Search Results (3,241)

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

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

Background: Black communities in England experience health inequalities rooted in structural racism, socioeconomic deprivation, and systemic exclusion from health systems that fail to address their specific needs. Digital health technologies offer potential for reducing these disparities, yet the existing evidence reveals an absence of culturally appropriate digital interventions designed with and for Black communities in England. Objective: To synthesise evidence on the structural and cultural determinants of health inequality affecting Black people in England and examine the potential of health apps for delivering culturally appropriate health promotion. Methods: This is a purposive, critical narrative literature review, not a systematic review; it does not aim for exhaustive or fully reproducible search coverage but for a structured, purposive synthesis of the evidence base relevant to four thematic domains. Purposive sampling was used to identify literature across the PubMed/MEDLINE, PsycINFO, Google Scholar, and policy databases. Findings were thematically synthesised around four domains: structural determinants of health inequality; cultural diversity and representation within Black communities; digital inclusion and health app access; and theoretical frameworks for culturally appropriate intervention design. Findings: Three intertwined problems underpin the absence of culturally appropriate digital health tools for Black communities: structural exclusion from health systems; methodological shortcomings of aggregating heterogeneous populations under broad ethnic labels such as BAME; and the systematic exclusion of Black people from digital health design processes. We propose a multi-layered theoretical framework combining the Health Belief Model, Beattie’s community development paradigm, and McCurdie’s user-centred design principles to guide the co-design of a culturally appropriate health promotion app. Conclusions: A culturally appropriate health promotion app for Black communities in England appears to be a promising and potentially feasible direction, provided it is developed through authentic community partnership and grounded in theories that account for structural determinants of health; this conclusion is conceptual, and no user research, prototype testing, or feasibility study has yet been undertaken to confirm it. These are identified as necessary next steps rather than results already achieved. Full article

Background: During the coronavirus disease 2019 (COVID-19) pandemic, changes in healthcare organisation may have affected the management of patients with chronic conditions, such as those with type 2 diabetes (T2D), who require close monitoring. Although there are studies that have analysed the access and management of patients with T2D in primary care (PC) during the pandemic, there is no synthesis of the results that inform us about the care provided and their effect. The aim of this study is to summarise the existing evidence on the care provided in PC settings to patients with T2D during the COVID-19 pandemic, as well as their follow-up care and outcomes, in order to understand the impact of the pandemic on their management. Methods: A scoping review was conducted according to the approach described by Arksey and O’Malley. Structured search strategies were developed for each of the selected databases (PubMed, EMBASE and Web of Science). We included articles published in English and Spanish up to 24 March 2026 on access to care for patients with T2D in PC during the pandemic. Two independent reviewers screened titles and abstracts to select studies related to the population, intervention, and outcomes of interest. In cases of disagreement, a third reviewer resolved the discrepancy. One of the reviewers extracted data and summarised them. Results: After duplicate removal, 535 records were identified, with 116 articles screened in full text and 26 included. Most studies were conducted in Europe and North America using retrospective designs and electronic health records. During the pandemic period, face-to-face visits and routine screenings generally declined, while telemedicine expanded and may have partially mitigated disruptions in patient contact, although inequalities in access were reported. Disease monitoring and complication screening also declined in several settings. Clinical outcomes such as HbA1c and blood pressure (BP) showed heterogeneous trends, with some studies reporting deterioration and others reporting stability. Some studies also highlighted increased adverse events and greater attention to mental health during care. Conclusions: Although telemedicine helped maintain patient follow-up, it could not fully replace face-to-face assessments and was implemented alongside some gaps in clinical monitoring, patient safety, and health equity. These findings underscore the need to maintain structured chronic disease management and to develop safe and inclusive telehealth models. Full article

Background: Adverse perinatal outcomes impose a substantial burden on maternal health services, particularly in regions with a high prevalence of maternal medical conditions and marked health inequities. Population-specific evidence on how common maternal conditions relate to delivery outcomes remains limited for high-burden Southeast Louisiana. Methods: We conducted a retrospective cohort study of 7161 delivery encounters at an urban New Orleans hospital between 2020 and 2024, using electronic health record data from the LSU Health Clinical Data Warehouse. Multivariable logistic regression estimated adjusted associations of three non-overlapping exposure groups—gestational hypertension/preeclampsia (O13/O14), diabetes in pregnancy (predominantly gestational), and coded obesity—with cesarean delivery, ascertained from the recorded delivery-mode code and adjusted for age, race, ethnicity, and marital status; a composite of cesarean or preterm-labor coding was examined only as an exploratory secondary outcome. Because each encounter carried a single defined-condition code, the exposures were mutually exclusive, and their estimates describe separate exposure groups rather than the relative contributions of co-occurring conditions. Results: The cesarean rate ascertained from the delivery-mode code (11.9%) was well below the national benchmark (approximately 32%), indicating substantial administrative under-capture; such non-differential misclassification of the primary outcome would be expected to bias associations toward the null and limit the reliability of the effect estimates. Gestational hypertension/preeclampsia (adjusted odds ratio [aOR] 1.83, 95% confidence interval [CI] 1.53–2.19), diabetes (aOR 1.94, 95% CI 1.51–2.49), and coded obesity (aOR 1.41, 95% CI 1.05–1.88) were each associated with higher odds of cesarean delivery after adjustment for the available covariates. Conclusions: Because important clinical confounders (e.g., parity, prior cesarean delivery, multiple pregnancy, gestational age) were unavailable and the outcomes were not validated against clinical records, these associations should be interpreted as adjusted rather than independent. They are hypothesis-generating observations from administrative data rather than evidence for a risk-stratification tool, and they illustrate both the potential and the limits of routinely collected delivery data for monitoring maternal health services in high-burden settings. Full article

In recent years, concerns about youth mental health, school disengagement and territorial inequalities have renewed interest in arts-based, participatory educational practices, including participatory video (PV) and youth-led filmmaking. This scoping review, conducted and reported in accordance with the PRISMA-ScR guidelines, maps empirical studies employing PV or youth-led filmmaking with adolescents and young people (approximately 9–24 years) in school, after-school and community-based programmes, focusing on engagement, belonging, psychological well-being, agency, empowerment and socio-emotional skills. A structured search was conducted in four electronic databases (Scopus, Web of Science, PubMed, PsycInfo) and complemented by manual screening of reference lists, yielding nineteen peer-reviewed articles in English using qualitative, quantitative or mixed-methods designs in which PV was a central component. Narrative thematic synthesis suggests that PV can create “third spaces” for expression and co-authorship, support participation and voice, strengthen trust, self-efficacy and relational competences, and foster school connectedness. At the same time, the literature points to limitations linked to structural constraints, power hierarchies and partial institutional recognition of youth-produced narratives. Overall, the review indicates that participatory video is a promising but context-dependent approach for supporting protective factors associated with school disengagement and early school leaving and outlines implications for integrated school–community interventions and future research on longer-term impacts. Full article

Population aging in Asia is arriving before the institutions to support it. Assessments of social protection usually treat sustainability, adequacy and fairness separately, obscuring how they trade off within one system. This study introduces NTA-SAFE, five indicators derived from the National Transfer Accounts lifecycle identity, applied to Japan, South Korea, Thailand, the Philippines and Indonesia. Base-year per capita profiles are combined with UN World Population Prospects 2024 populations through 2050, so all movement reflects age structure alone; results are reported across all five WPP series as a demographic sensitivity range. An explicit two-part rule classifies each economy by who provides net transfers to its elderly and by demographic stage. Japan and South Korea are state-led; the Philippines and Indonesia are family-asset-led, retaining the fiscal headroom of young populations. Thailand is transitional and the substantive case, carrying the demographic and fiscal exposure of a state-led system while families supply 78% of net transfer support to its elderly. Thai elderly consumption sits near working-age parity: the exposure lies not in current living standards but in the institutional basis on which they rest. Direction of change is robust in 24 of 25 country-indicator combinations. Higher benefit generosity is consistently associated with a narrower fiscal base, as a budget constraint implies, though five cases cannot establish universality. Whether family-mediated support reproduces life-course inequality into old age is a hypothesis the framework can pose but not test, the accounts carrying no distributional data. Indonesia’s classification is provisional, its profile predating the 2014 health insurance reform. NTA-SAFE is replicable wherever National Transfer Accounts exist. Full article

Introduction: The Roma, historically referred to as “Gypsies” (a term now widely considered pejorative in many contexts), appear to have originated in northern India and settled in Europe in the 14th century, spreading mainly to Eastern and Southern Europe. In Greece, they make up 1.13% of the total population and live in all geographical areas of the country. Aim: The aim of this article is to investigate and study the dietary habits of Roma and their health consequences. Methodology: A literature review was conducted in Medline, PubMed and Scopus databases, using the keywords “nutrition”, “health”, “outcomes”, and “Roma”. Results: In Europe, as well as in Greece, Roma continue to experience poverty, unemployment, socioeconomic inequalities, limited access to health services, and phenomena of racism, despite the efforts of states. These conditions negatively affect their dietary choices, leading to an unhealthy and unbalanced diet, with consequences such as obesity, cardiovascular diseases and diabetes mellitus. Conclusions: The profound gap between Roma and non-Roma populations in Europe requires not only targeted policies but also active interventions by health professionals. These interventions should aim at improving the nutritional status and general healthcare of Roma. Full article

This review examines how smart city technologies have influenced health equity in urban settings between 2019 and 2026, guided by a dual-lens framework that assesses both equity-related outcomes and the systemic factors enabling or constraining their realization. As cities increasingly turn to digital tools to strengthen healthcare delivery, it remains unclear whether these interventions narrow or widen existing health disparities. Drawing on interdisciplinary literature spanning public health, urban informatics, and digital governance, this synthesis finds that smart health initiatives have improved healthcare access for some underserved populations, but their overall effect on health equity remains modest, inconsistent, and highly dependent on local context. Persistent structural obstacles, including digital divides, socio-economic inequality, and fragmented governance, continue to limit equitable implementation, while institutional barriers emerge as the most widespread challenge. Conversely, people-centered design, participatory governance, inclusive digital infrastructure, and equity-sensitive policy frameworks stand out as critical enablers of more just outcomes. The review further identifies an underexplored link between environmental sustainability and smart city technology, showing that AI-driven tools addressing emissions and urban environmental quality can indirectly support more equitable health systems. Overall, the findings underscore that technological innovation alone is insufficient; realizing the equity potential of smart cities requires deliberate integration of social justice, environmental sustainability, and collaborative governance into digital health strategy and practice. Full article

This study conceptualizes the youth observatory as an analytical and governance-oriented framework for examining social change, inequality, and youth development in urban contexts characterized by persistent structural disparities, using Cartagena, Colombia, as an empirical case study. Rather than conceptualizing the observatory solely as a technical mechanism for data collection and monitoring, the article argues that it should be understood as a platform for knowledge production capable of identifying emerging patterns in youth trajectories, institutional fragmentation, and evolving forms of civic engagement. The research employed a qualitative, descriptive, and interpretive design based on documentary analysis and a focus group comprising institutional stakeholders involved in youth-related initiatives. Findings indicate that the principal challenge in Cartagena is not the absence of youth-related information but the fragmentation, discontinuity, and weak articulation of existing institutional and knowledge-production systems. As a result, valuable evidence remains underutilized in policy formulation and institutional decision-making processes. The findings further demonstrate that education, labour-market integration, political participation, cultural access, mental health, and digital vulnerability should not be treated as discrete dimensions but rather as interconnected and mutually reinforcing components of contemporary youth experience. Ultimately, this article contributes to current debates by proposing the youth observatory as an analytical, interpretive, and governance mechanism that links evidence generation, public deliberation, and policy development. The study provides both empirical and conceptual foundations for the establishment of youth observatories in contexts marked by urban inequality, institutional fragmentation, and accelerated social transformation. Full article

This systematic review analysed the role, opportunities and challenges of digital technologies in promoting physical activity among rural children and adolescents aged 10–18. By identifying and analyzing 10 eligible studies across four major databases between June 2016 and June 2026, the research classified the tools used into five categories: behaviour-monitoring technologies (like wearable activity trackers), educational technologies (digital learning platforms), communication and social media technologies, immersive technologies (virtual and augmented reality), and digital health technologies. The implications of these tools were examined in relation to physical education curricula and the development of healthy lifestyles. While the available evidence suggests that these technologies support rural youth by enhancing self-monitoring, increasing health awareness, improving access to educational resources, and creating context-specific opportunities for active engagement, the data reveals that evidence of sustained improvements in moderate-to-vigorous physical activity remains limited. Furthermore, implementation is heavily hindered by barriers such as the digital divide, limited technological infrastructure, inequalities in resource access, and the threat of sedentary behaviours associated with excessive screen time. Consequently, the findings underscore a need for coordinated educational and health strategies, offering practical recommendations to integrate these digital technologies within rural educational settings to foster long-term active lifestyles. Full article

Background: The COVID-19 pandemic exacerbated longstanding social and health inequities in predominantly Black and Latino communities in North and Central Brooklyn, in the form of disproportionately high hospitalization and mortality rates. Community organizations served as critical sources of information and resources during this period. Methods: The Bureau of Brooklyn Neighborhood Health within the NYC Health Department, conducted semi-structured virtual interviews with 19 representatives from 15 organizations that had partnered with the Bureau within the past five years. Interviews were conducted between November 2021 and February 2022. Transcripts were coded and analyzed using a hybrid deductive–inductive approach incorporating constant comparative techniques. Results: Partners described worsening food insecurity, inequitable vaccine and testing access, digital divide challenges, funding instability, staffing shortages, and escalating mental health needs. Organizations pivoted from routine operations to provide emergency food distribution, virtual programming, mental health support, advocacy, and disseminating information as trusted messengers in the community. Conclusions: Findings underscore the essential role of local community organizations in crisis response and recovery. Future preparedness efforts must center community expertise, strengthen cross-sector collaboration, streamline funding processes, and investments in social and digital infrastructures to advance health equity and community resilience. Full article

Psychological resilience is a key protective factor for mental health. Reducing inequalities in access to childhood experiential activities may foster resilience across socioeconomic backgrounds. However, Japan limits policies ensuring equitable access to such activities before entering elementary school. This cross-sectional study examined the association between exposure to experiential activities before entering elementary school and psychological resilience in Japanese individuals aged 15–39 years (n = 8000). Experiential activities were classified into nature-related, social, and cultural domains and by number and combination (none, any single, any two, and all three types). Psychological resilience was assessed using the 14-item Resilience Scale (Japanese version). Multivariable linear regression models were adjusted for demographic and socioeconomic covariates with Benjamini–Hochberg (BH) correction. Exposure to one or two activity domains was significantly associated with higher psychological resilience, except for the nature-related plus social activities combination. Exposure to all three domains showed the strongest association (β = 8.06, 95% confidence interval [6.73, 9.38], BH-adjusted p < 0.001). Therefore, early childhood experiential activities may promote psychological resilience, with persistent long-term effects. Implementing social policies to reduce the disparity in access may be a key strategy for promoting psychological resilience among Japanese individuals aged 15–39 years. Full article

The equitable allocation of health resources is fundamental to building healthy cities and advancing sustainable regional development. Using panel data for 122 county-level units in Hunan Province, China, from 2011 to 2022, this study constructs an evaluation index system for healthcare resource allocation and applies trend surface analysis, spatial autocorrelation, the Dagum Gini coefficient, and geographically and temporally weighted regression (GTWR) to examine the spatiotemporal evolution, equity, and driving factors of health resource allocation. The results show the following. (1) The level of health resource allocation in Hunan Province rose steadily, with the composite score increasing by 74%, yet a persistent spatial pattern of higher allocation in the east and north than in the west and south remained; hot spots clustered in Changsha, while cold spots concentrated in parts of Southern Hunan and Western Hunan. (2) Regional disparities narrowed gradually, and the Dagum decomposition identified transvariation density as the dominant source of inequality, with an average contribution of 53.58%, exceeding intra-group and inter-group differences. (3) The effects of the drivers exhibited marked spatiotemporal heterogeneity. Per capita GDP promoted health resource allocation mainly in developed regions, while urbanization exerted stronger positive effects in less-developed regions. The positive effect of per capita disposable income gradually shifted from less-developed to developed regions over time, and population density generally showed a positive effect, with stronger influences concentrated in the Greater Western Hunan region. This study contributes to a deeper understanding of how regional disparities and heterogeneous driving mechanisms shape health resource allocation, providing evidence for more adaptive and equitable healthcare governance. Full article

Background/Objectives: Health literacy is a critical determinant of health, closely linked to behaviours, outcomes, and broader social determinants. Given that young people navigate distinct social contexts and health-related challenges compared to adults, understanding how to support their health literacy development during this important period is essential for lifelong wellbeing. This study aimed to explore the perceptions of academics and community-based practitioners regarding the concept of health literacy in young people and the importance of supporting its development. Methods: Semi-structured interviews were conducted with 30 participants (academics n = 17, health and wellbeing practitioners n = 9, policy/research n = 4) based across Europe and Australasia, with experience in youth health literacy. Data were analysed using reflexive thematic analysis. Results: Three key themes were identified: (i) Building lifelong health agency: From early foundations to transitional autonomy; (ii) Navigating novel health changes; and (iii) Structural inequities and intergenerational barriers in health literacy. Conclusions: Participants emphasised that youth health literacy interventions should move beyond didactic, individual-level information delivery toward fostering critical digital competencies and addressing structural barriers through participatory co-design with young people. Full article