International Journal of Environmental Research and Public Health

18 pages, 576 KB

Open AccessArticle

Do Basic Psychological Needs and Self-Determined Motivation Outweigh Physical Activity Volume and Body Composition in Explaining Subjective Well-Being Among Community Gym Users?

by Marco Batista, João Freitas, Vera Simões, Ana Conceição, Marta Martins, Eduardo Teixeira, Paulo Rosa and Hugo Louro

Int. J. Environ. Res. Public Health 2026, 23(9), 1139; https://doi.org/10.3390/ijerph23091139 (registering DOI) - 31 Aug 2026

Abstract

This study examined the relative contribution of sociodemographic, psychological, behavioral, and physiological factors to subjective well-being (SWB) among community gym users and investigated the indirect association between basic psychological need satisfaction and SWB through self-determined motivation. A cross-sectional study was conducted with 348 [...] Read more.

This study examined the relative contribution of sociodemographic, psychological, behavioral, and physiological factors to subjective well-being (SWB) among community gym users and investigated the indirect association between basic psychological need satisfaction and SWB through self-determined motivation. A cross-sectional study was conducted with 348 adults (31.53 ± 12.86 years) recruited from community gyms in Portugal. Participants completed validated measures of basic psychological need satisfaction, motivational regulation, life satisfaction, and positive and negative affect. Moderate-to-vigorous physical activity (MVPA) was assessed through self-reported weekly physical activity, and body composition through bioelectrical impedance. Hierarchical multiple linear regression and mediation analysis were performed. Missing data were addressed using multiple imputation. Psychological variables produced the largest increase in explained SWB variance (ΔR² = 0.173, p < 0.001). MVPA added only 0.2% (ΔR² = 0.002, p = 0.478), while body composition indicators added 1.0% (ΔR² = 0.010, p = 0.303). The final model explained 21.7% of SWB variance. A significant indirect association through self-determined motivation was observed (B = 0.228, 95% CI [0.139, 0.324]). Psychological variables provided greater explanatory information about SWB than MVPA or body composition. The findings highlight the relevance of psychological experiences in exercise settings, while the cross-sectional design precludes causal interpretations. Full article

(This article belongs to the Special Issue Physical Activity, Body–Mind Training and Well-Being in Community Settings)

21 pages, 435 KB

Open AccessArticle

Feasibility of Targeted Case-Finding of Polyendocrine Metabolic Ovarian Syndrome in the Workplace: A Pilot Cohort Study

by Nicola Magnavita

Int. J. Environ. Res. Public Health 2026, 23(9), 1138; https://doi.org/10.3390/ijerph23091138 (registering DOI) - 31 Aug 2026

Abstract

Polyendocrine metabolic ovarian syndrome (PMOS) is the most common endocrine disorder in working women. Workplace screening could contribute to the early diagnosis and treatment of this chronic condition. Fertile women who participated in a 2022 health food promotion campaign and had suspected eating [...] Read more.

Polyendocrine metabolic ovarian syndrome (PMOS) is the most common endocrine disorder in working women. Workplace screening could contribute to the early diagnosis and treatment of this chronic condition. Fertile women who participated in a 2022 health food promotion campaign and had suspected eating disorders, overweight/obesity, metabolic abnormalities, sleep problems, or mental health concerns were interviewed about PMOS symptoms during their in-office medical examination. Twenty-eight of the 1170 women examined had symptoms of suspected PMOS. By 2023, 21 of these diagnoses had been confirmed by specialists. The prevalence of newly diagnosed PMOS among the women of childbearing age was 2.7% (CI95% 1.7; 4.2). The confirmation rate of the clinical suspicion of PMOS was 75% (CI95% 55.1; 89.3). Female workers with newly identified PMOS had a significantly higher frequency of eating disorders than their pre-menopausal colleagues and higher body mass index values, higher glycemia, and higher cholesterol values. PMOS patients also had higher depression symptom scores than other workers of childbearing age. In conclusion, with a short interview during mandatory medical examinations, the occupational physician can make a significant contribution to the diagnosis of PMOS, thereby hopefully improving the quality of life of women and reducing damage to their health. Full article

(This article belongs to the Special Issue Promoting Health and Safety in the Workplace)

25 pages, 897 KB

Open AccessArticle

Development and Psychometric Validation of the Multidimensional Measure of Purpose in Life II (MMOP-II)

by Louis Fang, Alfred Allan and Joanne M. Dickson

Int. J. Environ. Res. Public Health 2026, 23(9), 1137; https://doi.org/10.3390/ijerph23091137 (registering DOI) - 31 Aug 2026

Abstract

Purpose in life is a central motivational construct that has a profound influence on wellbeing. However, existing measures lack the breadth and precision needed to accurately capture this complex construct. In the present study, we aimed to develop a new measure rooted in [...] Read more.

Purpose in life is a central motivational construct that has a profound influence on wellbeing. However, existing measures lack the breadth and precision needed to accurately capture this complex construct. In the present study, we aimed to develop a new measure rooted in a holistic, systems-based theoretical framework of purpose in life: the 18-item Multidimensional Measure of Purpose in Life II (MMOP-II). In Study 1, our confirmatory factor analyses in a sample of 303 university students (female = 82.5.%, white = 78.5%) supported a strong five-factor higher-order model fit, outperforming the three-factor and unidimensional alternatives. The Study 2 results replicated these findings in a sample of 290 community adults (female = 54%, white = 76.6%). The results from Study 2 also showed that the MMOP-II correlated with concurrent, convergent, and divergent validity measures in theoretically consistent ways. Across both studies, internal consistency reliability met adequate thresholds for all subscales as well as the total MMOP-II score. Overall, our results support purpose in life as a coherent, higher-order construct measurable by the MMOP-II. Future research should aim to examine the test–retest reliability of the MMOP-II and its generalizability in diverse samples. Full article

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

14 pages, 443 KB

Open AccessArticle

Adult Vaccination and Healthy Aging in the UAE: Uptake, Determinants, and Policy Perspectives

by Areeba Irfan, Jinnu Jimmy, Zahraa Farhad, Anugraha Lisa Ciju, Reel Louai, Aadith Soorya Arunkumar Maivizhichelvi, Liju Susan Mathew, Sneha Reji and Jayakumary Muttappallymyalil

Int. J. Environ. Res. Public Health 2026, 23(9), 1136; https://doi.org/10.3390/ijerph23091136 (registering DOI) - 31 Aug 2026

Abstract

Adult vaccination is a critical component of preventive healthcare, reducing morbidity and mortality from vaccine-preventable diseases. Despite established recommendations, adult immunisation coverage remains suboptimal, particularly for vaccines beyond influenza and COVID-19. In the United Arab Emirates (UAE), limited evidence exists regarding adult vaccine [...] Read more.

Adult vaccination is a critical component of preventive healthcare, reducing morbidity and mortality from vaccine-preventable diseases. Despite established recommendations, adult immunisation coverage remains suboptimal, particularly for vaccines beyond influenza and COVID-19. In the United Arab Emirates (UAE), limited evidence exists regarding adult vaccine uptake and determinants influencing immunisation behaviour within its diverse population. Understanding vaccine-specific coverage and associated sociodemographic, healthcare, and workplace factors is essential to guide targeted strategies that strengthen adult immunisation. A cross-sectional study was conducted among 1330 adults aged ≥ 18 years residing in the UAE. Data were collected using a structured self- or interviewer-administered questionnaire assessing uptake of recommended adult vaccines, including COVID-19, influenza, pneumococcal, herpes zoster, Tdap, and HPV. Sociodemographic characteristics, healthcare access, insurance status, workplace factors, and perceived barriers were also assessed. Descriptive statistics summarised vaccination coverage, and associations between uptake and key determinants were examined using SPSS version 30. Statistical significance was defined as p < 0.05. Overall, 71.0% reported receiving at least one adult vaccine. Uptake was highest for COVID-19 (64.9%) and influenza (57.8%), while pneumococcal, herpes zoster, and Tdap coverage remained low (12–13%). HPV uptake was 22.6% among females and 18.9% among males. Higher uptake was observed among females and adults. Social encouragement, insurance coverage, and healthcare access were associated with vaccination, whereas lack of awareness and logistical barriers hindered uptake. Although overall uptake was moderate, significant gaps persist. Integrating vaccination into routine healthcare services and addressing structural and communication barriers are necessary to improve adult vaccination coverage. Full article

(This article belongs to the Section Global Health)

► Show Figures

Figure 1

21 pages, 6385 KB

Open AccessArticle

Emerging Heat Risk in South Florida: Temperature Trends, Hospitalizations, and Lessons from India to Inform Early Public Health Adaptation Strategies

by Luis Armas, Noel Singh Dias, Sarah Rodriguez, Brenda Barreto and Jessy Dévieux

Int. J. Environ. Res. Public Health 2026, 23(9), 1135; https://doi.org/10.3390/ijerph23091135 (registering DOI) - 31 Aug 2026

Abstract

Rising global temperatures are intensifying the frequency, duration, and severity of extreme heat events, posing a growing public health burden worldwide. Heat exposure is increasingly recognized as a major contributor to morbidity and mortality, particularly in regions with high baseline temperatures and large [...] Read more.

Rising global temperatures are intensifying the frequency, duration, and severity of extreme heat events, posing a growing public health burden worldwide. Heat exposure is increasingly recognized as a major contributor to morbidity and mortality, particularly in regions with high baseline temperatures and large vulnerable populations. This study examines long-term temperature trends and their unadjusted association with heat-related health outcomes across major cities in India and counties across South Florida from 2005 to 2023. Major cities in India are used as a high-burden reference setting with established heat adaptation strategies, providing a framework for understanding how similar risks are emerging in South Florida. This comparison is conceptual, given differences in data structure and availability across regions. A retrospective ecological analysis was conducted using secondary data. Climate variables included annual mean temperature, while health outcomes focused on age-adjusted heat-related hospitalization rates. Temporal trends were assessed using graphical analysis and exploratory statistical analysis to inform early public health adaptation strategies. South Florida exhibited a warming rate of approximately +0.0265 °F/year compared to +0.0230 °F/year in major Indian cities, indicating a slightly faster pace of temperature increase in the subtropical region. County-level regression models in South Florida showed strong model fit, with R² values ranging from 0.356 to 0.615 (all p < 0.01), indicating a consistent positive relationship between summer mean temperature and heat-related hospitalization rates. Miami-Dade County demonstrated the strongest association (R² = 0.615), while Palm Beach County showed greater variability despite maintaining a statistically significant relationship (p = 0.007). Across all counties, heat-related hospitalization trends increased over time in parallel with rising temperatures. These findings, even though exploratory and unadjusted, position South Florida as an emerging high-risk region, where increasing temperature trends are beginning to mirror patterns observed in historically heat-burdened settings such as India. Lessons from India’s implementation of heat action plans, early warning systems, and community-level interventions provide a framework for strengthening climate adaptation strategies in South Florida. Full article

(This article belongs to the Special Issue The Effects of Extreme Temperature, Pollution, and Climate Change on Human Health)

► Show Figures

Figure 1

23 pages, 679 KB

Open AccessReview

From Exposure to Intervention: A Scoping Review and Evidence Mapping of Nature-Based Approaches for Postpartum Depression

by Hui Guo, Qiang Wang and Yingqi Guo

Int. J. Environ. Res. Public Health 2026, 23(9), 1134; https://doi.org/10.3390/ijerph23091134 (registering DOI) - 31 Aug 2026

Abstract

Background: Postpartum depression (PPD) affects about 15–20% of women worldwide. While observational studies have increasingly linked nature exposure to improved perinatal mental health, the extent to which nature-based approaches constitute a viable non-pharmacological intervention for PPD remains unclear. This scoping review and evidence [...] Read more.

Background: Postpartum depression (PPD) affects about 15–20% of women worldwide. While observational studies have increasingly linked nature exposure to improved perinatal mental health, the extent to which nature-based approaches constitute a viable non-pharmacological intervention for PPD remains unclear. This scoping review and evidence mapping aimed to systematically characterize the current evidence base for nature-based approaches in PPD and perinatal populations. Methods: We searched PubMed, Web of Science, PsycINFO, Embase, Cochrane Library, Medline, CNKI, and WanFang Data from inception to December 2025. Two independent reviewers screened titles/abstracts and full texts against predefined inclusion criteria, with disagreements resolved through discussion. Empirical studies investigating any nature-based approach (NBA) (e.g., nature exposure, green space, forest therapy) in pregnant or postpartum women were incorporated. The review followed the PRISMA extension for Scoping Reviews (PRISMA-ScR) guidelines. No formal risk-of-bias assessment was conducted, consistent with scoping review methodology. The narrative synthesis and evidence mapping methodology were used to classify findings by population type and research design. Results: Of 1245 screened records, 11 studies fulfilled the inclusion criteria. To address the specific question of nature-based approaches for PPD, we classified evidence by its directness: studies on women with clinically significant PPD symptoms were treated as direct evidence; studies on general perinatal populations were treated as indirect evidence. Evidence mapping uncovered a significant deficiency: there are no randomized controlled trials (RCTs) that have specifically assessed NBA for women with PPD. Direct evidence was confined to two qualitative studies elucidating favorable experiences of nature engagement among postpartum women facing mental health challenges. Indirect evidence from observational studies (n = 10) generally supported associations between exposure to residential green space—especially tree canopy cover—and reduced risk of PPD and psychological distress, although some studies reported null findings. Physical activity was identified as a partial mediator in several studies. Only one pilot RCT focused on general postpartum women, indicating feasibility but not achieving significant depression reduction. Conclusions: Although encouraging observational data suggest a correlation between nature exposure and improved perinatal mental health, robust RCT evidence for structured Nature-Based Interventions in postpartum depression populations is lacking. Subsequent research must formulate and evaluate standardized, theoretically informed NBA protocols specifically tailored for women experiencing PPD. Full article

(This article belongs to the Topic Impact of the Forest Environment on Public Health: Forest Recreation, Forest Therapy, and Forest Bathing)

► Show Figures

Figure 1

19 pages, 317 KB

Open AccessArticle

Patterns of Daily and Non-Daily Nicotine Pouch Use Among U.S. Adults: An Exploratory Analysis of Use Contexts, Harm Perceptions, and Health Characteristics, 2025

by Delvon T. Mattingly, Meman Diaby, Saber Feizy, William A. Middleton, Josie Ricketts, Joy L. Hart, Melinda Ickes and Bethany Shorey Fennell

Int. J. Environ. Res. Public Health 2026, 23(9), 1133; https://doi.org/10.3390/ijerph23091133 (registering DOI) - 31 Aug 2026

Abstract

This study examined differences between daily and non-daily nicotine pouch (NP) use by adults across various contexts in the United States (U.S.). Data were drawn from a cross-sectional survey of adults (≥18 years) reporting past-year NP use (N = 1009). Differences between [...] Read more.

This study examined differences between daily and non-daily nicotine pouch (NP) use by adults across various contexts in the United States (U.S.). Data were drawn from a cross-sectional survey of adults (≥18 years) reporting past-year NP use (N = 1009). Differences between daily and non-daily use groups were assessed using chi-square tests. Among the sample, 17.5% reported daily NP use. Daily use was associated with greater intensity, higher nicotine strength, and distinct situational use, including at home, while commuting, and at work or school (all p < 0.01). Adults who used daily more often endorsed motivations related to stress reduction, craving management, convenience, and product appeal (p ≤ 0.03). Daily use was linked to perceiving NPs as less harmful relative to combustible and smokeless tobacco, and more addictive relative to combustible, vaporized, and smokeless products (p < 0.05). Current and former use of combustible tobacco products, but not other substances, was common and varied by daily/non-daily use. Finally, adults who used daily were more likely to report a diagnosed mental or behavioral health condition (p = 0.002). Daily NP use reflects more intensive and contextually flexible use with distinct motivations and perceptions, underscoring heterogeneity in use patterns and the need for continued surveillance and longitudinal research on potential health implications. Full article

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

16 pages, 302 KB

Open AccessArticle

Influence of Educational Campaigns on Community Knowledge About Chronic Kidney Disease: Results from a Community-Based Campaign

by Mothana Al Jabr, Nouf Alalmaei, Jory Almulhim, Sadeem Saad Alkaluf, Nour Ali Alnhwi, Abdulrahman Alrashed, Khalid Alkhawfi, Doaa Alabdulkraim, Saleh Alyousef, Mohammed Yousef Al Mulhim, Muthana Abdullah Al Sahlawi and Ossama Zakaria

Int. J. Environ. Res. Public Health 2026, 23(9), 1132; https://doi.org/10.3390/ijerph23091132 - 31 Aug 2026

Abstract

Chronic kidney disease (CKD) is an emerging public health problem, and low public awareness may result in late diagnosis and poor outcomes. We evaluated baseline knowledge of CKD among participants in a community awareness campaign and immediate knowledge change following a focused educational [...] Read more.

Chronic kidney disease (CKD) is an emerging public health problem, and low public awareness may result in late diagnosis and poor outcomes. We evaluated baseline knowledge of CKD among participants in a community awareness campaign and immediate knowledge change following a focused educational intervention. The study was designed as a biphasic pre- and post-intervention study that took place over the course of a 3-day public campaign that coincided with World Kidney Day on 13 March 2025. The campaign consisted of six educational stations on important topics of CKD, blood-pressure and blood-glucose measurements, with access to nephrologist consultation. Participants completed a validated questionnaire prior to and after attending the campaign. The changes in knowledge about kidney function, risk factors, symptoms, diagnostic methods, and treatment were evaluated. A total of 134 responses were received; 102 participants were eligible and completed both assessments. Knowledge scores and several item-level response proportions were higher immediately after campaign participation than before participation. The knowledge of diabetes mellitus as a risk factor for CKD increased from 34.3 to 80.4%, the knowledge of blood tests for renal assessment increased from 52.0 to 80.4%, and the knowledge of pharmacological treatments that slow down the progression of CKD increased from 52.9 to 78.4%. The percentage of people who think that herbal medicines are effective to treat CKD decreased from 19.6% to 8.8%. No demographic or clinical predictors of change in overall knowledge were statistically significant, although differences were seen in specific knowledge domains. These findings show higher CKD knowledge immediately after participation in a structured community campaign. Controlled studies with longer follow-up are needed to determine causality, durability, behavior change, and clinical impact. Full article

21 pages, 2669 KB

Open AccessArticle

Mapping District-Level Asbestos Exposure Risk in Java, Indonesia: Integrating Infrastructure, Demographics, and Seismic Vulnerability

by Anna Suraya, Lelitasari, Uci Sulandari, Lulus Suci Hendrawati, Edwina Rudyarti, Yunita Sari Purba, Putri Winda Lestari, Defi Arjuni, Ida Ayu Pusfitasari, Diaz Rosita Dewi, Cantika Fariyah Rahmah, Nada Aqeel Faiz, Deden Nursyafaat, Sayhriel Imam and Maryuni

Int. J. Environ. Res. Public Health 2026, 23(9), 1131; https://doi.org/10.3390/ijerph23091131 - 30 Aug 2026

Abstract

(1) Background: Indonesia is one of the world’s largest consumers of asbestos, with widespread use of asbestos-cement roofing. Java Island, characterized by high population density and seismic vulnerability, presents a complex risk landscape for asbestos exposure. This study aimed to develop a district-level [...] Read more.

(1) Background: Indonesia is one of the world’s largest consumers of asbestos, with widespread use of asbestos-cement roofing. Java Island, characterized by high population density and seismic vulnerability, presents a complex risk landscape for asbestos exposure. This study aimed to develop a district-level asbestos exposure risk map for Java by integrating asbestos roof prevalence, population density, and seismic hazard. (2) Methods: A descriptive, semi-quantitative approach was applied using secondary data from national statistics and geological hazard portals. Three variables—asbestos roof prevalence, population density, and seismic hazard—were categorized into five ordinal levels (very low to very high) and combined using GIS-based risk matrices to generate composite exposure risk maps. Sensitivity and statistical analyses were conducted to assess the robustness and internal consistency of the risk classification. (3) Results: Of 119 districts/municipalities, 43 (36%) were classified as very high risk and 45 (38%) as high risk under the primary GIS-based risk matrix classification. Major metropolitan corridors, including Greater Jakarta and Bandung, showed elevated risk where substantial asbestos use coincided with very high population density, whereas several southern and inland districts gained priority because of higher seismic hazard. Sensitivity analyses indicated that the classification was generally robust to moderate changes in weighting and threshold boundaries, although the predefined population density thresholds provided limited discrimination within Java. (4) Conclusions: Asbestos exposure risk in Java is both widespread and heterogeneous, shaped by the intersection of infrastructure, demographics, and seismic vulnerability. The map offers a practical tool for prioritizing asbestos control, public awareness campaigns, health surveillance, and disaster risk reduction measures in Indonesia. Full article

(This article belongs to the Topic Environmental Exposure and Health Risks for Vulnerable Populations)

► Show Figures

Figure 1

17 pages, 830 KB

Open AccessSystematic Review

Efficacy and Safety of Oral Creatine Supplementation in Patients with Heart Failure: A PRISMA 2020 Systematic Review and Narrative Evidence Synthesis

by Francisco Epelde and María Pilar Martínez López

Int. J. Environ. Res. Public Health 2026, 23(9), 1130; https://doi.org/10.3390/ijerph23091130 - 30 Aug 2026

Abstract

Background: Oral creatine is biologically plausible as an adjunct in heart failure (HF), but its clinical efficacy and safety remain uncertain. Methods: We performed a PRISMA 2020 systematic review (PROSPERO CRD420261391605) of oral creatine supplementation in adults with HF. Randomized parallel-group and crossover [...] Read more.

Background: Oral creatine is biologically plausible as an adjunct in heart failure (HF), but its clinical efficacy and safety remain uncertain. Methods: We performed a PRISMA 2020 systematic review (PROSPERO CRD420261391605) of oral creatine supplementation in adults with HF. Randomized parallel-group and crossover trials formed the primary causal evidence base; non-randomized HF evidence was analyzed separately. Risk of bias was assessed with RoB 2 and certainty with GRADE. Results: Four randomized HF-only trials were identified as primary evidence, with one additional open-label HF study retained as exploratory evidence. Because studies differed in dose, duration, outcome definitions, measurement scales, crossover structure, and availability of variance data, meta-analysis was not considered defensible. Randomized evidence showed no consistent benefit for peak VO2, 6-min walk distance, quality of life, or cardiac systolic function. A preliminary signal was observed for selected peripheral muscle and muscle-energetic outcomes. Safety reporting was sparse and insufficient to establish long-term renal or clinical safety. Certainty was very low across critical outcomes. Conclusions: Current evidence does not support routine oral creatine supplementation in HF. Larger contemporary placebo-controlled trials with systematic safety surveillance are required. Full article

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

► Show Figures

Graphical abstract

15 pages, 292 KB

Open AccessArticle

Self-Compassion and Eco-Anxiety: Examining Their Relationship in a Greek Sample

by Anna Papadimitriou and Eirini Karakasidou

Int. J. Environ. Res. Public Health 2026, 23(9), 1129; https://doi.org/10.3390/ijerph23091129 - 30 Aug 2026

Abstract

Background: Eco-anxiety refers to an individual’s emotional response to environmental conditions such as air pollution and climate change. Eco-anxiety has been associated with various psychological variables; however, there is limited research on positive factors such as self-compassion. Previous studies have examined the relationship [...] Read more.

Background: Eco-anxiety refers to an individual’s emotional response to environmental conditions such as air pollution and climate change. Eco-anxiety has been associated with various psychological variables; however, there is limited research on positive factors such as self-compassion. Previous studies have examined the relationship between eco-anxiety and certain dimensions of self-compassion, such as isolation and mindfulness, but have not investigated its relationship with self-compassion as a whole or with its other dimensions. Methods: The present cross-sectional study aims to address this gap by examining a sample of 586 adults of all genders from different regions of Greece. The participants were collected through convenience sampling and completed two scales: the Self-Compassion Scale and the Hogg Eco-Anxiety Scale (which has undergone a validation process in Greek). Results: Using linear multiple regression analysis, the results showed that isolation has a positive correlation with affective symptoms, rumination and behavioural symptoms. Mindfulness has a negative correlation with affective symptoms, behavioural symptoms and anxiety about personal impact. Anxiety about personal impact is positively associated with self-kindness and over-identification. Conclusions: Instead of assuming a uniform relationship between self-compassion and eco-anxiety, this dimensional approach may help clarify whether specific self-compassion processes are more relevant to particular emotional, cognitive, and behavioural manifestations of eco-anxiety. Full article

17 pages, 475 KB

Open AccessReview

Non-Combustible Nicotine Use Among Amateur and University Athletes: Prevalence, Patterns and Reasons—A Scoping Review

by Nguyen Hoang, Melis Selamoglu, Isabella Papadopoulos, Chi Lao, Holly Wild, Susan Kotwas, Ines Rio, Kim Turudia, Dale Cridland and Chris Barton

Int. J. Environ. Res. Public Health 2026, 23(9), 1128; https://doi.org/10.3390/ijerph23091128 - 29 Aug 2026

Abstract

Background: Nicotine exposure is increasingly occurring through non-combustible products such as electronic cigarettes and nicotine pouches. Although sport participation is often considered protective against substance use, nicotine use appears to be increasingly normalised within performance-oriented sporting environments. Methods: This scoping review synthesised evidence [...] Read more.

Background: Nicotine exposure is increasingly occurring through non-combustible products such as electronic cigarettes and nicotine pouches. Although sport participation is often considered protective against substance use, nicotine use appears to be increasingly normalised within performance-oriented sporting environments. Methods: This scoping review synthesised evidence on non-combustible nicotine use among amateur and university athletes. Following Joanna Briggs Institute (JBI) methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, the searches were conducted in Ovid MEDLINE, Web of Science, Embase, Scopus, SPORTDiscus, and CINAHL for peer-reviewed studies published from 2019 onwards that examined non-combustible nicotine use in these populations. Results: Eleven studies, predominantly cross-sectional and conducted in high-income Western countries, met the inclusion criteria. Nicotine use was more common among male athletes, younger athletes, and those participating in team and contact sports, particularly for e-cigarette use. Across studies, nicotine use was frequently characterised as socially normative and compatible with sport, influenced by peer networks, social identity, perceived harm reduction, and beliefs regarding performance enhancement, coping, and recovery. The evidence base was limited by inconsistent measurement approaches and a predominance of studies examining demographic correlates rather than behavioural drivers. Conclusions: Non-combustible nicotine use appears embedded within sport-specific social norms and performance-related beliefs, highlighting the need for theoretically informed research and sport-specific prevention strategies. Full article

► Show Figures

Figure 1

16 pages, 1006 KB

Open AccessSystematic Review

Prevalence of Hepatic and Splenic Melioidosis: A Systematic Review and Meta-Analysis

by Jongkonnee Thanasai, Anchalee Chittamma, Supphachoke Khemla, Atthaphong Phongphithakchai, Moragot Chatatikun, Jitbanjong Tangpong, Sa-ngob Laklaeng, Jirart Songsri and Wiyada Kwanhian Klangbud

Int. J. Environ. Res. Public Health 2026, 23(9), 1127; https://doi.org/10.3390/ijerph23091127 - 29 Aug 2026

Abstract

Background: Melioidosis is a potentially life-threatening infection caused by Burkholderia pseudomallei. Hepatic and splenic involvement are recognized manifestations of disseminated melioidosis; however, reported prevalence varies considerably across studies, and no quantitative synthesis has been available. This systematic review and meta-analysis aimed to [...] Read more.

Background: Melioidosis is a potentially life-threatening infection caused by Burkholderia pseudomallei. Hepatic and splenic involvement are recognized manifestations of disseminated melioidosis; however, reported prevalence varies considerably across studies, and no quantitative synthesis has been available. This systematic review and meta-analysis aimed to estimate the pooled prevalence of hepatic, splenic, and concomitant hepatosplenic involvement in patients with melioidosis. Methods: A systematic search of PubMed, Embase, and Scopus was conducted from database inception to May 2026, following the PRISMA 2020 guidelines. Observational studies reporting hepatic and/or splenic involvement among patients with confirmed melioidosis were eligible. Random-effects meta-analyses were performed to estimate pooled prevalence with 95% confidence intervals (CIs). Subgroup analyses were conducted according to geographic region and age group. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal checklist. Results: Fourteen eligible studies involving 1844 patients with melioidosis were included. The pooled prevalence of hepatic involvement was 11% (95% CI, 6–18%; I² = 84.8%), splenic involvement was 15% (95% CI, 7–27%; I² = 95.8%), and concomitant hepatosplenic involvement was 13% (95% CI, 4–34%; I² = 89.5%). Subgroup analyses demonstrated significantly higher pooled prevalence of hepatic and splenic involvement in Southeast Asia than in Oceania (p = 0.0164 and p = 0.0003, respectively). No significant differences were observed between adult and pediatric populations for hepatic (p = 0.1607) or splenic involvement (p = 0.8243). Most included studies were judged to have a moderate risk of bias, and no evidence of small-study effects was identified for analyses of hepatic or splenic involvement. Conclusions: Hepatic and splenic involvement are common manifestations of melioidosis, affecting approximately one in nine and one in seven patients, respectively. Significant geographic variation suggests that disease burden is greater in Southeast Asia than in Oceania. These findings support the routine consideration of abdominal imaging in patients with suspected or confirmed melioidosis, particularly in endemic regions, to facilitate early recognition of visceral involvement. Further prospective multicenter studies using standardized imaging protocols are needed to refine prevalence estimates and improve understanding of hepatosplenic melioidosis. Full article

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

► Show Figures

Figure 1

15 pages, 690 KB

Open AccessArticle

Urinary Organophosphate Metabolites and Laboratory-Derived Phenotypic Aging Acceleration in U.S. Adults: Evidence from NHANES 1999–2018

by Rubaiya Anika, Matthew Untalan, Emanuela Taioli and Stephanie Tuminello

Int. J. Environ. Res. Public Health 2026, 23(9), 1126; https://doi.org/10.3390/ijerph23091126 - 29 Aug 2026

Abstract

Biological aging, quantified through molecular and physiological biomarkers, provides a dynamic assessment of the aging processes. Although organophosphate (OP) pesticide exposure is known to disrupt cellular and metabolic functions, causing inflammation, its relationship with phenotypic (biological) aging acceleration (PAA) remains understudied. We examined [...] Read more.

Biological aging, quantified through molecular and physiological biomarkers, provides a dynamic assessment of the aging processes. Although organophosphate (OP) pesticide exposure is known to disrupt cellular and metabolic functions, causing inflammation, its relationship with phenotypic (biological) aging acceleration (PAA) remains understudied. We examined data from 1999–2008 and 2015–2018 National Health and Nutrition Examination Survey to determine the relationship between OP and PAA. Urinary levels of 6 Dialkyl-phosphate metabolites were used to assess OP exposure; participants were considered exposed if they had at least one urinary OP metabolite above the highest lower limit of detection (LLOD). Phenotypic age was estimated using BioAge R package combining nine laboratory biomarkers. PAA was derived as the residual from regressing phenotypic age onto chronological age. The association was assessed using survey-weighted linear regression. A total of 8988 participants with complete urinary, sociodemographic, and laboratory data were included; mean chronological age was 44.95 years (SE = 0.29), while mean phenotypic age was 43.19 years (SE = 0.31). In the fully adjusted model, individuals with detected OP metabolites had higher PhenoAgeAccel (β = 0.65; 95% CI: 0.14–1.17). OP metabolite detection was associated with greater PAA, extending limited literature and supporting further investigation of its implications for healthy aging. Full article

(This article belongs to the Section Environmental Health)

► Show Figures

Figure 1

17 pages, 307 KB

Open AccessArticle

“Anything That Can Prevent HIV Is Good”: Diverse Women Reflect on Potential Barriers, Facilitators, and Acceptability for PrEP

by Kayla Etienne, Peyton R. Willie, Kimberly Lazarus, Ivanee Cruz, Valerie Daniel, Maria Silva Fernanda, Chelsie Warman, Gray Maganga, Bisola O. Ojikutu and Sannisha K. Dale

Int. J. Environ. Res. Public Health 2026, 23(9), 1125; https://doi.org/10.3390/ijerph23091125 - 29 Aug 2026

Abstract

Introduction: Racially and ethnically diverse women experience sub-optimal outcomes on both the HIV treatment and prevention cascade when compared to their white counterparts due to factors including racism, sexism, and xenophobia. While PrEP is a promising biomedical tool that can narrow this [...] Read more.

Introduction: Racially and ethnically diverse women experience sub-optimal outcomes on both the HIV treatment and prevention cascade when compared to their white counterparts due to factors including racism, sexism, and xenophobia. While PrEP is a promising biomedical tool that can narrow this gap, similar trends are observed in PrEP utilization among culturally diverse women. We sought to explore the differences in diverse women’s preferences, challenges, and facilitators of PrEP uptake. Methods: From January 2022 to July 2023, thirty-one diverse women who could benefit from PrEP in Miami, FL, completed qualitative interviews with trained research staff to discuss their willingness, perceptions, and access to PrEP. Women also completed a demographic survey via Research Electronic Data Capture (REDCap). Semi-structured interviews were analyzed via NVivo using a hybrid inductive–deductive thematic analysis approach. Results: The majority of participants were Black (81%) and ethnically diverse (41.9% African American, 25.8% Hispanic/Latina, 16.1% Afro-Caribbean Black (non-Haitian) and 16.1% Haitian/Haitian American). Qualitative coding revealed numerous themes common across ethnic groups on (a) HIV transmission risk, reasons for prevention, and protective factors, (b) PrEP awareness, acceptability and willingness, (c) access to healthcare, and (d) relationships. Conclusions: To develop culturally sound interventions to increase PrEP uptake among women most impacted by HIV, an understanding of their perspectives and experiences is needed, as well as interventions/strategies informed by their insights. Full article

(This article belongs to the Special Issue Women and Pre-Exposure Prophylaxis for HIV Prevention)

14 pages, 1043 KB

Open AccessArticle

Bouldering Psychotherapy for Mental Health in Brazil: Preliminary Evidence from a Mixed-Methods Controlled Study

by Pedro Carvalho Frulane de Souza, Tatiana Arenas Mora, Tiago Arruda Sanchez and Erick Francisco Quintas Conde

Int. J. Environ. Res. Public Health 2026, 23(9), 1124; https://doi.org/10.3390/ijerph23091124 - 29 Aug 2026

Abstract

Previous studies have shown that Bouldering Psychotherapy (BPT), an emerging integrative intervention combining bouldering with psychotherapeutic techniques, may promote improvements in mental health and well-being. This pilot study aimed to examine the effects of BPT on symptoms of depression and anxiety in a [...] Read more.

Previous studies have shown that Bouldering Psychotherapy (BPT), an emerging integrative intervention combining bouldering with psychotherapeutic techniques, may promote improvements in mental health and well-being. This pilot study aimed to examine the effects of BPT on symptoms of depression and anxiety in a Brazilian population and explore participants’ perceptions of its psychological and social impacts. Eleven participants completed an eight-week BPT program and were compared with a matched control group. Symptoms of anxiety and depression were assessed before and after the intervention. Qualitative data were collected through semi-structured interviews and analyzed using word-frequency analysis and reflexive thematic analysis. The BPT group showed a significant reduction in depressive symptoms (p = 0.015, d = 0.66) and a marginally non-significant reduction in anxiety symptoms (p = 0.059, d = 0.44). The qualitative findings indicated perceived improvements in psychological well-being, emotional regulation, self-awareness, social connectedness, and psychological skills. Participants also reported transferring skills and insights acquired during the program to everyday life. Overall, the findings suggest that BPT may improve mental health, particularly depressive symptoms, while fostering supportive social relationships and positive psychological experiences. The results support the feasibility of adapting BPT to the Brazilian context and encourage further research on climbing-based psychotherapeutic interventions. Full article

(This article belongs to the Special Issue Sport and Exercise Psychology: Mental Health in Athletes and Exercisers)

► Show Figures

Figure 1

15 pages, 312 KB

Open AccessArticle

by Terhi Mustonen, Kirsimarja Raitasalo and Sari Castrén

Int. J. Environ. Res. Public Health 2026, 23(9), 1123; https://doi.org/10.3390/ijerph23091123 - 28 Aug 2026

Abstract

Background: Problematic social media use among adolescents has emerged as a growing public health concern. This study examined gender differences in problems related to social media use and their behavioural, psychosocial, family-related, and school-related correlates among Finnish adolescents. Methods: In this cross-sectional study, [...] Read more.

Background: Problematic social media use among adolescents has emerged as a growing public health concern. This study examined gender differences in problems related to social media use and their behavioural, psychosocial, family-related, and school-related correlates among Finnish adolescents. Methods: In this cross-sectional study, binary logistic regression analyses were conducted using data from the Finnish sample of the 2024 European School Survey Project on Alcohol and Other Drugs (ESPAD), including 3293 adolescents aged 15–16 years. Results: Overall, 45% of girls and 30% of boys were classified as having problems related to social media use. Significant gender interactions were observed in the associations of gaming-related problems and perceived family socioeconomic status with problems related to social media use. Gaming-related problems were the strongest correlate, with a substantially stronger association among boys. Elevated psychological distress was associated with a higher likelihood of problems related to social media use, particularly among girls, whereas higher parental monitoring was associated with a lower likelihood only among girls. Truancy and plans for general upper secondary school were both associated with a higher likelihood of problems related to social media use among girls and boys. Conclusions: The findings suggest that problems related to social media use are closely linked to adolescent well-being and behaviour. Prevention and intervention efforts may therefore benefit from addressing problematic social media use as part of adolescent mental health and digital well-being strategies, combining universal approaches with targeted support for adolescents experiencing problematic patterns of digital media use. Full article

(This article belongs to the Special Issue The Effect of Social Media on Adolescent Health Behaviors and Health-Related Outcomes)

20 pages, 791 KB

Open AccessArticle

Psychosocial Predictors of Emergency Management Behaviour for Non-Communicable Disease Emergencies Among Rural Community Adults in Thailand

by Sukontip Arunmonlaphat, Yupayong Paha and Pacharamon Soncharoen

Int. J. Environ. Res. Public Health 2026, 23(9), 1122; https://doi.org/10.3390/ijerph23091122 - 28 Aug 2026

Abstract

Background: Non-communicable disease (NCD) emergencies, including hypoglycaemia, stroke, acute coronary syndrome, and hypertensive crisis, call for prompt action by households and communities. The psychosocial mechanisms associated with emergency management behavior in rural Thailand, however, are not well understood. Objectives: The study pursued three [...] Read more.

Background: Non-communicable disease (NCD) emergencies, including hypoglycaemia, stroke, acute coronary syndrome, and hypertensive crisis, call for prompt action by households and communities. The psychosocial mechanisms associated with emergency management behavior in rural Thailand, however, are not well understood. Objectives: The study pursued three objectives. It described levels of NCD emergency management behavior and the characteristics of emergency events reported during the preceding six months. It examined associations linking knowledge, Health Belief Model (HBM) constructs, social support, participation, self-efficacy, and emergency management behavior. Then, it identified the constructs with the strongest relations to behavior, along with an indirect pathway operating through self-efficacy, via structural equation modelling. Methods: A cross-sectional study analyzed data from 1321 community adults in Sisaket Province, Thailand, drawn from an initial 1407 records after excluding 86 with age below 21 years, incomplete data on SEM variables, or invalid disease-status coding. A structured, interviewer-administered questionnaire measured knowledge of NCD emergencies, HBM constructs, social support, family and community participation, self-efficacy, and emergency management behavior. Covariance-based SEM with item parcels and maximum-likelihood estimation was conducted; knowledge was treated as an observed variable. Results: Mean age was 58.0 years (SD = 14.3); 15.5% reported a recent emergency event. Knowledge was moderate-to-low (mean = 5.79/10; KR-20 = 0.440). Model fit was acceptable (CFI = 0.980; RMSEA = 0.047; SRMR = 0.049). Discriminant validity was supported by the Fornell–Larcker criterion for all constructs. Participation was strongly associated with self-efficacy (β = 0.858) and with emergency management behavior (β = 0.433); self-efficacy was also associated with emergency management behavior (β = 0.354). Participation had the largest total effect on behavior (0.737), combining a direct effect (0.433) and an indirect, self-efficacy-related effect (0.304). All structural-path variance inflation factors (VIF) were below 5.0 except participation behavior (VIF = 6.19), which remained below the more permissive threshold of 10.0. Conclusions: NCD emergency management behavior in this rural community was most strongly associated with family and community participation and with self-efficacy. Because the design was cross-sectional, these findings indicate association rather than confirmed causal or mediating pathways. Programmes should combine scenario-based knowledge with participatory practice, family role preparation, rehearsal of emergency-service (1669) activation, and confidence-building activities. Full article

24 pages, 746 KB

Open AccessArticle

Cultural Fit, Privacy Concerns, and GCC Women’s Openness to AI-Enabled Menstrual Tracking: A Cross-Sectional Study

by Zeina M. Alkhalaf and Abdullah Alhauli

Int. J. Environ. Res. Public Health 2026, 23(9), 1121; https://doi.org/10.3390/ijerph23091121 - 28 Aug 2026

Abstract

Background/Objectives: Artificial intelligence (AI) is increasingly embedded in menstrual and reproductive health applications, yet little is known about how women in conservative, rapidly digitizing regions evaluate AI-enabled menstrual tracking tools. This study investigates how perceived cultural fit and data privacy concerns are associated [...] Read more.

Background/Objectives: Artificial intelligence (AI) is increasingly embedded in menstrual and reproductive health applications, yet little is known about how women in conservative, rapidly digitizing regions evaluate AI-enabled menstrual tracking tools. This study investigates how perceived cultural fit and data privacy concerns are associated with women’s openness to AI-enabled menstrual tracking in Gulf Cooperation Council (GCC) countries. Methods: We conducted an online cross-sectional survey using a convenience sample of adult women residing in GCC countries (n = 273), measuring openness to AI menstrual tools, perceptions of cultural fit (e.g., respect for religious and cultural norms, endorsement by trusted institutions, Arabic language, GCC-specific design), privacy concerns (e.g., worries about who can access menstrual health data), and key sociodemographic characteristics and smartphone use. Results: Higher perceived cultural-contextual fit was strongly and positively associated with openness to AI-enabled menstrual tracking, whereas composite privacy concerns showed no statistically significant association once cultural fit and sociodemographic factors were controlled. Item-level analyses indicated that beliefs about cultural sensitivity and GCC-specific design were the most robust predictors of openness, while concerns about data access, authority endorsement, and language accessibility played a limited role. Homemakers reported higher openness than employed women. Conclusions: Overall, the findings suggest that, in this sample and model, GCC women’s openness to AI-enabled menstrual tracking was more strongly associated with perceived cultural alignment and local design than with the measured privacy-concern construct, highlighting the importance of culturally grounded, trust-building design and communication strategies for AI-based women’s health applications. Full article

(This article belongs to the Special Issue Resilience and Rights: Advancing Women's Sexual and Reproductive Health in an Era of Crisis)

Journal Description

International Journal of Environmental Research and Public Health

Latest Articles

Journal Menu

Journal Browser

Highly Accessed Articles

Latest Books

E-Mail Alert

News

Topics

Conferences

Special Issues

Topical Collections

Further Information

Guidelines

MDPI Initiatives

Follow MDPI