International Journal of Environmental Research and Public Health

36 pages, 695 KB

Open AccessArticle

Recognition and Resistance in Early Psychotherapeutic Encounters: Therapist Response Style, Narcissistic Admiration and Rivalry, and Public Mental Health Engagement

by Avi Besser and Virgil Zeigler-Hill

Int. J. Environ. Res. Public Health 2026, 23(7), 876; https://doi.org/10.3390/ijerph23070876 (registering DOI) - 5 Jul 2026

Abstract

Early engagement with psychotherapy is a public mental health issue because potential patients’ first appraisals of psychological care may shape treatment expectations, willingness to continue, and openness to receiving effective support. In first-contact therapeutic encounters, people respond not only to the content of [...] Read more.

Early engagement with psychotherapy is a public mental health issue because potential patients’ first appraisals of psychological care may shape treatment expectations, willingness to continue, and openness to receiving effective support. In first-contact therapeutic encounters, people respond not only to the content of a therapist’s intervention but also to the interpersonal meaning conveyed by the therapist’s response style. Guided by a recognition–resistance framework and models of narcissistic self-regulation, we examined how therapist response style and trait narcissistic admiration and rivalry shape early appraisals of psychological care in a vignette-based psychotherapeutic encounter. In a between-subjects vignette experiment, Hebrew-speaking adults in Israel (N = 972) were randomly assigned to read a validation-based, recognition-supportive, autonomy-supportive therapist response or a more directive and challenging response to the same clinical scenario. Participants then reported perceived recognition, autonomy-related resistance, anticipated alliance, therapist credibility, expected benefit, and willingness to continue. The validation-based response elicited higher perceived recognition, lower autonomy-related resistance, and greater willingness to continue. Perceived recognition and autonomy-related resistance mediated the effects of response style on all therapy-related outcomes. Narcissistic admiration predicted more favorable appraisals, and narcissistic rivalry predicted lower recognition and greater resistance, but neither moderated style effects nor indirect pathways. Recognition and autonomy-related resistance emerged as proximal appraisal pathways linking therapist response style to anticipated engagement with psychological care in this analogue vignette context. However, the predicted moderation and moderated-mediation effects involving narcissistic admiration and rivalry were not supported. This pattern suggests that, in the present design, admiration and rivalry functioned more as general appraisal orientations than as differential-susceptibility moderators of therapist response style. The moderated-mediation component of the recognition–resistance framework should therefore be regarded as unsupported pending independent replication and more ecologically valid tests. These findings position first-contact therapist communication as a candidate modifiable feature of public mental health engagement, with implications for future research on treatment uptake, early retention, trust in services, and access to effective psychological care. Full article

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

12 pages, 378 KB

Open AccessArticle

Relationship Between Odds of Reporting a Fall in the Past Year and Health Literacy Among Community-Dwelling Older Adults in Japan: A Preliminary Cross-Sectional Study

by Akihiko Murayama, Ken Hirukawa and Tomoyuki Shinohara

Int. J. Environ. Res. Public Health 2026, 23(7), 875; https://doi.org/10.3390/ijerph23070875 (registering DOI) - 5 Jul 2026

Abstract

Background/Objectives: Research on falls among community-dwelling older adults has revealed limited knowledge regarding health literacy. This study aimed to evaluate health literacy in community-dwelling older adults in Japan and to clarify its relationship with the odds of reporting a fall in the past [...] Read more.

Background/Objectives: Research on falls among community-dwelling older adults has revealed limited knowledge regarding health literacy. This study aimed to evaluate health literacy in community-dwelling older adults in Japan and to clarify its relationship with the odds of reporting a fall in the past year. Methods: A preliminary cross-sectional study was conducted from January 2024 to May 2025, involving 218 community-dwelling older adults. The study collected data on age, sex, presence of multiple diseases, use of the long-term care insurance system, the Brief-Balance Evaluation Systems Test (Brief-BESTest), the Rapid Dementia Screening Test (RDST), the Communicative and Critical Health Literacy (CCHL) scale, and fall reports in the past year. Results: After excluding four participants, 214 participants (age, 76.9 ± 6.4 years; 61 men and 153 women) were included in the analysis. Of these, 43 (20.1%) participants had reported a fall. A binary logistic regression analysis was performed, adjusting for confounding factors (age, RDST score, and Brief-BESTest score). The reporting of a fall in the past year (falls/non-falls) was used as the dependent variable, and the CCHL score as the independent variable. The results showed that the CCHL score was associated with the reporting of a fall (odds ratio, 0.61; 95% confidence interval, 0.40–0.93). Conclusions: These findings suggest that higher CCHL scores, reflecting better communicative and critical health literacy, are associated with lower odds of reporting a fall. However, because of the cross-sectional design of this study, no causal relationship can be inferred. Future longitudinal studies with larger sample sizes are needed to clarify the temporal relationship between health literacy and falls, examine whether this association is causal, and investigate whether the relationship is linear or whether clinically meaningful threshold effects exist. Full article

(This article belongs to the Special Issue Achieving Effective Fall Prevention and Intervention for Older Adults)

21 pages, 1867 KB

Open AccessArticle

Long-Term Trends and Prognosis in Cardiovascular Mortality in the Kazakhstani Population Living Around the Semipalatinsk Nuclear Test Site

by Dariya Shabdarbayeva, Lyudmila Pivina, Nailya Chaizhunussova, Andrey Orekhov, Galiya Alibayeva, Meruyert Massabayeva, Assel Baibussinova, Gulnara Batenova, Zhanargul Smailova, Saulesh Apbassova, Saule Kozhanova, Madina Abenova, Alexandra Lipikhina, Asset Izdenov, Diana Ygiyeva, Raushan Dosmagambetova and Altay Dyussupov

Int. J. Environ. Res. Public Health 2026, 23(7), 874; https://doi.org/10.3390/ijerph23070874 (registering DOI) - 5 Jul 2026

Abstract

Background: The purpose of the study is the assessment of mortality from cardiovascular diseases (CVDs) and their dose–response relationships and the calculation of the number of years of life lost (YLL) in Kazakhstani residents living in territories around the Semipalatinsk nuclear test site. [...] Read more.

Background: The purpose of the study is the assessment of mortality from cardiovascular diseases (CVDs) and their dose–response relationships and the calculation of the number of years of life lost (YLL) in Kazakhstani residents living in territories around the Semipalatinsk nuclear test site. Materials and Methods: The study is based on the State Scientific Automated Medical Registry (SSAMR) database. The study included 3482 residents of the Abay and Beskaragai districts exposed to radiation and 1886 residents of the Kokpekty district (control group). The median equivalent radiation dose for the exposed group was 864.0 mSv, compared to 64.4 mSv in the control group. The study period was from 1949 to 2024. Results: Mortality rates in the exposed group exceeded those of the comparison group throughout the study. The relative risk (RR) of mortality was 1.41 for all CVDs, 2.0 for stroke, 7.88 for chronic cerebrovascular disease (CCVD), and 2.39 for congenital heart disease (CHD). Age-standardized mortality rates were higher in the radiation-exposed population, with the highest excess risk recorded in 1960–1964 (RR = 5.31; 95% CI 4.32–6.53). The number of YLL from acute myocardial infarction (AMI) was 6097.0 in the exposed group versus 5893.0 in the comparison group, 3857.5 from hemorrhagic stroke versus 1996.9, and 2696.6 from CHD versus 957.7. An increase in radiation dose by 1 cSv was associated with an 8.5% increase in the odds of death from CVDs (OR = 1.085; 95% CI 1.075–1.094; p < 0.001). Radiation dose demonstrated good predictive ability for mortality from cardiovascular diseases (AUC = 0.700). Conclusions: The results indicate an increased risk of CVD mortality among residents of radiation-contaminated areas of Kazakhstan throughout the study period. Full article

(This article belongs to the Section Environmental Health)

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30 pages, 827 KB

Open AccessSystematic Review

“I Was Embarrassed to Go and See a Counsellor”: Stigma Experienced by Individuals Diagnosed with Mental Illness (A Systematic Review and Meta-Synthesis)

by Oladapo Akinlotan, Dinithi Vidanage and Allen O’connor

Int. J. Environ. Res. Public Health 2026, 23(7), 873; https://doi.org/10.3390/ijerph23070873 (registering DOI) - 4 Jul 2026

Abstract

Background: Stigma is a persistent barrier to psychosocial wellbeing and recovery of individuals with mental illnesses. Aim: This study aims to examine stigma experienced by individuals diagnosed with mental illnesses. Method: A systematic review and meta-synthesis of peer-reviewed qualitative primary [...] Read more.

Background: Stigma is a persistent barrier to psychosocial wellbeing and recovery of individuals with mental illnesses. Aim: This study aims to examine stigma experienced by individuals diagnosed with mental illnesses. Method: A systematic review and meta-synthesis of peer-reviewed qualitative primary studies followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Five databases: CINAHL Ultimate, APA PsycArticles, APA PsycINFO, MEDLINE Ultimate, and Embase were searched for studies published between 2021 and 2025. A total of 17 studies were included after rigorous screening. Results: Thematic analysis identified three major themes and fifteen sub-themes. These are manifestations of stigma (prevalence of stigma, operation of stigma, stigma related to mental health diagnosis, stigma related to motherhood and impacts of stigma), multiple factors shaping stigma (ignorance and misunderstanding, spiritual and religious beliefs, family and friends, cultural beliefs) and management of stigma (management strategies, internalising stigma, isolation due to stigma, disclosure of mental illness, non-disclosure of mental illness and help-seeking for mental illness). Conclusions: Stigma related to mental illness remains widespread and continues to influence individuals’ experiences, relationships, and help-seeking behaviours. Addressing stigma through improved mental health awareness and supportive environments is essential to promote recovery and wellbeing. Full article

(This article belongs to the Special Issue Reducing Stigma and Discrimination in Global Mental Health)

18 pages, 838 KB

Open AccessArticle

Perspectives Among Veterans with Chronic Pain and Co-Occurring Mild Traumatic Brain Injury: Mixed-Method Findings from a Neuromodulation and Yoga Intervention

by Amy M. Kemp, Kelly Krese, Bella Etingen, Bridget A. Cotner, Sadie Walker, Ibuola Kale, Miriam R. Rafferty, Sandra Kletzel, Rachana P. Shah, Sabrina Bedo, Sarmistha Chaudhuri, Alexandra L. Aaronson, Kyla Z. Donnelly, Sonia Bobra, Andrea Billups, Pei-Shan Yen, Dulal Bhaumik, Theresa L. Bender Pape and Amy A. Herrold

Int. J. Environ. Res. Public Health 2026, 23(7), 872; https://doi.org/10.3390/ijerph23070872 - 3 Jul 2026

Abstract

Chronic pain is the leading cause of disability worldwide and frequently co-occurs with mild traumatic brain injury among Veterans (mTBI + CP), creating complex treatment challenges and a need for novel, non-pharmacological interventions. This study evaluated a pilot intervention combining intermittent theta burst [...] Read more.

Chronic pain is the leading cause of disability worldwide and frequently co-occurs with mild traumatic brain injury among Veterans (mTBI + CP), creating complex treatment challenges and a need for novel, non-pharmacological interventions. This study evaluated a pilot intervention combining intermittent theta burst stimulation (iTBS), a neuromodulatory approach, with the evidence-based LoveYourBrain Yoga program to enhance rehabilitation outcomes. In a six-week open-label trial, ten Veterans with mTBI + CP received weekly iTBS followed by yoga sessions. Pilot quantitative outcomes included quality of life (Traumatic Brain Injury Quality of Life [TBI-QoL]) and functional ability (Mayo Portland Adaptability Inventory-4 [MPAI-4]), assessed pre- and post-intervention, alongside qualitative semi-structured interviews and interdisciplinary clinical notes. Significant improvements were observed in TBI-QoL Fatigue (p = 0.021) and MPAI-4 Grief and Loss (p = 0.016), with clinically meaningful but non-significant gains in Ability and Adjustment. Qualitative findings revealed improved pain management and enhanced self-management, with participants describing better emotional regulation, more effective coping strategies, and stronger social connections. Some benefits were more evident in qualitative data than in standardized measures. These pilot findings suggest that combining iTBS with mind–body therapy may provide complementary tools for pain management and functional recovery in Veterans with mTBI + CP, supporting further investigation of integrated neuromodulation and behavioral interventions. Full article

(This article belongs to the Special Issue Invisible Wounds: Addressing Veterans' Mental Health Challenges by Centering Their Experiences and Perspectives)

22 pages, 614 KB

Open AccessArticle

Improving Cancer Awareness and Knowledge in Johannesburg and iLembe Districts Through a Tailored Community-Based Educational Intervention: A Pilot Study

by Buhle Lubuzo, Usangiphile Buthelezi, Zamasomi Prudence Luvuno, Sithabisile Gugulethu Gigaba, Bridgette Goeieman, Wilbroda Hlolisile Chiya and Sibongile Ramotshela

Int. J. Environ. Res. Public Health 2026, 23(7), 871; https://doi.org/10.3390/ijerph23070871 - 3 Jul 2026

Abstract

Cancer remains a growing public health concern in South Africa, particularly in underserved communities where disparities in awareness and access to care contribute to delayed diagnosis. This study evaluated the impact of a culturally tailored educational intervention based on an adapted Cancer-Community Awareness [...] Read more.

Cancer remains a growing public health concern in South Africa, particularly in underserved communities where disparities in awareness and access to care contribute to delayed diagnosis. This study evaluated the impact of a culturally tailored educational intervention based on an adapted Cancer-Community Awareness Access Research and Education (c-CARE) module in Johannesburg and iLembe districts. A pilot study using a quasi-experimental pre–post design was conducted to assess changes in knowledge and attitudes among 210 traditional health practitioners, community health workers, and faith-based leaders. Structured surveys measured awareness of multiple myeloma, prostate, lung, breast, and cervical cancers. Data were captured in REDCap and analyzed using SPSS version 30. Significant improvements in knowledge were observed across all cancers. Awareness of lung cancer increased from 74.3% to 96.7%, multiple myeloma from 26.7% to 96.7%, prostate cancer from 52.5% to 98.3%, breast cancer from 93.4% to 98.7%, and cervical cancer from 84.8% to 96.0%. Participants demonstrated improved understanding of screening modalities and risk factors, including tobacco-related harms. Despite these gains, screening-related fears remained evident. These findings demonstrate that contextually adapted, community-based training can strengthen cancer literacy and support early detection strategies in underserved settings. Full article

18 pages, 368 KB

Open AccessArticle

Problematic Smartphone Use and Quality of Life Among Greek Nursing Students: A Cross-Sectional Study

by Georgios Manomenidis, Vasiliki Georgousopoulou, Elena Vasileiou, Savvato Karavasileiadou, Nikoletta T. Karavasili, Stefanos Mavroudis and Eman Atef

Int. J. Environ. Res. Public Health 2026, 23(7), 870; https://doi.org/10.3390/ijerph23070870 - 3 Jul 2026

Abstract

Background: Problematic smartphone use may threaten student well-being, especially among nursing students who rely on smartphones for academic and clinical activities. This study estimated potential problematic smartphone use among Greek nursing students, examined its association with quality of life (QoL), and explored whether [...] Read more.

Background: Problematic smartphone use may threaten student well-being, especially among nursing students who rely on smartphones for academic and clinical activities. This study estimated potential problematic smartphone use among Greek nursing students, examined its association with quality of life (QoL), and explored whether contextual factors modified these associations. Methods: A cross-sectional study was conducted among 331 nursing students in Greece from September to November 2025. Participants completed an anonymous online questionnaire including sociodemographic data, the Smartphone Addiction Scale–Short Version (SAS-SV), and the World Health Organization Quality of Life–BREF (WHOQOL-BREF). Results: The mean SAS-SV score was 29.30 ± 9.69, and 18.9% of students screened positive for potential problematic smartphone use. Mean overall QoL and general health satisfaction were 3.80 ± 0.78 and 3.97 ± 0.88, respectively. Higher SAS-SV scores were associated with lower physical, psychological, and environmental QoL, but not with social QoL. Years of study moderated only the association with environmental QoL. Conclusions: Problematic smartphone use was associated with poorer physical, psychological, and environmental QoL among Greek nursing students. These domain-specific findings extend existing evidence and support integrating digital well-being, self-regulation, and sleep-hygiene strategies into nursing education and student-support services. Full article

20 pages, 650 KB

Open AccessReview

Built Environment and Assistive Technology Design in Residential Aged Care: A Scoping Review and Mapping of Evaluation Methods and Measures to the World Health Organization’s International Classification of Functioning, Disability and Health

by Libby Callaway, Natasha Layton, Phillippa Carnemolla, Lisa Licciardi, Maryam Gusheh and Em Bould

Int. J. Environ. Res. Public Health 2026, 23(7), 869; https://doi.org/10.3390/ijerph23070869 - 3 Jul 2026

Abstract

Globally, the growth of ageing populations is significant, with more people requiring supported living environments, including residential aged care (RAC). Given the influence of the environment on health outcomes, it is important to consider approaches to evaluate aged care design, including both the [...] Read more.

Globally, the growth of ageing populations is significant, with more people requiring supported living environments, including residential aged care (RAC). Given the influence of the environment on health outcomes, it is important to consider approaches to evaluate aged care design, including both the built environment and products and technology. With the overarching aim to identify the scope of RAC-built environment and assistive technology design interventions and the way this data is captured methodologically, this review (i) identified methods and measures used to evaluate RAC-built environment and assistive technology design, and examined populations these methods and measures were used with, and (ii) mapped identified approaches to the International Classification of Functioning, Disability and Health (ICF). An a priori review protocol was developed, and a scoping review was then conducted. Eight databases were searched for publications between January 2000 and February 2023, resulting in 81 included studies, which were then mapped to ICF activity, participation and environment domains. Twenty methods and 16 methodologies were identified. Sixty-one articles collected data directly from resident populations, primarily including older adults (n = 52). Forty-nine publications reported on the evaluation of built design, 23 reported on products and technology, and nine reported on both, but with limited inclusion of valued participation as a goal or outcome. While some participatory methods were identified, 25% of the studies did not include consumer perspectives. Analyzing aged care design can identify ways to facilitate, or remove barriers to, healthier spaces and lives in RAC. Use of internationally recognized terminology and an integrative lens on the relationship between technology and environmental design is recommended. Full article

(This article belongs to the Special Issue Healthy Spaces, Healthy Lives: Analyzing the Role of Built Environment on Human Health)

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1 pages, 162 KB

Open AccessCorrection

Correction: Ling, X. The Coordination of Environmental Protection and Female Discrimination Based on the Concept of Affirmative Action. Int. J. Environ. Res. Public Health 2023, 20, 3419

by Xia Ling

Int. J. Environ. Res. Public Health 2026, 23(7), 868; https://doi.org/10.3390/ijerph23070868 - 3 Jul 2026

Abstract

Yanhong Liu was removed from the author list, and the Author Contributions section was removed from the original publication [...] Full article

21 pages, 3693 KB

Open AccessArticle

Evaluating the Feasibility and Acceptability of a Culturally Adapted Intervention to Promote Resistance Exercise in Young Black Women: A Randomized Controlled Trial

by Chloe S. Jones, Katherine E. Spring and Danielle D. Wadsworth

Int. J. Environ. Res. Public Health 2026, 23(7), 867; https://doi.org/10.3390/ijerph23070867 - 3 Jul 2026

Abstract

Young Black women face barriers to exercise and elevated cardiometabolic risk, yet resistance exercise (RE) remains underutilized despite its benefits. We evaluated the feasibility and acceptability of a 24-week culturally adapted RE intervention + text messages in young Black women. Participants were randomized [...] Read more.

Young Black women face barriers to exercise and elevated cardiometabolic risk, yet resistance exercise (RE) remains underutilized despite its benefits. We evaluated the feasibility and acceptability of a 24-week culturally adapted RE intervention + text messages in young Black women. Participants were randomized to the motivational exercise group (MEG; n = 14) or the standard exercise group (SEG; n = 13). Both groups received 10 and 11 weeks of supervised (by a Black woman) and unsupervised RE. MEG received additional cultural adaptations and weekly discussions to build competence, autonomy, and self-regulation strategies + mobile support. Feasibility and acceptability were assessed via recruitment, consent, and retention rates, adherence, and thematic analysis of semi-structured interviews. Recruitment and consent rates were 97.2% and 100.0%, respectively. Retention rates were 93.3% (MEG) and 86.7% (SEG) at 12 weeks, and 93.3% and 80.0% at 24 weeks, respectively. Supervised adherence was 93.9% and 88.8% in MEG and SEG, and 14.3% and 15.4%, respectively, during unsupervised RE. Participants desired continued support and a more tailored mobile experience during unsupervised RE. Supervised RE with ethnically matched trainers was feasible and acceptable. Future interventions should incorporate mobile tools with tailored feedback and accountability strategies to sustain long-term RE to improve health outcomes in this population. Full article

(This article belongs to the Special Issue Adherence to Physical Activity and Its Role in Health Promotion)

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15 pages, 1367 KB

Open AccessArticle

Malaria Test Positivity, Temporal Trends, and Associated Factors Among Clinically Suspected Adult Cases in Maruleng Sub-District, Limpopo Province, South Africa, 2018–2023

by Stella Mashego and Tanusha Singh

Int. J. Environ. Res. Public Health 2026, 23(7), 866; https://doi.org/10.3390/ijerph23070866 - 2 Jul 2026

Abstract

Background: Malaria remains a significant public health challenge in sub-Saharan Africa and is endemic in certain areas of South Africa despite ongoing elimination efforts. This study assessed malaria positivity, temporal trends, seasonal patterns, and factors associated with malaria positivity among clinically suspected adult [...] Read more.

Background: Malaria remains a significant public health challenge in sub-Saharan Africa and is endemic in certain areas of South Africa despite ongoing elimination efforts. This study assessed malaria positivity, temporal trends, seasonal patterns, and factors associated with malaria positivity among clinically suspected adult in Maruleng Sub-District, Limpopo Province. Methods: A retrospective cross-sectional study analysed routine malaria surveillance records from 2018 to 2023 among suspected adult cases (≥18 years) tested for malaria at 11 clinics and one hospital. Descriptive, regression, and seasonal trend analyses were performed. Results: Of 385 adult records analysed, 366 were malaria-positive (test positivity rate = 95.1%). Cases were mostly males (66.7%) and adults aged 18–35 years (47.5%). Malaria cases were highest in 2018 and 2019, declined between 2020 and 2022, and increased in 2023. Significant seasonal variation was observed, with the highest numbers of cases occurring in April and May (p < 0.001). Exploratory regression analyses did not identify any statistically significant independent predictors of malaria positivity after adjustment for potential confounders. Behavioural risk factors showed a non-significant trend towards increased odds of malaria positivity (aOR = 3.42; 95% CI: 0.78–14.98), although estimates should be interpreted cautiously because of the limited number of malaria-negative records. Conclusions: Malaria remains an important public health concern in Maruleng. The observed temporal and seasonal patterns highlight the importance of strengthening surveillance, seasonal preparedness, and targeted vector control interventions before peak transmission periods. Larger studies with greater outcome variability are needed to better characterise factors associated with malaria positivity. Full article

(This article belongs to the Section Environmental Health)

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15 pages, 273 KB

Open AccessReview

Ethical and Legal Considerations in Posthumous Oocyte Retrieval for Minor Girls

by Anushka Chalmeti, Jason Lesandrini and David S. Reis

Int. J. Environ. Res. Public Health 2026, 23(7), 865; https://doi.org/10.3390/ijerph23070865 - 2 Jul 2026

Abstract

Posthumous gamete retrieval has emerged as a complex issue at the intersection of reproductive technology, bioethics, consent, and law. While posthumous sperm retrieval has received small amounts of legal, ethical, and clinical attention, posthumous oocyte retrieval, particularly in minors, remains largely unaddressed. This [...] Read more.

Posthumous gamete retrieval has emerged as a complex issue at the intersection of reproductive technology, bioethics, consent, and law. While posthumous sperm retrieval has received small amounts of legal, ethical, and clinical attention, posthumous oocyte retrieval, particularly in minors, remains largely unaddressed. This review examines the clinical, legal, and ethical considerations surrounding posthumous oocyte retrieval in minor girls. First, the paper explores the medical processes involved in posthumous gamete retrieval, drawing a significant distinction between sperm and oocyte retrieval. Second, it reviews international legal standards and U.S. jurisprudence relevant to posthumous reproduction, including both constitutional reproductive rights cases and court decisions directly addressing posthumous gamete use at the state level. Third, it analyzes existing institutional and professional guidelines governing posthumous reproduction in the United States. Across these three domains, the analysis reveals three main takeaways. First, current frameworks overwhelmingly assume adult decedents and focus primarily on sperm retrieval requested by spouses or partners, leaving a large unaddressed gap for minors and posthumous oocyte retrieval. Second, posthumous oocyte retrieval in minors presents distinct challenges related to medical burden, consent, parental authority, and the upbringing and welfare of potential offspring. Lastly, institutional, professional, and legislative guidance that prohibits posthumous oocyte retrieval in minors should be issued to provide clarity and recommendations for clinicians confronted with such requests. Full article

9 pages, 735 KB

Open AccessReview

Global Health Research on Refugees and Other Forcibly Displaced Populations: A Bibliometric Analysis from 2000 to 2024

by Zaid Ahmed Shaik, Noor Fathima Shaik and Aba Barden-Maja

Int. J. Environ. Res. Public Health 2026, 23(7), 864; https://doi.org/10.3390/ijerph23070864 - 1 Jul 2026

Abstract

The global population of forcibly displaced persons (FDPs), including refugees and asylum seekers, surpassed 120 million in 2024. Understanding research trends on FDP health is essential for addressing their complex needs. To characterize trends in health research focused on these populations, we conducted [...] Read more.

The global population of forcibly displaced persons (FDPs), including refugees and asylum seekers, surpassed 120 million in 2024. Understanding research trends on FDP health is essential for addressing their complex needs. To characterize trends in health research focused on these populations, we conducted a bibliometric analysis of PubMed-indexed publications from 2000 to 2024 using the title and abstract-based search terms “refugee,” “asylum seeker,” “asylee,” and “forcibly displaced.” A total of 1590 relevant publications were included. Research output grew modestly from 2000 to 2013, surged between 2013 and 2017, and slowed from 2017 to 2024. Review articles dominated (64%), followed by comparative studies (13%) and randomized controlled trials (8%). Mental and psychosocial health was the most common theme (31%), followed by health policy (26%) and children/youth (22%). Non-communicable diseases (9%) and climate-related health (1.5%) were underrepresented. Geographic focus shifted from Southeast Asia and East Africa in the early 2000s, to Syria post-2016, then with emerging attention to Rohingya and Ukrainian refugees in the early 2020s. This study provides an updated overview of Pubmed-indexed research trends, and highlights thematic and geographic gaps that warrant further investigation. Full article

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17 pages, 662 KB

Open AccessArticle

Relationality, Overload, and Trust: How Housing-Insecure Youth Navigated Health Information During the COVID-19 Pandemic

by Hannah E. Reynolds, Alana R. Lopez, Renatta Escobedo, Lorilee Chien, Samia Saeb, Jacob Carson, Jerel P. Calzo, Corinne McDaniels-Davidson, Steven Jellá and Jennifer K. Felner

Int. J. Environ. Res. Public Health 2026, 23(7), 863; https://doi.org/10.3390/ijerph23070863 - 30 Jun 2026

Abstract

Youth experiencing homelessness and housing instability (YEH) face disproportionate health risks and structural barriers to health equity, which were intensified during the COVID-19 pandemic. We conducted a community-based participatory research study with 21 adolescents (ages 13–17) and transitional-aged youth (ages 18–26) experiencing homelessness [...] Read more.

Youth experiencing homelessness and housing instability (YEH) face disproportionate health risks and structural barriers to health equity, which were intensified during the COVID-19 pandemic. We conducted a community-based participatory research study with 21 adolescents (ages 13–17) and transitional-aged youth (ages 18–26) experiencing homelessness or housing instability in San Diego, California, USA. Between February and July 2023, we conducted six “arts-based engagement sessions” (5 in English, 1 in Spanish) that blended expressive arts and focus group approaches to examine how YEH accessed, evaluated, and applied health information, and how trust and material and structural resource constraints shaped engagement with COVID-19 information and prevention guidance. We analyzed data via applied thematic analysis. Participants described how COVID-19 restrictions and economic disruption amplified pre-existing housing precarity, worsening material conditions and mental health. Participants selectively trusted COVID-19 information based on who provided it, how credible it felt, and whether it aligned with their lived experiences. Community-based providers and, for some, churches and cultural or ancestral knowledge were key information sources. Trust in government and public health messaging was conditional and shaped by perceptions of credibility, coherence, and political motivation. Participants described information overload and rapidly changing guidance as overwhelming and often incompatible with their material realities, leading to disengagement, reliance on intuition, or deprioritization of prevention behaviors. Effective communication during future health emergencies must center trusted relational messengers, align guidance with lived realities, and address the structural conditions that shape whether health information can be meaningfully acted upon. Full article

(This article belongs to the Special Issue Psychosocial Impact in the Post-pandemic Era)

28 pages, 2422 KB

Open AccessArticle

Research Trends and Collaborative Patterns in Wolbachia and Aedes aegypti Studies: A Scientometric Analysis

by Yoon Ling Cheong, Jia Hui Lim, Mohd Hazilas Mat Hashim, Nor Syahaliyana Saidin, Shyamini Ann Samson, Mohd Khairuddin Che Ibrahim, Hui Li Lim, Farah Diana Ariffin, Han Lim Lee, Nazni Wasi Ahmad, Azahadi Omar and Kuang Hock Lim

Int. J. Environ. Res. Public Health 2026, 23(7), 862; https://doi.org/10.3390/ijerph23070862 - 30 Jun 2026

Abstract

Aedes aegypti (Ae. aegypti) is the primary vector for dengue, Zika and chikungunya, which represent major global public health concerns. The use of Wolbachia as a biological control agent in Ae. aegypti has gained significant international attention following the successful establishment [...] Read more.

Aedes aegypti (Ae. aegypti) is the primary vector for dengue, Zika and chikungunya, which represent major global public health concerns. The use of Wolbachia as a biological control agent in Ae. aegypti has gained significant international attention following the successful establishment of field-released mosquitoes in Australia, Malaysia, Brazil, Indonesia and Singapore. This study presents a comprehensive scientometric analysis of the research landscape of Wolbachia and Ae. aegypti. Data comprising 662 English-language publications from 2000 to 2025 were extracted from the Scopus database. Analytic tools, including VOSviewer and R-based Biblioshiny, were employed to quantify author productivity, transcontinental collaboration networks, thematic evolution, research gaps and future directions, while Bradford’s Law of Scattering was used to identify core dissemination channels. Publications have shown a steady upward trajectory since 2000, with an overall relative growth rate of 0.3%, while annual citations peaked in 2009 and 2011 (3337 and 3460 citations, respectively). The dataset strictly conformed to Bradford’s distribution (0.16% error), identifying PLOS Neglected Tropical Diseases (11.9%) and Parasites and Vectors (5.6%) as the core journals. Global research networks are predominantly led by Australia and the United States, supported primarily by the National Institutes of Health (14.8%) and the National Health and Medical Research Council (14.2%). Crucially, thematic analysis using a methodological triangulation approach demonstrates a progressive maturation in the field, shifting from foundational laboratory mechanisms toward large-scale deployment logistics and microbiome dynamics. Overall, this study highlights the intellectual landscape, underscores the vital role of global collaboration, and provides strategic insights to guide future evidence-based policies in Wolbachia–Aedes aegypti research. Full article

(This article belongs to the Special Issue Prevention and Control of Vector-Borne Infectious Diseases)

18 pages, 571 KB

Open AccessArticle

No Roadblocks: How Mobile Primary Care Navigates Barriers to Health Access

by Kayleigh E. Zinter, Ryan Burns, Ellen Pinnette, Trent B. Legare, Sheena C. McNeill, Alissa L. Sedelow, Jeremy Moseley, Jennifer Snow, Latoya Mallard Alexander, Renee M. Stakeman and Ashley B. Foster

Int. J. Environ. Res. Public Health 2026, 23(7), 861; https://doi.org/10.3390/ijerph23070861 - 30 Jun 2026

Abstract

Healthcare disparities are widespread across the U.S. Mobile health programming is designed to dismantle systemic healthcare barriers for medically underserved communities. The purpose of this study was to assess the effectiveness of two southeastern U.S. mobile primary care programs. Guided by the Social [...] Read more.

Healthcare disparities are widespread across the U.S. Mobile health programming is designed to dismantle systemic healthcare barriers for medically underserved communities. The purpose of this study was to assess the effectiveness of two southeastern U.S. mobile primary care programs. Guided by the Social Determinants of Health framework, this descriptive study examines the programs’ patient populations to determine reach and patient medical data to ascertain patients’ connection to the medical system and long-term primary care. Data were collected via electronic health record (EHR) and analyzed in Power BI and R. Basic descriptive, crosstab and chi-square statistics were conducted to assess the patient population and explore patient healthcare engagement prior to and following their initial mobile primary care visit. The results indicate that mobile primary care programs are utilized by systemically underserved groups, with both program A and B’s patient population identifying primarily as Latin/Hispanic (69.6% and 41.3% respectively), uninsured (99.1% and 59.8%), and Spanish-speaking (64.4% and 42.3%). Additionally, each program demonstrates an ability to engage patients in long-term primary care utilization via repeat utilizers (65.5% and 25.9%). McNemar’s chi-square results show that participation in either of the mobile primary care programs has a statistically significant, non-random measurable effect on patient primary care enrollment. Differences in program structure and findings are explored, and recommendations for future practice, research, and policy are discussed. Full article

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

13 pages, 627 KB

Open AccessArticle

Smoking and Depth-Related Anaerobic Bacteria in Endodontic–Periodontal Lesions: A Pilot Study

by Cássio Vicente Pereira, Natália Galvão Garcia, Douglas Campideli Fonseca, Pedro Gustavo Machado, Michele de Fátima Rezende, Sarah Ferreira Mattos Alcântara, Eric Francelino Andrade and Luciano José Pereira

Int. J. Environ. Res. Public Health 2026, 23(7), 860; https://doi.org/10.3390/ijerph23070860 - 30 Jun 2026

Abstract

Endodontic–periodontal lesions are complex conditions in which endodontic infection and periodontal breakdown coexist and may create anaerobic microbial niches along the root surface. Although smoking is a well-established modifier of periodontal disease progression and subgingival microbial ecology, its influence on the depth-related distribution [...] Read more.

Endodontic–periodontal lesions are complex conditions in which endodontic infection and periodontal breakdown coexist and may create anaerobic microbial niches along the root surface. Although smoking is a well-established modifier of periodontal disease progression and subgingival microbial ecology, its influence on the depth-related distribution of anaerobic periodontal bacteria in teeth affected by endodontic–periodontal lesions remains incompletely understood. This cross-sectional study investigated the distribution patterns and co-occurrence of selected anaerobic periodontal bacteria in smokers and non-smokers with endodontic–periodontal lesions, considering periodontal pocket depth and anatomical site. Subgingival samples were collected from periodontal pockets of different probing depths (3–4 mm, 5–6 mm, and ≥7 mm), as well as from healthy gingival sulci and oral mucosa, in 26 patients with endodontic–periodontal lesions. The presence of Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, Prevotella nigrescens, and Aggregatibacter actinomycetemcomitans was assessed. Detection was performed using polymerase chain reaction (PCR). Qualitative detection frequencies and microbial co-occurrence patterns were compared between smokers and non-smokers across sites and pocket depths. Non-smokers showed higher detection of Tannerella forsythia in pockets ≥7 mm (p<0,05). Overall microbial co-occurrence was lower in smokers in deeper periodontal pockets, whereas detection patterns in healthy gingival sulci and oral mucosa were broadly comparable between groups. Our findings suggest that smoking may be associated with an attenuated depth-related detection pattern and reduced co-occurrence of selected anaerobic periodontal bacteria in endodontic–periodontal lesions. Full article

(This article belongs to the Special Issue Oral Health Outcomes from Childhood to Adulthood)

16 pages, 1809 KB

Open AccessArticle

Utilizing the All of Us Dataset to Assess the Socioeconomic and Health Impacts of COVID-19 on Hispanics in the United States

by William O. Agyapong, Amy Wagler, Bryan J. Castro and Kyle Melin

Int. J. Environ. Res. Public Health 2026, 23(7), 859; https://doi.org/10.3390/ijerph23070859 - 30 Jun 2026

Abstract

Background. Hispanic populations in the United States experienced disproportionate health and economic impacts during the COVID-19 pandemic. This study assessed relationships between social determinants of health (SDOH) and COVID-19-related health and economic outcomes among Hispanic and non-Hispanic participants in the All of Us [...] Read more.

Background. Hispanic populations in the United States experienced disproportionate health and economic impacts during the COVID-19 pandemic. This study assessed relationships between social determinants of health (SDOH) and COVID-19-related health and economic outcomes among Hispanic and non-Hispanic participants in the All of Us Research Program. Methods. Descriptive analyses and logistic regression models explored associations between all variables. Iterative proportional fitting (raking) was used to align survey samples with known population margins. Results. Hispanics reported worse outcomes across all COVID-19-related variables: lower vaccination rates and higher rates of COVID-19 symptoms and experiencing hardships due to COVID-19. Final post-raking models found Hispanics had greater odds of experiencing hardships (OR = 1.81, 95% CI = 1.55, 2.11) especially among those reporting COVID-19 symptoms (OR = 2.45, 95% CI = 1.51, 3.97). The final model identified increased rates of COVID-19 vaccination among Hispanics when controlling for gender, age, and SDOH (OR = 1.22, CI = 1.09, 1.37) than have been reported nationally during the examined time period for Hispanics. Conclusions. Uptake of COVID-19 vaccination and disproportionate negative health, economic, and social impacts of COVID-19 experienced by Hispanic communities were driven by SDOH. Findings underscore the need for targeted efforts to address SDOH to achieve the best health outcomes for all. Full article

(This article belongs to the Special Issue Health Inequities: Structural Causes, Intervention Strategies, and Methodological Challenges)

40 pages, 4077 KB

Open AccessArticle

Structural Equation Modelling of Socioeconomic Status on Malnutrition Among Urban Preschoolers: Multi-Group Analysis of Hungary and Indonesia

by Arie Dwi Alristina, Éva Kovács, Diyah Arini and Helga Judit Feith

Int. J. Environ. Res. Public Health 2026, 23(7), 858; https://doi.org/10.3390/ijerph23070858 - 30 Jun 2026

Abstract

Background: Child malnutrition is a major public health problem worldwide, but the pathways through which socioeconomic status (SES) affects nutritional outcomes differ markedly between economic and welfare regimes. Differentiating whether these impacts are direct or through behavioural and structural factors is key to [...] Read more.

Background: Child malnutrition is a major public health problem worldwide, but the pathways through which socioeconomic status (SES) affects nutritional outcomes differ markedly between economic and welfare regimes. Differentiating whether these impacts are direct or through behavioural and structural factors is key to focused policy intervention. Objective: This study aimed to investigate the effects of socioeconomic inequalities, maternal knowledge and feeding practices, and food insecurity on preschool undernutrition in Hungary and Indonesia. Methods: The study employs a cross-national comparative design. Respondents were households with children 36 to 59 months old; the sample comprised 128 households in Budapest, Hungary and 535 households in Surabaya, Indonesia. The instruments were designed to fit within a survey for data collection. Data were analysed using Partial Least Squares Structural Equation Modelling (PLS-SEM) with Multi-Group Analysis (MGA). Results: In Hungary, SES and food insecurity are positively associated with malnutrition, whereas in Indonesia, SES and biological factors drive malnutrition. Intermediate factors such as maternal feeding practices (Hungary) and health coverage (Indonesia) did not directly affect malnutrition. Although the model identified significant socioeconomic pathways, its very low explanatory and predictive power for child malnutrition in both urban Hungary (R² = 0.024) and Indonesia (R² = 0.062), and the predictive relevance ((Q² Hungary: −0.009); Q² Indonesia: 0.016), which remained close to zero or negative, indicate that these variables only partially capture the complex, multifactorial mechanisms driving nutritional status. Conclusions: These findings indicate that a more targeted approach to food insecurity and behavioural screening within the Hungarian welfare system would be necessary to address malnutrition effectively. Findings in Indonesia underline the potential benefits of prioritising equity in health coverage and income support. Full article

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