International Journal of Environmental Research and Public Health

13 pages, 289 KB

Open AccessArticle

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

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

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

Abstract

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

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

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

18 pages, 1183 KB

Open AccessArticle

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

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

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

Abstract

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

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

28 pages, 843 KB

Open AccessArticle

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

by Ihsen Abid

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

Abstract

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

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

(This article belongs to the Section Environmental Health)

15 pages, 291 KB

Open AccessArticle

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

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

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

Abstract

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

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

14 pages, 397 KB

Open AccessArticle

The Mediating Role of Social Support on the Relationship Between Alexithymia and Internet Addiction Among Jordanian University Students: A Cross-Sectional Study

by Shaher H. Hamaideh, Abdallah Abu Khait, Sawsan Abuhammad, Hanan Al-Modallal, Ayman Hamdan-Mansour, Rami Masa’deh and Mohammed ALBashtawy

Int. J. Environ. Res. Public Health 2026, 23(6), 748; https://doi.org/10.3390/ijerph23060748 - 2 Jun 2026

Abstract

Background: Alexithymia and Internet addiction are emerging concerns among university students, and perceived social support may help explain how difficulties in identifying and expressing emotions relate to problematic Internet use. This study examined the mediating role of perceived social support in the relationship [...] Read more.

Background: Alexithymia and Internet addiction are emerging concerns among university students, and perceived social support may help explain how difficulties in identifying and expressing emotions relate to problematic Internet use. This study examined the mediating role of perceived social support in the relationship between alexithymia and Internet addiction among Jordanian university students. Methods: A descriptive cross-sectional online survey was conducted among 300 university students in Jordan during the 2022/2023 academic year using Google Forms distributed through Facebook and Microsoft Teams. Participants completed the Toronto Alexithymia Scale (TAS-20), Internet Addiction Test (IAT), Multidimensional Scale of Perceived Social Support (MSPSS), and demographic questions. Data were analyzed using descriptive statistics, Pearson correlations, multiple regression, and Hayes PROCESS macro Model 4 with 5000 bootstrap samples. Results: The overall mean scores for alexithymia, Internet addiction, and social support were 62.57, 46.05, and 55.13, respectively. Alexithymia was positively correlated with Internet addiction and negatively correlated with social support. Social support partially mediated the relationship between alexithymia and Internet addiction, indicating that higher alexithymia was associated with lower perceived social support, which in turn was associated with higher Internet addiction. Conclusions: The findings support the need for university-based screening and prevention programs that address emotional awareness, healthy Internet use, and social support. Theoretically, the results suggest that social support is a meaningful psychosocial pathway linking alexithymia with problematic Internet use among university students. Full article

(This article belongs to the Special Issue Psychological Distress in Adolescents: Its Prevalence and Relation to Addictive Behaviors)

31 pages, 934 KB

Open AccessArticle

Contextualizing Evaluation in Research Consortia: A Reflective Case Study from the Research Centers in Minority Institutions (RCMIs) Program

by Kelly A. Laurila, Suzanne M. Randolph Cunningham, Lakesha Stevenson, Melissa Tarasenko, Lauren M. Ramsey, Carlamarie Noboa-Ramos, Katherine Matos, Akash Dania and Angela Sy

Int. J. Environ. Res. Public Health 2026, 23(6), 747; https://doi.org/10.3390/ijerph23060747 - 2 Jun 2026

Abstract

In 2020, evaluators within the Research Centers in Minority Institutions (RCMIs) program proposed a conceptual framework identifying four primary evaluation targets: scientific productivity, scientific collaboration, professional growth, and research resources. This study extends prior work by capturing the contextual and process-oriented dimensions of [...] Read more.

In 2020, evaluators within the Research Centers in Minority Institutions (RCMIs) program proposed a conceptual framework identifying four primary evaluation targets: scientific productivity, scientific collaboration, professional growth, and research resources. This study extends prior work by capturing the contextual and process-oriented dimensions of program impact. This reflective practice-based project examines how non-quantitative approaches complement traditional metrics to better characterize RCMI outcomes. Evaluators representing ten RCMI sites participated in a multi-site case study guided by three questions addressing: (1) qualitative evidence of impact beyond metrics; (2) challenges and successes in implementation of non-quantitative methods; and (3) potential expansion of evaluation targets. Evaluators provided descriptive responses, generating a 22-page dataset that was analyzed thematically. Thirteen non-quantitative evaluation domains emerged: investigator consultations, investigator productivity, investigator success, community partnerships, intra-RCMI collaborations, implementation of team science, career progression, programmatic support, mentoring support, impact on RCMI affiliates, intellectual resources, physical resources, and faculty hires. Key challenges included inconsistent data capture and limited evaluation resources, while successes highlighted improved cross-site learning and visibility of program impact. Findings support retaining the original evaluation targets while expanding the framework to include institutional transformation, equitable research environments, and longitudinal societal impact. A conceptual map was developed to depict how mixed methods that include non-quantitative approaches can yield RCMI evaluations that expand upon the current approach, which relies primarily on quantitative data. The authors recommend quantitative targets and non-quantitative strategies to provide context, communicate evidence of success, and inform programmatic changes to deepen the findings and strengthen the rigor of RCMI evaluation practices. Full article

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

28 pages, 759 KB

Open AccessReview

Perinatal Health Promotion in Indigenous Maternal Health: A Scoping Review of Peer-Reviewed Evidence and Australian Community-Controlled Programs

by Cecilia Castiello, Kai W. Wheeler, Judith Ann Dean and Federica Barzi

Int. J. Environ. Res. Public Health 2026, 23(6), 746; https://doi.org/10.3390/ijerph23060746 - 2 Jun 2026

Abstract

Indigenous women experience a disproportionate burden of adverse perinatal health outcomes, yet the extent and nature of health promotion interventions addressing modifiable behavioural and social determinants remain poorly synthesised. This scoping review mapped smoking, nutrition, alcohol, physical exercise, and social and emotional wellbeing [...] Read more.

Indigenous women experience a disproportionate burden of adverse perinatal health outcomes, yet the extent and nature of health promotion interventions addressing modifiable behavioural and social determinants remain poorly synthesised. This scoping review mapped smoking, nutrition, alcohol, physical exercise, and social and emotional wellbeing (SNAPS(o))-related perinatal health promotion programs delivered through Australian Aboriginal Community Controlled Health Organisations (ACCHOs), supplemented by relevant peer-reviewed evidence identified across Australia, Aotearoa New Zealand, Canada, and the United States. A two-phase design looked at peer-reviewed literature from January 2010 to January 2025 across PubMed, CINAHL, and the Cochrane Library, followed by a structured review of Aboriginal Community Controlled Health Organisation (ACCHO) websites in Australia (n = 145). Data were extracted on program characteristics, SNAPS(o) components, implementation models, and evaluation outcomes. Findings were synthesised using content analysis. Thirty-four programs were identified in total, most delivered through ACCHOs (n = 26) and predominantly implemented in Australia (n = 29). Smoking was the most frequently addressed component (n = 18, 55%), while nutrition and social and emotional wellbeing were each included in 27% of programs (n = 9), physical exercise in 18% (n = 6), and alcohol in 15% (n = 5). Grey-literature programs more commonly reflected multi-component, holistic models compared with peer-reviewed studies and formal evaluations. Only 10 programs had identifiable formal evaluation evidence, including published or publicly reported evaluations, almost all of which were identified through academic sources. Evaluations focused primarily on tobacco-related behavioural outcomes, with limited reporting of sustained maternal or infant health endpoints. The perinatal SNAPS(o) intervention landscape for Indigenous women is characterised by strong community-controlled delivery but limited published evaluation, particularly of integrated models implemented within ACCHOs. The concentration of evidence on smoking cessation highlights a need to expand evaluation across broader domains of maternal wellbeing. Strengthening Indigenous-led evaluation frameworks and outcome measures that reflect holistic models of care is essential to advancing equitable and culturally grounded perinatal health systems. Full article

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19 pages, 663 KB

Open AccessReview

Birth Equity and Maternal Health Among Immigrant Communities in the United States: A Narrative Review

by Akanksha Anand, Ian Lindong and Sharon Barrett

Int. J. Environ. Res. Public Health 2026, 23(6), 745; https://doi.org/10.3390/ijerph23060745 - 2 Jun 2026

Abstract

Background: Immigrant communities and first-generation immigrants in the United States face persistent disparities in maternal health outcomes. These inequities are shaped by intersecting structural conditions, including socioeconomic exclusion, language barriers, cultural differences, and institutional constraints documented in prior research. Methods: This narrative review [...] Read more.

Background: Immigrant communities and first-generation immigrants in the United States face persistent disparities in maternal health outcomes. These inequities are shaped by intersecting structural conditions, including socioeconomic exclusion, language barriers, cultural differences, and institutional constraints documented in prior research. Methods: This narrative review examined 28 peer-reviewed studies published between 2010 and 2024 that applied an intersectional framework to maternal health research focused on immigrant communities in the United States. Studies were identified through PubMed, Scopus, Web of Science, and Google Scholar. The review analyzed how each study conceptualized, designed, and interpreted maternal health in these populations. Results: Seven recurring themes were identified: barriers to and access to care; gaps in clinical guidance; limitations in health data and surveillance; immigration-related policy context; health system influences; intersectional vulnerability across subgroups; and the role of individual- and community-level supports. Conclusions: The literature highlights the importance of community-based strategies, Medicaid policy considerations, and culturally responsive care in addressing maternal health disparities among immigrant communities. Advancing birth equity will require coordinated efforts across healthcare systems, public health programs, and policy environments. Full article

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21 pages, 553 KB

Open AccessArticle

Clinicopathological Profile of Prostate Cancer Patients at a Tertiary Hospital in the Eastern Cape, South Africa

by Monde Magadla, Mojisola Clara Hosu, Linda Sobekwa and Mirabel Kah-Keh Nanjoh

Int. J. Environ. Res. Public Health 2026, 23(6), 744; https://doi.org/10.3390/ijerph23060744 - 2 Jun 2026

Abstract

Background: Prostate cancer remains a major cause of cancer-related morbidity and mortality among men worldwide. Limited access to oncology services contributes to late presentation, delayed diagnosis, and treatment. This study describes the clinicopathological profile of prostate cancer and identifies factors associated with disease [...] Read more.

Background: Prostate cancer remains a major cause of cancer-related morbidity and mortality among men worldwide. Limited access to oncology services contributes to late presentation, delayed diagnosis, and treatment. This study describes the clinicopathological profile of prostate cancer and identifies factors associated with disease severity at presentation in an Eastern Cape population. Methods: A retrospective cross-sectional study was conducted among men diagnosed with prostate cancer at a tertiary hospital between 2014 and 2024. Demographic, clinical, and pathological data were extracted. Descriptive analyses were performed, and multivariable logistic regression was used to identify independent predictors of advanced disease. Results: The study included 202 patients with a mean age of 67.2 years. Thirty-four (16.8%) reported a family history of prostate cancer, and 62.4% had never undergone PSA screening before diagnosis. Elevated PSA levels were common (60.4%), and more than half of patients presented with advanced disease (54.5%). High-risk and very high-risk disease were identified in 44.1% and 21.3% of patients, respectively. Lack of prior PSA screening was independently associated with high-risk disease (aOR 2.4, 95% CI 1.1–5.0), advanced stage at presentation (aOR 2.4, 95% CI 1.2–4.8), and PSA > 20 ng/mL. Conclusions: There is a high burden of late-stage, high-risk prostate cancer at presentation. These findings highlight ongoing challenges in early detection and emphasize the need for improved awareness, screening, and referral pathways to improve outcomes. Full article

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

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18 pages, 532 KB

Open AccessArticle

Community Care Stakeholders’ Reflection on Using Telepresence Robots as a Tool to Reduce School Absence for Children and Young People with Chronic Illness in the Scandinavian Municipalities

by Sofie Skoubo, Hanne Bækgaard Larsen, Mette Weibel Willard and Charlotte Handberg

Int. J. Environ. Res. Public Health 2026, 23(6), 743; https://doi.org/10.3390/ijerph23060743 - 1 Jun 2026

Abstract

Chronic illness negatively affects education due to school absence. Telepresence robots can be a valuable educational tool for reducing school absence among students with chronic illnesses. This study aimed to investigate the reflections of Scandinavian community care stakeholders on telepresence robots as a [...] Read more.

Chronic illness negatively affects education due to school absence. Telepresence robots can be a valuable educational tool for reducing school absence among students with chronic illnesses. This study aimed to investigate the reflections of Scandinavian community care stakeholders on telepresence robots as a tool to reduce school absence for students with chronic illnesses in the education system. We conducted fifteen semi-structured interviews and four focus group interviews with 25 community care stakeholders. Our study used the interpretive description methodology and Edgar Schein’s organizational culture as the theoretical lens. The analysis identified three categorical themes and six subthemes: The action of integrating telepresence robots into the education system, the telepresence robots as a pathway to educational opportunities, and the adoption and management of telepresence robots. Our findings showed that stakeholders had to motivate and communicate the purpose of telepresence robots to reduce skepticism among multiple people in the school environment. Our study provides insights into the barriers and challenges to integrating and adopting telepresence robots in the Scandinavian education systems, as well as how stakeholders should communicate with and support the education system during their implementation. Full article

11 pages, 286 KB

Open AccessArticle

Maternal Knowledge, Attitudes, and Practices Towards the Prevention of Birth Defects in Eastern Cape, South Africa: A Multi-Level Contextual Analysis

by Thando Tetana, Muambangu Jean Paul Milambo and Longo-Mbenza Benjamin

Int. J. Environ. Res. Public Health 2026, 23(6), 742; https://doi.org/10.3390/ijerph23060742 - 1 Jun 2026

Abstract

Background: Birth defects remain a major global public health concern, particularly in low-resource settings where awareness and preventive practices are limited. Maternal knowledge, attitudes, and practices (KAP) are critical in the prevention and management of birth defects. This study explored contextual factors influencing [...] Read more.

Background: Birth defects remain a major global public health concern, particularly in low-resource settings where awareness and preventive practices are limited. Maternal knowledge, attitudes, and practices (KAP) are critical in the prevention and management of birth defects. This study explored contextual factors influencing maternal KAP using a mixed-methods approach in three rural districts of the Eastern Cape, South Africa. Methods: A convergent mixed-methods cross-sectional study was conducted among 72 mothers selected through purposive sampling. Quantitative data were collected using a structured questionnaire administered in English only, covering socio-demographic characteristics, obstetric history, knowledge, and preventive practices. Qualitative data were obtained through interviews exploring beliefs, perceptions, and cultural explanations of birth defects. Quantitative data were analysed using descriptive statistics and linear regression analysis to identify factors associated with birth defects, while qualitative data were thematically analysed to provide contextual understanding. Results: Most participants resided in the Amathole district (63.89%), followed by Alfred Nzo (18.06%) and Joe Gqabi (18.06%). Most women were aged between 20 and 35 years (52.78%), while 15.28% were younger than 20 years and 6.94% were older than 45 years. Over half of the respondents were single (55.56%), 34.72% were married, and the remainder were either separated (4.17%) or divorced (5.56%). Numerous participants had primary education (56; 77.78%), followed by secondary (11; 15.28%) and tertiary education (5; 6.94%). The majority were unemployed (56; 77.78%), while smaller proportions were employed (10; 13.89%) or engaged in other income-generating activities (6; 8.33%), indicating limited participation in formal employment among respondents. Nearly all participants (95.83%) had experienced pregnancy, with 70.83% reporting pregnancy-related complications. Only 2.78% reported having a child with a birth defect, while 90.28% reported a family history of birth defects. Knowledge of genetic causes was relatively high (69.23%), but awareness of modifiable risk factors was limited. Although 93.06% recognized alcohol use during pregnancy as harmful, fewer participants identified smoking or medication use (18.06%) and advanced maternal age (26.39%) as risk factors. Only 13.89% acknowledged the preventive role of antenatal care. Qualitative findings revealed strong cultural influence on perceptions of birth defects, with causes attributed to medical factors (38.89%), supernatural beliefs such as witchcraft or curses (18.06%), immoral behaviour (12.50%), and dietary taboos (11.11%). Traditional health-seeking behaviour was common, with 91.67% consulting traditional healers during pregnancy. Linear regression analysis identified significant predictors of birth defects, including family history (β = 1.36, p = 0.008), alcohol use during pregnancy (β = 1.13, p = 0.050), and inadequate antenatal care attendance (β = 0.99, p = 0.040). Advanced maternal age showed a weaker and non-significant association (β = 0.79, p = 0.080). Conclusions: The study highlights substantial gaps in maternal knowledge and the strong influence of cultural beliefs on birth defect prevention. Strengthening culturally sensitive health education, improving antenatal care services, and engaging traditional healers in community-based interventions are essential to improve maternal health outcomes in rural South Africa. Full article

15 pages, 863 KB

Open AccessArticle

Development and Internal Validation of a Predictive Model of Perceived Stress Among Military Students: A LASSO Regression Analysis

by Tamadhir Al-Mahrouqi, Mohammed Al Alawi, Alya Al Harrasi, Mohammed Al Zadjali, Atheer Al Jahwari, Siham Al Shamli and Amira Al Housni

Int. J. Environ. Res. Public Health 2026, 23(6), 741; https://doi.org/10.3390/ijerph23060741 - 1 Jun 2026

Abstract

This study aimed to develop and internally validate a predictive model of perceived stress among first-year military male students to examine the predictive contribution of personality traits, depressive symptoms, and psychological well-being. Understanding these psychological predictors may support interventions for students at elevated [...] Read more.

This study aimed to develop and internally validate a predictive model of perceived stress among first-year military male students to examine the predictive contribution of personality traits, depressive symptoms, and psychological well-being. Understanding these psychological predictors may support interventions for students at elevated risk of stress during military and academic transition. A cross-sectional web-based survey included 274 first-year male students at the Military Technological College in Oman. Outcome measures included the Perceived Stress Scale (PSS-10), the Patient Health Questionnaire (PHQ-9) for depressive symptoms, the WHO-5 Well-being Index, and the Big Five Inventory assessing personality traits. All variables were analyzed as continuous measures. Predictive modeling was performed using Least Absolute Shrinkage and Selection Operator (LASSO) linear regression with repeated 70/30 train–test splitting across 100 iterations and 10-fold cross-validation for internal validation. The final analytic sample included 266 participants after exclusion of incomplete responses. Across the 100 internal validation runs, the LASSO model accounted for approximately 40% of the variance in perceived stress (training R² = 0.44 ± 0.04; test R² = 0.40 ± 0.08). Neuroticism (β = 0.35) and depressive symptoms (β = 0.15) showed positive associations with perceived stress, whereas psychological well-being showed a negative association (β = −0.32). PHQ-9, WHO-5, and neuroticism were selected in 100% of the repeated LASSO models, which showed the most stable predictive contribution. Model performance on the test datasets showed stable predictive accuracy (MSE = 20.24 ± 2.48; RMSE = 4.49 ± 0.28; MAE = 3.61 ± 0.23). These findings demonstrate that personality traits, depressive symptoms, and psychological well-being collectively contribute to the statistical modeling of perceived stress among military students. The internally validated associative model may support institutional interventions for students vulnerable to elevated stress, informing targeted preventive mental health strategies within military training environments. Full article

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15 pages, 305 KB

Open AccessCommentary

“To Care for One Another on the Lands That Sustain Us”: Reflective Commentaries for Land-Based Healing Among Indigenous Cancer Survivors

by Hugh Burnam, Reesa R. Abrams, Marissa L. Bennett, Nancy Washburn, McKenzie Paterson, William O. Carson, Chelsea G. Redeye, Whitney Ann Henry, Josie Raphaelito and Rodney C. Haring

Int. J. Environ. Res. Public Health 2026, 23(6), 740; https://doi.org/10.3390/ijerph23060740 - 1 Jun 2026

Abstract

Significant gaps exist in survivorship services across the cancer care continuum for Indigenous Peoples in the United States. Despite overcoming overwhelming cancer burden and high mortality risk, Indigenous cancer survivors report lower quality of life compared to non-Indigenous cancer survivors. Using an Indigenous [...] Read more.

Significant gaps exist in survivorship services across the cancer care continuum for Indigenous Peoples in the United States. Despite overcoming overwhelming cancer burden and high mortality risk, Indigenous cancer survivors report lower quality of life compared to non-Indigenous cancer survivors. Using an Indigenous social determinants of health framework, this article shares reflective commentaries from four Indigenous (Haudenosaunee) cancer care professionals who provide insights into the need for traditional Indigenous land-based healing practices among Indigenous cancer survivors, their families, and caregivers. Results suggest that (1) traditional Indigenous healing practices, (2) Indigenous patient navigation services, (3) communities of care, and (4) Indigenous lands and social determinants of health are important factors to support the health and wellbeing of Indigenous cancer survivors. Land-based healing for Indigenous cancer survivors requires further research for future implementation. Full article

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

16 pages, 409 KB

Open AccessArticle

Eating Together, Eating Alone: A Cross-Sectional Survey of Associations Between Social Eating Contexts, Mealtime Emotions, Technology Use, and Loneliness in UK University Students

by Laura Chandler, Yanyan Li, Diya Agarwal, Jan Antkiewicz, Judah Chike-Michael, Domenico Giacco, Sagar Jilka, Daniel Mensah, Ian Saunders, Carla Toro and Helena Tuomainen

Int. J. Environ. Res. Public Health 2026, 23(6), 739; https://doi.org/10.3390/ijerph23060739 - 1 Jun 2026

Abstract

Background: Loneliness is prevalent amongst university students and may be influenced by social eating behaviours. This study explored associations between loneliness and social eating habits and practices and examined whether loneliness varies by demographic characteristics and mealtime behaviours. Methods: A cross-sectional [...] Read more.

Background: Loneliness is prevalent amongst university students and may be influenced by social eating behaviours. This study explored associations between loneliness and social eating habits and practices and examined whether loneliness varies by demographic characteristics and mealtime behaviours. Methods: A cross-sectional online survey was conducted amongst 255 undergraduate and postgraduate students at a UK campus-based university. Loneliness was measured using the UCLA Loneliness Scale (ULS-8). Self-reported social eating habits, emotional experiences during mealtimes, and technology use while eating were assessed. Results: The mean loneliness score was 18.27 (SD = 4.90), with 16.1% of participants experiencing severe loneliness. Loneliness did not differ across most demographic groups, except by year of study, with first-year undergraduates reporting higher loneliness than PhD students. Higher loneliness was reported by students who felt embarrassed or lonely when eating alone, were apprehensive about eating with others, or lacked someone to eat with. Greater use of electronic devices or television during meals was also associated with higher loneliness. Conclusions: Loneliness is common amongst university students and is associated with social eating habits/practices and emotional experiences during mealtimes. Interventions promoting social eating could address discomfort and anxiety related to eating alone or with others. Full article

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27 pages, 1250 KB

Open AccessArticle

Coping as a Pathway Linking Religiosity and Spirituality to Mental Health and Early Cardio-Cerebrovascular Risk Among University Students in Malaysia

by Zaw Myo Hein, Anastasiya Spaska, Abdullah Duraid Nasif Jasim, Hafizah Abdul Hamid, Usman Jaffer and Che Mohd Nasril Che Mohd Nassir

Int. J. Environ. Res. Public Health 2026, 23(6), 738; https://doi.org/10.3390/ijerph23060738 - 31 May 2026

Abstract

Background: Mental health disorders such as depression, anxiety, and stress are increasingly prevalent among university students and contribute to long-term cardio-cerebrovascular disease (CCVD) risk. However, limited research has examined the interplay between mental health, CCVD risk factors, and religiosity/spirituality within Southeast Asia’s multicultural [...] Read more.

Background: Mental health disorders such as depression, anxiety, and stress are increasingly prevalent among university students and contribute to long-term cardio-cerebrovascular disease (CCVD) risk. However, limited research has examined the interplay between mental health, CCVD risk factors, and religiosity/spirituality within Southeast Asia’s multicultural context. Methods: This cross-sectional study investigated these relationships among 484 undergraduate students enrolled in medical and health sciences programs across Peninsular Malaysia. Mental health status was assessed using the Depression, Anxiety, and Stress Scale (DASS-21). Self-reported clinical indicators associated with early CCVD vulnerability were also assessed. Religiosity and spirituality were measured using the Duke University Religion Index (DUREL), Brief Religious Coping (RCOPE), Spirituality Scale (SS), and Spiritual Coping Questionnaire (SCQ). Results: High prevalence rates of severe anxiety (50.4%), depression (29.3%), and stress (21.1%) were observed, with significant associations across ethnicity, religion, and academic programs. Higher religiosity and spirituality were generally associated with better mental health outcomes. However, coping style emerged as a key modifier of the relationship between religiosity/spirituality and mental health outcomes, with negative religious coping associated with greater psychological distress, whereas positive coping demonstrated mixed associations and partial mediating effects. Students with poorer mental health also exhibited higher CCVD risk burden. Conclusions: These findings highlight the importance of culturally and spiritually sensitive strategies in promoting student well-being. Full article

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

15 pages, 266 KB

Open AccessArticle

Healthcare Workers’ Perceptions of the Effectiveness of Personal Protective Equipment in Reducing the Risk of COVID-19 Infection from 2020 to 2022

by Ndabereye Aubin Ndizeye and Makhutsisa Charlotte Mokoatle

Int. J. Environ. Res. Public Health 2026, 23(6), 737; https://doi.org/10.3390/ijerph23060737 - 31 May 2026

Abstract

Background/Objectives: Healthcare workers (HCWs) face occupational hazards that increase their risk of Coronavirus Disease of 2019 (COVID-19). This study aims to evaluate HCWs’ perceptions of the effectiveness of Personal Protective Equipment (PPE) in preventing COVID-19 infection and to identify risk factors associated with [...] Read more.

Background/Objectives: Healthcare workers (HCWs) face occupational hazards that increase their risk of Coronavirus Disease of 2019 (COVID-19). This study aims to evaluate HCWs’ perceptions of the effectiveness of Personal Protective Equipment (PPE) in preventing COVID-19 infection and to identify risk factors associated with HCW infection. Methods: A cross-sectional study design was used, with a structured, self-administered, closed-ended questionnaire to collect retrospective data for the period 2020 to 2022 at a tertiary hospital in Johannesburg, South Africa. Results: PPE was effective in reducing COVID-19 infection, according to 230 (57.07%) participants, while 173 (42.93%) disagreed. A significant association (p = 0.034) with a small effect size (Cramer’s V = 0.161) was found between the number of HCWs infected with COVID-19 and their perceptions of PPE’s effectiveness. White HCWs were more likely to perceive PPE as effective than Black HCWs (AOR = 3.82, p = 0.046). Support and clerical staff reported higher perceived effectiveness of PPE (AOR = 2.98, p = 0.040). Conclusions: HCWs encountered COVID-19 infections and various challenges that necessitate interventions and policies to safeguard them in hospital settings and ensure prompt virus management, including ensuring sufficient PPE supplies. The perceptions of PPE effectiveness among HCWs are shaped by an interplay of institutional practices, personal beliefs, and structural factors. These perceptions are closely tied to essential elements such as training, reliable PPE availability, and regular hand hygiene practices, underscoring the need to address both systemic and behavioral dimensions. Full article

17 pages, 854 KB

Open AccessArticle

Towards Inclusive Fiscal Policy: A Disability-Responsive Taxation Framework for Equity and Economic Empowerment

by Michael Mncedisi Willie, Siyabonga Jikwana, Onke Ronaldy Mnyaka, Wezile Wilson Chitha and Khona Dyantyi

Int. J. Environ. Res. Public Health 2026, 23(6), 736; https://doi.org/10.3390/ijerph23060736 - 31 May 2026

Abstract

Introduction: Disability in South Africa remains a key driver of socioeconomic inequality, affecting labour market participation, income security, and access to social protection. Conventional fiscal instruments, including medical tax credits and deductions, favour formally employed, higher-income taxpayers, leaving many persons with disabilities fiscally [...] Read more.

Introduction: Disability in South Africa remains a key driver of socioeconomic inequality, affecting labour market participation, income security, and access to social protection. Conventional fiscal instruments, including medical tax credits and deductions, favour formally employed, higher-income taxpayers, leaving many persons with disabilities fiscally excluded. This study used a mixed-methods secondary analysis of peer-reviewed literature, policy documents, labour force data, disability grant records, and household cost estimates to develop a conceptual framework for disability-responsive fiscal inclusion. Results: Labour force data indicate that 10.2% of individuals outside the labour force are due to illness or disability, while discouraged jobseekers rose from 15.2% (2016) to 20.6% (2025). Households with severe disabilities face opportunity costs estimated at R2441 per month from lost earnings, caregiving, transport, and medical expenses. Disability grant patterns show male dominance in permanent disability grants for ages 18–45, with females surpassing males at 50–60. Temporary disability grants follow similar trends, with male predominance in the 18–35 age range and female predominance in the 40–60 age range. These findings reveal systematic gender- and age-related inequities in access to fiscal relief. Conclusions: Existing tax measures insufficiently address the financial burden of disability, disproportionately favouring urban, formally employed households. Implementing refundable tax credits, simplifying administrative processes, and adopting gender- and age-sensitive policies can enhance fiscal inclusion, reduce inequities, and strengthen economic participation for persons with disabilities in South Africa. This study proposes a framework to guide policymakers in implementing refundable disability tax credits, simplifying administrative processes, and targeting vulnerable groups, including older women, rural households, and low-income earners, to enhance fiscal inclusion, equity, and access to essential services. Full article

15 pages, 1944 KB

Open AccessReview

Indigenous 2SLGBTQIA+ Identities and Age-Related Cognitive Decline: A Scoping Review

by Keith D. King, Skye Wilson, Letebrhan Ferrow, Lane Bonertz, Jessy Dame, Megan Kennedy and Jennifer D. Walker

Int. J. Environ. Res. Public Health 2026, 23(6), 735; https://doi.org/10.3390/ijerph23060735 - 30 May 2026

Abstract

Research on Two-Spirit (2S) and Lesbian, Gay, Bisexual, Trans, Queer, Intersex, Asexual and other identities (LGBTQIA+) Indigenous communities and age-related cognitive decline (ARCD) is still an emerging field of study. Historically, Indigenous and 2SLGBTQIA+ individuals are underrepresented in healthcare research and practices. Our [...] Read more.

Research on Two-Spirit (2S) and Lesbian, Gay, Bisexual, Trans, Queer, Intersex, Asexual and other identities (LGBTQIA+) Indigenous communities and age-related cognitive decline (ARCD) is still an emerging field of study. Historically, Indigenous and 2SLGBTQIA+ individuals are underrepresented in healthcare research and practices. Our research question was as follows: what is the scope, breadth, and depth of published and gray literature about First Nations, Métis, and Inuit 2SLGBTQIA+ people’s experiences of aging and dementia? This scoping review used an Indigenous-informed methodology, grounding our research in a guidance committee comprising all Two-Spirit knowledge-keepers, community advocates, and scholars. This method adapts a five-step scoping review approach, including Indigenous knowledge through consultation with Indigenous community members. The committee informed all five steps of the scoping review methodology. Our initial search identified 1320 articles; after screening, seven articles remained, comprising six journal articles and one book chapter. Manuscripts were published in Canada, the USA, and Australasia. There were five qualitative studies, one scoping review, and a book chapter. The aims, results and recommendations from the included studies are presented. We found minimal published literature on the intersecting identities of 2SLGBTQIA+ Indigenous Peoples and ARCD. Gaps included epidemiological research, assessment and interventions, and qualitative experiences in this population. Further investment in research is needed to expand what is known to understand the needs of Indigenous 2SLGBTQIA+ people with dementia. Full article

(This article belongs to the Special Issue Dementia Prevention and Care in Indigenous Communities: Opportunities to Advance Cognitive Health Equity)

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27 pages, 715 KB

Open AccessArticle

Advancing Sustainable Healthcare in Obstetric and Maternity Nursing: Nurses’ Knowledge, Awareness, and Clinical Practice—A Cross-Sectional Study

by Mirfat Mohamed Labib Elkashif, Doaa Mostafa Sheashaa, Mohamed Sayed Abdellatif, Darelglal Ahmed Gassmelseed, Shimaa Mohamed Mohamed Koabar and Sally Abd-Elrahman Mohamed

Int. J. Environ. Res. Public Health 2026, 23(6), 734; https://doi.org/10.3390/ijerph23060734 - 30 May 2026

Abstract

Background: Sustainable healthcare in obstetric and maternity nursing emphasizes the provision of high-quality, safe, and environmentally responsible care for women and newborns. Nurses’ knowledge, awareness, and clinical practices are central to the implementation of sustainable approaches, including efficient resource management, evidence-based interventions, and [...] Read more.

Background: Sustainable healthcare in obstetric and maternity nursing emphasizes the provision of high-quality, safe, and environmentally responsible care for women and newborns. Nurses’ knowledge, awareness, and clinical practices are central to the implementation of sustainable approaches, including efficient resource management, evidence-based interventions, and patient education. Evaluating these dimensions is essential for identifying gaps, informing targeted training, and supporting sustainable and effective maternal care aligned with global health goals. Accordingly, this study aimed to assess obstetric and maternity nurses’ knowledge, awareness, and clinical practices related to sustainable healthcare. Method: A cross-sectional study design was employed. A convenience sampling technique was used to recruit obstetric and maternity nurses working in the selected study settings during the data collection period. A total sample of 120 participants was targeted. The study was conducted at Al-Azhar University Hospital in New Damietta and selected Family Medicine Centers in Damietta Governorate, Egypt. Data were collected using a structured, self-administered questionnaire developed specifically for this study to assess eco-conscious nursing practices in obstetrics and gynecology units. The questionnaire included sections addressing demographic and professional characteristics, knowledge and awareness of sustainable healthcare, eco-conscious clinical practices in maternity settings, perceived barriers and institutional support, attitudes and advocacy toward environmental sustainability, procedure- and material-related environmental concerns, and energy and water conservation behaviors. Responses were measured using standardized 5-point Likert and frequency scales, with composite scores calculated to categorize levels of knowledge, practices, and attitudes toward sustainability; higher scores indicated greater knowledge, awareness, and engagement in sustainable practices. Results: Overall, among the 120 nurses, of whom 62 (51.7%) had reported having heard about sustainability and received training about it, whereas 58 (48.3%) had not. Most participants held a bachelor’s degree (n = 54, 45.0%), nearly half had more than 10 years of nursing experience (n = 58, 48.3%), and the largest proportion worked in delivery rooms (n = 53, 44.2%). Regarding knowledge, attitude, and practice, good knowledge was observed in 61 participants (50.8%), good practice in 46 participants (38.3%), and positive attitudes in 108 participants (90.0%). The findings also showed that trained nurses in obstetrics and gynecology units demonstrated significantly higher knowledge, more positive attitudes, and better eco-conscious practices compared to untrained nurses across all domains (p < 0.001). Conclusions: The study demonstrates that maternity nurses showed moderate to high awareness and positive attitudes toward sustainability, while environmentally sustainable practices were less consistently implemented, indicating a clear knowledge–attitude–practice gap. Nurses who received sustainability-related training consistently achieved significantly higher knowledge, attitude, and practice scores than untrained nurses. Full article

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