International Journal of Environmental Research and Public Health

12 pages, 567 KB

Open AccessArticle

Sociodemographic and Structural Risk Factors for Dengue in a Rapidly Developing Indonesian District

by Inke Nadia Diniyanti Lubis, Nelli Khalilah Sari Siregar, Gema Nazri Yanni, Isti Ilmiati Fujiati and Lenni Evalina Sihotang

Int. J. Environ. Res. Public Health 2026, 23(6), 796; https://doi.org/10.3390/ijerph23060796 (registering DOI) - 14 Jun 2026

Abstract

Background: Dengue infection is an expanding public health threat in Indonesia, increasingly reported in semi-urban areas undergoing rapid demographic and environmental change, where household-level determinants remain poorly characterised. Methods: We conducted a case–control study in the Deli Serdang district, North Sumatra, evaluating sociodemographic [...] Read more.

Background: Dengue infection is an expanding public health threat in Indonesia, increasingly reported in semi-urban areas undergoing rapid demographic and environmental change, where household-level determinants remain poorly characterised. Methods: We conducted a case–control study in the Deli Serdang district, North Sumatra, evaluating sociodemographic and environmental risk factors for dengue. Patients admitted to the district referral hospital (July–September 2024) were screened via medical records. Laboratory-confirmed dengue cases were compared with non-dengue febrile controls. Housing conditions and sociodemographic characteristics were assessed using a validated electronic questionnaire with photographic documentation. Multivariable logistic regression identified independent risk factors. Results: Of 238 individuals screened, 39 dengue cases and 78 controls were enrolled. Male sex (aOR 6.7, 95% CI 1.3–33.7), student status (aOR 7.8, 95% CI 1.1–56.5), absence of window screens (aOR 12.9, 95% CI 3.1–53.8), and surrounding vegetation (aOR 7.3, 95% CI 1.7–31.9) were independently associated with dengue infection. Rural residence was overrepresented among cases, suggesting expansion beyond traditional urban boundaries. Conclusions: Dengue risk in a transitional setting is shaped by demographic exposure and modifiable structural vulnerabilities. Integrated prevention strategies, including window screening, covered water storage, environmental management, and school-based vector control, are needed in rapidly urbanising districts. Full article

25 pages, 1199 KB

Open AccessArticle

Decomposing Wealth-Based Inequalities in Neonatal Mortality in India: Evidence from National Family Health Survey (2019–2021)

by Diksha Gautam, Anuj Kumar Pandey, Benson Thomas M and Sutapa Bandyopadhyay Neogi

Int. J. Environ. Res. Public Health 2026, 23(6), 795; https://doi.org/10.3390/ijerph23060795 (registering DOI) - 12 Jun 2026

Abstract

India exhibits substantial variation in neonatal mortality across regions and socioeconomic groups. This study used nationally representative survey data (2019–2021) to examine wealth-based inequalities in neonatal mortality. Socioeconomic disparities were assessed using Erreygers’ Normalized Concentration Index (ECI) and concentration curves, with subgroup analyses [...] Read more.

India exhibits substantial variation in neonatal mortality across regions and socioeconomic groups. This study used nationally representative survey data (2019–2021) to examine wealth-based inequalities in neonatal mortality. Socioeconomic disparities were assessed using Erreygers’ Normalized Concentration Index (ECI) and concentration curves, with subgroup analyses by residence, state development status (Empowered Action Group (EAG) vs. non-EAG), district typology, and region. Inequality was further decomposed using the Wagstaff method. Analysis of 176,843 most recent live births revealed marked rural–urban disparities, with neonatal mortality in rural areas (18.3 per 1000 live births) 1.6 times higher than in urban areas (11.5). Neonatal mortality was significantly concentrated among poorer households (ECI: −0.0123; p < 0.001), with greater inequality in urban areas, EAG states, and non-aspirational districts. Regional variation was evident, with the highest inequality in the Western and Central regions. Decomposition analysis showed that inequality was primarily driven by adverse household conditions and maternal risk factors concentrated among poorer populations. Key contributors included unclean cooking fuel, higher parity, large family size, normal delivery and inadequate antenatal care. These findings highlight the need for equality-focused strategies addressing both social determinants and gaps in access to quality maternal and newborn care. Full article

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

► Show Figures

Figure 1

21 pages, 653 KB

Open AccessArticle

What Characterizes Employees with Emotional Exhaustion and Employees with Work Overload?

by Celine-Chantal Elster-Kann and Beate Muschalla

Int. J. Environ. Res. Public Health 2026, 23(6), 794; https://doi.org/10.3390/ijerph23060794 (registering DOI) - 12 Jun 2026

Abstract

Emotional exhaustion has been discussed as a major contributor to work ability problems, with substantial economic, individual, and social consequences. Research largely focuses on specific professions and sometimes overlooks that exhaustion and work overload problems are partly distinct. This study uses a differential [...] Read more.

Emotional exhaustion has been discussed as a major contributor to work ability problems, with substantial economic, individual, and social consequences. Research largely focuses on specific professions and sometimes overlooks that exhaustion and work overload problems are partly distinct. This study uses a differential analysis to explore working conditions and individual characteristics in employees with emotional exhaustion or perceived work overload, aiming to identify potential common risk factors. A representative German cross-sectional sample of 2289 employees aged 15–67, working at least 10 h per week, was analyzed. Employees with and without treatment for exhaustion, and with and without perceived work overload, were compared using variance analysis. Overloaded employees reported more work demands, while exhausted employees appear to be more often female and not in their preferred occupation. Several psychosocial work factors (e.g., responsibility) were more consistently associated with the overload and exhaustion groups than many of the physical work conditions. Employee characteristics such as openness and internal locus of control appeared to be similarly distributed across groups. Overload without exhaustion can be distinguished from combined exhaustion and overload, suggesting that work overload may occur with or without exhaustion, in relation to individual psychosocial resources. Preventive interventions for work ability may benefit from addressing overload as a distinct risk factor, besides illness-related exhaustion. Full article

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

15 pages, 8122 KB

Open AccessArticle

Influence of the GSTP1 rs1695 Polymorphism on Mercury Levels and Memory Performance in the Suruí Indigenous from the Brazilian Amazon

by Mayara Calixto da Silva, Paulo Cesar Basta, Bruna Duarte Pinto, Daniel Escorsim Machado, Felipe Oliveira Pessoa-Silva, Rogério Adas Ayres de Oliveira, Ana Claudia Santiago de Vasconcellos and Jamila Alessandra Perini

Int. J. Environ. Res. Public Health 2026, 23(6), 793; https://doi.org/10.3390/ijerph23060793 (registering DOI) - 12 Jun 2026

Abstract

Mercury (Hg) is a major neurotoxicant and public health concern and gold mining is a significant source of Hg contamination in the Amazon. There, Indigenous peoples are vulnerable to this exposure. Individual susceptibility influences both internal mercury levels and related clinical outcomes. In [...] Read more.

Mercury (Hg) is a major neurotoxicant and public health concern and gold mining is a significant source of Hg contamination in the Amazon. There, Indigenous peoples are vulnerable to this exposure. Individual susceptibility influences both internal mercury levels and related clinical outcomes. In this context, the GSTP1 gene stands out due to its role in detoxification of xenobiotics. The objectives were to assess the associations between: (1) Hg levels and neurotoxicity signs; (2) the GSTP1 rs1695 polymorphism and Hg levels; and (3) whether the GSTP1 rs1695 polymorphism modifies the effect of mercury on neurotoxicity signs. A cross-sectional study was conducted between April and May 2023, with 113 Paiter-Suruí Indigenous people. Sociodemographic and clinical data were collected using a validated methodology. Hair and oral mucosa cells were collected to assess Hg levels and the GSTP1 rs1695 polymorphism. Hg levels ranged from 0.1 μg/g to 6.5 μg/g (median = 1 μg/g, IQR = 1.43). Individuals with impaired memory and muscle strength had significantly higher mercury levels (β = 4.39 and β = 1.24). Carriers of the GSTP1AA genotype showed a 0.46-point reduction for each 1 μg/g increase in mean Hg levels, compared to individuals with the GSTP1GG genotype (β = −0.46). These results may support public policies by identifying priority groups for intervention based on genetic profiles. Full article

(This article belongs to the Section Environmental Health)

► Show Figures

Figure 1

16 pages, 296 KB

Open AccessArticle

Examine Facilitators and Barriers to Return to Work (RTW) for Employees with Common Mental Disorder (CMD) Symptoms: A Multi-Stakeholder Qualitative Study

by Nandini Khatter, Sapna Chotai and Giouliana Kadra-Scalzo

Int. J. Environ. Res. Public Health 2026, 23(6), 792; https://doi.org/10.3390/ijerph23060792 (registering DOI) - 12 Jun 2026

Abstract

Returning to work (RTW) following sickness absence due to common mental disorder (CMD) symptoms, such as anxiety, depression and stress, is increasingly recognised as a critical yet complex phase of recovery. Despite this, individuals do not always experience the process as supportive or [...] Read more.

Returning to work (RTW) following sickness absence due to common mental disorder (CMD) symptoms, such as anxiety, depression and stress, is increasingly recognised as a critical yet complex phase of recovery. Despite this, individuals do not always experience the process as supportive or straightforward. This study explored the factors shaping RTW by examining the perspectives of service users, employment advisors (EAs) and human resource (HR) professionals. In a qualitative study, using purposive sampling, we recruited 17 participants across the three stakeholder groups. Data were collected through semi-structured interviews and analysed using thematic analysis. The findings suggest that RTW is shaped by a dynamic interplay between individual experiences, workplace relationships and organisational structures. Participants described returning to work as an ongoing and often uncertain process, influenced by shifts in confidence, expectations of support and the extent to which workplaces were able to respond flexibly to individual needs. While some accounts reflected collaborative and supportive environments, others highlighted disconnection, misalignment and unmet expectations across stakeholders. Overall, the findings point to RTW as a negotiated process, requiring alignment between employees, managers and organisational systems. The study highlights the importance of consistent, flexible and context-sensitive approaches to support sustainable RTW following CMD-related absence. Full article

(This article belongs to the Special Issue Mental Health Promotion in the Workplace)

15 pages, 324 KB

Open AccessArticle

The Mediation Effect of Eudaimonic Well-Being in the Relationship Between Self-Determination and Somatic Symptoms

by Ivana Marcinko, Ana Kurtovic and Ana Babic Cikes

Int. J. Environ. Res. Public Health 2026, 23(6), 791; https://doi.org/10.3390/ijerph23060791 (registering DOI) - 12 Jun 2026

Abstract

The majority of somatic symptoms have unexplained medical causes, and it is claimed that psychological factors are important in the initiation and exacerbation of somatic complaints. This study, cross-sectional and correlational in nature, investigated the mediating role of eudaimonic well-being on the relationship [...] Read more.

The majority of somatic symptoms have unexplained medical causes, and it is claimed that psychological factors are important in the initiation and exacerbation of somatic complaints. This study, cross-sectional and correlational in nature, investigated the mediating role of eudaimonic well-being on the relationship between self-determination and somatic symptoms. Mediations were examined at both the whole-construct and component levels to better understand these relationships. A total of 486 participants took part in this study, comprising 403 females (82.9%) and 83 males (17.1%), with an age range of 18 to 36 years (M = 22, SD = 2.27). Self-determination, eudaimonic well-being, and somatic symptoms were measured using questionnaires. Mediations were tested at the construct and component levels using the PROCESS macro. The results show that eudaimonic well-being mediates the relationship between self-determination and somatic symptoms (b = −0.21, SE = 0.03, 95% CI = [−0.32, −0.10]). Component-level analyses reveal that the relationship between controlling motives and somatic symptoms is mediated by negative affect (b = 0.39, SE = 0.08, 95% CI [0.23, 0.56]). These findings identify the variables that may explain the origin of somatic symptoms, emphasising self-determination as a starting point and eudaimonic well-being as a mechanism by which motivational factors affect health outcomes. Full article

(This article belongs to the Special Issue The Effect of Positive Psychology on Health)

10 pages, 274 KB

Open AccessArticle

Suicide and Coping: Specific Coping Behaviours Associated with Suicidal Ideation and Differences Between Predicted and Actual Coping Among Help-Seeking Individuals

by David John Hallford, Emily J. Wallman, Ryan A. Kaplan and Glenn A. Melvin

Int. J. Environ. Res. Public Health 2026, 23(6), 790; https://doi.org/10.3390/ijerph23060790 (registering DOI) - 11 Jun 2026

Abstract

Suicide is a substantial contributor to global mortality, with suicidal ideation (SI) a significant predictor of suicide. Research has demonstrated relationships between dispositional coping styles and SI. This study aimed to advance this research by examining the specific coping strategies people use when [...] Read more.

Suicide is a substantial contributor to global mortality, with suicidal ideation (SI) a significant predictor of suicide. Research has demonstrated relationships between dispositional coping styles and SI. This study aimed to advance this research by examining the specific coping strategies people use when experiencing SI. Further, it assessed predicted use of coping strategies of people with a history of SI would differ from the actual coping strategies employed by people have experienced SI. Seventy-seven help-seeking adults (Mage = 31.6, SD = 10.4) with (n = 49) or without (n = 28) history of SI completed the Brief Coping Orientations to Problems Experienced (Brief COPE) adapted to SI-related coping and current emotional distress measured by the 21-item version of the Depression Anxiety Stress Scale (DASS-21). An ANCOVA, while controlling for current emotional distress levels, showed a greater predicted Problem-Focused coping use than actual use reported by participants with SI history. Facet-level ANCOVAs attributed this to differences in Active Coping, Use of Informational Support, and Planning strategies. There were no group differences in emotion-focused or avoidant coping. The preliminary findings suggest individuals without a history of SI may prognosticate more frequent use adaptive coping strategies, relative to how frequently people actually employ them during these times. Future research may examine the factors explaining these differences to help inform programs related to SI and coping. Full article

(This article belongs to the Special Issue Research on Suicide Assessment, Prevention and Management)

17 pages, 544 KB

Open AccessArticle

Community-Driven Grassroots Intervention on Adolescent Vaping Attitudes, Harm Perceptions, and Knowledge: Randomized Controlled Trial

by Mirza Ali Anser Beg, Yahya Dawood and Scott Burton Patten

Int. J. Environ. Res. Public Health 2026, 23(6), 789; https://doi.org/10.3390/ijerph23060789 (registering DOI) - 11 Jun 2026

Abstract

This study evaluated the effectiveness of a youth-developed vaping intervention created by the Airdrie Board of Youth Affairs (ABYA) in changing Grade 7 and 8 students’ knowledge, attitudes, and harm perceptions regarding e-cigarette use. The vaping video trial followed a preceding local education [...] Read more.

This study evaluated the effectiveness of a youth-developed vaping intervention created by the Airdrie Board of Youth Affairs (ABYA) in changing Grade 7 and 8 students’ knowledge, attitudes, and harm perceptions regarding e-cigarette use. The vaping video trial followed a preceding local education program on smoking harms. A total of 107 students were randomly assigned to either the intervention group (ABYA video) or the control group (expert-developed video). Four instruments were used: the Video Survey, Personal Information Questionnaire, Knowledge and Attitudes Regarding E-cigarette Ingredients, Safety, and Addictive Properties (KAS), and the E-cigarette Harm Perception and Reduction (EHI). Pre- and post-intervention data were analyzed using t-tests and Mann–Whitney U tests. Compared with controls, the intervention group showed a significantly larger mean decrease in total EHI scores (mean change 9.05 vs. 2.06; t(105) = 3.34, p = 0.001; Cohen’s d = 0.65), indicating that the youth-developed video increased the perceived risk of vaping relative to cigarettes to a greater extent than the expert-developed video. Students also rated the ABYA video significantly higher on a 5-point scale for overall enjoyment (3.13 vs. 2.33; p < 0.001; Cohen’s d = 0.81) and for perceived increase in knowledge about vaping (3.34 vs. 2.84; p = 0.023; Cohen’s d = 0.44). The KAS instrument showed low internal consistency in this sample, so item-level KAS findings were treated as exploratory. Notably, unlike the expert-developed video, which explicitly acknowledged uncertainty, the ABYA video conveyed a clearer and more direct message, which may have contributed to its greater appeal while also carrying a risk of overstating absolute risk of e-cigarettes relative to cigarettes. Overall, these findings suggest that grassroots, youth-led interventions may be an effective approach for adolescent vaping education and may offer advantages over traditional expert-developed messaging in some contexts. Full article

16 pages, 607 KB

Open AccessArticle

Hospitalizations After Bicycle Accidents: Injury Patterns, Severity and Costs

by José Antonio Guerrero Serrano, Samuel Lozano Martín, Julia Sánchez García, Marta Arroyo Hernández and Pedro Caba Doussoux

Int. J. Environ. Res. Public Health 2026, 23(6), 788; https://doi.org/10.3390/ijerph23060788 (registering DOI) - 11 Jun 2026

Abstract

Background Although cycling has definite health benefits, it is certainly not a risk-free activity; its increasing use is associated with a rise in accidents. This study aims to characterize cycling injuries and their associated factors in a tertiary trauma center, including injury severity, [...] Read more.

Background Although cycling has definite health benefits, it is certainly not a risk-free activity; its increasing use is associated with a rise in accidents. This study aims to characterize cycling injuries and their associated factors in a tertiary trauma center, including injury severity, accident circumstances, and in-hospital costs. Methods: A retrospective observational study was conducted on patients over 15 years of age hospitalized after a cycling accident. Collected variables included the characteristics of the accident, the epidemiology of musculoskeletal injuries, helmet use, injury severity as assessed using the Abbreviated Injury Scale (AIS), the Injury Severity Score (ISS), and costs. Results: A total of 131 patients were included, of whom 90.8% were male, with a mean age of 43.2 ± 14.1 years. Most accidents were due to falls (83.7%). Accidents occurred in urban areas (56.3%), inter-urban roads (28.1%), and rural areas (15.6%). Upper limb fractures, particularly clavicle fractures (13.7%), were the most frequent injuries (31.0%). Traumatic brain injury (TBI) was present in 30.0% of patients, and 17.6% were polytraumatized. Injury severity was higher in males (p = 0.009) and in collisions compared with falls (p = 0.033). It was also correlated with length of hospital stay (r = 0.376). Patients with TBI exhibited significantly higher ISSs (p < 0.001). Helmet use was reported in 71.1% of patients and was more frequent in rural areas (p < 0.001) and associated with lower neurological AIS scores (p = 0.031). The mean cost per patient was €8545 ± 15,298, increasing with severity of injury (p < 0.001), and was higher in polytraumatized patients (p < 0.001) and in those with TBI. Conclusions: Cycling accidents most frequently resulted in upper limb fractures. Helmet use was more common where mandatory and was associated with less severe neurological injuries but not with a lower incidence of TBI. Costs increased with injury severity, particularly in patients with TBI and longer hospital stays. Full article

(This article belongs to the Special Issue Sports Injuries: Epidemiology, Assessment, Prevention and Rehabilitation)

► Show Figures

Figure 1

16 pages, 1444 KB

Open AccessArticle

Association of Park Size, Access and Neighbourhood Walkability with Physical Activity and Obesity: A Cross-Sectional Analysis

by Ghazal S. Fazli, Jane Polsky, Ashley Johns, Peter Gozdyra, Jin Luo and Gillian L. Booth

Int. J. Environ. Res. Public Health 2026, 23(6), 787; https://doi.org/10.3390/ijerph23060787 (registering DOI) - 11 Jun 2026

Abstract

Background: We examined whether higher access to parks and greenspace is independently associated with an increase in physical activity and lower rates of obesity when neighbourhood walkability is accounted for and whether neighbourhood walkability and park access have synergistic effects on these outcomes. [...] Read more.

Background: We examined whether higher access to parks and greenspace is independently associated with an increase in physical activity and lower rates of obesity when neighbourhood walkability is accounted for and whether neighbourhood walkability and park access have synergistic effects on these outcomes. Materials and Methods: We used cross-sectional data from the Canadian Community Health Survey between 2007 and 2014 for adults aged 20 to 74 in Ontario, Canada. Neighbourhood-level park access exposures included size of parks and number of parks within 800 m of residential areas, and neighbourhood walkability was based on a validated index. The main outcomes were physical activity during leisure time (LPA), both leisure and transportation physical activity (LTPA), and obesity. Descriptive and multivariate logistic regression analyses were conducted, stratified by age groups, accounting for sex, income, ethnicity, and season. Results: Among 41,945 respondents, park access was associated with higher LPA and LTPA, with effects modified by neighbourhood walkability (p < 0.001). Physical activity was highest in neighbourhoods with high walkability and park access and lowest in low walkability areas without parks. In highly walkable neighbourhoods, ≥1 small- or medium-sized park was associated with 29% higher odds of LPA (OR: 1.29, 95%CI: 1.21–1.37) and 48% higher odds of LTPA (OR: 1.48, 95%CI: 1.38–1.57) than low walkability/no park access. In contrast, associations were modest in low-walkability neighbourhoods (4–7%). High walkability was also associated with lower obesity and marked reductions when combined with very high access to large parks (OR: 0.72, 95%CI: 0.55–0.94). Findings were consistent across age groups. Conclusions: High neighbourhood walkability was the strongest predictor of physical activity and lower obesity risk, with park access providing additional benefits primarily in already walkable environments. These findings suggest that population health interventions targeting urban design need to consider the combined benefits of neighbourhood walkability and park access on health. Full article

► Show Figures

Figure 1

15 pages, 399 KB

Open AccessArticle

Substance Use and Traumatic Brain Injury: Evidence from a Rural Trauma Center

by Monica R. Lininger and Michael Anastario

Int. J. Environ. Res. Public Health 2026, 23(6), 786; https://doi.org/10.3390/ijerph23060786 (registering DOI) - 11 Jun 2026

Abstract

Background: Traumatic brain injury (TBI) and substance use disorder (SUD) frequently co-occur due to shared risk factors and a potentially bidirectional relationship. However, epidemiological patterns in rural populations remain understudied despite known disparities in access and outcomes. This study aimed to characterize [...] Read more.

Background: Traumatic brain injury (TBI) and substance use disorder (SUD) frequently co-occur due to shared risk factors and a potentially bidirectional relationship. However, epidemiological patterns in rural populations remain understudied despite known disparities in access and outcomes. This study aimed to characterize the relationship between TBI and SUD in a rural Southwestern population, including demographic and clinical patterns of diagnostic sequencing. Methods: A retrospective observational study was conducted using electronic health records and trauma registry data (2022–2023) from a rural trauma center. Cohort one included 24,389 emergency department encounters with ICD-10 codes for TBI or SUD. Cohort two included 248 trauma registry patients with TBI and SUD diagnoses. Descriptive statistics and multinomial logistic regression models were used to evaluate diagnostic patterns and associated demographic factors. Results: Males were more likely to have co-occurring TBI and SUD (Relative Risk Ratio [RRR] = 1.35), while increasing age was associated with TBI-only diagnoses. Among patients with multiple visits and diagnoses, 16% had co-diagnoses, while 9% had sequential diagnoses. American Indian/Alaska Native patients had higher co-diagnosis risk compared to White patients (RRR = 2.21, p < 0.001). Higher blood alcohol concentration was associated with lower Glasgow Coma Scale scores (r = −0.15, p = 0.022), indicating greater severity. Conclusions: TBI and SUD frequently co-occur in rural populations, with notable disparities by sex and race/ethnicity. Emergency Departments are critical points of care for interventions such as screening for both substance use and head injury when either is suspected, and employing culturally responsive education and referral pathways upon discharge. Full article

(This article belongs to the Special Issue Substance Use Disorders: Etiology, Epidemiology, Prevention, Treatment and Recovery)

► Show Figures

Figure 1

19 pages, 5425 KB

Open AccessArticle

Spatiotemporal Associations Between Ambient Air Pollution and Neoplasm Morbidity in Eastern Kazakhstan: Age-Specific Patterns and Spatial Heterogeneity, 2014–2024

by Gulnaz Sadykanova, Sanat Kumarbekuly, Ayauzhan Yessimbekova and Gulfat Kalelova

Int. J. Environ. Res. Public Health 2026, 23(6), 785; https://doi.org/10.3390/ijerph23060785 - 11 Jun 2026

Abstract

Industrial settlements of the East Kazakhstan Region face a persistent technogenic burden driven by the dense concentration of non-ferrous metallurgy and heat-and-power enterprises, further compounded by unfavorable pollutant dispersion conditions inherent to the region’s mountain–basin topography. This study evaluated spatiotemporal associations between annual [...] Read more.

Industrial settlements of the East Kazakhstan Region face a persistent technogenic burden driven by the dense concentration of non-ferrous metallurgy and heat-and-power enterprises, further compounded by unfavorable pollutant dispersion conditions inherent to the region’s mountain–basin topography. This study evaluated spatiotemporal associations between annual mean concentrations of NO₂, SO₂, H₂S, and CO, the integrated air pollution index (API₅), and primary neoplasm morbidity across five settlements over the period 2014–2024. A retrospective ecological analysis was carried out for Ust-Kamenogorsk, Ridder, Altai, Shemonaikha, and the settlement of Glubokoe, incorporating Spearman’s rank correlation, lag analysis (1–3 years), and the Mann–Kendall trend test. Throughout the study period, neoplasm morbidity in the region consistently exceeded the national average by a factor of 1.3 to 2.0. In Ust-Kamenogorsk—where metallurgical SO₂ and NO₂ emissions are most heavily concentrated—strong positive associations were found in children for SO₂ (ρ = 0.791, p < 0.05) and in adolescents for NO₂ and CO, reflecting elevated inhalation exposure under conditions of chronic pollution. The negative associations with API₅ observed in Ridder and Altai, where the index showed a statistically significant downward trend, are interpreted as evidence of the inertial character of oncological processes and the lasting influence of cumulative past exposure. Across all studied settlements, SO₂ emerged as the most consistent predictor of morbidity variation. These findings support prioritizing stricter emission controls for SO₂ and NO₂ from metallurgical and energy facilities, establishing oncological screening programs for children and adolescents in chronically polluted areas, and strengthening ambient air monitoring—measures whose effective implementation will require coordinated action between public health authorities and environmental regulators. Full article

(This article belongs to the Special Issue Air Pollution Exposure and Its Impact on Human Health)

► Show Figures

Figure 1

19 pages, 279 KB

Open AccessProject Report

Community Coalition Building and Human-Centered Design Strategies to Advance Homeless Health Systems: A Case Study from Rural North Carolina

by Ashley Jarrett, Oscar Fleming, Jacob Shomali and William Romani

Int. J. Environ. Res. Public Health 2026, 23(6), 784; https://doi.org/10.3390/ijerph23060784 - 11 Jun 2026

Abstract

In Burke County, North Carolina, a Hepatitis A outbreak among unsheltered residents exposed gaps in access to clinic-based care and prompted early, ad hoc “backpack medicine” outreach efforts to deliver care directly in nontraditional settings. While this approach addressed immediate needs, it highlighted [...] Read more.

In Burke County, North Carolina, a Hepatitis A outbreak among unsheltered residents exposed gaps in access to clinic-based care and prompted early, ad hoc “backpack medicine” outreach efforts to deliver care directly in nontraditional settings. While this approach addressed immediate needs, it highlighted the inadequacy of isolated interventions, prompting local partners to pursue more structured, coordinated, and community-driven approaches to homeless health system design. This project report describes how Burke County Public Health, in partnership with the University of North Carolina at Chapel Hill, applied systems thinking, community coalition building, and human-centered design to transition from reactive outreach to a structured, sustainable mobile health delivery model for people experiencing homelessness. Guided by Community Coalition Action Theory (CCAT), partners used human-centered design methods to engage over 40 community stakeholders and 10 individuals with lived experience of homelessness or housing instability. Through empathy mapping, iterative prototyping, and thematic analysis, the team identified priority service gaps, defined operational requirements, and developed prototype service models, while building cross-agency readiness for implementation. Full article

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

20 pages, 1100 KB

Open AccessArticle

Implementing Caring Technologies and Social Mobilisation for Older Adults: A Mixed-Methods Evaluation Across Seven European Case Studies

by Toni Wright, Michelle England, Thomas Thompson, Sabina Hulbert, Theofanis Fotis and Eleni Hatzidimitriadou

Int. J. Environ. Res. Public Health 2026, 23(6), 783; https://doi.org/10.3390/ijerph23060783 - 11 Jun 2026

Abstract

Population ageing presents growing challenges for health and social care systems, particularly in supporting older adults to remain independent and involved in decisions concerning their own health and wellbeing. The EMPOWERing individuals and communities to manage their own CARE (EMPOWERCARE) project evaluated asset-based [...] Read more.

Population ageing presents growing challenges for health and social care systems, particularly in supporting older adults to remain independent and involved in decisions concerning their own health and wellbeing. The EMPOWERing individuals and communities to manage their own CARE (EMPOWERCARE) project evaluated asset-based initiatives designed to support older adults in managing their health and wellbeing across seven pilot sites in Belgium, France, the Netherlands and the United Kingdom. Initiatives were categorised as caring technologies, which focused on digital tools and assistive technologies to improve autonomy, promote self-management, and support independent living, and social mobilisation initiatives aimed at building stronger community networks, reducing loneliness, and fostering engagement. A multi-site, embedded case study design combined quantitative and qualitative methods. Survey data were collected at baseline (T0; n = 187) and endpoint (T2; n = 105) between July 2021 and January 2023. Outcomes included self-efficacy, mental wellbeing, loneliness and digital literacy. Descriptive statistics and repeated-measures t-tests were conducted, while Photovoice and focus group data were analysed using summative content analysis. Findings indicated improvements in self-efficacy and mental health among some participants, alongside positive trends in digital literacy and internet-based health-seeking behaviour. Qualitative findings further highlighted increased confidence, social connectedness and empowerment among participants. Full article

(This article belongs to the Section Health Care Sciences)

► Show Figures

Figure 1

3 pages, 193 KB

Open AccessReply

Reply to Villafuerte, R.; Funa, A. Comment on “Skjerve et al. Using Simulations to Help Public Health Students Overcome Language Barriers for Better Health Outcomes. Int. J. Environ. Res. Public Health 2023, 20, 6259”

by Hilde Skjerve, Lars Erik Braaum, Ursula Småland Goth and Anette Sørensen

Int. J. Environ. Res. Public Health 2026, 23(6), 782; https://doi.org/10.3390/ijerph23060782 - 11 Jun 2026

Abstract

We sincerely thank the authors of the comment [...] Full article

3 pages, 191 KB

Open AccessComment

Comment on Skjerve et al. Using Simulations to Help Public Health Students Overcome Language Barriers for Better Health Outcomes. Int. J. Environ. Res. Public Health 2023, 20, 6259

by Rochele Villafuerte and Aaron Funa

Int. J. Environ. Res. Public Health 2026, 23(6), 781; https://doi.org/10.3390/ijerph23060781 - 11 Jun 2026

Abstract

Skjerve et al [...] Full article

10 pages, 549 KB

Open AccessArticle

Caregiver-Mediated Adherence and Perceived Health System Factors Associated with Viral Suppression Among Children Receiving Antiretroviral Therapy in Rural South Africa

by Sinentlahla Mamane, Monwabisi Faleni, Guillermo Alfredo Pulido Estrada, Ziphelele Ncane and Laston Gonah

Int. J. Environ. Res. Public Health 2026, 23(6), 780; https://doi.org/10.3390/ijerph23060780 - 10 Jun 2026

Abstract

Background: While caregiver and health system factors are known to influence paediatric ART outcomes, their roles within routine rural South African settings remain insufficiently characterised. Aim: The aim of this study is to assess the association between caregiver-mediated ART adherence, perceived healthcare access [...] Read more.

Background: While caregiver and health system factors are known to influence paediatric ART outcomes, their roles within routine rural South African settings remain insufficiently characterised. Aim: The aim of this study is to assess the association between caregiver-mediated ART adherence, perceived healthcare access and service quality with viral suppression among children receiving ART in a rural South African province. Methods: A cross-sectional study was conducted among 86 children aged <15 years receiving ART in routine paediatric HIV care. Viral load suppression was defined as <1000 copies/mL. Predictor variables included caregiver-reported adherence (30-day recall; adherent vs. non-adherent), perceived healthcare access and perceived service quality. Associations were assessed using Chi-square or Fisher’s exact tests, where appropriate. Effect sizes were estimated using risk differences. Results: Overall, 77.9% of the child participants were virally suppressed. Caregiver-reported adherence was significantly associated with VLS (p = 0.034). The probability of viral suppression was 100% among adherent children compared to 73.2% among non-adherent children (risk difference: 26.8 percentage points). Caregiver-reported adherence demonstrated high specificity (100%) and positive predictive value (100%) but low sensitivity (22.4%) and negative predictive value (26.8%), indicating that while reported adherence reliably identified children who were suppressed, non-adherence did not consistently predict virological failure. Perceived healthcare access (p = 0.372) and service quality (p = 0.267) were not significantly associated with viral suppression. Conclusions: Caregiver-mediated adherence was strongly associated with viral suppression, whereas perceived health system factors were not independently associated with treatment outcomes in this cohort. These findings should be interpreted cautiously given the cross-sectional design and reliance on short-term adherence measures. Strengthening household-level adherence support is critical for improving paediatric HIV outcomes in rural settings. Full article

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

► Show Figures

Figure 1

17 pages, 900 KB

Open AccessArticle

From Risk to Flourishing: Organizational Resources in Seasonal Tourism Work

by Stefania Fantinelli, Michela Cortini, Morena Santoriello, Leonardo Pagano and Teresa Galanti

Int. J. Environ. Res. Public Health 2026, 23(6), 779; https://doi.org/10.3390/ijerph23060779 - 10 Jun 2026

Abstract

Seasonal workers in the tourism sector are exposed to significant psychosocial risks, such as work overload, emotional exhaustion, and precarious employment conditions. Despite growing interest in positive organizational psychology, little is known about how organizational culture impacts perceptions and experiences of seasonal workers [...] Read more.

Seasonal workers in the tourism sector are exposed to significant psychosocial risks, such as work overload, emotional exhaustion, and precarious employment conditions. Despite growing interest in positive organizational psychology, little is known about how organizational culture impacts perceptions and experiences of seasonal workers in Italy. This study explores the role of positive organizational culture in promoting well-being among seasonal workers in the tourism sector, examining their direct perspectives on organizational climate, work challenges, and individual and organizational resources. Eight semi-structured interviews were conducted with seasonal workers employed in the hospitality industry in Italy. Data were analyzed through an integrated mixed-method approach combining Grounded Theory methodology with quantitative lexical analysis using T-LAB software, ensuring both analytical rigor and interpretive depth. Five macro-categories emerged inductively from the data: trust and relations, coping strategies and emotions, perceived justice, teamwork, and meaning of work. These were integrated into a core category defined as flourishing at work, interpreted through the lens of Seligman’s PERMA model. These findings suggest that well-being in seasonal work is an active and relational achievement, sustained by emotional self-regulation, perceived fairness, and collective identity. The results carry direct implications for organizational policies and psychosocial risk prevention strategies in precarious work contexts. In particular, positive organizational culture and environments can act as protective factors against psychosocial risks, with direct implications for organizational policies, psychosocial risk prevention, and evidence-based workplace interventions. The specificity of the analysis method offers an original contribution by integrating qualitative and quantitative textual analysis to investigate psychosocial well-being in an under-explored population: Italian seasonal workers. Full article

(This article belongs to the Special Issue Psychological Well‑Being and Psychosocial Risks in Evolving Workplaces and Communities)

► Show Figures

Figure 1

19 pages, 380 KB

Open AccessArticle

Suicidality, Psychological Inflexibility, and Emotional Resilience Among Black College Students

by TyWanda L. McLaurin-Jones, Shannon M. Hughley and Joi J. Wright

Int. J. Environ. Res. Public Health 2026, 23(6), 778; https://doi.org/10.3390/ijerph23060778 - 10 Jun 2026

Abstract

Research examining risk and protective factors of suicidality among Black students remains limited. This study assessed the effects of psychological inflexibility and emotional resilience on suicidal behaviors among Black college students. We conducted a secondary data analysis of the 2022–2024 Healthy Minds Study. [...] Read more.

Research examining risk and protective factors of suicidality among Black students remains limited. This study assessed the effects of psychological inflexibility and emotional resilience on suicidal behaviors among Black college students. We conducted a secondary data analysis of the 2022–2024 Healthy Minds Study. Black students (aged 18–24) who completed the suicidality matrix, psychological inflexibility (Acceptance & Action Questionnaire II) and emotional resilience (Brief Resilience Scale) measures were included in the analysis. Logistic regressions were performed to examine the effect of psychological inflexibility and resilience on suicidal ideation, plans for suicide, and suicide attempts. The students (N = 4557) represented diverse backgrounds, with 61% being African American, 12.2% African, 13.8% Caribbean, and 7% Afro-Latinx. Further, 18.7% endorsed suicidal ideation, 9.2% endorsed suicide plans, and 3.2% reported a suicidal attempt within the past 12 months. Psychological inflexibility was associated with increased risk of suicidal ideation (OR = 1.04, p < 0.001), suicidal plan (OR = 1.05, p < 0.001) and suicide attempt (OR = 1.03, p = 0.011). Emotional resilience was not associated with any suicidal behaviors as a protective or risk factor. The findings support previous research identifying psychological inflexibility as a suicidal risk factor. Prevention and intervention strategies may warrant a focus on promoting psychological flexibility. Full article

(This article belongs to the Special Issue Proceedings of the 2024 and 2025 Research Centers in Minority Institutions (RCMI) Consortium National Conferences)

Journal Description

International Journal of Environmental Research and Public Health

Latest Articles

Journal Menu

Journal Browser

Highly Accessed Articles

Latest Books

E-Mail Alert

News

Topics

Conferences

Special Issues

Topical Collections

Further Information

Guidelines

MDPI Initiatives

Follow MDPI