International Journal of Environmental Research and Public Health

20 pages, 2166 KiB

Open AccessArticle

Suicides Mortality of Unemployed Individuals Becomes a Serious Public Health Concern in Japan in Post-COVID-19 Pandemic Era

by Tomoka Oka, Ryusuke Matsumoto, Eishi Motomura and Motohiro Okada

Int. J. Environ. Res. Public Health 2025, 22(9), 1315; https://doi.org/10.3390/ijerph22091315 - 22 Aug 2025

Abstract

Identification of temporal relations among suicide mortality and economic/political implementations provides important information for not only planning suicide prevention but also socioeconomic/psychosocial measures. This cross-sectional observation study analyzed temporal fluctuations and causalities of suicide mortalities of working-age individuals, disaggregated by age/gender/social standing (employed/unemployed), [...] Read more.

Identification of temporal relations among suicide mortality and economic/political implementations provides important information for not only planning suicide prevention but also socioeconomic/psychosocial measures. This cross-sectional observation study analyzed temporal fluctuations and causalities of suicide mortalities of working-age individuals, disaggregated by age/gender/social standing (employed/unemployed), in Japan from 2009 to 2024, using government databases, by joinpoint and vector-autoregressive analyses. Suicide mortality among total and employed females decreased until the COVID-19 pandemic outbreak but sharply increased, synchronized with the pandemic outbreak, before resuming a downward trend. Among males, the decreasing trends attenuated from 2016, followed by a transient increase in 2022. Unemployed males aged 40–69 exhibited four joinpoints: 2016 (decreasing–increasing), 2018 (increasing–decreasing), 2022 (decreasing–increasing), and 2023 (increasing–stable). In contrast, suicide mortality among unemployed females aged 40–69 sharply increased in 2022 and maintained the high level. Among individuals aged 30–39, suicide mortality reversed from decreasing to increasing in 2016 (males) and 2018 (unemployed females). Economic expansion was protective for employed individuals but had no significant effect on unemployed populations. The government management instability (AENROP) index was positively associated with suicide mortality among employed and unemployed males and employed females. Unemployed females aged 30–39 were sensitive to AENROP but not economic conditions, while those aged 40–69 were largely unaffected by either. Increasing employment of individuals with psychiatric disabilities was positively associated with suicide mortality among unemployed males (30–69) and females under 40. Positive impacts of the employment rates of individuals with psychiatric disabilities and unemployment enhanced from 2016 and 2022, respectively, whereas the impacts were inconstantly affected by political rather than economic factors. Suicide mortality among unemployed individuals has emerged as a critical public health concern in Japan, with rates more than doubling among males and tripling among females in the 2020s. These findings underscore the need for integrated suicide prevention policies that address both labor market vulnerabilities and psychosocial determinants. Full article

(This article belongs to the Special Issue Depression and Suicide: Current Perspectives)

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16 pages, 444 KiB

Open AccessArticle

Food Security in a College Community: Assessing Availability, Access, and Consumption Patterns in a Mexican Context

by Wendy Jannette Ascencio-López, María Teresa Zayas-Pérez, Ricardo Munguía-Pérez, Guadalupe Virginia Nevárez-Moorillón, Manuel Huerta-Lara, María del Carmen Guadalupe Avelino-Flores, Teresa Soledad Cid-Pérez and Raúl Avila-Sosa

Int. J. Environ. Res. Public Health 2025, 22(9), 1314; https://doi.org/10.3390/ijerph22091314 - 22 Aug 2025

Abstract

Food security among college students is an increasing concern, with potential implications for their health, academic performance, and future well-being. This study investigated food security within a college community in Mexico, focusing on food availability, access (both economic and physical), and consumption patterns. [...] Read more.

Food security among college students is an increasing concern, with potential implications for their health, academic performance, and future well-being. This study investigated food security within a college community in Mexico, focusing on food availability, access (both economic and physical), and consumption patterns. A mixed-methods approach was employed at Ciudad Universitaria, BUAP, Mexico, between 2023 and 2024. Stratified random sampling was used, resulting in a final sample of 606 students. Data were collected through structured questionnaires covering sociodemographic characteristics and eating habits, the ELCSA, structured cafeteria observations, semi-structured interviews with key informants, and three focus groups. Statistical analysis was performed using chi-square tests (p < 0.05). Post hoc analysis with Bonferroni adjustment confirmed that origin (p = 0.0017), mode of transportation (p = 2.31 × 10⁻⁵) and private vehicles (p = 1.77 × 10⁻⁵) were the key determinants. Although the environment offered a variety of options, processed and ultra-processed products dominated the food choices. A total of 95.9% of students purchased food on campus, yet only 21.8% reported engaging in healthy eating habits. Focus groups revealed that students’ food choices were influenced by availability, access, and perceptions of affordability and convenience. These findings highlight the urgent need for targeted interventions to improve food security and promote healthier dietary practices within the college setting. Full article

(This article belongs to the Section Global Health)

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12 pages, 1219 KiB

Open AccessArticle

Disparities in Suicide Mortality Between Indigenous and Non-Indigenous Populations in Southern Brazil (2010–2019)

by Thiago Fuentes Mestre, Fernando Castilho Pelloso, Deise Helena Pelloso Borghesan, Ana Carolina Jacinto Alarcao, Pedro Beraldo Borba, Vlaudimir Dias Marques, Paulo Acácio Egger, Kátia Biagio Fontes, Fernanda Cristina Coelho Musse, José Anderson Labbado, Elizabeth Amâncio de Souza da Silva Valsecchi, Jorge Luiz Lozinski Musse, Amanda Carina Coelho de Morais, Raissa Bocchi Pedroso, Sandra Marisa Pelloso and Maria Dalva de Barros Carvalho

Int. J. Environ. Res. Public Health 2025, 22(9), 1313; https://doi.org/10.3390/ijerph22091313 - 22 Aug 2025

Abstract

The objective of this study was to evaluate the temporal trend of suicide deaths and the disparities in the occurrence of suicide death between Indigenous and non-Indigenous populations. This ecological study analyzed deaths from intentionally self-inflicted injuries in the southern region of Brazil [...] Read more.

The objective of this study was to evaluate the temporal trend of suicide deaths and the disparities in the occurrence of suicide death between Indigenous and non-Indigenous populations. This ecological study analyzed deaths from intentionally self-inflicted injuries in the southern region of Brazil (states of Paraná, Santa Catarina, and Rio Grande do Sul) from 2010 to 2019. The variables analyzed included annual frequency of events, age, sex, marital status, and education level. Descriptive analysis, association measures, and verification of temporal trends were performed. The average age-standardized suicide mortality rate for both populations was approximately 9.0 per 100,000 inhabitants, with a predominance among males (80%), single individuals (65%), and youth (37%). When only the state of Paraná was considered, the mortality rate during the period was 12.41 among the Indigenous population versus 6.94 per 100,000 inhabitants in the non-Indigenous population. In this state, the probability of suicide death was found to be almost twice as high among Indigenous men and women, with 13 times greater odds of death among Indigenous children and youth. A statistically significant temporal increase in the number of cases was observed only in the non-Indigenous population. An annual seasonal pattern of events among Indigenous individuals was suggested. The findings indicate a high suicide rate among the Indigenous population, particularly in Paraná, especially among young, single individuals, with a growing trend over the years. Full article

(This article belongs to the Special Issue Associations between Mental Health and Intrapersonal, Interpersonal and Cultural Factors)

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11 pages, 286 KiB

Open AccessArticle

Impact of Maternal Nutritional Status and Mental Health on Children with Obesity: Relationship Between Anthropometric Parameters, Food Addiction, and Stress

by Joicy Karla Grangeiro Pereira, Rúbia Cartaxo Squizato de Moraes, Thallyta Alanna Ferreira Viana das Neves, Davyson Barbosa Duarte, Cristiane Cosmo Silva-Luis, Paulo César Trindade da Costa, Carla Lúcio Alves, Melyssa Kellyane Cavalcanti Galdino, Carla Alexandra da Silva Moita Minervino, Nassib Bezerra Bueno, José Luiz de Brito Alves and Vinicius José Baccin Martins

Int. J. Environ. Res. Public Health 2025, 22(9), 1312; https://doi.org/10.3390/ijerph22091312 - 22 Aug 2025

Abstract

Childhood obesity is a complex and multifactorial disease influenced by various factors including behavioral, physical, and psychological conditions. This cross-sectional study aimed to evaluate the impact of maternal and child stress and food addiction on the nutritional status of children with obesity. Children [...] Read more.

Childhood obesity is a complex and multifactorial disease influenced by various factors including behavioral, physical, and psychological conditions. This cross-sectional study aimed to evaluate the impact of maternal and child stress and food addiction on the nutritional status of children with obesity. Children aged 6 to 12 years were divided into Control Group (n = 42) and Obesity Group (n = 68) according to BMI-Z score. Mothers were allocated to their children’s respective groups. Anthropometric measures, body composition, stress levels, and food addiction were evaluated in both children and mothers. Children with obesity exhibited a significantly higher prevalence of food addiction compared to controls (22.1% vs. 2.6%, p = 0.006), while mothers in the control group showed higher stress levels (68.6% vs. 46.3%, p = 0.039). Positive correlations were observed between mother–child pairs for weight (r = 0.433, p < 0.01) and waist circumference (r = 0.461, p < 0.01). In children, food addiction was a significant predictor of BMI-Z scores (adjusted R square = 0.186); however, maternal BMI and stress were more important predictors (adjusted R square = 0.468). These findings highlight the influence of maternal physical and psychological health on childhood BMI-Z scores. Effective interventions should target both mother and child to improve overall health outcomes. Full article

(This article belongs to the Section Health Care Sciences)

11 pages, 260 KiB

Open AccessArticle

Participatory Development of Digital Innovations for Health Promotion Among Older Adults: Qualitative Insights on Individual, Contextual, and Technical Factors

by Katja A. Rießenberger, Karina Povse and Florian Fischer

Int. J. Environ. Res. Public Health 2025, 22(8), 1311; https://doi.org/10.3390/ijerph22081311 - 21 Aug 2025

Abstract

Location-based games offer innovative approaches for health promotion among older adults, but their effectiveness depends on understanding complex contextual factors beyond technological design. In our study, we aimed to adapt a location-based game in the form of a smartphone application which originally targeted [...] Read more.

Location-based games offer innovative approaches for health promotion among older adults, but their effectiveness depends on understanding complex contextual factors beyond technological design. In our study, we aimed to adapt a location-based game in the form of a smartphone application which originally targeted younger people. We employed ethnographic observations in a field test under real-world conditions for identifying the needs and preferences of older adults in this regard. Field notes of one co-creative workshop were analyzed using thematic analysis. Four key contextual factor categories emerged that significantly influenced user engagement: (1) temporal/spatial factors including weather conditions, topography, and traffic safety that impacted screen visibility and cognitive function; (2) virtual-physical orientation challenges requiring high cognitive load to transfer abstract digital maps to real environments; (3) individual factors such as technical competence, mobility levels, and prior accessibility experiences that shaped usage patterns; and (4) social dynamics that provided motivation and peer support while potentially creating exclusionary practices. Successful digital health innovations for older adults require a socio-technical systems approach that addresses environmental conditions, reduces cognitive transfer demands between virtual and physical navigation, leverages social elements while preventing exclusion, and accounts for heterogeneity among older adults as contextually interactive factors rather than merely individual differences. Full article

(This article belongs to the Special Issue Digital Innovations for Health Promotion)

18 pages, 1022 KiB

Open AccessArticle

The Influence of Therapist Adherence on Multisystemic Therapy Treatment Outcome for Adolescents with Antisocial Behaviours: A Retrospective Study in Western Australian Families

by Leartluk Nuntavisit and Mark Robert Porter

Int. J. Environ. Res. Public Health 2025, 22(8), 1310; https://doi.org/10.3390/ijerph22081310 - 21 Aug 2025

Abstract

Multisystemic Therapy (MST) is an intensive family and community-based treatment targeting antisocial behaviours in adolescents. Treatment fidelity has proved crucial for successful implementation of the MST intervention, with prior research demonstrating a strong association with positive and enduring treatment outcomes. The Therapist Adherence [...] Read more.

Multisystemic Therapy (MST) is an intensive family and community-based treatment targeting antisocial behaviours in adolescents. Treatment fidelity has proved crucial for successful implementation of the MST intervention, with prior research demonstrating a strong association with positive and enduring treatment outcomes. The Therapist Adherence Measure (TAM) is a standardised measure reported by caregivers and comprised of 28 items based on the nine treatment principles of MST. Several randomised control trials have confirmed that therapist adherence to the MST model is a valid predictor for a reduction of antisocial behaviours in adolescents. However, there is limited understanding of mechanisms by which therapist model adherence is related to positive changes in family relations and association with decreased adolescent behavioural problems. In this retrospective study, we evaluated effects of therapist adherence on changes in parental factors (e.g., parental mental well-being, monitoring and discipline approach) which in turn were associated with decreased behavioural problems in adolescents. We extracted data collected from 186 families engaged with the MST research program operating within the Western Australian Child and Adolescent Mental Health Service (CAMHS) during 2018–2024. Data for TAMs were collected monthly during treatment, and family outcome measures were collected at pre-treatment and post-treatment. The finding highlights the importance of therapists maintaining treatment fidelity and addressing treatment barriers throughout MST intervention to ensure the desired therapeutic outcomes. Full article

(This article belongs to the Special Issue Promoting Mental Health and Wellbeing in Children and Young People at Risk)

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16 pages, 327 KiB

Open AccessReview

Health Promotion and Support Grounded in Interconnected Influences on Alcohol Use in Pregnancy

by Nancy Poole, Lindsay Wolfson and Ella Huber

Int. J. Environ. Res. Public Health 2025, 22(8), 1309; https://doi.org/10.3390/ijerph22081309 - 21 Aug 2025

Abstract

There are a range of factors that influence alcohol use in pregnancy and create risk of fetal harm. However, limited research has articulated the multilevel nature of these influences and their entanglement. The purpose of this narrative review is to analyze the types [...] Read more.

There are a range of factors that influence alcohol use in pregnancy and create risk of fetal harm. However, limited research has articulated the multilevel nature of these influences and their entanglement. The purpose of this narrative review is to analyze the types of factors that influence alcohol use and consider what factors need to be addressed in future health promotion and intervention efforts. Six databases were searched using EBSCOhost articles published between January and December 2023 on alcohol use in pregnancy and Fetal Alcohol Spectrum Disorder (FASD) prevention. English-language articles were screened for relevance and a subset of articles exploring the prevalence, influences, and risk-factors associated with pregnancy were included for analysis. Thirty-two (n = 32) articles were included in the review and categorized into five key areas of influence on maternal alcohol use: (1) informational factors; (2) stress-related factors; (3) social determinant of health-related (SDoH) influences; (4) preconception- and prenatal-health-related factors; and (5) structural factors. Future efforts to reduce alcohol use in pregnancy should address these five categories of factors through non-judgmental, health-promoting, trauma-informed, harm-reduction-oriented, and culturally safe education, programming, and policy. Full article

(This article belongs to the Special Issue Health Promotion and Interventions for Marginalized Mothers and Children)

27 pages, 1210 KiB

Open AccessSystematic Review

Neurodevelopmental Outcomes Associated with Early-Life Exposure to Heavy Metals: A Systematic Review

by André Soares da Silva, Renata Maria Silva Santos, Patricia Gazire De Marco, Victhor Hugo Martins Rezende, Tamires Coelho Martins, Joyce Romano Silva, Marco Aurélio Romano-Silva and Débora Marques de Miranda

Int. J. Environ. Res. Public Health 2025, 22(8), 1308; https://doi.org/10.3390/ijerph22081308 - 21 Aug 2025

Abstract

Introduction: Globally, approximately 53 million children under the age of five live with some form of developmental disability. Exposure to heavy metals has been identified in the literature as a contributing factor in the etiology of neurodevelopmental disorders, however it usually is understudied. [...] Read more.

Introduction: Globally, approximately 53 million children under the age of five live with some form of developmental disability. Exposure to heavy metals has been identified in the literature as a contributing factor in the etiology of neurodevelopmental disorders, however it usually is understudied. Even at low concentrations, these toxicants pose a risk to neurodevelopment, when affecting children early as in the prenatal period. This study aims to systematically review the literature on the associations between exposure to toxic heavy metals and neurodevelopmental outcomes in children. Method: The review was registered at the International Prospective Register of Systematic Review-PROSPERO, under number CRD420250653229 and searches were conducted in the PubMed, Scopus, Web of Science, EMBASE, Lilacs and PsycInfo databases. Results: A total of 68 articles were included, comprising 48 longitudinal studies and 20 cross-sectional studies, published between 2006 and 2025, with a combined sample of 215,195 individuals from 23 countries. Lead was the most consistently investigated metal, appearing in 75% of the studies, followed by mercury, cadmium, and arsenic. Most findings referred to prenatal exposure. Cognitive and motor outcomes were predominantly affected by exposure to Pb and Hg, while behavioral outcomes showed negative associations mainly with Pb and As. Conclusions: The majority of the studies analyzed indicated adverse effects resulting from exposure to heavy metals during pregnancy, especially in the early months, highlighting the vulnerability of the developing brain. Full article

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16 pages, 285 KiB

Open AccessArticle

The Impacts of Parental Migration on the Mental and Physical Health, Daily Needs, and Social Lives of Indonesian Caregivers of Left-Behind Children: A Qualitative Study

by Nelsensius Klau Fauk, Alfonsa Liquory Seran and Paul Russell Ward

Int. J. Environ. Res. Public Health 2025, 22(8), 1307; https://doi.org/10.3390/ijerph22081307 - 20 Aug 2025

Abstract

Despite its positive impact on household income, parental labour migration negatively affects left-behind children (LBC) and their caregivers. Studies in various settings have reported different impacts on LBC, but less is known about the consequences faced by their caregivers. This qualitative study used [...] Read more.

Despite its positive impact on household income, parental labour migration negatively affects left-behind children (LBC) and their caregivers. Studies in various settings have reported different impacts on LBC, but less is known about the consequences faced by their caregivers. This qualitative study used in-depth interviews to collect data from caregivers of LBC whose parents migrated for employment. Participants were recruited using the snowball sampling technique, starting with the distribution of study information sheets through village offices in Belu and Malacca districts, Indonesia. Data analysis was guided by a qualitative data analysis framework, which involved several steps, including familiarisation with the data or transcripts, identification of a thematic framework, indexing the data, charting the data, and mapping and interpreting the entire data. The findings showed that despite some benefits, including monthly remittances and positive feelings of living with and receiving support from LBC experienced by some caregivers, parental labour migration negatively impacted most caregivers due to their caregiving roles and responsibilities. These challenges included (i) mental and physical health issues, (ii) impacts on daily food and healthcare needs, and (iii) difficulties in their social lives and overall well-being. The findings underscore the need for comprehensive support systems and interventions to address these challenges and improve caregiver well-being. Such support systems should include access to mental and physical health services, financial assistance, employment opportunities, and social support networks. Future large-scale studies are recommended to explore the various impacts of parental migration and caregiving roles and responsibilities on caregivers of LBC, as the findings can better inform the development of policies and interventions to support them. Full article

(This article belongs to the Special Issue Family Caregiving, Nursing and Health Promotion)

17 pages, 4801 KiB

Open AccessArticle

The Development of the CAIRDE General Awareness Training

by Jack Sweeney, Noel Richardson, Paula Carroll, P. J. White, Emilie Roche and Shane O’Donnell

Int. J. Environ. Res. Public Health 2025, 22(8), 1306; https://doi.org/10.3390/ijerph22081306 - 20 Aug 2025

Abstract

Suicide is a leading cause of death among construction workers, particularly younger and lower-skilled employees. Barriers such as stigma, low mental health literacy, and traditional masculine norms hinder help-seeking in this male-dominated sector. Few mental health interventions are tailored to this context. This [...] Read more.

Suicide is a leading cause of death among construction workers, particularly younger and lower-skilled employees. Barriers such as stigma, low mental health literacy, and traditional masculine norms hinder help-seeking in this male-dominated sector. Few mental health interventions are tailored to this context. This study developed a co-designed, theory-informed training to improve mental health literacy, reduce stigma, and increase help-seeking among construction workers in Ireland. Using the Medical Research Council’s framework, the training was developed with the Theory of Planned Behavior (TPB), Behavior Change Techniques, and extensive stakeholder co-design. Two systematic reviews, a broad literature review, and focus groups with industry managers informed the content and structure. The training will be pilot-tested using validated measures: the Literacy of Suicide Scale (LOSS), the Stigma of Suicide Scale (SOSS), and the General Help-Seeking Questionnaire (GHSQ), the results of which will be the subject of a separate study. CAIRDE is a promising, evidence-based training that addresses key mental health barriers in Irish construction. Embedding the TPB within a co-design methodology has resulted in the development of a training program that is underpinned by theoretical fidelity and cultural relevance and provides a framework for other male-dominated industries to draw upon. Future work should address remaining challenges related to stigma and help-seeking, and explore broader implementation through integration into mandatory safety training. Full article

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

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25 pages, 1928 KiB

Open AccessReview

Governance in Crisis: A Mixed-Methods Analysis of Global Health Governance During COVID-19

by Kadria Ali Abdel-Motaal and Sungsoo Chun

Int. J. Environ. Res. Public Health 2025, 22(8), 1305; https://doi.org/10.3390/ijerph22081305 - 20 Aug 2025

Abstract

Background: The COVID-19 pandemic exposed major structural deficiencies in global health governance, including stark inequities in vaccine access, intervention timing, and mortality outcomes. While economic resources played a role, the influence of governance performance remains insufficiently examined. This study addresses a significant gap [...] Read more.

Background: The COVID-19 pandemic exposed major structural deficiencies in global health governance, including stark inequities in vaccine access, intervention timing, and mortality outcomes. While economic resources played a role, the influence of governance performance remains insufficiently examined. This study addresses a significant gap by integrating governance metrics with pandemic response data to assess how governance quality, independent of income level, affected national outcomes. Although the Oxford COVID-19 Government Response Tracker (OxCGRT) dataset has been widely used to document policy responses, this study offers a novel contribution by linking these policy interventions with governance performance and evaluating their joint effect on health outcomes and vaccine equity. Methods: This mixed-methods study combines quantitative analysis of global datasets with a qualitative literature review. Quantitative data were mainly obtained from the Oxford COVID-19 Government Response Tracker (OxCGRT), the World Bank’s Worldwide Governance Indicators (WGIs), and World Bank/WHO databases. A governance performance index was constructed using two WGI components: Government Effectiveness and Regulatory Quality. Countries were grouped into high, medium, or low governance categories. Statistical tests included ANOVA, Kaplan Meier survival analysis, and multivariable OLS regression. The qualitative component reviewed 45 academic and institutional sources on governance performance during COVID-19. Results: Countries with high governance performance had earlier public health interventions, lower mortality, and broader vaccine coverage, independent of income level. Kaplan Meier analysis revealed faster school closures in these countries (p < 0.01). Multivariable regression showed governance remained a significant predictor after adjusting for income and health spending. Qualitative findings highlighted recurring weaknesses in legal enforceability, intergovernmental coordination, and global financing mechanisms. Conclusions: Governance performance had a decisive impact on pandemic outcomes. The COVID-19 crisis revealed the need for robust governance systems capable of responding to complex emergencies that extend beyond the health sector into institutional, economic, and social spheres. Full article

(This article belongs to the Special Issue Advancing Health Equity: Challenges and Opportunities)

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18 pages, 293 KiB

Open AccessArticle

Cultural Adaptation of the Mothers and Babies Online Course for Black Mothers with Preterm Infants: A Delphi Study

by Kobi V. Ajayi, Robin Page, Kelly Wilson, Carly McCord and Whitney Garney

Int. J. Environ. Res. Public Health 2025, 22(8), 1304; https://doi.org/10.3390/ijerph22081304 - 20 Aug 2025

Abstract

With persistent racial inequities, cultural adaptations of health programs can promote equitable maternal mental health. Despite the intersecting identities of Black mothers with preterm birth combined with racial discrimination, previous mental health programs in the neonatal intensive care unit (NICU) are void of [...] Read more.

With persistent racial inequities, cultural adaptations of health programs can promote equitable maternal mental health. Despite the intersecting identities of Black mothers with preterm birth combined with racial discrimination, previous mental health programs in the neonatal intensive care unit (NICU) are void of the sociocultural context that perpetuates racially motivated care. This study uses a two-round Delphi process to gather knowledge on the cultural appropriateness and content validity of the adapted Mothers and Babies Online Course, a United States Prevention Service Task Force-recommended intervention for managing mental health symptoms in pregnant and new mothers for Black mothers with preterm birth. The Black feminist theory and cultural adaptation strategies were used to conceptualize the adaptation process. Opinions were solicited from Black mothers and professionals based on predetermined criteria. Eleven participants, comprising eight mothers and three professionals, participated in Round One. Of these, only one professional did not participate in Round Two, totaling 10 participants who participated in Round Two. The participants rated the adapted program—eMB 4 Blackmamas, positively, and four themes emerged, substantiating the importance of culturally responsive mental health. The themes also offered additional feedback related to improving the program delivery. Including diverse stakeholders in mental health research offers unique and balanced insights into designing culturally appropriate programs to promote and protect Black maternal mental health in the NICU. Full article

16 pages, 293 KiB

Open AccessArticle

Using a Community-Based Participatory Research Approach to Study the Mental Health of Older Adults with a Refugee Life Experience

by Rochelle L. Frounfelker, Puja Thapa and Tej Mishra

Int. J. Environ. Res. Public Health 2025, 22(8), 1303; https://doi.org/10.3390/ijerph22081303 - 20 Aug 2025

Abstract

Older adults with a refugee life experience have a disproportionate burden of mental health problems compared to non-refugee aging populations. Community-based participatory research (CBPR) is a promising approach to identify the challenges and strengths of older refugee adults and identify solutions to mental [...] Read more.

Older adults with a refugee life experience have a disproportionate burden of mental health problems compared to non-refugee aging populations. Community-based participatory research (CBPR) is a promising approach to identify the challenges and strengths of older refugee adults and identify solutions to mental health disparities. We present a case study of one such CBPR program of research with older ethnic Nepali Bhutanese adults resettled in North America, Project Bhalakushari. We highlight the many opportunities to integrate older adults and members of the broader Bhutanese community in activities throughout the research process, starting with forming academic–community partnerships, identifying the needs and strengths of the community, conducting research, and sharing study findings with a broad audience of community members, health practitioners, policy-makers, and academics. Our case study emphasizes that a successful, culturally informed partnership should consider the involvement of the entire community, regardless of age, in the initiative to secure buy-in and support and maximize the positive impact of the work. We identify concrete strategies to overcome challenges specific to conducting research, with a focus on recruitment, outreach, and data collection. Full article

(This article belongs to the Special Issue Global Migrants and Refugees: Recent Trends, Health Inequities and Aging)

20 pages, 380 KiB

Open AccessArticle

Predictors of COVID-19 Pandemic-Related Pregnancy Stress: Prenatal and Postpartum Experiences in Canada

by Sigourney Shaw-Churchill and Karen P. Phillips

Int. J. Environ. Res. Public Health 2025, 22(8), 1302; https://doi.org/10.3390/ijerph22081302 - 20 Aug 2025

Abstract

The COVID-19 pandemic and related public health and hospital restrictions directly influenced Canadian perinatal healthcare. This study aimed to evaluate predictors of pandemic-related pregnancy and postpartum stress in Canada. A sample of 398 women with Canadian pandemic pregnancy experiences completed an online cross-sectional [...] Read more.

The COVID-19 pandemic and related public health and hospital restrictions directly influenced Canadian perinatal healthcare. This study aimed to evaluate predictors of pandemic-related pregnancy and postpartum stress in Canada. A sample of 398 women with Canadian pandemic pregnancy experiences completed an online cross-sectional survey between September 2021 and February 2022. Demographic factors, perinatal healthcare characteristics, and psychometric measures including Oslo Social Support Scale (OSSS-3) and Brief COPE were analyzed by independent hierarchical generalized linear models (GLM) to identify predictive variables associated with prenatal and postpartum pandemic-related pregnancy stress scales (PREPS). Respondents reported low social support, low–moderate Problem-Focused and Emotion-Focused Coping scores, with low Avoidant Coping. Middle income and canceled prenatal care appointments were associated with prenatal PREPS-Preparedness Stress, with provider satisfaction negatively associated. Avoidant Coping was positively associated with both prenatal and postpartum Preparedness Stress and Infection Stress scores, whereas Problem-Focused Coping was associated with both prenatal and postpartum Positive Appraisal. High COVID-19 rates and region of healthcare were associated with prenatal and postpartum Infection Stress. Our findings that perinatal healthcare characteristics and psychometric measures, rather than demographic characteristics, were greater predictors of pandemic-related stress reflect the broad societal disruptions that shaped Canadian pregnancy experiences in our sample of mostly high income, well-educated, non-racialized women. Full article

11 pages, 246 KiB

Open AccessArticle

Assessing Public Health Capacity for Infectious Disease Modeling: A Qualitative Study of State and Local Agencies

by Skyler J. Crouch, Katie S. Allen, Delaney Thornton, Joel Hartsell, Elizabeth H. Weybright, Julia E. Szymczak and Kimberley I. Shoaf

Int. J. Environ. Res. Public Health 2025, 22(8), 1301; https://doi.org/10.3390/ijerph22081301 - 20 Aug 2025

Abstract

Infectious disease modeling and forecasting tools are crucial for outbreak management. However, variability exists in the capacity of state and local health departments to effectively utilize these tools, influenced by factors such as infrastructure, funding, staff capacity, and data access. This study aims [...] Read more.

Infectious disease modeling and forecasting tools are crucial for outbreak management. However, variability exists in the capacity of state and local health departments to effectively utilize these tools, influenced by factors such as infrastructure, funding, staff capacity, and data access. This study aims to identify the current priorities, needs, and capacities of state and local public health departments regarding infectious disease modeling and forecasting tools. Key informant interviews were conducted with epidemiologists, informaticists, and leadership across state and local health departments from Montana, Utah, and Washington. Thematic coding and axial coding were used for thematic analysis. Three themes emerged: (1) models and tools must be adaptable based on the jurisdiction type (rural, urban, state); (2) building trust in models and tools is an important precursor to adoption; and (3) there are concerns about the availability and quality of data. This study highlights the need for adaptable modeling tools that are tailored to specific public health jurisdictions. Building trust in modeling and forecasting tools and addressing data quality issues are essential for successful tool implementation and adoption across diverse public health settings. Full article

10 pages, 241 KiB

Open AccessProtocol

Pre-Exposure Prophylaxis Uptake, Implementation and Barriers in Africa: A Scoping Review Protocol

by Silingene Joyce Ngcobo and Tracy Zhandire

Int. J. Environ. Res. Public Health 2025, 22(8), 1300; https://doi.org/10.3390/ijerph22081300 - 20 Aug 2025

Abstract

Background: Despite significant advancements in HIV prevention, Africa continues to bear a disproportionately high burden of new infections. Pre-exposure prophylaxis (PrEP) has demonstrated over 90% efficacy in preventing HIV acquisition when taken consistently; however, its implementation and uptake across African countries remain suboptimal. [...] Read more.

Background: Despite significant advancements in HIV prevention, Africa continues to bear a disproportionately high burden of new infections. Pre-exposure prophylaxis (PrEP) has demonstrated over 90% efficacy in preventing HIV acquisition when taken consistently; however, its implementation and uptake across African countries remain suboptimal. Objective: This scoping review aims to systematically map existing literature on PrEP uptake and implementation in Africa, identify key barriers and facilitators influencing access and adherence, examine targeted population groups, and explore policy and programmatic approaches to PrEP delivery across diverse African contexts. Methods: The review will follow the methodological framework proposed by Arksey and O’Malley, refined by Levac et al., and will include comprehensive searches of electronic databases, grey literature, and official reports. Data will be thematically synthesized to identify research trends, gaps, and contextual variations. Expected Outcomes: The findings will provide a comprehensive overview of the current landscape of PrEP implementation in Africa, highlighting research trends, contextual variations across countries, and gaps in service delivery and policy frameworks. This will inform future implementation strategies, guide evidence-based approaches to enhance PrEP uptake, and support policymaking to scale up effective interventions across diverse African settings, ultimately contributing to HIV prevention efforts on the continent. Full article

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

28 pages, 2422 KiB

Open AccessReview

Chemical Hazards in Products of Animal Origin in Cambodia from 2000 to 2023: A Systematic Review and Meta-Analysis

by Shwe Phue San, Linda Nicolaides, Delia Grace, Tumnoon Charaslertrangsi, Chhoun Chamnan, Shetty Seetharama Thombathu, Ra Thorng, Leab Kong, Sreymom Noeurn, Kuok Fidero, Che Ratana, Nazanin Zand and Rortana Chea

Int. J. Environ. Res. Public Health 2025, 22(8), 1299; https://doi.org/10.3390/ijerph22081299 - 19 Aug 2025

Abstract

Chemical hazards in food present a significant health risk. The objective of our review is to understand health risks associated with chemical contaminants in products of animal origin (POAO) in Cambodia, where there is no known published study. We followed the “Preferred Reporting [...] Read more.

Chemical hazards in food present a significant health risk. The objective of our review is to understand health risks associated with chemical contaminants in products of animal origin (POAO) in Cambodia, where there is no known published study. We followed the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines. A total of 23 reports were included for review. The findings are presented according to the PRISMA guidelines. The studies mostly focused on fishery products, with arsenic and mercury being the most frequently studied hazards. The evidence of banned substances such as chloramphenicol and certain organochlorine pesticides (OCPs), including chlordane and Mirex, was reported in fish and meat. Additionally, mercury levels were measured in beef, pork, viscera, and eggs, but the average concentration remained significantly below the hazard index. The average concentration of polycyclic aromatic hydrocarbons (PAH) in smoked fish exceeded the EU limits, ranging from 0.034 to 17.2 mg/kg, with an average mean concentration of 1.92 mg/kg. The pooled geometric means of arsenic and mercury in fish were 0.40 mg/kg (95% CI: 0.25–0.66) and ~0.14 mg/kg (95% CI: 0.087 to 0.223), respectively. The health risk of mercury contamination in fishery products needs the attention of the risk managers. However, industrial contaminants such as polybrominated diphenyl ethers (PBDEs) and butyl tin in marine fishes were lower than those reported elsewhere, such as Japan. We discuss the implications of the findings for human health and national food control systems (NFCS), the capacity of different agencies to undertake chemical risk assessment, the utility of systematic literature reviews (SLRs) for risk assessment and communication in low- and middle-income countries (LMICs), and the need for further research. Full article

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32 pages, 2403 KiB

Open AccessArticle

Beyond Storytime: Oklahoma Public Libraries’ Comprehensive Approach to the Resilience of Refugee Children and Their Families Support

by Salma Akter and Suchismita Bhattacharjee

Int. J. Environ. Res. Public Health 2025, 22(8), 1298; https://doi.org/10.3390/ijerph22081298 - 19 Aug 2025

Abstract

Public libraries serve as vital community hubs that foster engagement, empowerment, and education, particularly for vulnerable populations, including refugee children and families. This study examines how Oklahoma’s public libraries contribute to refugee resilience and identifies challenges they face in providing these essential services. [...] Read more.

Public libraries serve as vital community hubs that foster engagement, empowerment, and education, particularly for vulnerable populations, including refugee children and families. This study examines how Oklahoma’s public libraries contribute to refugee resilience and identifies challenges they face in providing these essential services. Using a qualitative method approach, including 20 semi-structured interviews with library staff, questionnaire surveys, and observations conducted across three Oklahoma library systems (Metropolitan, Pioneer, and Tulsa City-County) the study explored programs, services, and strategies that support refugee adaptation and integration. Findings reveal that libraries excel in three key areas: cognitive services (language literacy, digital access, educational resources), socio-cultural services (community building, cultural exchange), and physiological services (safe spaces, welcoming environments). These services contribute to building human, social, and economic capital, with human capital consistently ranked as most crucial for refugee resilience. However, libraries face significant challenges, with language barriers, program gaps, and outreach limitations being the most prevalent obstacles. Additional barriers include facility constraints, transportation difficulties, resource limitations, and privacy concerns. The study proposes nine comprehensive guidelines for creating sustainable pathways to refugee resilience through enhanced library services, emphasizing proactive community engagement, staff training, multilingual resources, advocacy, strategic partnerships, tailored programming, transportation solutions, cultural competence, and welcoming environments. This study contributes to understanding how public libraries can function as inclusive institutions that support refugee children’s successful integration and development in their new communities. Full article

(This article belongs to the Special Issue Refugee Health and Well-Being: Psychological, Behavioral and Biochemical Insights)

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19 pages, 4882 KiB

Open AccessArticle

“Slowly but Steadily, You’re Running Out of Steam”: Aging Parents’ Caregiving Experiences Through Photovoice

by Martin Nagl-Cupal, Marlene Werner, Daniela Haselmayer and Thomas Falkenstein

Int. J. Environ. Res. Public Health 2025, 22(8), 1297; https://doi.org/10.3390/ijerph22081297 - 19 Aug 2025

Abstract

Aging parents caring for adult children with disabilities or other care needs face significant challenges and health-related issues over extended periods. The aim of this study was to explore the experiences of aging parents with caregiving responsibilities. This qualitative participatory study followed the [...] Read more.

Aging parents caring for adult children with disabilities or other care needs face significant challenges and health-related issues over extended periods. The aim of this study was to explore the experiences of aging parents with caregiving responsibilities. This qualitative participatory study followed the research process of a photovoice study. Thirteen parents, aged 51 to 76 years, of adult children with care needs, aged 20 to 49 years, participated in this study. The parents captured photographs depicting their daily lives which were contextualized and coded during group discussions. The data were analyzed using thematic analysis and reviewed collaboratively with the participants. Six key themes emerged in the data analysis. 1. mastering complexity, 2. being an expert and advocate, 3. balancing autonomy and care, 4. care as a lifelong journey, 5. standing on the margins of society, and 6. worrying about the future. This study underscores the urgent need for comprehensive and coordinated support systems that ensure the well-being of aging caregivers while addressing the evolving needs of their adult children. Full article

(This article belongs to the Special Issue Family Caregiving of Older Adults)

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International Journal of Environmental Research and Public Health

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