International Journal of Environmental Research and Public Health

20 pages, 693 KB

Open AccessArticle

Social–Emotional Competence Growth Profiles in Upper Elementary School Years and Pathways to Mental Health Outcomes in Middle School

by Juyeon Lee and Chenxiao Wang

Int. J. Environ. Res. Public Health 2025, 22(11), 1744; https://doi.org/10.3390/ijerph22111744 - 18 Nov 2025

Abstract

Social–emotional competence (SEC) is an essential factor for healthy youth development. However, few studies have examined patterns of SEC growth trajectories among non-Western youth, and whether and how their SEC growth patterns during elementary school years predict later mental health. Using five-year panel [...] Read more.

Social–emotional competence (SEC) is an essential factor for healthy youth development. However, few studies have examined patterns of SEC growth trajectories among non-Western youth, and whether and how their SEC growth patterns during elementary school years predict later mental health. Using five-year panel data on a nationally representative sample of South Korean youth (N = 2607; 49.6% girl, M_age = 10, SD_age = 0.1 at baseline), we first identified three latent profiles of SEC growth trajectories throughout upper elementary years (Grades 4 to 6), distinguished by initial and continued mean-level differences in both self-management and group collaboration. Informed by self-determination theory, we found that these SEC growth profiles significantly predicted depression and life satisfaction in middle school (Grade 8), mediated by peer relatedness and academic competence during the middle school transition (Grade 7). This study discusses implications for future research and practice to promote young adolescents’ social–emotional development and mental health. Full article

(This article belongs to the Special Issue Mental Health and Health Promotion in Young People)

13 pages, 487 KB

Open AccessArticle

Digital Health Innovation by Design: A Logic Model Scaffold for Rural, Regional, and Remote Settings

by Michelle A. Krahe, Nico Adams and Sarah L. Larkins

Int. J. Environ. Res. Public Health 2025, 22(11), 1743; https://doi.org/10.3390/ijerph22111743 - 18 Nov 2025

Abstract

Digital health innovations (DHIs) have the potential to transform access, continuity, and quality of healthcare in rural, regional, and remote (RRR) settings, yet they often fall short in practice. Barriers extend beyond infrastructure and technology to include workforce challenges and the complex realities [...] Read more.

Digital health innovations (DHIs) have the potential to transform access, continuity, and quality of healthcare in rural, regional, and remote (RRR) settings, yet they often fall short in practice. Barriers extend beyond infrastructure and technology to include workforce challenges and the complex realities of delivering care across diverse geographic, cultural, and social contexts. Effective DHIs must therefore be designed with local needs and systemic constraints in mind. Conventional logic models can align inputs and activities with intended outcomes, but their linear and static assumptions often fail to capture the adaptive, relational, and place-based nature of RRR health systems. This paper presents a logic model scaffold—an iterative, four-step process for planning, implementing, and evaluating DHIs in RRR settings. Informed by program theory and implementation science, the scaffold is illustrated through a case example from the Northern Australian Regional Digital Health Collaborative. The process involves understanding context and needs, aligning interventions with system enablers, translating these into targeted activities and outputs, and embedding reflexivity and iterative adaptation. Applying the scaffold from the earliest stages of planning enhances methodological rigor, transparency, and responsiveness to local priorities, workforce realities, and system-level enablers in RRR healthcare. Full article

(This article belongs to the Special Issue Public Health: Rural Health Services Research—2nd Edition)

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11 pages, 962 KB

Open AccessSystematic Review

Educational Technologies to Support Rational Antimicrobial Prescribing in Primary Healthcare: A Systematic Review

by Maria Karolayne de Araújo Pereira, Denise de Andrade, Ana Larissa Gomes Machado, Açucena Leal de Araújo, Priscila Rodrigues Moura de Carvalho, Maria Zélia de Araújo Madeira, Odinéa Maria Amorim Batista and Andréia Rodrigues Moura da Costa Valle

Int. J. Environ. Res. Public Health 2025, 22(11), 1742; https://doi.org/10.3390/ijerph22111742 - 18 Nov 2025

Abstract

Background: Antimicrobial resistance is a global public health challenge that compromises patient safety and has gained particular relevance in primary healthcare, where the prescription of antimicrobials is frequent and often based on empirical knowledge. In this context, educational technologies emerge as strategies to [...] Read more.

Background: Antimicrobial resistance is a global public health challenge that compromises patient safety and has gained particular relevance in primary healthcare, where the prescription of antimicrobials is frequent and often based on empirical knowledge. In this context, educational technologies emerge as strategies to strengthen professional training and promote rational antimicrobial use. Methods: A systematic review of randomized controlled trials was conducted, registered in PROSPERO (CRD42024504630) and guided by the PICOS framework. The search was carried out in 14 national and international databases, including PubMed/MEDLINE, Embase, Cochrane Library, SCOPUS, and LILACS, with no restrictions on language or publication year. Results: A total of 763 studies were identified, of which seven met the inclusion criteria and were included in the qualitative synthesis. The educational technologies reported comprised booklets, interactive seminars, workshops, training programs, online courses, and multifaceted interventions. Inter-rater agreement was substantial (κ = 0.823), although 85.7% of the studies presented a high risk of bias, mainly related to deviations from intended interventions. Conclusions: Educational technologies show potential to support appropriate antimicrobial prescribing and represent valuable tools in preventing antimicrobial resistance, although current evidence remains limited by methodological weaknesses. Full article

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23 pages, 350 KB

Open AccessArticle

Unpacking the Oral Healthcare Landscape in India: A Qualitative Inquiry into Strengths, Shortfalls, and Future Directions Through the Lens of Public Health Dentists

by Parul Dasson Bajaj, Ramya Shenoy, Latha Davda, Kundabala Mala, Gagan Bajaj, Ashwini Rao, Navya Karkera, Srinivas Pachava, Mithun Pai, Praveen Jodalli and Avinash Badekkila Ramachandra

Int. J. Environ. Res. Public Health 2025, 22(11), 1741; https://doi.org/10.3390/ijerph22111741 - 18 Nov 2025

Abstract

The World Health Organization’s Bangkok Declaration, ‘No health without oral health,’ recognizes oral health as a global public health priority. Despite being largely preventable, oral diseases affect nearly half of the global population, and India mirrors this crisis while facing persistent systemic challenges. [...] Read more.

The World Health Organization’s Bangkok Declaration, ‘No health without oral health,’ recognizes oral health as a global public health priority. Despite being largely preventable, oral diseases affect nearly half of the global population, and India mirrors this crisis while facing persistent systemic challenges. This qualitative study explores India’s oral healthcare landscape from the perspective of public health dentists to inform context-sensitive reforms. Thirty-one in-depth interviews were conducted with public health dentists from dental colleges registered with the Dental Council of India, recruited across six regions. Interviews were conducted online via MS Teams using a piloted interview guide and video-recorded with consent. Subsequently, the interviews were transcribed verbatim, anonymized, and qualitative data was analyzed using Atlas.ti, following reflexive thematic analysis. Analysis yielded four main themes: facets of oral health inequalities, dental public health initiatives, strategies to mobilize and optimize dental workforce in rural areas, and recommendations to optimize oral healthcare. This study offers contextually grounded yet globally relevant perspectives on oral health reform. By bridging local insights with international priorities, this study proposes a sustainable, equity-driven framework for transforming oral health systems while laying the foundation for future research and policy action aimed at achieving universal oral health coverage. Full article

(This article belongs to the Section Health Care Sciences)

28 pages, 627 KB

Open AccessArticle

“I Somehow Survived… but I Will Never Do It Again”: Teachers’ Perspectives on Past and Future Educational Disruptions in Slovenia

by Urška Štremfel and Manja Veldin

Int. J. Environ. Res. Public Health 2025, 22(11), 1740; https://doi.org/10.3390/ijerph22111740 - 18 Nov 2025

Abstract

Five years after the COVID-19 pandemic, namely, the biggest disruption to education in the last century, this article provides insights into the consequences it holds for teachers’ well-being, their (non)preparedness for and support needed in any such future disruptions in Slovenia. By utilising [...] Read more.

Five years after the COVID-19 pandemic, namely, the biggest disruption to education in the last century, this article provides insights into the consequences it holds for teachers’ well-being, their (non)preparedness for and support needed in any such future disruptions in Slovenia. By utilising the Job Demands–Resources Model, insights are provided concerning job demands (stress) and job resources (support) on different levels (individual, micro, meso, macro, chrono) of Bronfenbrenner’s ecological systems theory. The importance of complementing large-scale, representative, quantitative data (from the Responses to Educational Disruption Survey (REDS)) with qualitative data obtained from two focus groups comprising eight teachers in total is demonstrated to gain a comprehensive understanding of teachers’ well-being during educational disruptions. This study confirms that the intertwining of different levels in Bronfenbrenner’s socio-ecological system explains job demands (sources of stress) and job resources (support for teacher well-being) during the COVID-19 pandemic. The majority of stressors at the time of the pandemic were identified on the micro level, whereas sources of support were primarily located on the individual and meso (school) levels. For any future educational disruptions, however, the most significant sources of support for teachers’ well-being are expected on the macro level (system and society). Full article

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

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19 pages, 301 KB

Open AccessArticle

Identifying Mental Health Issues in Indian Immigrants in Canada: A Comparison with Non-Indian Immigrants

by Sahej Kaur and Mark Rosenberg

Int. J. Environ. Res. Public Health 2025, 22(11), 1739; https://doi.org/10.3390/ijerph22111739 - 18 Nov 2025

Abstract

Much of the literature on the mental health of immigrants tends to generalize, treating all immigrants as one category, and not accounting for how life experiences in the country of origin can shape mental health. Therefore, the purpose of this study is to [...] Read more.

Much of the literature on the mental health of immigrants tends to generalize, treating all immigrants as one category, and not accounting for how life experiences in the country of origin can shape mental health. Therefore, the purpose of this study is to contrast the differences in self-rated mental health between Indian immigrants and non-Indian immigrants based on immigration-related factors, sociodemographic factors and health and healthcare utilization-related factors. Cross-sectional data from two cycles of the Canadian Community Health Survey were analyzed. Logistic regression models were analyzed to assess self-reported mental health and those reporting a mood or anxiety disorder. Results provide support for the healthy immigrant effect and find that immigrating in later life is advantageous for mental health for Indian immigrants. Having a lower income, a smaller household, and living in a rural area are associated with good mental health among Indian immigrants, but not among all immigrants. Being male does not have the same protective effect against mental health concerns in Indian immigrants as it does in all immigrants. Results demonstrate the need to study immigrant groups by their country of origin and how life experiences in a particular country shape immigrant mental health differently from country to country. Full article

16 pages, 1374 KB

Open AccessArticle

Association Between Alcohol Use Disorder and Glaucoma: Evidence from the National Institutes of Health All of Us Research Program

by Fatima Elghazali, Alexandria N. Hughes, Gwenyth R. Wallen, Eitan Burstein and Jennifer J. Barb

Int. J. Environ. Res. Public Health 2025, 22(11), 1738; https://doi.org/10.3390/ijerph22111738 - 18 Nov 2025

Abstract

Alcohol use disorder (AUD), defined by compulsive alcohol consumption despite harmful consequences, affected an estimated 28.1 million U.S. adults in 2023. Beyond well-known systemic effects, growing evidence suggests that alcohol may negatively influence eye health potentially contributing to the development of glaucoma, a [...] Read more.

Alcohol use disorder (AUD), defined by compulsive alcohol consumption despite harmful consequences, affected an estimated 28.1 million U.S. adults in 2023. Beyond well-known systemic effects, growing evidence suggests that alcohol may negatively influence eye health potentially contributing to the development of glaucoma, a leading cause of irreversible blindness worldwide. This retrospective cohort study evaluated the association between AUD and glaucoma in a large, diverse population using data from the National Institutes of Health (NIH) All of Us Research Program. Multivariable logistic regression, adjusting for sociodemographic confounders, was applied to assess glaucoma diagnoses among participants with and without AUD. Adults (n = 122,706) with a mean age of 56.7 years (SD = 16.8) and 66% female were assessed. Individuals with AUD had significantly higher odds of a glaucoma diagnosis compared with those without AUD (odds ratio: 1.45; 95% confidence interval: 1.35–1.57; p < 0.001). These findings suggest that AUD may be an underrecognized risk factor for glaucoma and that preventative care for eye health may be warranted in this population. Additional screening in higher-risk individuals may improve long-term quality of life and reduce the broader public health burden of glaucoma. Full article

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17 pages, 1087 KB

Open AccessArticle

Integrated Strategies for Early Diagnosis and Prevention of Oral Diseases in Asia Pacific

by Liang Lin Seow, Michael Antonio F. Mendoza, Fatimah Maria Tadjoedin, Sheng-Wei Feng, Pong Pongprueksa, Linh Van Truong, Leo Gerald R. de Castro, Yun Yee Amber Lee, Vandana Garg, Melissa Adiatman and Loc Giang Do

Int. J. Environ. Res. Public Health 2025, 22(11), 1737; https://doi.org/10.3390/ijerph22111737 - 17 Nov 2025

Abstract

Oral diseases pose a significant global public health challenge, affecting 3.5 billion people and surpassing the prevalence of major noncommunicable diseases. There is a growing burden of oral diseases, including dental caries, periodontal diseases, and dentine hypersensitivity (DH) from several countries in Southeast [...] Read more.

Oral diseases pose a significant global public health challenge, affecting 3.5 billion people and surpassing the prevalence of major noncommunicable diseases. There is a growing burden of oral diseases, including dental caries, periodontal diseases, and dentine hypersensitivity (DH) from several countries in Southeast Asia including Malaysia, the Philippines, Vietnam, Thailand, Indonesia, and Taiwan. The impact of oral diseases on quality of life and their association with systemic health emphasize the need for preventive strategies and early interventions. The objectives of the Oral Health Steering Committee were to gain insights and a comprehensive picture of the oral disease burden in the Southeast Asian region including Malaysia, the Philippines, Vietnam, Thailand, Indonesia, and Taiwan, to highlight the importance of early prevention of oral health diseases, as well as the importance of identifying early symptoms of oral discomfort associated with oral diseases and to examine the correlation between oral diseases and systemic health. The committee included nine experts from the region with significant expertise in dental health. A steering committee of nine dental experts from seven Southeast Asian countries reviewed evidence on the burden of oral diseases, the prevention of oral discomfort in early diagnosis and its impact on systemic health. The association between oral health and systemic health was discussed by the group. The committee highlighted that there is a need for comprehensive public health strategies, including population-level preventive measures, professional evaluations, and awareness programs to improve oral health outcomes and reduce treatment costs. The role in interprofessional collaboration between dental professionals and medical professionals in achieving early identification of oral diseases and increases referrals to dental professionals at early stages of diseases was highlighted. These insights stress the importance of early diagnosis, prevention and targeted interventions to mitigate the impact of oral health issues and improve overall public health outcomes in the region. Full article

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

20 pages, 753 KB

Open AccessArticle

Transition from 24-Hour Shifts to Safer Work Schedules for Nurses in Latvian Healthcare: Policy Analysis and Recommendations

by Olga Cerela-Boltunova and Kristine Klavina

Int. J. Environ. Res. Public Health 2025, 22(11), 1736; https://doi.org/10.3390/ijerph22111736 - 17 Nov 2025

Abstract

In Latvia, extended shifts, including 24 h duties, remain common inpatient care settings despite extensive international evidence on their adverse effects on staff well-being and patient safety. We conducted an evidence-informed policy analysis combining a structured review of national legislation and institutional reports [...] Read more.

In Latvia, extended shifts, including 24 h duties, remain common inpatient care settings despite extensive international evidence on their adverse effects on staff well-being and patient safety. We conducted an evidence-informed policy analysis combining a structured review of national legislation and institutional reports with comparative policy mapping across OECD/EU countries. The interpretation was guided by three theoretical frameworks: the Job Demands–Resources model, Effort–Recovery theory, and the Work–Life Interface framework. Latvian practice shows high reliance on long shifts amid workforce shortages and incomplete overtime/rest accounting. In contrast, most OECD and EU countries have implemented 8–12 h multi-shift systems with mandated rest, which are associated with lower error rates, reduced burnout, and higher staff satisfaction. We synthesised four policy options (12 h transition model; 16 h cap; modular 2 × 6 h/3 × 8 h; flexible unit-profiled schedules) and identify seven prerequisites for feasible implementation (regulatory alignment; staffing; financing; management training; digital scheduling; pilot projects; monitoring). A phased transition from 24 h shifts to structured schedules appears both feasible and desirable, with pilot implementation and monitoring aligning with WHO/ILO recommendations. Implications for policy and practice: Reform is a system-level intervention to improve staff well-being, patient safety, and workforce sustainability in Latvia. Full article

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11 pages, 242 KB

Open AccessReview

A Comparative Policy Analysis of Health Inequities in Access to Healthcare Across Low- and High-Income Contexts: The Cases of Pakistan and Canada

by Fatima Durrani, Maidah, Faryal Shaikh and Mohammed Alkhaldi

Int. J. Environ. Res. Public Health 2025, 22(11), 1735; https://doi.org/10.3390/ijerph22111735 - 17 Nov 2025

Abstract

Globally, poverty remains a major obstacle to health parity, compromising well-being. This policy analysis aims to examine how poverty affects health inequities and healthcare access in two contexts: Canada, a high-income nation, and Pakistan, a low-income nation. This study employs a grounded approach, [...] Read more.

Globally, poverty remains a major obstacle to health parity, compromising well-being. This policy analysis aims to examine how poverty affects health inequities and healthcare access in two contexts: Canada, a high-income nation, and Pakistan, a low-income nation. This study employs a grounded approach, integrating a thorough review of the existing critical literature using systematic thematic analysis and synthesis. In Pakistan, chronic underinvestment, rural–urban gaps, inadequate infrastructure, and political instability exacerbate inequities in access to healthcare. Limited coverage, ineffective administrative processes, and gaps in rural healthcare delivery impede growth despite encouraging programs like the Sehat Card and the Ehsaas Program. Conversely, universal healthcare in Canada has lowered financial obstacles to access, but low-income and Indigenous communities are still impacted by service gaps, particularly in dental care, pharmacare, and mental health. Although child poverty rates have been significantly reduced by programs like the Canada Child Benefit, Indigenous children continue to endure disproportionate health risks. Findings underscore a need for equity-driven changes: Pakistan must expand rural health infrastructure and legislate health equity, while Canada should extend coverage to essential but excluded services. Findings underscore the intersecting nature of inequities driven by poverty, gender, geography, and systemic exclusion that highlight opportunities for cross-context policy learning. Canada’s equity monitoring frameworks could strengthen Pakistan’s health data systems, while Pakistan’s community-based Lady Health Worker program offers scalable grassroots models relevant for marginalized Canadian regions. Both countries must prioritize poverty alleviation as a health intervention, integrating justice, sustainability, and accountability to advance global health equity. Full article

13 pages, 294 KB

Open AccessPerspective

Understanding the Risks and Benefits of Implementing AI-Enabled Remote Patient Monitoring Systems for Disease Management

by Junaid Nabi, Richard Staynings, Javaid Iqbal Sofi and Henry H. Willis

Int. J. Environ. Res. Public Health 2025, 22(11), 1734; https://doi.org/10.3390/ijerph22111734 - 17 Nov 2025

Abstract

Effectively managing risk is essential for fostering innovation in healthcare, especially with advancements like artificial intelligence (AI) and machine learning (ML). These technologies aim to enhance accessibility, efficiency, and equity in healthcare delivery. To assess the practical utility of AI-enabled remote patient monitoring [...] Read more.

Effectively managing risk is essential for fostering innovation in healthcare, especially with advancements like artificial intelligence (AI) and machine learning (ML). These technologies aim to enhance accessibility, efficiency, and equity in healthcare delivery. To assess the practical utility of AI-enabled remote patient monitoring (RPM) devices, it is crucial to identify and evaluate associated risks while distinguishing between acceptable risk, which society tolerates, and optimal risk, which balances risk reduction costs with benefits. This paper outlines how policymakers should adopt the framework of optimal risk to ensure patient safety while maximizing the advantages of these technologies. Full article

(This article belongs to the Topic Artificial Intelligence in Public Health: Current Trends and Future Possibilities, 2nd Edition)

14 pages, 275 KB

Open AccessArticle

Hospitalized Adults’ Willingness to Use Mobile Apps for Air Quality and Heat Monitoring: A Survey-Based Study

by Elizabeth Cerceo, Lydia Abbott, Roger Sheffmaker, Mariam Ansar, Jean-Sebastien Rachoin and Katherine T. Liu

Int. J. Environ. Res. Public Health 2025, 22(11), 1733; https://doi.org/10.3390/ijerph22111733 - 16 Nov 2025

Abstract

Climate change and environmental degradation pose growing threats to health. Despite increasing recognition of these risks, climate-related education and counseling are rarely incorporated into adult inpatient care. A survey-based study was conducted with 250 adult inpatients on the medicine services at Cooper University [...] Read more.

Climate change and environmental degradation pose growing threats to health. Despite increasing recognition of these risks, climate-related education and counseling are rarely incorporated into adult inpatient care. A survey-based study was conducted with 250 adult inpatients on the medicine services at Cooper University Health Care (New Jersey) and Maine Medical Center (Maine). Patients received a standardized 30-s educational statement from their physician on the health impacts of air pollution and extreme heat, with introduction to two smartphone applications on air quality and heat conditions. Survey items evaluated patients’ prior awareness of environmental health risks, willingness to use digital monitoring tools, and perceived barriers to use. Descriptive statistics and content analysis were used for data interpretation. Overall, 84% of participants reported awareness of environmental threats to health, indicating high baseline recognition. However, only 50% expressed willingness to adopt smartphone apps as protective tools with barriers including lack of smartphone access, unfamiliarity with technology, and concerns about utility during hospitalization. Twenty-three percent of participants in Maine did not own a smartphone, as compared with 7% in NJ. Despite less smartphone ownership in Maine compared to NJ, participants showed similar willingness to use the suggested apps for monitoring environmental conditions (53% vs. 49.3%). Responses suggested that while patients generally acknowledge climate-related health risks, enthusiasm for technological solutions varies considerably, especially among older and underserved populations. This study highlights a critical gap between awareness of climate health risks and the adoption of digital health tools for self-protection. While brief inpatient education may increase recognition, technology-based interventions alone may not reach all patient groups. Future strategies should focus on accessible, low-barrier methods of environmental health education in clinical care, including integration into inpatient counseling and discharge planning. Addressing technology access gaps and tailoring resources to diverse populations will be essential for advancing climate-related patient education in healthcare settings. Full article

(This article belongs to the Special Issue Advancing Climate Health Literacy for Public Health Promotion and Resilience)

22 pages, 1117 KB

Open AccessReview

Lessons Learned from Air Quality Assessments in Communities Living near Municipal Solid Waste Landfills

by Custodio Muianga, John Wilhelmi, Jennifer Przybyla, Melissa Smith and Gregory M. Zarus

Int. J. Environ. Res. Public Health 2025, 22(11), 1732; https://doi.org/10.3390/ijerph22111732 - 15 Nov 2025

Abstract

Over 292 million tons of municipal solid waste (MSW) are generated annually in the United States, with more than half disposed of in landfills. Municipal solid waste landfills (MSWLFs) are stationary sources of air pollution and potential health risks for nearby communities. The [...] Read more.

Over 292 million tons of municipal solid waste (MSW) are generated annually in the United States, with more than half disposed of in landfills. Municipal solid waste landfills (MSWLFs) are stationary sources of air pollution and potential health risks for nearby communities. The Agency for Toxic Substances and Disease Registry (ATSDR) has completed over 300 public health assessments (PHAs) and related investigations at MSWLFs and open dumps since the 1980s. This paper reviews the ATSDR’s evaluations of air pathway concerns at 125 MSWLF sites assessed between 1988 and early 2025, with many being evaluated during the 1990s. Most sites were located in the Midwest and Northeast, and only 25% remained active. The ATSDR found no air-related public health hazard at 86% of sites. At sites where hazards were identified, common issues included elevated outdoor or indoor toxicants (e.g., hydrogen sulfide, benzene, trichloroethylene, and mercury) and unsafe methane accumulations. Contributing factors included older site designs, inadequate gas-collection, subsurface fires, and distance from nearby residences. Corrective actions effectively reduced exposures at the affected sites. Results suggest that well-located and maintained landfills minimize public health hazards, while aging or poorly managed sites pose risks. Continued monitoring and research are warranted as waste management shifts toward reducing, reusing, recycling, composting, and energy-recovery technologies to improve efficiency, advance technologies, and address systemic public health challenges. Full article

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19 pages, 539 KB

Open AccessArticle

Long-Term Effects of the COVID-19 Pandemic: Emotional Regulation, Psychological Symptoms, and College Adjustment

by Barbara M. Gfellner and Ana I. Cordoba

Int. J. Environ. Res. Public Health 2025, 22(11), 1731; https://doi.org/10.3390/ijerph22111731 - 15 Nov 2025

Abstract

The COVID-19 pandemic was responsible for an unprecedented increase in psychological problems among post-secondary students worldwide. Drawing on data from a repeated cross-sectional (RCS) project, this study investigated changes in psychological symptoms, emotional regulation (cognitive reappraisal and emotional suppression), and academic, social, and [...] Read more.

The COVID-19 pandemic was responsible for an unprecedented increase in psychological problems among post-secondary students worldwide. Drawing on data from a repeated cross-sectional (RCS) project, this study investigated changes in psychological symptoms, emotional regulation (cognitive reappraisal and emotional suppression), and academic, social, and personal–emotional college adjustment, and associations between these variables among students in two countries during the phases of lockdown (2021), lifting of restrictions (2022), and the endemic phase (2023). University students in Canada (n = 1014) and Spain (n = 447) completed online surveys during these periods. Students in both countries reported significant declines in perceived COVID-19 stress across the pandemic phases. In comparison with pre-pandemic rates, elevated psychological symptoms remained constant. There were some country differences, but sex differences were consistent. Psychological symptoms mediated the association between cognitive reappraisal and the adjustment measures among Canadian students during each pandemic period. Alternatively, they mediated the linkages of maladaptive emotional suppression with academic, social, and personal–emotional functioning of Spanish students at every phase, but only during the lifting of restrictions and the endemic phase for Canadian students. The results indicate the complexity of country and context in the role of emotional regulation during uncontrollable conditions and provide directions for intervention in stressful situations, including adjustment to university and future disastrous environmental events. Full article

(This article belongs to the Special Issue Coping with Anxiety and Psychological Distress)

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19 pages, 884 KB

Open AccessArticle

Modern Contraceptive Use Among Young Women in Kampala Slums: Research Findings from the TOPOWA Study

by Monica H. Swahn, Josephine Namuyiga, Gideon Matovu, Charles Natuhamya, Jane Palmier, Anna Nabulya and Harriet Kebirungi

Int. J. Environ. Res. Public Health 2025, 22(11), 1730; https://doi.org/10.3390/ijerph22111730 - 15 Nov 2025

Abstract

Unintended pregnancies among adolescent and young women in low- and middle-income countries pose major public health challenges, underscoring the need for improved access to modern contraceptives. This study examined prevalence, preferences, and correlates of modern contraceptive use among young women living in urban [...] Read more.

Unintended pregnancies among adolescent and young women in low- and middle-income countries pose major public health challenges, underscoring the need for improved access to modern contraceptives. This study examined prevalence, preferences, and correlates of modern contraceptive use among young women living in urban slums of Kampala, Uganda, to inform targeted interventions. We analyzed baseline data from The Onward Project On Wellbeing and Adversity (TOPOWA), an NIH-funded, multi-component prospective cohort study on mental health among women aged 18–24 years. In 2023, 300 participants were recruited from three sites (Banda, Bwaise, Makindye). Interviewer-administered surveys assessed contraceptive choices, lifestyle, and demographic factors. Modified Poisson regression was used to examine correlates of contraceptive use. Among participants, 66.0% had ever used contraception, 40.0% were current users, and 38.0% reported modern contraceptive use. Multivariable analyses showed that having a consistent partner (PR = 3.28; 95% CI: 1.90–5.67), engaging in sex work (PR = 2.10; 95% CI: 1.46–3.02), older age (PR = 1.08; 95% CI: 1.01–1.16), and having children (PR = 1.72; 95% CI: 1.12–2.66) were associated with higher modern contraceptive use. Findings highlight important gaps in sustained contraceptive use and the need for tailored interventions addressing economic, social, and educational barriers to improve reproductive health in this low-resource setting. Full article

(This article belongs to the Special Issue Promoting Women's Sexual and Reproductive Health)

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14 pages, 623 KB

Open AccessReview

Artificial Light at Night, Sleep Disruption, and Liver Health: Implications for MASLD Pathogenesis

by Damaris Guadalupe Nieva-Ramírez, Misael Uribe and Natalia Nuño-Lámbarri

Int. J. Environ. Res. Public Health 2025, 22(11), 1729; https://doi.org/10.3390/ijerph22111729 - 15 Nov 2025

Abstract

This narrative review explores the role of artificial light at night (ALAN) as an emerging environmental determinant of liver and metabolic health, with particular emphasis on its contribution to metabolic dysfunction-associated steatotic liver disease (MASLD). The objective was to synthesize and critically evaluate [...] Read more.

This narrative review explores the role of artificial light at night (ALAN) as an emerging environmental determinant of liver and metabolic health, with particular emphasis on its contribution to metabolic dysfunction-associated steatotic liver disease (MASLD). The objective was to synthesize and critically evaluate experimental and epidemiological evidence linking nocturnal light exposure, circadian disruption, and hepatic metabolic alterations. Literature was retrieved from PubMed, Scopus, Web of Science, and Google Scholar databases covering the period 1980–2025 using predefined search terms related to ALAN, circadian rhythm disturbance, melatonin suppression, sleep disruption, and MASLD. Relevant experimental studies in animal models and observational studies in humans were included. Evidence indicates that blue-enriched light (~460–480 nm) suppresses melatonin, desynchronizes central and hepatic circadian clocks, and disrupts glucose–lipid metabolism, leading to insulin resistance, oxidative stress, and hepatic steatosis. Chronic ALAN exposure also alters gut microbiota composition and increases intestinal permeability, suggesting a light–gut–liver axis in MASLD pathogenesis. Human epidemiological studies associate higher environmental ALAN exposure with obesity, metabolic syndrome, and poor sleep quality—recognized risk factors for MASLD. Recognizing ALAN as a modifiable environmental exposure highlights the need for public health strategies and clinical guidelines to mitigate its metabolic impact through improved lighting design and sleep hygiene. Full article

(This article belongs to the Special Issue Exploring the Link—Better Sleep Equals Better Health)

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15 pages, 420 KB

Open AccessArticle

The Role of Fatigue in the Relationship Between Sleep and Concentration Among Online College Students

by Fethi Ahmet Inan, Deniz Unal, Fatemeh Marzban, Edwin Teye Sosi and Gail Alleyne Bayne

Int. J. Environ. Res. Public Health 2025, 22(11), 1728; https://doi.org/10.3390/ijerph22111728 - 15 Nov 2025

Abstract

Sleep deprivation is a common issue among college students, critically impairing their well-being and academic performance. This study specifically investigated the impact of sleep duration on concentration among online college students, a population with unique living situations and often irregular sleep patterns. Furthermore, [...] Read more.

Sleep deprivation is a common issue among college students, critically impairing their well-being and academic performance. This study specifically investigated the impact of sleep duration on concentration among online college students, a population with unique living situations and often irregular sleep patterns. Furthermore, it explored how this relationship is mediated by subjective physical and mental fatigue, providing a clearer understanding of the underlying process. An online survey assessed these variables using the Demographics and Background Questionnaire for sleep duration, the Student Mental Fatigue Survey (SMFS) for mental fatigue, and two subscales from the Checklist Individual Strength (CIS) for subjective physical fatigue and concentration. Path analysis revealed that both subjective physical and mental fatigue significantly and negatively predicted concentration, and that sleep duration positively influenced concentration indirectly by reducing both types of fatigue. The findings highlight the essential function of sleep in improving concentration. The results provide valuable guidance for developing targeted interventions to improve sleep quality and manage fatigue, which can directly promote mental and physical health, and academic success of this growing, often overlooked, online college student population. Full article

(This article belongs to the Special Issue Health Behaviors and Mental Health Among College Students)

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12 pages, 295 KB

Open AccessArticle

Environmental Stressors, Anemia, and Depressive Symptoms in Pregnancy: Unpacking the Combined Risks

by Ruth A. Pobee, Rebecca K. Campbell, Prathiba Balakumar, Yongchao Huang, Beatriz Peñalver Bernabé and Mary Dawn Koenig

Int. J. Environ. Res. Public Health 2025, 22(11), 1727; https://doi.org/10.3390/ijerph22111727 - 15 Nov 2025

Abstract

Chronic exposure to structural violence and environmental hazards may disrupt stress regulation, trigger inflammation, and impair iron metabolism in women. Iron deficiency has been associated with depression, but the combined impact of environmental stressors and anemia on maternal mental health remains understudied. We [...] Read more.

Chronic exposure to structural violence and environmental hazards may disrupt stress regulation, trigger inflammation, and impair iron metabolism in women. Iron deficiency has been associated with depression, but the combined impact of environmental stressors and anemia on maternal mental health remains understudied. We analyzed associations between 28 neighborhood-level environmental stressors, hemoglobin levels, and depressive symptoms (measured by the Patient Health Questionnaire-9) during early pregnancy, using retrospective data from 1964 pregnant patients (2015–2019) at an urban health center in Chicago. Demographic and residential data were linked to environmental indicators from the Chicago Health Atlas. Factor analysis reduced the environmental variables, and multivariable regression models examined associations with PHQ-9 scores at first pregnancy encounter. Participants were predominantly non-Hispanic Black (56%) and Hispanic (27%), with 13% anemic and 16% screening positive for depressive symptoms. Poverty, non-Hispanic Black race, single status, public or no insurance, and unemployment were associated with higher depressive symptoms. Among anemic individuals, neighborhood crime was significantly associated with depressive symptoms, while hemoglobin levels and gestational age were not. These findings highlight how environmental and social inequities contribute to maternal mental health disparities and support the need for integrated, equity-focused prenatal care interventions. Full article

15 pages, 279 KB

Open AccessArticle

Influence of Social Determinants on Physical Performance and Geriatric Syndromes in Community-Dwelling Older Adults

by Roberto Israel Vázquez-Garza, Armando Martin Moreno-Amador, Carlos de la Cruz-de la Cruz and Karina Alejandra Rodriguez-Quintanilla

Int. J. Environ. Res. Public Health 2025, 22(11), 1726; https://doi.org/10.3390/ijerph22111726 - 14 Nov 2025

Abstract

Background: Healthy aging involves ensuring a good quality of life and maintaining autonomy. Physical performance is a key indicator of health and autonomy in old age, and it is influenced by social determinants of health. The aim of this study was to evaluate [...] Read more.

Background: Healthy aging involves ensuring a good quality of life and maintaining autonomy. Physical performance is a key indicator of health and autonomy in old age, and it is influenced by social determinants of health. The aim of this study was to evaluate differences in physical performance and geriatric health outcomes among older adults attending a community center, according to their educational level, pension status, and access to health services. Methods: An observational, descriptive, retrospective and cross-sectional study was carried out using the database of subjects aged 60 and over who attend a community gerontological center. Results: A total of 536 older adults (mean age 70.7 ± 8.4 years, 71.5% women, 86.9% with public health coverage) with an average age of 70.7 ± 8.4 years were included; subjects with higher education had higher weight, as well as better indicators of physical functionality: higher scores in the Barthel and Lawton–Brody indices, greater walking speed, less time in the test to get up from the chair and in the test “Time Up and Go” (TUG), and increased prehensile strength. Conclusion: Social determinants, including education, economic independence, health coverage, and pension status, significantly influence physical performance and geriatric syndromes in older adults. Full article

(This article belongs to the Special Issue Addressing Healthcare Inequities for Older Adults: Challenges and Pathways to Equitable Healthcare Services)

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International Journal of Environmental Research and Public Health

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