Search Results (1,208)

Background: Adolescent pregnancy is a public health problem in Latin America, with a higher prevalence in rural areas. This population faces barriers to accessing education and healthcare services, increasing the risk of maternal and neonatal complications. Methods: This study employed a cross-sectional analytical design and included 72 adolescents aged 12 to 17 years in Lonya Grande. The associations between structural and intermediate social determinants of health and the prevalence of adolescent pregnancy were assessed. Results: Among the structural determinants, extreme poverty (PR: 2.48; 95% CI: 1.23–5.03; p = 0.004), type of public health insurance (PR: 3.05; 95% CI: 1.21–7.72; p = 0.005), and parental educational level were associated with a higher prevalence of adolescent pregnancy. After adjustment, having public health insurance (aPR: 0.49; 95% CI: 0.36–0.66; p < 0.001) and having parents who had completed primary school (aPR: 1.67; 95% CI: 1.15–2.42; p = 0.01) were associated with a higher prevalence of adolescent pregnancy. Among the intermediate determinants, alcohol consumption (PR: 2.77; 95% CI: 1.85–4.16; p < 0.001), knowledge about contraceptives (PR: 0.21; 95% CI: 0.03–0.85; p = 0.04), and being 17 years old (PR: 4.44; 95% CI: 1.48–13.39; p = 0.01) were associated with adolescent pregnancy. In the adjusted model, adolescents aged 15 years (aPR: 3.15; 95% CI: 1.04–9.52; p = 0.04) maintained a higher prevalence compared with those aged 14 years. Conclusions: An association was found between structural and intermediate social determinants of health and adolescent pregnancy in rural settings. These findings suggest the need for additional studies to better understand interventions targeting these associated factors. Full article

Coal phase-out regions concentrate the distributional risks of the energy transition, yet the tools used to identify energy-poor households in these territories still rely mainly on income and welfare criteria. This study asks whether such criteria can identify the households that suffer. Drawing on a survey of 706 households across six municipalities of Western Macedonia, Greece, the core territory of the national lignite phase-out, we validate a four-item Thermal Stress Index (polychoric ω = 0.885; loadings = 0.71–0.88; no differential item functioning by gender, income, or survey wave) and test nine hypotheses and one descriptive benchmark on prevalence, mechanisms, typologies, and targeting. Winter thermal inadequacy reaches 22.9%, which sits above the 19.0% national EU-SILC figure, reported as descriptive context. Dwelling energy features dominate all socioeconomic predictors of severe thermal stress (pseudo-R-squared 0.482 against 0.024), and no direct tenure association remains once envelope quality is included, while the protective association of income operates primarily through dwelling quality and is not observed across the range of inefficient dwellings. Latent class analysis identifies a hidden energy poverty class, 19.5% of households with severe experiential deprivation, above-average income, and no payment problems. A machine learning targeting audit shows that administrative criteria alone identify severely stressed households and show no discriminative capacity for identifying severely stressed households (AUC = 0.517), whereas adding dwelling and financial-strain information raises discrimination to an area under the curve of 0.938. Finally, in this sample, income-based screening is weakly associated with the households reporting severe thermal deprivation. Full article

This study explores the role of arts-based educational interventions in fostering social mending and urban regeneration in disadvantaged urban contexts. The intervention consisted of participatory mosaic workshops designed to foster cooperation, inclusion, and civic engagement, culminating in the co-creation of public artworks installed in a degraded urban underpass and included 193 children aged 5–15 living in Tor Bella Monaca, a highly marginalized suburb of Rome (Italy). The analysis of the intervention used a mixed-methods approach, based on systematic observation, questionnaires, interviews, and document analysis. The findings indicate that the artistic process acted as a catalyst for both individual and collective transformation: at the individual level, participation enhanced relational skills, emotional expression, and sense of agency; at the community level, the intervention contributed to the reactivation of public space, increased social cohesion, and improved care for the urban environment. We interpret these outcomes through the capability approach, identifying art as a “conversion factor” linking individual capabilities to collective regeneration. The intervention aligns with SDGs 4, 10, 11, and 17 of the 2030 Agenda and supports the relevance of scalable, community-based models for inclusive and sustainable urban policies in deprived areas. Full article

Seawater intrusion (SWI) represents an increasingly critical challenge for coastal groundwater systems, with particularly pronounced impacts observed along the Indian coastline. Coastal aquifers constitute a vital freshwater resource supporting domestic, agricultural, and industrial demands. This study evaluates SWI vulnerability along the entire Indian coast, extending from Gujarat to West Bengal, covering approximately 7517 km of shoreline and up to 100 km inland. The assessment applies the GALDIT vulnerability framework that combines several hydrogeological and hydrochemical criteria such as groundwater occurrence, aquifer hydraulic conductivity, depth to groundwater, distance from shoreline, hydrochemical data, and groundwater quality data. We also assessed the intrusion of existing seawater, shoreline location, and aquifer thickness. However, conventional vulnerability assessments are inherently static and often fail to capture anthropogenic influences. To address this limitation, the present study integrates multi-temporal land use and land cover (LULC) datasets derived from ESA WorldCover remote sensing data for the period 2017–2024. Incorporating LULC dynamics enables a more comprehensive evaluation of the impacts of urban expansion and agricultural intensification on coastal susceptibility to SWI. Accordingly, a modified GALDIT-LU framework is developed to assess the spatiotemporal evolution of coastal vulnerability. The outcomes suggest that huge parts of the Indian coastline are vulnerable to moderate or very high classes, with the very high vulnerability class growing from 13,295 km² in 2017 to 38,257 km² in 2024, a 188% increase in vulnerability over the course of seven years. Groundwater chloride concentrations from Central Ground Water Board (CGWB) monitoring well locations have been used for validation over the proposed assessment, and show good spatial agreement between areas identified as high vulnerability and the spatial distribution of groundwater salinity for all three assessment periods, lending support to the robustness and predictive power of the proposed groundwater salinity assessment. The findings carry direct implications for the United Nations 2030 Agenda, demonstrating that the identified vulnerability patterns intersect with critical targets related to clean water and sanitation, food security, public health, climate action, and poverty reduction along one of the world’s most densely populated coastlines. Full article

Here, changes in sustainability are assessed using statistical data for all countries between 1990 and 2015, with a focus on the fifteen most populous countries. The indicators used cover GDP for the economy; poverty, education, and health for human capabilities; as well as environmental impacts on water, climate, air, and bioresources. An authoritative model is used to describe the environmental impacts, resulting from pressures driven by population and affluence; and responses, through decreasing resource intensity, measured by the resource use per GDP, and improving environmental efficiency, defined as emissions per resource use. Resource intensity decreases in most countries. Environmental efficiency improves for wastewater and NOx, hardly changes for CO₂, and increases in nature protection areas, but this rarely compensates for deforestation. The combination of pressures and responses reduced water pollution and air pollution, and mitigated climate change in high-income countries, but did not reduce the degradation of biodiversity. While the pressures, responses, and environmental impacts of economic growth vary across all countries, twenty-five growing economies have reduced those environmental impacts. Changes toward sustainability are discussed with regard to the growing share of services in economies in the ‘EKC hypothesis’, innovation for achieving higher value at lower impact in the ‘green growth’ idea, and regulations that lead to profitable environmental investments in the ‘Porter hypothesis’. Combined, they only partially explain the changes because they ignore the low prices of natural resources and high shareholder consumption. Additionally, regulations are needed that increase the price of environmental impacts relative to the price of man-made resources and enforce high-quality performance standards. Full article

In the context of global advocacy of sustainable agriculture and urban-rural coordinated development, it is important to explore the socio-economic effects of agricultural eco-efficiency. In this study, we aim to empirically examine the impact of agricultural eco-efficiency (AEE) on the urban-rural income gap (URIG) and its mechanisms in China in order to provide policy recommendations for promoting the coordinated development of environmental sustainability and social equity. Based on Chinese provincial panel data from 2011 to 2024, a two-way fixed-effects model was employed. Robustness was tested through winsorization and variable replacement, and the lag of AEE was used as a variable to address endogenous problems. Furthermore, the adjustment effect model, the panel threshold model, and group regression were used to analyse the regulatory effect of financial support, threshold effect of urbanization levels, and heterogeneity across regions, technologies, and infrastructure. The research results show the following: (1) Improvement in AEE is significantly associated with a narrowing of the URIG, and this conclusion remains true under multiple tests. (2) Financial support plays a significant positive moderating role. (3) The impact of AEE has a double threshold effect based on the urbanization level, which is only significant in the range of medium urbanization level. (4) The effect is more obvious in the main grain-producing areas, areas with a high agricultural mechanization level, and areas with a high transportation infrastructure level. (5) AEE helps narrow the URIG in the target and neighbouring areas. Improving the ecological efficiency of agriculture has both environmental and income distribution benefits. Policy formulation should focus on strengthening the precise orientation of financial support and implementing differentiated strategies according to the urbanization stage, regional functional positioning, and technical foundation, so as to maximise its effectiveness in reducing poverty, increasing income, and promoting urban and rural equity. Full article

Background/Objectives: Food insecurity (FI) is a major public health challenge and is monitored globally using the Food Insecurity Experience Scale (FIES). In Peru, the recent incorporation of the FIES into the National Household Survey (ENAHO) enables the generation of nationally representative estimates. This study evaluated the statistical validity of the FIES and estimated the prevalence of food insecurity among Peruvian households. Methods: A cross-sectional study was conducted using ENAHO 2025 data. FI was assessed using the eight-item FIES. Rasch analysis evaluated item fit, severity ordering, reliability, residual correlations, and differential item functioning. National prevalence estimates of moderate-or-severe and severe FI were calculated using the Food and Agriculture Organization of the United Nations (FAO) FIES methodology and household sampling weights. Results: The study included 32,041 households, representing approximately 9.9 million households nationwide. The FIES demonstrated satisfactory statistical validity, with a Rasch reliability of 0.796. Item severities followed the expected progression of FI, residual correlations remained below the recommended threshold, and no substantial differential item functioning was observed. The prevalence of moderate-or-severe FI was 30.9%, while severe FI affected 4.0% of households. Higher prevalence was observed among households living in extreme poverty, with unmet basic needs, lower educational attainment, permanent functional limitations, and in rural and Amazonian areas. Conclusions: The FIES demonstrated adequate validity for household-level monitoring of FI in Peru. Nearly one-third of households experienced moderate-or-severe FI, and prevalence varied across socioeconomic and geographic groups. The integration of the FIES into ENAHO provides a valuable platform for routine monitoring and food security policymaking. Full article

Currently, access to safe drinking water in developing countries remains a structural challenge. Despite progress, many households still lack access to clean and safe water, leading to serious consequences for health, human dignity, and the economy. This research aims to evaluate the impact of drinking water and sanitation investment projects on monetary expenditures for water consumption. Using data from the 2017 and 2023 National Household Survey (ENAHO-INEI) in Peru, a longitudinal study with a retrospective cohort design was conducted. The complex, probabilistic sampling method allowed for modeling both periods using ordered multiple response logit regression. The results show that household connections to potable water positively impacted water consumption expenditures in 2017 (n = 21,251) and 2023 (n = 19,482). Similarly, connections to sanitation facilities positively influenced expenditures in 2017, although no significant evidence was found in 2023. Having access to safe water (adequate chlorine) versus unsafe water (inadequate chlorine) showed a positive effect on consumption expenditures in both years, reflecting that families must bear a double expense to access alternatives such as bottled water. A higher monthly income of the head of household, associated with greater age and years of education, increases expenditures on potable water, excluding households in monetary poverty. A differentiated design of water policies is recommended, based on natural region (coast, highlands, and rainforest) and area (urban or rural), considering the different water access alternatives according to the geographic location of the dwelling. Full article

As urban areas are vulnerable to destructive and sometimes lethal fires, modern water supply networks are designed with firefighting in mind. This work tests whether the requirements for higher fire flows are associated with lower fire mortality rates. The work is primarily a review of the relevant international literature with a simple case study. It was found that, despite having some of the world’s most demanding fire flow requirements, the US fire mortality rate (deaths/100,000 people/year) is nearly double (0.91) that of Belgium, New Zealand, Ireland, France, the Netherlands, and Great Britain (<0.47). When it comes to fire flows, many European countries require 20 L/s or less. In contrast, North America has a higher minimum fire flow requirement of 32 L/s that can reach 95 L/s. Additional fire flow in North America appears to provide little benefit to mortality rates, which is a key finding of this work. Fire flow requirements and fire mortality appear to be weakly correlated. Other factors, such as the absence of smoke alarms, smoking, rural residence, poverty, and disability, are likely more important for fire mortality than municipal fire flows, which is another key finding. Providing fire flows that do not reduce mortality comes at a cost. A common fire flow restriction in North America is that pipes must be at least 150 mm in diameter. A simple case study demonstrates that relaxing this requirement reduces network costs and improves water quality. Suggestions are included on how to mitigate these effects for North American networks. Full article

Background: Missed and zero-dose children remain major barriers to polio eradication in settings affected by insecurity, poverty, weak health systems, and social exclusion. This narrative review synthesized evidence on how gender norms and related social determinants influence childhood polio vaccination in Afghanistan, Nigeria, Pakistan, and Sudan. Afghanistan and Pakistan remain the only countries with endemic wild poliovirus transmission, while northern Nigeria, especially areas affected by insurgency, and war-affected Sudan continue to report substantial numbers of polio zero-dose and under-immunized children, together with occasional reports of circulating vaccine-derived poliovirus. Methods: A comprehensive search of peer-reviewed and institutional literature was conducted in major databases and relevant grey literature sources. Eligible studies examined childhood immunization or polio vaccination among children under five and reported gender-related determinants of vaccination uptake. Findings were synthesized thematically. Results: Forty-one studies were included. Five interconnected domains emerged: women’s empowerment, autonomy, and household decision-making; male involvement, household gender norms, and family power relations; socioeconomic and structural gender-related barriers; education, information access, community perceptions, and health system responsiveness; and war, insurgency and their gendered impact on childhood polio immunization. Across countries, limited maternal autonomy, restricted mobility, dependence on male decision-makers, poverty, conflict, displacement, misinformation, and weak health services reduced access to vaccination. Supportive male engagement, female health workers, trusted community leadership, and culturally responsive outreach facilitated vaccine acceptance. Conclusions: Gender influences childhood polio vaccination through intersecting household, community, structural, and health-system pathways. Family power extends beyond male decision-making, with women’s education and influence within households shaping vaccination decisions. Strengthening women’s agency, constructively engaging men (e.g., through husband schools), and delivering culturally responsive services are essential for reaching missed and zero-dose children and accelerating polio eradication. Full article

Climate change has become one of the most urgent challenges of the 21st century, shaping environmental, economic, and social dynamics on a global scale. In the Mediterranean basin, temperatures have risen by 1.5 °C, with projections suggesting a further increase of 5.6 °C by 2100. The building sector represents a critical intervention point, accounting for 30% of final energy consumption and 27% of global carbon dioxide emissions. While passive strategies mitigate these impacts, current energy policies fail to consider future variations in heating and cooling demand due to climate change. Using OpenStudio and EnergyPlus, three reference models (small office, residential building, and hospital) were simulated across five Spanish climatic areas (Almería, Córdoba, Cáceres, Lleida, León). Current conditions were compared against 2050 projections under four Shared Socioeconomic Pathways (SSP1-2.6 to SSP5-8.5) utilizing the morphing method. The results revealed a systemic shift toward cooling-dominated profiles. Small office heating demand drops by 18–34%, while cooling demand increases by 80–274%. Residential heating decreases by 19–36%, while cooling increases by 85–706%. Hospitals show milder relative variations, yet cooling demand rises 64–114%. These findings, based on thermal energy demand (kWh/m²), emphasize the need for climate-responsive design and efficient retrofitting. Conclusions regarding peak power grid stress, carbon emissions, or energy poverty are indirect implications; translating thermal demand to final energy, primary energy, or emissions requires accounting for HVAC system efficiency, energy source mix, and emission factors, which are outside the scope of this study. Full article

Understanding multidimensional deprivation requires consideration not only of who experiences overlapping disadvantages but also of how those disadvantages vary geographically. This study provides a comprehensive descriptive assessment of geographic variation in multidimensional deprivation across the United States using pooled 2022–2023 American Community Survey (ACS) Public Use Microdata Sample data and a Multidimensional Deprivation Index (MDI) constructed using the Alkire–Foster methodology. The MDI incorporates eight indicators spanning four equally weighted dimensions of well-being: economic security, education, health, and housing. Variation is examined across four nested geographic scales—Census regions, Census divisions, states, and all 2487 Public Use Microdata Areas (PUMAs)—using the Headcount Ratio (H), Average Deprivation Intensity (A), and the MDI. The results reveal substantial geographic differences in multidimensional deprivation across the United States, with progressively finer geographic scales revealing increasingly localized patterns. Geographic areas with similar overall MDI values often differ substantially in the composition of deprivation, underscoring the importance of examining the composition as well as the overall level of deprivation. Across all geographic scales, differences in multidimensional deprivation primarily reflect variation in deprivation incidence rather than deprivation intensity, while the PUMA-level analysis suggests that important local variation is obscured by broader regional and state averages. The principal contribution of this study is its integrated multiscale framework. Rather than developing a new deprivation measure or evaluating formal spatial dependence, the analysis applies an established Alkire–Foster methodology to recent nationally representative ACS microdata. This framework provides a consistent descriptive assessment of multidimensional deprivation across multiple nested geographic scales. The findings establish a descriptive empirical benchmark for geographically informed policy discussions and for demonstrating that both the level and composition of multidimensional deprivation vary systematically across geographic scales and that important local variation is obscured by broader regional and state averages. Full article

Background: Adolescent substance abuse is a growing public health concern associated with poor mental health, unsafe sexual behaviour, violence, school dropout, and psychosocial dysfunction. In rural South Africa, peer influence, cultural practices, poverty, and inadequate psychosocial support may increase learners’ vulnerability to substance use. However, limited qualitative evidence exists on how these factors influence substance abuse among school learners in rural communities. Aim: This study explored peer-group and cultural influences on substance abuse among school learners in a rural community in Limpopo Province, South Africa. Methods: A qualitative, exploratory, descriptive, and contextual design was adopted. Purposive sampling was used to recruit 30 learners from selected secondary schools in the DIMAMO area of the Capricorn District, Limpopo Province. Data were collected through semi-structured one-on-one interviews until data saturation was reached. Interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis guided by Social Learning Theory. Trustworthiness was ensured through credibility, dependability, confirmability, and transferability. Ethical approval and informed consent were obtained prior to data collection. Results: Two major themes emerged: causes of substance abuse and factors maintaining substance use. Peer pressure and social influence contributed to the initiation of alcohol, cannabis, cigarette, and snuff use. Cultural practices and ancestral beliefs further normalised substance use behaviours. Psychological distress associated with poverty, family conflict, and inadequate parental support increased learners’ vulnerability. Continued substance use was reinforced by addiction, perceived emotional relief, social tolerance, and easy access to substances. Conclusions: Adolescent substance abuse in rural communities is influenced by interconnected social, cultural, psychological, and environmental factors. Integrated school- and community-based psychosocial interventions are needed to strengthen adolescent mental health and substance abuse prevention strategies. Full article

Energy poverty remains a persistent challenge in South Africa, despite relatively high levels of electricity access in urban townships. This study investigates household energy consumption patterns, energy-related challenges, and community perceptions of renewable energy in South Africa. In this study, a quantitative research design was employed, using a structured questionnaire administered to households selected from both electrified and non-electrified areas. The data were analyzed using descriptive statistics and inferential analysis with the Statistical Package for the Social Sciences (SPSS Version 30). The findings demonstrated that although electricity is widely used for basic services such as cooking and lighting, many households continue to rely on multiple fuels to meet their daily energy needs. This practice of energy stacking reflects ongoing concerns about affordability, reliability, and safety, and highlights that access to electricity alone does not guarantee energy security. Households also report significant financial pressure from energy costs, as well as health and fire risks associated with the use of unsafe alternative fuels. While awareness of renewable energy is present within the community, knowledge levels are uneven and not strongly associated with demographic factors, suggesting the need for more inclusive and targeted engagement strategies. Overall, the study demonstrates that energy poverty in urban South African townships extends beyond physical grid connection and is shaped by complex socio-economic and safety considerations. By foregrounding community perspectives, this research contributes to the international literature on multidimensional energy poverty and supports the design of integrated, people-centered interventions that advance affordable, reliable, and clean energy transitions in the Global South. Full article

Cardiovascular disease (CVD) is the leading cause of mortality in the United States, yet the role of atmospheric exposures as independent predictors of county-level CVD mortality remains poorly characterized. We integrated satellite-derived atmospheric data alongside socioeconomic, demographic, and livestock predictors across 24,487 county-year observations in the contiguous United States (2012–2019) and applied an XGBoost model with SHAP-based interpretability to identify the leading predictors of county-level CVD mortality (Test R² = 0.706, RMSE = 29.55 per 100,000 persons). Four of the top ten predictors came from CAMS/ERA5. Ambient formaldehyde exposure frequency ranked second among all 43 predictors, exceeded only by educational attainment and surpassing poverty rate. Wet-bulb temperature ranked third, Leaf Area Index for High Vegetation ranked seventh, and sulphate aerosol mixing ratio ranked eighth. These variables added county-level prediction information beyond socioeconomic covariates. Integrating atmospheric exposure monitoring into county-level CVD surveillance alongside socioeconomic indicators may improve the identification of high-risk geographies. Full article