Search Results (427)

Background: Access to safe and reliable water and sanitation remains a critical public health and development challenge, with rural and low-income communities being disproportionately affected by inadequate services and heightened exposure to waterborne diseases. Despite global efforts and infrastructure-based progress indicators, significant disparities persist, and these often overlook users’ perceptions of water quality, reliability, and safety. This study explores the determinants of household satisfaction with drinking water in rural areas, comparing subjective user feedback with official access data to reveal gaps in current monitoring approaches and support more equitable, user-centered water governance. Methods: This study was conducted in Kazakhstan’s Atyrau Region, where 1361 residents from 86 rural villages participated in a structured survey assessing household access to drinking water and perceptions of its quality. Data were analyzed using descriptive statistics and multinomial logistic regression to identify key predictors of user satisfaction, with results compared against official records to evaluate discrepancies between reported experiences and administrative data. Results: The field survey results revealed substantial discrepancies between official statistics and residents’ reports, with only 58.1% of respondents having in-house tap water access despite claims of universal coverage. Multinomial logistic regression analysis identified key predictors of user satisfaction, showing that uninterrupted supply and the absence of complaints about turbidity, odor, or taste significantly increased the likelihood of higher satisfaction levels with drinking water quality. Conclusions: This study underscores the critical need to align official water access statistics with household-level experiences, revealing that user satisfaction—strongly influenced by supply reliability and sensory water quality—is essential for achieving equitable and effective rural water governance. Full article

Introduction: Sexual minority men (SMM) are at increased risk for psychosocial stressor exposure, substance use, and poor mental health relative to heterosexual men. While the burden of mental health is growing in the United States, among SMM these trends are increasing at a greater rate, driving health disparities. Methods: Framed within a minority stress framework, these analyses examine how stressors explain substance use and poorer mental health over time. Participants were asked questions on stressor exposure (stigma, discrimination, internalized homophobia, perceived stress), mental health (anxiety, depression, PTSD), and substance use (alcohol to intoxication, club drugs, poly club drugs) over 36 months among 528 SMM in NYC. Results: Perceived stress increased frequency of all substance use, whereas discrimination decreased days of club and poly club drug use. Depression severity predicted increased days of club drug and poly club drug use. PTSD severity predicted increased days of club drug and poly club drug use. Conclusion: We are able to expand on the literature with granular substance use data to highlight associations with stressors and mental health. These findings support an increased need for systematic policy solutions and public health interventions to address drivers of substance use disparities among young SMM. Full article

Cancer disparities in low- and middle-income countries (LMICs) arise from multifaceted interactions between environmental exposures, infectious agents, and systemic inequities, such as limited access to care. The exposome, a framework encompassing the totality of non-genetic exposures throughout life, offers a powerful lens for understanding these disparities. In LMICs, populations are disproportionately affected by air and water pollution, occupational hazards, and oncogenic infections, including human papillomavirus (HPV), hepatitis B virus (HBV), Helicobacter pylori (H. pylori), human immunodeficiency virus (HIV), and neglected tropical diseases, such as schistosomiasis. These infectious agents contribute to increased cancer susceptibility and poor outcomes, particularly in immunocompromised individuals. Moreover, climate change, food insecurity, and barriers to healthcare access exacerbate these risks. This review adopts a population-level exposome approach to explore how environmental and infectious exposures intersect with genetic, epigenetic, and immune mechanisms to influence cancer incidence and progression in LMICs. We highlight the critical pathways linking chronic exposure and inflammation to tumor development and evaluate strategies such as HPV and HBV vaccination, antiretroviral therapy, and environmental regulation. Special attention is given to tools such as exposome-wide association studies (ExWASs), which offer promise for exposure surveillance, early detection, and public health policy. By integrating exposomic insights into national health systems, especially in regions such as sub-Saharan Africa (SSA) and South Asia, LMICs can advance equitable cancer prevention and control strategies. A holistic, exposome-informed strategy is essential for reducing global cancer disparities and improving outcomes in vulnerable populations. Full article

Extreme heat poses growing health risks in tropical regions, yet public perception of this threat remains understudied in the Caribbean. This study examines how residents in Puerto Rico perceived heat-related health risks and how these perceptions relate to vulnerability and protective behaviors during the extreme heat events of the summer of 2020. We conducted a cross-sectional telephone survey of 500 adults across metropolitan and non-metropolitan areas of Puerto Rico, using stratified probability sampling. The questionnaire assessed heat risk perception, sociodemographic characteristics, health status, prior heat exposure, and heat-related behaviors. While most participants expressed concern about climate change and high temperatures, fewer than half perceived heat as a high level of personal health risk. Higher levels of risk perception were significantly associated with being male, aged 50–64, unemployed, and in fair health, having multiple chronic conditions, and prior experience with heat-related symptoms. Those with symptoms were nearly five times more likely to report high levels of risk perception (OR = 4.94, 95% CI: 2.93–8.34). In contrast, older adults (65+), despite their higher level of vulnerability, reported lower levels of risk perception and fewer symptoms. Nighttime heat exposure was widespread and strongly associated with heat-related symptoms. Common coping strategies included the use of fans and air conditioning, though economic constraints and infrastructure instability limited access. The findings highlight the disparity between actual and perceived vulnerability, particularly among older adults. Public health strategies should focus on risk communication tailored to vulnerable groups and address barriers to heat adaptation. Strengthening heat resilience in Puerto Rico requires improved infrastructure, equitable access to cooling, and targeted outreach. Full article

The Parnassos-Ghiona region constitutes the most significant bauxite-bearing province in Greece, with a well-documented history of research highlighting its geotectonic complexity and its importance for bauxite exploitation. Among the three principal bauxite horizons, the lower stratum (b1) remains the least thoroughly investigated, in contrast to the upper (b3) and intermediate (b2) strata. This disparity is primarily attributed to the limited surface exposure of the b1 horizon within the broader Parnassos-Ghiona Unit. The present study examines the characteristics of the b1 strata through an integrated mineralogical and geochemical approach. For the first time, the confirmed presence of rare earth element (REE) minerals within the b1 horizon is documented. Geochemical proxies, including REE distribution patterns and elemental ratios, indicate a genetic relationship with igneous parent rocks of intermediate to basic affinity. Full article

Prostate Cancer (PCa) is the most commonly diagnosed cancer and the second leading cause of cancer death among men. In Louisiana (LA), Black men are disproportionately diagnosed at later stages compared to White men. This study explores environmental risk factors as potential intermediate variables linking race to cancer diagnosis stage. The Louisiana Tumor Registry data included 24,647 male patients diagnosed with PCa in LA between 2010 and 2018. Among them, 15,875 (64.40%) were Caucasian American (CA) and 8772 (35.59%) African American (AA). Mediation analysis using multiple additive regression trees (MART) identified possible intermediate variables that potentially explain the observed disparity. The study found that individual characteristics and environmental factors jointly explained 84% (95% CI: 44.1%, 94.6%) and 18.6% (95% CI: 7.3%, 53.7%) of the observed racial disparity in PCa stage at diagnosis, respectively. Individual factors included BMI (35.9%), marital status (28.5%), CDI (8.2%), female-headed households (2.3%), comorbidity (3.9%), and insurance status (6.3%). Environmental contributors included cancer risk due to air toxicity exposure (7.2%), asthma prevalence (6.6%), acetaldehyde levels (2.1%), railroad proximity (2.1%), walkability (0.3%), and ozone level (−0.1%). Environmental factors jointly played a significant role in the observed racial disparity. The factors such as air toxicity, acetaldehyde levels, and asthma prevalence highlight the need to address industrial pollutants to reduce the differences. Full article

Background: Hearing loss is increasingly prevalent and poses a significant public health concern. While both aging and occupational noise exposure are recognized contributors, their interactive effects and gender-specific patterns remain underexplored. Methods: This cross-sectional study analyzed data from 135,251 employees in Jiangsu Province, China. Demographic information, noise exposure metrics, and hearing thresholds were obtained through field measurements, questionnaires, and audiometric testing. Multivariate logistic regression, restricted cubic spline modeling, and interaction analyses were conducted. Machine learning models were employed to assess feature importance. Results: A nonlinear relationship between age and high-frequency hearing loss (HFHL) was identified, with a critical inflection point at 37.8 years. Noise exposure significantly amplified HFHL risk, particularly in older adults (OR = 2.564; 95% CI: 2.456–2.677, p < 0.001), with consistent findings across genders. Men exhibited greater susceptibility at high frequencies, even after adjusting for age and co-exposures. Aging and noise exposure have a joint association with hearing loss (OR = 2.564; 95% CI: 2.456–2.677, p < 0.001) and an interactive association (additive interaction: RERI = 2.075, AP = 0.502, SI = 2.967; multiplicative interaction: OR = 1.265; 95% CI: 1.176–1.36, p < 0.001). And machine learning also confirmed age, gender, and noise exposure as key predictors. Conclusions: Aging and occupational noise exert synergistic effects on auditory decline, with distinct gender disparities. These findings highlight the need for integrated, demographically tailored occupational health strategies. Machine learning approaches further validate key risk factors and support targeted screening for hearing loss prevention. Full article

Autoimmune diseases such as systemic lupus erythematosus and Sjögren’s syndrome show pronounced sex disparities in prevalence, severity, and clinical outcomes, with females disproportionately affected. Emerging evidence highlights sex-based differences in immune and inflammatory responses as key contributors to this bias. Genetic factors—including sex chromosomes, skewed X chromosome inactivation, and sex-biased microRNAs—as well as sex hormones and pregnancy modulate gene expression and immune cell function in a sex-specific manner. Additionally, sex hormone-dependent epigenetic modifications influence the transcription of critical immune regulators. These genetic and hormonal factors collectively shape the activation, differentiation, and effector functions of diverse immune cell types. Environmental factors—including infections, gut microbiota, environmental chemicals and pollutants, and lifestyle behaviors such as diet, smoking, UV exposure, alcohol and caffeine intake, physical activity, and circadian rhythms—further modulate immune function and autoimmune disease pathogenesis in a sex-dependent manner. Together, these mechanisms contribute to the heightened risk and distinct clinical features of autoimmunity in females. A deeper understanding of sex-biased immune regulation will facilitate the identification of novel biomarkers, enable patient stratification, and inform the development of sex-specific diagnostic and therapeutic strategies for autoimmune diseases. Full article

Geographic disparities threaten equitable access for children to health-promoting safe green spaces, and quality early education in the communities in which they live and grow. To address gaps in the field, we integrated the fields of developmental psychology, public health, and environmental science to examine, at the population level, associations between the environmental burden, socioeconomic vulnerability, and kindergarten readiness in a diverse urban county. Three administrative datasets were integrated through an early childhood data sharing research partnership in Miami-Dade County. The Bruner Child Raising Vulnerability Index, the five domains of the Environmental Burden module from the Environmental Justice Index, and public school kindergarten readiness scores were aggregated at the census tract level. Analysis of variance and multiple regression analyses found associations between socioeconomic vulnerability and race/ethnicity. The socioeconomic vulnerability levels were highest in census tracts with a higher percentage of Black residents, compared to all other races/ethnicities. Areas of greater social vulnerability had lower kindergarten readiness and a higher environmental burden. A higher environmental burden predicted lower kindergarten readiness scores above and beyond race/ethnicity and socioeconomic vulnerability. The findings advance our understanding of global challenges to sustainable healthy child development, such as the persistence of a disproportionate environmental burden and inequitable access to resources such as green spaces and early education programs. The present study results can inform community health improvement plans to reduce risk exposures and promote greater access to positive environmental and educational resources for all children. Full article

Between approximately 725 and 518 Ma, a suite of specialized felsic plutons and granitic stocks were emplaced across the Arabian Shield, many of which are now recognized as highly mineralized prospects enriched in rare earth elements (REEs), rare metals, and radioactive elements bearing mineralizations. The current investigation focused on the radiological and geochemical characterization of naturally occurring radionuclides, specifically ²³⁸U, ²²⁶Ra, ²³²Th, and ⁴⁰K, within three strategically selected granitic prospects, namely, J. Tawlah albite granite (TW), J. Hamra (HM), and J. Abu Al Dod alkali feldspar syenite and granites (AD). Concerning the radioactivity levels of the investigated granitic stocks, specifically the activity concentrations of ²³⁸U, ²²⁶Ra, ²³²Th, and ⁴⁰K, the measured average values demonstrate significant variability across the TW, HM, and AD stocks. The average ²³⁸U concentrations are 195 (SD = 38.7), 88.66 (SD = 25.6), and 214.3 (SD = 140.8) Bq/kg for TW, HM, and AD granitic stocks, respectively. Corresponding ²²⁶Ra levels are recorded at 172.4 (SD = 34.6), 75.62 (SD = 25.9), and 198.4 (SD = 139.5) Bq/kg. For ²³²Th, the concentrations are markedly elevated in TW at 5453.8 (SD = 2182.9) Bq/kg, compared to 77.16 (SD = 27.02) and 160.2 (SD = 103.8) Bq/kg in HM and AD granitic stocks, respectively. Meanwhile, ⁴⁰K levels are reported at 1670 (SD = 535.9), 2846.2 (SD = 249.9), and 3225 (SD = 222.3) Bq/kg for TW, HM, and AD granitic plutons, respectively. Notably, these values exceed the global average background levels, indicating an anomalous enrichment of the studied granitic occurrences. The mean radiological hazard indices for each granitic unit generally exceed global benchmarks, except for AEDE_out in the HM and AD stocks, which remain below international limits. The geochemical disparities observed are indicative of post-magmatic alteration processes, as substantiated by the interpretation of remote sensing datasets. In light of the significant radiological burden presented by these granitic stocks, it is essential to implement a rigorous precautionary framework for any future mining. These materials must be categorically excluded from uses that entail direct human exposure, especially in residential construction or infrastructure projects. Full article

Southwest China, with typical karst, is one of the 36 biodiversity hotspots in the world, facing extreme ecological fragility due to thin soils, limited water retention, and high bedrock exposure. This fragility intensifies under climate change and human pressures, threatening regional sustainable development. Ecological strategic areas (ESAs) are critical safeguards for ecosystem resilience, yet their spatiotemporal dynamics and driving mechanisms remain poorly quantified. To address this gap, this study constructed a multidimensional ecological health assessment framework (pattern integrity–process efficiency–function diversity). By integrating Sen’s slope, a correlated Mann–Kendall (CMK) test, the Hurst index, and fuzzy C-means clustering, we systematically evaluated ecological health trends and identified ESA differentiation patterns for 2000–2024. Orthogonal partial least squares structural equation modeling (OPLS-SEM) quantified driving factor intensities and pathways. The results revealed that ecological health improved overall but exhibited significant spatial disparity: persistently high in southern Guangdong and most of Yunnan, and persistently low in the Sichuan Basin and eastern Hubei, with 41.47% of counties showing declining/slightly declining trends. ESAs were concentrated in the southwest/southeast, whereas high-EHI ESAs increased while low-EHI ESAs declined. Additionally, the natural environmental and human interference impacts decreased, while unique geographic factors (notably the rock exposure rate, with persistently significant negative effects) increased. This long-term, multidimensional assessment provides a scientific foundation for targeted conservation and sustainable development strategies in fragile karst ecosystems. Full article

Renewable energy stands as a pivotal solution to environmental concerns, prompting substantial research and development endeavors to promote its adoption and enhance energy efficiency. Despite the recognized environmental superiority of renewable energy systems, there is a lack of globally standardized indicators specifically focused on renewable energy efficiency. This study aims to develop and apply a non-parametric data envelopment analysis (DEA) indicator, termed the Renewable Energy Indicator (REI), to measure environmental performance at the national level and to identify differences in renewable energy efficiency across countries grouped by development status and income level. The REI incorporates new factors such as agricultural methane emissions (thousand metric tons of ${\mathrm{CO}}_2$ equivalent), PM2.5 air pollution exposure (µg/m³), and aspects related to electricity, including consumption (as % of total final energy consumption), production from renewable sources, excluding hydroelectric (kWh), and accessibility in rural and urban areas (% of population with access), aligning with the emerging paradigm outlined by the United Nations. By segmenting the REI into global, developmental, and income group classifications, this study conducts the Mann–Whitney U test and the Kruskal–Wallis H tests to identify variations in renewable energy efficiency among different country groups. Our findings reveal top-performing countries globally, highlighting both developed (e.g., Sweden) and developing nations (e.g., Costa Rica, Sri Lanka). Central and North European countries demonstrate high efficiency, while those facing political and economic instability perform poorly. Agricultural-dependent nations like Australia and Argentina exhibit lower REI due to significant methane emissions. Disparities between developed and developing markets underscore the importance of understanding distinct socio-economic dynamics for effective policy formulation. Comparative analysis across income groups informs specific strategies tailored to each category. Full article

Purpose: This exploratory retrospective analysis examined racial disparities in fall-related injuries among Black and White breast cancer survivors who received chemotherapy, focusing on the risks associated with specific chemotherapy regimens. Methods: Using real-world data from the TriNetX research platform, we analyzed a cohort of 3223 Stage I–III breast cancer survivors with complete data on race, chemotherapy exposure, and fall-related injuries. The final sample included only Black and White patients treated with chemotherapy between 1 January 2019 and 31 December 2023. Fall events within six months post-chemotherapy were analyzed. Logistic regression models evaluated associations between chemotherapy type and fall risk by race. Results: Black breast cancer survivors experienced a significantly higher rate of fall-related injuries (14.7%) compared to White survivors (10.0%) (p < 0.001). The risk was especially elevated among Black patients receiving Cyclophosphamide, Docetaxel, and Carboplatin. Conclusion: This study highlights racial differences in chemotherapy-associated fall risk. While the findings are observational and limited by data availability, they underscore the need for more inclusive survivorship care and further investigation using detailed clinical and contextual variables. Real-world platforms like TriNetX can help identify early signals of disparities that merit prospective study. Full article

Cities are the growth engines responsible for shaping the global economy, major contributors to climate change, and are significantly affected by it. However, the United Nations adopted the Sustainable Development Goals (SDGs) to make these cities and human settlements inclusive, safe, resilient, and sustainable. Yet, the rapid and unplanned urban expansion exacerbates various environmental challenges and reduces green cover in urban areas. To address these issues and meet the SDGs, stakeholders need to emphasise and optimise urban spaces. This study investigates the borough-level analysis of green spaces and human exposure to green spaces across London using satellite-derived datasets on vegetation and socio-economic factors to examine the variations in urban vegetation cover and urban population exposure to vegetation cover between 2017 and 2024. This study highlights the spatial disparity in green space coverage and exposure to green space between the inner and outer boroughs of London. The methodology used here suggests an average loss of approximately 11 and 9 percent in green space coverage and green space exposure to population, respectively, between 2017 and 2024 across London boroughs. Full article

Objective: This study aimed to explore the burden attributable to different groups of risk factors (environmental/occupational, behavioral, and metabolic) in Saudi Arabia that were stratified by gender and year and measured by summary exposure values (SEVs) and disability-adjusted life years (DALYs) per 100,000. Design: This study was structured as a systematic analysis. Methods: Using the GBD 2021 data, we extracted information on different risk factors attributed to the disease burden in Saudi Arabia to quantify the differences in exposure value (SEV) and disability-adjusted life year (DALY) rates (per 100,000) between females and males across different years. Results: Over the years, sustained progress in reducing the number of DALYs attributable to specific environmental and occupational risks has been observed, as well as a slight decrease in some behavioral risks. The highest disease burden was attributed to metabolic and behavioral risk factors, with body mass index being the leading risk factor for both genders. Between 1990 and 2021, the age-standardized DALY rate in those with high body mass indices increased by 168.4% and reached 3436.23 (95% UI 1878.7–5031.5) in males and increased by 125.2% to reach 2952.6 (95% UI 1456.9–4.407) in females. The age-standardized SEVs were the highest in females with a high body mass index, reaching an SEV of 57.98 (95% UI: 64.1–49.2), and in males, an SEV of 50.75 (95% UI: 57.1–42.3) was achieved. Regarding their attributable deaths in 2021, metabolic risk factors were identified as the primary contributors to NCD mortality in 2021. Conclusions: These results reveal persistent health disparities between males and females, underscoring the urgent need for gender-specific research, policies, and interventions. Strategies aimed at promoting health and reducing disease burden should acknowledge the unique health challenges encountered by males and females. Full article