International Journal of Environmental Research and Public Health

22 pages, 655 KB

Open AccessSystematic Review

Climate Change and Suicidal Behavior in Older Adults: Determinants, Associated Factors, and Risk Factors: A Systematic Literature Review

by Diego De Leo, Josephine Zammarrelli, Elena Zamò, Fausto Carlo De Rossi, Francesca Lippi, Martina Andrea Viecelli, Luca Vannucci and Cristina Bordignon

Int. J. Environ. Res. Public Health 2026, 23(9), 1158; https://doi.org/10.3390/ijerph23091158 (registering DOI) - 5 Sep 2026

Abstract

Background: Climate change is being recognized as a factor associated with increased suicidal behavior, especially in the older adult population. Extreme temperatures, thermal anomalies, and intense weather events can amplify pre-existing physical, psychological, and social vulnerabilities, increasing the risk of suicidal ideation and [...] Read more.

Background: Climate change is being recognized as a factor associated with increased suicidal behavior, especially in the older adult population. Extreme temperatures, thermal anomalies, and intense weather events can amplify pre-existing physical, psychological, and social vulnerabilities, increasing the risk of suicidal ideation and behavior in older adults. Objectives: This systematic review aims to map the literature on the relationship between climate change and suicidal behavior in older people, identifying risk and protective factors, as well as the prevention and intervention strategies aimed at this age group. Methods: A systematic review was conducted according to PRISMA guidelines. The literature search was performed in the EBSCO PsycINFO, Scopus and MEDLINE (PubMed) databases in the period 2007–2025, using combinations of the keywords “climate change”, “global warming”, “older adults”, “elderly”, “suicide”, “suicidal ideation” and related terms. Out of 35 studies, 16 articles were included in the final analysis. Results: Five thematic areas emerged from the analysis of the studies: (1) risk factors, (2) protective factors, (3) sociodemographic factors, (4) prevention and intervention strategies and (5) variables associated with suicidal behavior. Across the included studies, suicidal ideation, non-fatal attempts, and suicide mortality were examined with differing frequency and are reported separately in the thematic synthesis rather than pooled, reflecting the heterogeneity of outcome definitions and study designs. Significant limitations in the literature remain, including the paucity of longitudinal studies, the widespread use of aggregate data and the limited integration of environmental, social, and psychological factors. Conclusions: Climate change and extreme weather events may contribute to suicidal behavior in older adults. It is therefore necessary to develop multidimensional approaches that address structural vulnerabilities and promote the active role of older adults in climate resilience and social cohesion. Full article

36 pages, 3317 KB

Open AccessSystematic Review

Nature-Based Solutions, Climate, and Health in Chinese Cities: A Secondary Analysis of an English-Language Systematic Review with Implications for Urban Policy and Practice

by Yirong Jia and Catalina Turcu

Int. J. Environ. Res. Public Health 2026, 23(9), 1157; https://doi.org/10.3390/ijerph23091157 (registering DOI) - 5 Sep 2026

Abstract

Urban nature-based solutions (NbSs) are increasingly deployed to address climate risks, yet their health co-benefits remain poorly understood. This paper presents a secondary analysis of 90 peer-reviewed, English-language China-specific studies drawn from a registered systematic review covering January 2015 to April 2025. Evidence [...] Read more.

Urban nature-based solutions (NbSs) are increasingly deployed to address climate risks, yet their health co-benefits remain poorly understood. This paper presents a secondary analysis of 90 peer-reviewed, English-language China-specific studies drawn from a registered systematic review covering January 2015 to April 2025. Evidence was analyzed by geographical distribution, NbS category, climate-adaptation pathway, health outcome, and greenness measurement, with complementary comparison against 88 non-China-specific studies. Air-quality pathways and physical-health outcomes predominated, whereas heat received less attention, and only one study examined flood-related health. Thirty studies (33.3%) were located wholly in eastern China, while 9 of the 31 mainland provincial-level jurisdictions lacked dedicated or separately reported evidence. Setting-based greenery dominated the five-category NbS classification. Of 126 association units, 100 (79.4%) were favorable; null or adverse findings were confined to specific exposures or contexts, including allergenic or low-diversity vegetation and reduced visibility. Although the two subsets covered broadly similar topics, China-specific studies relied more heavily on aggregate greenness indices (e.g., NDVI: 73.3% versus 45.5%), less often distinguished vegetation types or strata (14.4% versus 36.4%), and included no studies treating urban trees or community gardens as distinct exposures. These findings support five China-specific policy priorities and adapt four international policy themes to Chinese governance contexts. Full article

(This article belongs to the Section Environmental Health)

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31 pages, 420 KB

Open AccessArticle

Co-Creating Healthy Ageing: A Mixed-Methods Pilot Study of a Community-Based Intergenerational Programme

by Adelinda Araújo Candeias and Adriana Simões Félix

Int. J. Environ. Res. Public Health 2026, 23(9), 1156; https://doi.org/10.3390/ijerph23091156 (registering DOI) - 5 Sep 2026

Abstract

Population ageing, social isolation, and limited opportunities for meaningful contact between generations pose important challenges to healthy ageing and community well-being. This mixed-methods pilot study examined the feasibility, acceptability, co-creation process, and preliminary outcomes of the P-IN Programme, a community-based intergenerational intervention involving [...] Read more.

Population ageing, social isolation, and limited opportunities for meaningful contact between generations pose important challenges to healthy ageing and community well-being. This mixed-methods pilot study examined the feasibility, acceptability, co-creation process, and preliminary outcomes of the P-IN Programme, a community-based intergenerational intervention involving preschool children and older adults living in residential care. The programme was developed and implemented in partnership with a preschool and a residential care facility in Portugal and comprised ten intergenerational sessions shaped through an iterative co-creation process involving participants, professionals, and researchers. Twenty-three children, eighteen older adults, and five professionals contributed to the study. Quantitative pre–post assessment explored fluency in both generations and cognitive functioning, quality of life, subjective well-being, and social participation in older adults. Qualitative data examined intergenerational beliefs, participants’ experiences, relationships, and reciprocal learning, while also informing the co-creation process. Most quantitative outcomes remained stable, although cognitive functioning showed a moderate, non-significant effect. Perceived quality of life changed significantly in an unfavourable direction. In contrast, qualitative findings revealed broader and more relational representations of the other generation, alongside shared experiences and clearer recognition of reciprocal learning. The integration of both components showed that positive relational and experiential changes were not necessarily accompanied by changes in broader standardised outcomes. Overall, the P-IN Programme was feasible to implement and generally well received within the two participating community settings. These findings support further evaluation of co-created intergenerational programmes using larger samples, controlled designs, and longer-term follow-up. Full article

(This article belongs to the Special Issue Health and Vulnerability in Societal Emotional Environments: Community-Based Interventions, Public Policy, and Environmental Determinants)

17 pages, 294 KB

Open AccessArticle

Beyond Belief: Immigrant Youths’ Socially Constructed Climate Change Risk Perceptions and Implications for Climate Communication and Public Health

by Md Badrul Hyder, Ranjan Datta, Didem Erman, Mozharul Islam, Mustahseem Chowdhury, Ruksana Rashid and Tanvir C. Turin

Int. J. Environ. Res. Public Health 2026, 23(9), 1155; https://doi.org/10.3390/ijerph23091155 (registering DOI) - 5 Sep 2026

Abstract

Climate change perception among youth has gained increasing scholarly attention; however, immigrant youth remain underrepresented in empirical research despite navigating climate change impacts across multiple sociocultural and geopolitical contexts. This study investigates (1) immigrant youths’ beliefs about climate change, (2) how climate risks [...] Read more.

Climate change perception among youth has gained increasing scholarly attention; however, immigrant youth remain underrepresented in empirical research despite navigating climate change impacts across multiple sociocultural and geopolitical contexts. This study investigates (1) immigrant youths’ beliefs about climate change, (2) how climate risks are perceived across space and time, and (3) how they construct their climate change beliefs and associated risks. Drawing on Social Constructivism, and Risk Perception Theory, the study employs a qualitative descriptive design using eight focus group discussions with 41 immigrant youth aged 14–18 in Calgary, Canada. Reflexive thematic analysis reveals that immigrant youth widely recognise climate change as real and intensifying, with beliefs shaped through lived and observed environmental experiences, social interaction, family narratives, and transnational comparisons rather than abstract scientific reasoning alone. Climate risk perception emerges as complex and relational. Participants associated climate change with impacts on health, wellbeing, food security, and everyday life; however, they often perceived its most severe consequences as temporally and spatially distant. This produces a notable “belief–risk gap,” where acceptance of climate change does not translate into a strong sense of personal vulnerability or urgency. Risk perceptions are mediated by everyday experiences, institutional trust in the host country, and comparisons with other global crises. The findings highlight the critical role of transnational experiences in shaping climate understanding and advance an integrated interpretation linking socially constructed climate knowledge with perceptions of risk and psychological distance, with implications for climate communication and public health communication strategies for immigrant youth. Full article

14 pages, 311 KB

Open AccessProtocol

Violent Disciplinary Practices in Early Childhood Among Low-Income Families: A Protocol for a Global Scoping Review

by Anyelle Barroso Saldanha, Denise Lima Nogueira, Tiago Neuenfeld Munhoz, Marcia Maria Tavares Machado, Luciano Lima Correia and Ana Cristina Lindsay

Int. J. Environ. Res. Public Health 2026, 23(9), 1154; https://doi.org/10.3390/ijerph23091154 - 4 Sep 2026

Abstract

Parenting practices involving violent discipline are a global health concern, particularly among low-income families. While the current literature offers general prevalence data, it lacks a comprehensive global perspective evaluating how diverse sociodemographic, cultural, and historical contexts intersect within disadvantaged households. This scoping review [...] Read more.

Parenting practices involving violent discipline are a global health concern, particularly among low-income families. While the current literature offers general prevalence data, it lacks a comprehensive global perspective evaluating how diverse sociodemographic, cultural, and historical contexts intersect within disadvantaged households. This scoping review protocol aims to map the global evidence on parenting practices related to physical and psychological violence used as disciplinary practices against children within low-income contexts. Following the JBI Manual for Evidence Synthesis and PRISMA-ScR guidelines, we will conduct a comprehensive search across databases, including MEDLINE/PubMed (via the National Library of Medicine), CINAHL (EBSCO), APA PsycINFO (APA), Embase (Elsevier), ERIC, IBECS (via the VHL) and the WHO Global Index Medicus to capture global evidence published in recent years. Studies published in English, Portuguese, and Spanish between January 2015 and June 2026 that report violent disciplinary practices by parents or caregivers of children aged 1–8 years will be included. Rayyan software will assist with study selection. Mapping these practices across diverse socioeconomic settings may clarify current research gaps and synthesize the characteristics of families globally, shifting the interpretation of violent discipline from isolated parental choices to broader understanding of its social determinants and providing a clearer baseline to support future child protection research. Full article

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

14 pages, 315 KB

Open AccessArticle

Breastfeeding Myths Among Nursing and Midwifery Students: A Descriptive Cross-Sectional Study

by Şehma Şen, Meserret Aslan, Songül Gökkaya and Elif İlhan

Int. J. Environ. Res. Public Health 2026, 23(9), 1153; https://doi.org/10.3390/ijerph23091153 - 4 Sep 2026

Abstract

Background: Breastfeeding myths held by healthcare professionals may affect the accuracy and consistency of counseling provided to women and families. This study evaluated nursing and midwifery students’ breastfeeding myths and associated factors. Methods: This descriptive, cross-sectional study included 218 nursing and midwifery students [...] Read more.

Background: Breastfeeding myths held by healthcare professionals may affect the accuracy and consistency of counseling provided to women and families. This study evaluated nursing and midwifery students’ breastfeeding myths and associated factors. Methods: This descriptive, cross-sectional study included 218 nursing and midwifery students at a university in Türkiye. Data were collected using a Personal Information Form and the Breastfeeding Myths Scale (BMS). Descriptive statistics, nonparametric tests, Spearman correlation, and a multivariable generalized linear model with robust covariance estimates were used. Results: The mean age was 21.24 ± 1.80 years, and 196 participants (89.9%) were female. The mean BMS score was 67.43 ± 16.39; 214 students (98.2%) had low myth levels and 4 (1.8%) had high levels. In unadjusted analyses, scores differed by gender, department, academic year, family breastfeeding experience, perceived knowledge, and age. In the adjusted model, female students had lower scores than male students (B = −9.481, 95% CI: −18.261 to −0.700, p = 0.034), nursing students had lower scores than midwifery students (B = −4.557, 95% CI: −8.321 to −0.793, p = 0.018), and each one-year increase in age was associated with a 1.52-point decrease in BMS scores (B = −1.524, 95% CI: −2.884 to −0.163, p = 0.028). Academic year, parental education, family income, family breastfeeding experience, and perceived knowledge were not independently associated with BMS scores. Conclusions: Most students had low levels of breastfeeding myths. Female gender, nursing enrollment, and older age were associated with lower BMS scores; however, the gender finding should be interpreted cautiously because all male participants were nursing students. Full article

(This article belongs to the Special Issue Reproductive Health Decision-Making Among Women and Couples)

19 pages, 1059 KB

Open AccessArticle

Quantitative Evaluation of a Community DX Health Promotion Initiative Using Wearable Sensor Data: A Case Study in Older Adults

by Jongseong Gwak, Takayuki Fujie, Akira Motohashi and Tatsumi Tokunaga

Int. J. Environ. Res. Public Health 2026, 23(9), 1152; https://doi.org/10.3390/ijerph23091152 - 4 Sep 2026

Abstract

Community-based digital transformation (DX) initiatives are increasingly used to promote healthy aging, although their effects are often evaluated using subjective self-reported measures. This study aimed to quantitatively evaluate a community DX health promotion initiative with Takashimadaira as its primary target area in Japan [...] Read more.

Community-based digital transformation (DX) initiatives are increasingly used to promote healthy aging, although their effects are often evaluated using subjective self-reported measures. This study aimed to quantitatively evaluate a community DX health promotion initiative with Takashimadaira as its primary target area in Japan using wearable sensor data. A total of 500 community-dwelling older adults participated in the initiative, and wearable sensor data were obtained from 355 participants during the five-month observational period. The initiative combined wearable device distribution with event-information dissemination via the messaging platform. Daily step count and heart-rate indices were analyzed. Within-participant analyses showed significant increases in daily step counts in the information-provision groups, whereas the primary linear mixed-effects model showed no significant information-provision × time interaction for daily step count. Information provision was associated with differences in mean and minimum daily heart rate in cross-sectional analyses. Adherence and dropout also varied by residential area. Age, BMI, and exercise frequency were associated with several health-related indices, but these associations were not interpreted as evidence of wearable measurement validity. These findings demonstrate the potential utility of using wearable sensor data to evaluate longitudinal changes in health-related behavior and physiological signals in community-based DX initiatives, while also revealing important feasibility limitations, including substantial attrition (only 222 of 355 participants met the 14-day criterion; 90-day dropout 58.3%) and indicating that observed within-participant changes should not be interpreted as demonstrated intervention effects. Community context may also be relevant to sustained participation in such programs. Full article

(This article belongs to the Special Issue Community-Based Physical Activity Interventions for Health and Well-Being)

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20 pages, 3408 KB

Open AccessArticle

Quality, Safety, and Public Awareness of Regulated and Unregulated Cannabis Products: A Comparative Survey Study of Dispensary Customers and the General Public Integrated with Laboratory Evaluation

by Arvind Bagde, Hannah Burton, Sediqua Mctier, Sanskar Chouhan, Rajesh Singh Rathore, Tammie Johnson and Mandip Singh

Int. J. Environ. Res. Public Health 2026, 23(9), 1151; https://doi.org/10.3390/ijerph23091151 - 4 Sep 2026

Abstract

Cannabis use is expanding rapidly across the United States, yet product quality and consumer safety knowledge remain significant public health concerns. This cross-sectional study surveyed 325 adults in Florida dispensary customers (n = 185) and general public participants (n = 140) to compare [...] Read more.

Cannabis use is expanding rapidly across the United States, yet product quality and consumer safety knowledge remain significant public health concerns. This cross-sectional study surveyed 325 adults in Florida dispensary customers (n = 185) and general public participants (n = 140) to compare cannabis use patterns, purchasing behaviors, and safety awareness. Cannabinoid gummy products were characterized using texture analysis; oil and topical formulations were evaluated for label accuracy by high-performance liquid chromatography (HPLC) against USP specifications (90–110% of label claim). Inter-laboratory variability accelerated stability testing, and a machine learning microsimulation projecting knowledge trend (2026–2031) were also conducted. Texture analysis revealed substantial variability in mechanical properties across gummy brands. Oil and topical formulations demonstrated generally acceptable labeling accuracy, though significant inter-laboratory variability in CBD quantification was observed. Dispensary respondents reported more frequent cannabis use, stronger brand loyalty, greater perceived quality-of-life benefits, and higher product knowledge than the general public; however, critical safety knowledge gaps regarding THC–cardiovascular drug interactions and pregnancy risks persisted across both groups. These findings highlight the need for stronger product quality standards, standardized analytical testing, and targeted public health education to promote safe and informed cannabis use. Full article

(This article belongs to the Section Health Care Sciences)

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21 pages, 1256 KB

Open AccessArticle

General Self-Efficacy and Physical Activity Among Healthcare Students: Associations with Self-Reported and Objectively Measured Activity, Physical Activity Habits, and Demographic Characteristics

by Lāsma Spundiņa, Una Veseta, Agita Abele and Māris Munkevics

Int. J. Environ. Res. Public Health 2026, 23(9), 1150; https://doi.org/10.3390/ijerph23091150 - 4 Sep 2026

Abstract

PA is associated with numerous physical and mental health benefits, while self-efficacy is an important associated factor of health-related behaviors. However, evidence of the relationship between general self-efficacy and PA among healthcare students remains limited. This cross-sectional study included 747 healthcare students who [...] Read more.

PA is associated with numerous physical and mental health benefits, while self-efficacy is an important associated factor of health-related behaviors. However, evidence of the relationship between general self-efficacy and PA among healthcare students remains limited. This cross-sectional study included 747 healthcare students who completed an online survey comprising the General Self-Efficacy Scale (GSES), IPAQ-SF, and measures of PA habits. A subsample of 50 participants additionally completed one week of activity monitoring using a Fitbit Versa 4. Associations were examined using non-parametric tests, Spearman’s rank correlation analyses, and multivariable linear regression models. Higher general self-efficacy was associated with greater self-reported PA, more frequent PA habits, and better self-rated physical fitness. Self-efficacy was also weakly associated with lower sitting time during weekends, but not during working days. Bivariate associations between self-efficacy and physical activity-related measures were weak (|ρ| ≤ 0.284). Total self-reported PA remained independently associated with self-efficacy in multivariable models, while the association with exercise frequency was attenuated after accounting for self-rated physical fitness. Model explanatory power was modest (adjusted R² = 0.054–0.073). No clear associations were observed between self-efficacy and objectively measured weekly steps or active zone minutes. The agreement between self-reported and device-based measures was partial. General self-efficacy was associated with self-reported PA and perceived physical fitness, although associations were modest. Findings should be interpreted cautiously given the cross-sectional design, small monitoring subgroup, and multiple exploratory comparisons. Longitudinal studies are needed to clarify temporal relationships. Full article

(This article belongs to the Special Issue Physical Activity and Its Association with Health in University Students)

22 pages, 2226 KB

Open AccessArticle

by Kanokporn Somporn, Niwat Songsin, Sittichai Singsu and Adithep Phranphithak

Int. J. Environ. Res. Public Health 2026, 23(9), 1149; https://doi.org/10.3390/ijerph23091149 - 4 Sep 2026

Abstract

Background: Health-promoting behavior is central to healthy aging, and digital platforms are an increasingly important channel through which older adults encounter health information. This study examined demographic, health-status, and health-related social media use factors associated with health-promoting behavior among older adults in Samut [...] Read more.

Background: Health-promoting behavior is central to healthy aging, and digital platforms are an increasingly important channel through which older adults encounter health information. This study examined demographic, health-status, and health-related social media use factors associated with health-promoting behavior among older adults in Samut Songkhram Province, Thailand, a small province with a disproportionately large share of older residents. Methods: A cross-sectional study was conducted among 402 community-engaged, functionally independent adults aged ≥ 60 years, recruited through a mixed multistage procedure with convenience recruitment at the individual level in the final stage, at community gathering points. Health-related social media use (22 items, four proposed content domains) and health-promoting behavior (31 items, six domains, adapted from the Health-Promoting Lifestyle Profile-II) were measured using structured, pilot-tested questionnaires. Associations were assessed with Spearman correlation and simultaneous multiple linear regression. Because regression diagnostics indicated heteroscedasticity, HC3 heteroscedasticity-consistent standard errors, 95% confidence intervals, and p-values were used as the primary regression inference. Results: Overall health-related social media use (M = 2.58, SD = 0.55) and health-promoting behavior (M = 3.34, SD = 0.48) were both classified as “high” under the pre-specified four-band descriptive convention. The adjusted model explained 54.65% of the variance in health-promoting behavior (R² = 0.5465; adjusted R² = 0.5349). Under HC3 robust inference, overall health-related social media use (β = 0.715, p < 0.001), marital status, bachelor’s-degree-or-higher education (inverse association), chronic condition status, and average monthly income (small inverse association, p = 0.032) were independently associated with the outcome. In a domain-specific sensitivity model, general/recreational use (B = 0.439, HC3 95% CI: 0.345 to 0.533, p < 0.001) and diverse types of use (B = 0.112, HC3 95% CI: 0.040 to 0.184, p = 0.002) were independently associated with health-promoting behavior, whereas duration of use and interpersonal health communication were not. Conclusions: Greater overall health-related social media use was associated with health-promoting behavior among community-engaged, functionally independent older adults; however, the domain-specific pattern suggests that this association primarily reflects broader digital/social engagement rather than specifically health-focused social media activity. Given the cross-sectional design, weak support for the proposed social-media subdomain structure, and the possibility of common-method variance and construct overlap, the findings should be regarded as hypothesis-generating and require confirmation in longitudinal or intervention studies using psychometrically refined measures. Full article

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18 pages, 3895 KB

Open AccessArticle

Impact of a Treatment Peer-Support Intervention on Linkage and Retention in Long-Term Hepatitis B Care in the West Nile Region of Uganda: An Interrupted Time Series Study

by Joan Nankya Mutyoba, Julius Kiwanuka, Lourita Nakyagaba, Sara Nsibirwa, Emmanuel Seremba and Ponsiano Ocama

Int. J. Environ. Res. Public Health 2026, 23(9), 1148; https://doi.org/10.3390/ijerph23091148 - 4 Sep 2026

Abstract

Background: Strengthening hepatitis B(HBV) linkage and retention in care remains critical to the elimination of population health risks posed by HBV. Yet too few studies have assessed the effectiveness of peer-support-driven HBV care models in enhancing continuity in care in low-resource settings. Methods: [...] Read more.

Background: Strengthening hepatitis B(HBV) linkage and retention in care remains critical to the elimination of population health risks posed by HBV. Yet too few studies have assessed the effectiveness of peer-support-driven HBV care models in enhancing continuity in care in low-resource settings. Methods: We co-designed and evaluated the impact of a treatment peer-support (TPS) intervention on HBV linkage and retention in care at two study sites (Arua and Koboko Hospitals) located in the north-west sub-region of Uganda using a quasi-experimental interrupted time series design and assessed factors related to long-term retention. Results: After TPS intervention, changes in the post-intervention trends of linkage to care of 16.2% (95% CI: 3.3, 29.0) (p = 0.014) and 45.9% (95% CI: 26.1, 65.6) (p < 0.001) were observed for Arua and Koboko respectively. Differences between pre- and post-intervention trends were 11.9% (95% CI: 0.3, 23.5) (p = 0.044) and 34.6% (95% CI: 29.5, 39.7) (p < 0.001) for Arua and Koboko respectively. The post-intervention level change for early retention increased by 6.4% (95% CI: 0.4, 12.4) (p = 0.035) at Arua but not at Koboko (22.8%, 95% CI: −20.9, 66.5) (p = 0.306). At Arua, the TPS intervention correlated with an overall declining trend of −3.9% (95% CI: −5.4, −2.3) (p < 0.001), while at Koboko it correlated with a difference between pre- and post-intervention trends of 0.7% (95% CI: −0.01, 1.4) (p = 0.053). For long term retention, the TPS intervention correlated with a change in post-intervention trend of −1.5% (95% CI: −2.3, −0.7) (p < 0.001) and a difference between pre- and post-intervention trends of −1.4% (95% CI: −2.1, −0.6) (p < 0.001) at Arua hospital. At Koboko hospital, the TPS intervention was associated with a difference between pre- and post-intervention trends of 12.8% (95% CI: 9.8, 15.8) (p < 0.001). In the stratified analysis, early retention was associated with the TPS intervention at Koboko (aPR = 1.16, 95% CI: 1.05, 1.28) (p = 0.004) but not Arua (aPR = 1.01, 95% CI: 0.95, 1.06) (p = 0.771). At Arua hospital, a previous history of HBV treatment predicted early retention in care (aPR = 1.08, 95% CI: 1.05, 1.11) (p < 0.001), whereas at Koboko, a PLHBV having a “treatment buddy” (aPR = 1.21, 95% CI: 1.11–1.33) (p < 0.001), being aged 19–24 years (aPR = 1.39, 95% CI: 1.04, 1.88) (p = 0.026) and being aged 25–34 years (aPR = 1.38, 95% CI: 1.04, 1.83) (p = 0.023) predicted early retention. Conclusions: Innovative interventions are needed to advance linkage to care and shift the trajectory of retention in long-term HBV care, including approaches that target young people living with HBV. Full article

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

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9 pages, 424 KB

Open AccessBrief Report

Regional Variation in Parental Stroke History Among Korean Populations: Insights into Chronic Disease Risk

by Grace Heyborne, Sujeong Kim, Choongwon Jeong, Martin Tristani-Firouzi, Edgar J. Hernandez and Melissa A. Ilardo

Int. J. Environ. Res. Public Health 2026, 23(9), 1147; https://doi.org/10.3390/ijerph23091147 - 4 Sep 2026

Abstract

Background: Despite having one of the highest prevalences of hypertension in Korea, Jeju Island maintains the lowest rate of stroke mortality nationwide. This paradoxical cardiovascular disease health profile raises questions about the underlying factors contributing to differential stroke risk in the Jeju population. [...] Read more.

Background: Despite having one of the highest prevalences of hypertension in Korea, Jeju Island maintains the lowest rate of stroke mortality nationwide. This paradoxical cardiovascular disease health profile raises questions about the underlying factors contributing to differential stroke risk in the Jeju population. Methods: We used health data from the Korea National Health and Nutrition Examination Survey (KNHANES) to investigate whether differences in regional stroke outcomes can be explained by known environmental and behavioral health contributors to increased cerebrovascular disease risk. We applied logistic regression with backward feature selection and cross-validation to identify predictors of parental history of stroke. Results: We found that individuals from Jeju Island were less likely to report a parental history of stroke compared to individuals from Seoul. This finding persisted even after adjusting for known cerebrovascular risk factors, including age, sex, SBP, antihypertensive use, dietary sodium intake, BMI, and hematocrit. Conclusions: Our results suggest that other hidden factors may contribute to the risk of cerebrovascular disease. Given the unique genetic architecture of the island, these findings prompt future analyses to explore whether genetic variation on Jeju contributes meaningfully to their reduced stroke mortality. Full article

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5 pages, 1865 KB

Open AccessCorrection

Correction: Mazareanu et al. Estrogen Status and Temporomandibular Disorders: A Systematic Review. Int. J. Environ. Res. Public Health 2026, 23, 717

by Alexandru Mazareanu, Claudia Grigorov, Alin Pandea, Maria Iacob, Dragos George Balaiasa, Tzvika Greenbaum and Petr Konecny

Int. J. Environ. Res. Public Health 2026, 23(9), 1146; https://doi.org/10.3390/ijerph23091146 - 4 Sep 2026

Abstract

In the original publication [...] Full article

(This article belongs to the Special Issue Headache and Evidence-Based Rehabilitation Strategies)

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17 pages, 454 KB

Open AccessArticle

Mental Health Burden and Developmental Timing of Premature Ovarian Insufficiency in Adolescents and Young Adult Females: A Retrospective Cohort Study

by Faith Summersett Williams, Isabella Zaniletti, Lindsay F. Schwartz, Robert Garofalo, Lisa M. Kuhns, Karin Felsher, Yiyang Liu and Melissa Simon

Int. J. Environ. Res. Public Health 2026, 23(9), 1145; https://doi.org/10.3390/ijerph23091145 - 2 Sep 2026

Abstract

POI and EOI are rare but impactful conditions among adolescents and young adults (AYAs). Little is known about the timing and incidence of mental health (MH) conditions among AYAs diagnosed with POI/EOI. Data were collected using MarketScan Medicaid administrative claims among females aged [...] Read more.

POI and EOI are rare but impactful conditions among adolescents and young adults (AYAs). Little is known about the timing and incidence of mental health (MH) conditions among AYAs diagnosed with POI/EOI. Data were collected using MarketScan Medicaid administrative claims among females aged 12–25 with POI/EOI. Merative™ MarketScan^® Research Databases are large, de-identified U.S. administrative healthcare claims databases that contain individual-level information on enrollment, inpatient and outpatient medical services, and outpatient prescription drug claims. The databases include commercially insured individuals, Medicare beneficiaries with employer-sponsored supplemental coverage, and selected Medicaid populations. Claims are linked longitudinally using unique encrypted patient identifiers, allowing individuals to be followed over time across healthcare settings. In addition to healthcare utilization, the databases include demographic characteristics, diagnosis and procedure codes, dates of service, and payment information, making them well suited for epidemiologic, health services, and outcomes research. We characterized prevalence and timing of MH diagnoses, examined MH subtypes, and estimated new-onset MH among those without prior MH. Comparisons were made to demographically matched controls without POI/EOI (matched on age and calendar time) and to diagnosis-anchored comparator groups. Among 859 AYAs with POI/EOI, 53.9% had any MH diagnosis, including 32.9% with MH diagnoses before and after POI/EOI diagnosis and 11.9% with new-onset MH after POI/EOI diagnosis. Of all anxiety disorders, 60.1% were present pre- and post-diagnosis, while 25.4% were new-onset after diagnosis. Depressive disorders showed a similar pattern, with 58.1% being pre- and post-diagnosis MH group and 22.3% being new-onset. In total, 49.4% of individuals with trauma-related disorders had the diagnosis both before and after POI/EOI diagnosis, while 30.1% had it as a new-onset. In adjusted models, POI/EOI was associated with increased odds of MH diagnoses after diagnosis (aOR ~2.1, 95% CI ~1.4–3.1). Prior MH diagnoses were the strongest predictor of MH after diagnosis (aOR ~12.1). AYAs with POI/EOI experience substantial MH burden, with elevated risk of new-onset MH conditions following diagnosis. Findings highlight the importance of early MH screening and integrated care models for AYAs. Full article

(This article belongs to the Special Issue Addressing Adolescent Sexual and Reproductive Health Disparities: Determinants, Effectiveness, and Implementation)

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17 pages, 377 KB

Open AccessArticle

Sustaining Mana in Mate Wareware Care: Whānau Perspectives

by Kirsten Robertson (Kāi Tahu), Tui Kaitai-Martin (Kāi Tahu), Rob Thomson, Diane Ruwhiu (Ngā Puhi) and Maree Thyne

Int. J. Environ. Res. Public Health 2026, 23(9), 1144; https://doi.org/10.3390/ijerph23091144 - 2 Sep 2026

Abstract

Māori experience inequities in the recognition of mate wareware and in access to dementia and aged care support in Aotearoa New Zealand. Less is known about how whānau experience supporting a whānau member with mate wareware, what support they find helpful, and what [...] Read more.

Māori experience inequities in the recognition of mate wareware and in access to dementia and aged care support in Aotearoa New Zealand. Less is known about how whānau experience supporting a whānau member with mate wareware, what support they find helpful, and what they consider important for mate wareware-friendly communities. This kaupapa Māori qualitative study involved a co-design phase with seven kaumātua, which informed the study questions and whānau hui guide, followed by ten in-depth whānau Māori hui involving 12 individual participants; the whānau hui formed the analytic dataset. Whānau hui data were analysed using reflexive thematic analysis. Four interconnected themes were developed: delayed recognition; whānau caregiving as collective strength alongside concentrated responsibility; sustaining wairua, identity, and belonging; and care transitions and structural barriers. Interpreted together, these themes informed a four-condition account of mana-preserving care, in which mana may be sustained or eroded through interactions among recognition and knowledge, whānau caregiving, wairua, identity and belonging, and service and institutional conditions at transitions. Where continuity fragmented, whānau frequently undertook integrative work to bridge gaps across people, places, culture, and services. The findings point to earlier mate wareware information and support through Māori-facilitated and community-based approaches, support that recognises concentrated caregiving responsibility, continuity across services and transitions, and routine practices that embed tikanga, while reducing reliance on whānau to compensate for fragmentation. Full article

(This article belongs to the Special Issue Improving Health and Social Care Services for People with Dementia)

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18 pages, 1465 KB

Open AccessArticle

Tree Canopy and Self-Reported Mental and Physical Health in Urban Alabama: A Census Tract-Level Ecological Study

by Simona N. Shirley, Bisakha Sen, Ye Liu, Rajarshi Dey, Elizabeth H. Baker and Laurie A. Malone

Int. J. Environ. Res. Public Health 2026, 23(9), 1143; https://doi.org/10.3390/ijerph23091143 - 2 Sep 2026

Abstract

Background: Urban tree canopy, the proportion of a city’s land surface covered by trees, has been linked to physical and mental health benefits. This association is understudied in the U.S. Deep South despite its high burden of poor health and environmental inequity. This [...] Read more.

Background: Urban tree canopy, the proportion of a city’s land surface covered by trees, has been linked to physical and mental health benefits. This association is understudied in the U.S. Deep South despite its high burden of poor health and environmental inequity. This study examined associations between census tract-level tree canopy and self-reported mental and physical health in urban Alabama. Methods: We linked tract-level tree canopy estimates for Alabama metropolitan statistical areas with self-reported health and contextual measures from publicly available data, retaining tree canopy as the exposure of interest. A bootstrap-stabilized penalized variable-selection approach identified covariates from socioeconomic, demographic, housing, transportation, environmental, and health-related measures; we then mapped spatial distributions and fit spatial error multivariable models. Results: A higher proportion of land surface covered by trees was associated with a lower age-adjusted prevalence of adults who report 14 or more days during the past 30 days during which their mental health was not good (estimate: −0.0110; p < 0.001). A higher proportion of land surface covered by trees was also associated with a lower age-adjusted prevalence of adults who report 14 or more days during the past 30 days during which their physical health was not good (estimate: −0.0045; p = 0.002). Spatial error parameters persisted in both models, indicating residual spatial patterning not fully explained by canopy or the selected covariates. Conclusions: The findings extend the urban tree canopy literature to an understudied setting and demonstrate how publicly available tract-level data, combined with machine learning-guided covariate selection and spatial modeling, can generate actionable hypotheses for environmental health and equity research. Full article

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21 pages, 433 KB

Open AccessArticle

Water Insecurity as Health Crisis: Everyday Embodiment and Gendered Vulnerability Among Girls in Ghana’s Upper West Region

by Mildred Naamwintome Molle, Sulemana Ansumah Saaka, Cornelius K. A. Pienaah, Elijah Bisung and Isaac Luginaah

Int. J. Environ. Res. Public Health 2026, 23(9), 1142; https://doi.org/10.3390/ijerph23091142 - 2 Sep 2026

Abstract

In semi-arid Ghana, girls bear primary responsibility for household water collection in communities without on-premises access, a burden intensified by climate change associated with rising temperatures and frequent droughts. Yet little is known about how this responsibility shapes their embodied health and well-being. [...] Read more.

In semi-arid Ghana, girls bear primary responsibility for household water collection in communities without on-premises access, a burden intensified by climate change associated with rising temperatures and frequent droughts. Yet little is known about how this responsibility shapes their embodied health and well-being. Guided by a political ecology of health framework, this qualitative study examined how water insecurity shapes girls’ physical, psychosocial, and neurological health in two communities, Wechiau and Kandue, in Ghana’s Upper West Region. We conducted in-depth interviews with nineteen purposively selected girls aged 10 to 19 and analyzed the transcripts thematically. Four interconnected themes emerged: structural and political determinants of water access, environmental and ecological conditions, gendered social relations, and embodied health consequences. Financial barriers, governance failures, and infrastructure deficits force girls into long queues and repeated trips, a burden that falls disproportionately on girls under cultural norms exempting boys from water duties. This gendered allocation of labour produces gendered health harm, whereby girls sustain musculoskeletal pain and injury carrying heavy loads over hazardous terrain, while chronic time loss disrupts sleep, schooling, and psychological well-being. Girls with pre-existing conditions such as epilepsy face the most acute risk, as water fetching directly exacerbates their vulnerability to seizures. These findings show that addressing this crisis requires more than infrastructure investment. Coordinated public–private investment in water access must be paired with social protection for vulnerable households, gender-responsive water policy, and rainwater-harvesting strategies that confront the structural and gendered inequities placing this burden on girls. Full article

(This article belongs to the Special Issue Health Impacts of Resource Insecurity on Vulnerable Populations)

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26 pages, 657 KB

Open AccessReview

Shame, Stigma and Indebtedness in Gambling-Related Harm: A Rapid Review of Help-Seeking and Suicidality

by Sharon Mallon, Jessica Runacres, Fiona McCormack, Victoria Riley and Emily Motta-Yanac

Int. J. Environ. Res. Public Health 2026, 23(9), 1141; https://doi.org/10.3390/ijerph23091141 - 2 Sep 2026

Abstract

Background: Gambling-related harm is recognised as a public health concern, yet limited synthesis has examined how shame, stigma and indebtedness shape help-seeking and suicidality across gendered and cultural contexts. This review addressed the following question: among individuals experiencing gambling-related harms, how do cultural [...] Read more.

Background: Gambling-related harm is recognised as a public health concern, yet limited synthesis has examined how shame, stigma and indebtedness shape help-seeking and suicidality across gendered and cultural contexts. This review addressed the following question: among individuals experiencing gambling-related harms, how do cultural and gender-based understandings of shame and indebtedness influence suicidality and help-seeking across diverse settings? Methods: This rapid review searched MEDLINE, PsycINFO and CINAHL, alongside grey-literature and reference-list searches, for studies since 2000. Included studies were appraised (CASP, MMAT, or MQC-SP) and synthesised narratively. Results: Twenty-six qualitative, quantitative and mixed-methods studies were included. Gambling was portrayed as socially embedded and normalised, while gambling-related harm remained associated with judgement. Shame was linked to concealment, self-management and delayed disclosure. Indebtedness was associated with concealment, relationship strain, and sometimes made previously hidden gambling-related harm visible; however, the evidence did not allow firm conclusions about its relationship with crisis or suicidality. Help-seeking commonly occurred after harms had escalated and was facilitated by confidential, non-judgemental and culturally appropriate support. Gender and culture shaped meanings of responsibility, control, family reputation and disclosure, but were rarely examined analytically. Conclusions: Public health responses should improve early recognition of gambling-related harm through clear, non-judgemental messaging and stronger links between support services. Further research should clarify how shame, stigma and indebtedness relate to disclosure and suicidal distress, and should evaluate public health messaging, early-support routes, self-directed interventions and support for affected others. Full article

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

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22 pages, 356 KB

Open AccessReview

Culturally Sensitive Dimensions of Subjective Wellbeing Linked to Objective Measures: A Narrative Review

by Joy M. Rooney

Int. J. Environ. Res. Public Health 2026, 23(9), 1140; https://doi.org/10.3390/ijerph23091140 - 31 Aug 2026

Abstract

Background: Subjective wellbeing frameworks are widely used to determine individual and collective holistic dimensions of wellness. Increasingly, they may be linked to objective measures for use in government wellbeing policy-making across the world, although their cultural sensitivity is questioned. Methods: Fifty-nine peer-reviewed studies [...] Read more.

Background: Subjective wellbeing frameworks are widely used to determine individual and collective holistic dimensions of wellness. Increasingly, they may be linked to objective measures for use in government wellbeing policy-making across the world, although their cultural sensitivity is questioned. Methods: Fifty-nine peer-reviewed studies published between 2000 and 2026 were identified following Boolean searches in open access journals, screened, and quality assessed. Translated Western-English frameworks of seven authorities were compared, as were those ten within indigenous cultural groups. Ten other studies for consideration included objective and cultural dimensions. The remainder were used in background and synthesis presentation. Results: Five themes were distinguished: use of solid theoretical background; conceptual rationale for framework; methodological limitations; links, convergence, divergence, and contradictions; conceptual rationale for interpretation of related findings and theoretical considerations. Within a cultural group, even with great care in translation, and semantic amendments, most authorities’ dimensions of wellbeing models were questioned. Many interesting and adequate indigenous frameworks need invariance and longitudinal testing. Studies including quantitative objective measures of wellbeing more clearly defined unique cultural group effects within their environments. Conclusions: Dimensions of wellbeing need to be created, validated and reliably evaluated within the cultural groups they are intended to be used, rather than using translations. Much more quantitative research is needed with lay-consultation before, during, and following longitudinal studies. Full article

(This article belongs to the Section Global Health)

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