factors among 327 community-dwelling individuals in Northern Thailand. Data were collected through face-to-face interviews using the 47-item European Health [...] Read more.

Health literacy (HL) is an important factor associated with individuals’ capacity to manage their health effectively. This cross-sectional study assessed HL and its associated factors among 327 community-dwelling individuals in Northern Thailand. Data were collected through face-to-face interviews using the 47-item European Health Literacy Questionnaire (HLS-EU-Q47). The participants were predominantly female (59.9%), with a mean age of 59.0 ± 11.7 years. Overall, 60.2% of the participants exhibited problematic HL across all domains. In bivariate analyses, overall HL was significantly associated with sex, age, body mass index (BMI), education, marital status, and hypertension. Age was negatively correlated with overall HL (r = −0.250, p < 0.001), whereas BMI was positively correlated with overall HL (r = 0.130, p = 0.019). In the multivariable linear regression model, higher education (β = 4.251, p < 0.001), female sex (β = 2.310, p = 0.002), and alcohol consumption (β = 1.411, p = 0.047) were independently associated with higher HL scores. Conversely, marital status (β = −1.747, p = 0.033) was associated with lower HL scores. Problematic HL was highly prevalent in this population and was associated with sociodemographic and health-related factors. These findings highlight the need for targeted, context-specific health communication and education strategies to improve HL among vulnerable community-dwelling populations, particularly older adults and individuals with lower educational attainment. Full article

(This article belongs to the Special Issue 2nd Edition: Health Equity and Universal Health Coverage)

18 pages, 1342 KB

Open AccessArticle

Effectiveness of a Geographic Information System-Integrated Mobile Platform for Coordinating Early Stage Rehabilitation After Total Hip Arthroplasty: A Randomized Controlled Trial

by Zhandos Kurban, Sholpan Bulekbayeva, Natalia Slivkina, Elena Titskaya, Yersin Ussin, Galym Zorgulov, Farkhad Adylkhanov and Dana Aldakuatova

Int. J. Environ. Res. Public Health 2026, 23(6), 751; https://doi.org/10.3390/ijerph23060751 - 3 Jun 2026

Abstract

Total hip arthroplasty (THA) is among the most effective orthopedic interventions for osteoarthritis, yet post-operative rehabilitation is frequently delayed due to informational and organizational barriers. Geographic information system (GIS) technology offers a promising approach to improving rehabilitation access coordination, though its integration into [...] Read more.

Total hip arthroplasty (THA) is among the most effective orthopedic interventions for osteoarthritis, yet post-operative rehabilitation is frequently delayed due to informational and organizational barriers. Geographic information system (GIS) technology offers a promising approach to improving rehabilitation access coordination, though its integration into patient-facing mobile platforms remains insufficiently studied. This two-arm, parallel-group, superiority randomized controlled trial enrolled 142 adult patients (≥18 years) within seven days of primary THA at the National Research Oncology Center LLC, Astana, Kazakhstan. Participants were randomized 1:1 to the GIS-integrated Health-GIS mobile coordination platform (experimental group) or standard general practitioner (GP)-mediated referral (control group). Key exclusion criteria included severe cognitive or visual impairment, absence of smartphone access or digital literacy, and medical contraindications to rehabilitation. The primary outcomes were time to second-stage rehabilitation initiation and health-related quality of life assessed by the SF-12 (Physical and Mental Component Summaries). Secondary outcomes included the Harris Hip Score (HHS), Visual Analogue Scale (VAS) for pain, System Usability Scale (SUS), and quality-adjusted life years (QALYs) over a 12-month follow-up. Of 142 randomized participants (61% male, 39% female), 131 completed follow-up and were included in the modified intention-to-treat analysis (experimental: n = 66; control: n = 65). The experimental group initiated second-stage rehabilitation significantly earlier (median 43 vs. 59 days; p = 0.021). At 12 months, the experimental group demonstrated superior SF-12 Physical Component Summary scores (48.21 vs. 42.84; p < 0.001), while Mental Component Summary scores did not differ significantly between groups (46.96 vs. 47.05; p = 0.669). Quality-adjusted life years were significantly higher in the experimental group (0.74 ± 0.04 vs. 0.72 ± 0.04; p = 0.008). Harris Hip Scores were significantly better in the experimental group at 6 weeks (p < 0.001) and 6 months (p = 0.009), converging by 12 months (p = 0.068). No statistically significant between-group differences in pain intensity (VAS) were observed at any time point (baseline: p = 0.814; 6 weeks: p = 0.336; 6 months: p = 0.066; 12 months: p = 0.105). Platform usability was rated as good-to-excellent by clinicians (SUS: 86.9 at 6 months) and acceptable by patients (mean SUS: 71.4). A GIS-integrated mobile coordination platform significantly reduced time to rehabilitation initiation and improved physical health-related quality of life and health utility following THA compared to standard referral practice. These findings support platform-based care coordination as an effective complement to surgical care, with important implications for rehabilitation access policy. Future multi-center studies and formal cost-effectiveness analyses are warranted to establish generalizability. Trial Registration: ClinicalTrials.gov, NCT07201116, registered 23 September 2025. Full article

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27 pages, 2270 KB

Open AccessArticle

Environmental Quality, Renewable Energy, and Life Expectancy in Gulf Cooperation Council Countries

by Ihsen Abid

Int. J. Environ. Res. Public Health 2026, 23(6), 750; https://doi.org/10.3390/ijerph23060750 - 3 Jun 2026

Abstract

Life expectancy is a key indicator of public health and sustainable development in Gulf Cooperation Council (GCC) countries, where rapid economic growth, urbanization, and fossil-fuel dependence create environmental and health challenges. This study examines the determinants of life expectancy in six Gulf Cooperation [...] Read more.

Life expectancy is a key indicator of public health and sustainable development in Gulf Cooperation Council (GCC) countries, where rapid economic growth, urbanization, and fossil-fuel dependence create environmental and health challenges. This study examines the determinants of life expectancy in six Gulf Cooperation Council countries from 2000 to 2023, focusing on death rates, renewable energy consumption, gross domestic product (GDP) per capita growth, government health expenditure, and carbon dioxide (CO₂) emissions. The empirical strategy combines cross-sectional dependence and slope heterogeneity tests, second-generation panel unit root tests, panel cointegration analysis, and a dynamic System Generalized Method of Moments (System GMM) estimator, with Driscoll–Kraay fixed-effects estimates used for robustness. The results show that higher death rates significantly reduce life expectancy, whereas renewable energy consumption and government health expenditure improve longevity. GDP per capita growth has a modest positive effect, while CO₂ emissions negatively affect life expectancy, confirming the adverse public health consequences of environmental degradation. Robustness checks support the reliability of the main findings. Overall, the evidence highlights the need for integrated policies that combine clean energy transition, stronger environmental regulation, preventive healthcare investment, and sustainable urban development to improve long-term health outcomes in resource-dependent economies in the region. Full article

(This article belongs to the Section Environmental Health)

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15 pages, 291 KB

Open AccessArticle

Impact of Demographic Factors and Other Characteristics on Housing Outcomes at Discharge from Transitional Care Program

by Kayla Blackburn, Mina Silberberg, Sandra Stinnett and Donna Biederman

Int. J. Environ. Res. Public Health 2026, 23(6), 749; https://doi.org/10.3390/ijerph23060749 - 3 Jun 2026

Abstract

Homelessness is a major public health concern, and successful rehousing is an important outcome for people experiencing homelessness (PEH). However, limited evidence exists on which individual factors are associated with rehousing after transitional care; this study examined characteristics associated with being rehoused at [...] Read more.

Homelessness is a major public health concern, and successful rehousing is an important outcome for people experiencing homelessness (PEH). However, limited evidence exists on which individual factors are associated with rehousing after transitional care; this study examined characteristics associated with being rehoused at discharge from Durham Homeless Care Transitions (DHCT). We analyzed data from DHCT, a transitional care program serving PEH. Independent variables included demographic characteristics, self-efficacy, mental healthcare status, and unmet identity and communication access (ICA) needs, including lack of personal identification documentation and technology access. We performed bivariate analyses and multivariable regression to assess associations with being rehoused at discharge. In both bivariate and multivariable analyses, non-White PEH were less likely to be rehoused at discharge than White PEH. Greater unmet ICA needs were also significantly associated with lower likelihood of rehousing. These findings add to the mixed prior literature regarding racial inequities in rehousing among PEH. The concept of ICA needs has not previously been studied and may offer an actionable target for transitional care programs seeking to improve rehousing outcomes and advance equity. Full article

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