Search Results (673)

Background/Objectives: Halitosis in geriatric patients is multifactorial, but the joint contribution of prosthetic rehabilitation type and polypharmacy after routine dental procedures has rarely been quantified. We investigated how prosthesis type, polypharmacy, and salivary function were associated with volatile sulfur compound (VSC) burden and self-perceived halitosis in elderly dental patients. Methods: This cross-sectional study enrolled 88 patients aged ≥65 years, four weeks after completing routine dental procedures. Participants were stratified into three groups: complete denture wearers (n = 30), partial removable denture wearers (n = 28), and fixed prostheses/implants (n = 30). We measured unstimulated salivary flow rate (uSFR), tongue coating index (TCI), denture biofilm index, total VSCs (Halimeter^®), organoleptic score (0–5), and self-perceived halitosis. Polypharmacy, comorbidities, and the Geriatric Oral Health Assessment Index (GOHAI) were recorded. Analyses included one- and two-way ANOVA, Spearman correlations, theory-informed multivariable linear and logistic regression, exploratory mediation analysis, and ROC curves. Results: Forty-two participants (47.7%) reported halitosis. Mean VSC differed across groups (complete dentures 278.2 ± 38.6 ppb; partial 211.2 ± 46.3 ppb; fixed 164.4 ± 43.9 ppb; ANOVA p < 0.001). uSFR correlated inversely with VSC (ρ = −0.61, p < 0.001) and TCI correlated positively (ρ = 0.56, p < 0.001). A significant prosthesis × polypharmacy interaction was observed (F = 3.74, p = 0.029, η²_p = 0.082): polypharmacy was associated with higher VSC most clearly among partial and fixed prostheses wearers, whereas complete denture wearers showed high VSC levels regardless of polypharmacy status. Exploratory mediation findings were consistent with partial indirect association, with 45.9% of the polypharmacy–VSC association statistically explained by reduced uSFR; however, the cross-sectional design precludes causal or temporal interpretation. The full multivariable model showed apparent discrimination for self-perceived halitosis (AUC = 0.92), while the simplified four-item chairside composite model showed AUC = 0.89; neither estimate was optimism-corrected or externally validated. Conclusions: In elderly post-procedure patients, complete denture wearing, polypharmacy, and salivary hypofunction were independently and jointly associated with higher halitosis burden. Reduced salivary flow was consistent with a partial indirect statistical pathway in the polypharmacy–VSC association, supporting hydration counseling and meticulous prosthesis hygiene as low-cost geriatric interventions. Sensitivity analyses excluding implant-supported restorations, participants with MMSE scores of 24–26, and expanded mediation models including TCI and biofilm/plaque did not materially change the main inference. Full article

Background: The increasing use of e-cigarettes among adolescents is a growing public health concern in Thailand, where they are prohibited but remain accessible. This study aimed to examine the psychosocial correlates of preventive behaviors regarding e-cigarettes among adolescents in central Thailand. Methods: A cross-sectional correlational study was conducted with 383 secondary school students (Grades 7–12) selected through proportionate stratified random sampling from two government schools in Ongkharak District, Thailand. Data were collected using a validated self-administered online questionnaire assessing attitudes toward e-cigarettes, peer influence, family attachment, and preventive behaviors. Item analysis, confirmatory factor analysis (CFA), and factor-score regression with bootstrapped indirect-association analysis (k = 5000) were performed to examine direct and indirect associations. Results: The four-factor measurement model demonstrated acceptable absolute fit (SRMR = 0.069) but weaker incremental fit (CFI = 0.70), expected given the large number of ordinal indicators estimated via maximum likelihood, with standardized factor loadings ranging from 0.621 to 0.926 (p < 0.001). The structural model explained 44.2% of the variance in preventive behaviors (R² = 0.442). Family attachment showed the strongest total association (β = 0.456), including both direct and indirect associations through attitudes (β = 0.116) and peer influence (β = 0.162), consistent with a pattern of statistically significant indirect associations. Conclusions: Family attachment was associated with self-reported e-cigarette preventive behavior, with statistically significant indirect associations through attitudes and peer influence. Given the cross-sectional design, these findings should be interpreted as model-consistent associations rather than causal mediation, and may inform future family- and peer-oriented prevention research in comparable settings. Full article

Objectives: Fear of falling (FoF) is a common psychological phenomenon in later life and is often accompanied by avoidance behavior and activity restriction. Although FoF is associated with anxiety, depressive symptoms, reduced self-efficacy, and fear of loss of autonomy, older adults with FoF may differ substantially in the configuration of these characteristics. The present study aimed to identify data-derived profiles of older adults based on FoF, avoidance behavior, self-efficacy, and fear of loss of autonomy, and to examine profile-specific psychological predictors of FoF and avoidance behavior. Methods: The main analytical sample included 217 older adults aged 60–97 years (M = 76.45, SD = 10.14) with Mini-Mental State Examination scores of 20 or higher. Latent profile analysis was conducted using FoF, avoidance behavior, self-efficacy, and fear of loss of autonomy. Anxiety components, depressive symptoms, coping strategies, pain catastrophizing, and loneliness-related indicators were examined in class-specific regression models. The stability of the class solution was tested across different MMSE cut-off scores. Between-class comparisons were conducted for functional, fall-related, socio-demographic, and psychological indicators. Results: A three-class solution was selected and interpreted as adaptive, vulnerable, and maladaptive profiles. The profile structure remained relatively consistent across MMSE cut-off scores, including in the broader sample with MMSE ≥ 15. The classes did not differ significantly in postural balance or number of falls, suggesting that the profiles could not be fully explained by objective fall-risk indicators. Significant between-class differences were found for age, daily pain level, and state social defense. Class-specific regression models suggested that psychological variables associated with FoF and avoidance behavior differed across profiles. Pain appraisal and emotion-related coping were more relevant in the adaptive profile, phobic anxiety and anxious appraisal of future events in the vulnerable profile, and anxiety-related, depressive, interpersonal, and coping-related factors in the maladaptive profile. All reported associations remained significant after false discovery rate correction. Conclusions: FoF and avoidance behavior are related but not identical phenomena and vary across data-derived psychological profiles. A profile-oriented approach may provide a more differentiated understanding of activity restriction in older adults and help identify profile-specific targets for psychological support. Full article

Background: Adolescence and emerging adulthood are periods of heightened risk for the onset of psychopathology. Emotion dysregulation (ED), impulsiveness, and rumination are transdiagnostic processes implicated across symptom domains, but their relative contributions in clinical youth samples remain unclear. This study examined these three self-regulatory processes simultaneously in first-time help-seeking adolescents and young adults, addressing their differential associations with psychopathological symptom dimensions at an early stage of clinical contact. Methods: We conducted a retrospective observational study with a cross-sectional design in outpatients aged 16–25 years presenting for a first-time psychiatric outpatient consultation at a university hospital in Catania, Italy. Participants completed self-report measures of rumination (RRS), impulsiveness (BIS-11), ED (DERS), and psychopathological symptoms (SCL-90-R). Associations were examined using Spearman’s and partial correlations. Multivariate multiple regression, followed by outcome-specific multiple linear regression models, assessed the relative associations of rumination, ED, and impulsiveness across symptom dimensions. Results: Rumination showed the broadest pattern of unique associations, with FDR-significant associations with eight SCL-90-R domains; the largest coefficient was observed for depression (B = 0.053, 95% CI [0.042, 0.064]). ED was associated with obsessive–compulsive symptoms, depression, anxiety, anger–hostility, and phobic anxiety. Impulsiveness showed more limited associations, remaining significant for anger–hostility and psychoticism. Conclusions: Findings are consistent with a transdiagnostic framework in which rumination and ED relate to multiple symptom dimensions, whereas impulsiveness shows more domain-specific associations. Because the study was cross-sectional and based on self-report measures, these associations should be tested in larger longitudinal and multimethod studies. Full article

Background/Objectives: Uncontrolled diabetes and associated comorbidities disproportionately affect African American (AA) adults. Medication adherence is key to diabetes control yet is often suboptimal, particularly among AA adults. This study examined associations between patient characteristics and adherence among AA adults with uncontrolled diabetes and compared two medication adherence instruments for predicting diabetes control. Methods: This cross-sectional analysis used baseline data from the Management of Diabetes in Everyday Life (MODEL) study, a clinical trial to improve diabetes self-care among AA adults with uncontrolled diabetes. Internal consistency of the 12-item Adherence to Medication Refills and Medications Scale for diabetes medications (ARMS-D) was evaluated by comparing its Cronbach α to the standardized Cronbach α calculated from MODEL data. Associations with variables were examined using correlations, t-tests, or ANOVA, as appropriate. Stepwise multiple regression identified predictors of diabetes control assessed by hemoglobin A1c (HbA1c). Results: Among 665 participants (mean age = 54 years, HbA1c = 10.24%; 67% female; 73% high health literacy), 75% reported perfect adherence on the Summary of Diabetes Self-Care Activities Medications Subscale (SDSCA-MS) versus 7.3% on ARMS-D. ARMS-D showed strong internal consistency (α = 0.81). Lower adherence by ARMS-D was associated with younger age, higher social complexity, and depression (all p ≤ 0.001). ARMS-D score, age, depression, and insulin, dipeptidyl peptidase 4 inhibitor, and sodium-glucose co-transporter 2 inhibitor use predicted baseline HbA1c. Conclusions: This study demonstrates that younger age, depression, and high social complexity are associated with lower medication adherence measured using the ARMS-D. Adherence gaps identified by ARMS-D may validly predict diabetes control and help guide interventions to improve diabetes care in AA adults with uncontrolled diabetes. Full article

In green credit markets, information asymmetry and corporate greenwashing increasingly undermine the efficiency of resource allocation, while traditional assessment models relying on static, self-reported environmental data fail to impose effective constraints. To address this limitation, this paper develops a dynamic corporate carbon credit evaluation framework by integrating multiple sources of physical (hard) signals and embeds it into commercial banks’ credit management systems. Anchored in multi-source power-carbon signals (e.g., carbon intensity and compliance records), the framework integrates verifiable physical metrics with ESG disclosures via a Bayesian AHP–CRITIC weighting scheme to construct a dual-dimensional classification scheme (“Credit Rating–Green Label”). It further embeds carbon credit scores into dynamic adjustments to credit limits and differentiated interest rate pricing, forming an integrated risk management mechanism. Empirically, a stratified validation strategy is adopted. Analysis based on a sample of 3327 firms shows that the proposed framework achieves a classification consistency of 81.3%, significantly outperforming both a financial-only baseline model (46.8%) and models based on voluntary carbon disclosure (61.4%). Ablation studies further confirm that physical (hard) signal indicators contribute substantially to ranking stability. Moreover, panel regression analysis, based on 36,185 firm-year observations from 3327 firms over the period 2000–2023, demonstrates that carbon credit scores have robust predictive power for future financial distress. Overall, the proposed framework offers a sustainable, data-driven approach to green credit risk management. Full article

This study examined how digital equity conditions and bundled professional development policies are associated with sustainable teacher learning, self-efficacy, and student engagement in Greek primary schools. A total of 460 in-service teachers from urban, suburban, and rural areas participated in the study. Data were collected through Likert-scale measures assessing information systems use, TPACK-aligned professional development outcomes, teacher self-efficacy, implementation challenges, and student engagement. The analysis included ANOVA, MANOVA, OLS regression with interaction terms, and theory-informed indirect-pathway models. The findings indicated that infrastructure funding alone was not significantly associated with teacher capacity or student engagement after the introduction of relevant controls. More consistent associations emerged when funding was combined with mandated and time-protected professional development, together with minimum connectivity standards. Teacher self-efficacy was consistent with a partial indirect pathway between information systems use and student engagement, while stronger indirect associations were observed among early-career teachers. In addition, a bundled governance index was associated with narrower urban–rural disparities in teacher capacity. The findings suggest that sustainable digital equity in primary education depends not only on access to resources but also on coherent professional support structures that are associated with teacher confidence, instructional continuity, and long-term engagement. Implications are discussed for the design of sustainable professional development policies in teacher education and primary schooling. Full article

Investigating the predictors of moral distress is particularly important for protecting nurses’ mental health and professional satisfaction, thereby preventing burnout and attrition from the profession. The primary aim of this study was to evaluate the predictors of moral distress among nurses. A cross-sectional study design was used. The sample consisted of 412 nurses from 11 hospitals across Slovakia. The mean age of the respondents was 40.48 years (SD = 10.92). Moral distress was assessed using the Modified Moral Distress Scale. Linear regression analysis was used to evaluate predictors of moral distress. Personal accomplishment, the maladaptive coping strategy of self-distraction, continuous shift operation, and emotional burnout emerged as significant predictors of the frequency of moral distress among nurses (AdjR² = 15.5%; R² = 0.155). Regarding the intensity of moral distress, significant predictors included personal accomplishment, the maladaptive strategy of self-distraction and the adaptive strategy of religiosity and spirituality (AdjR² = 14.0%; R² = 0.140), which appear to function as adaptive coping mechanisms for dealing with the intensity of moral distress. Systematic investigation of predictors of moral distress among nurses may contribute to the development of interventions and programs that support nurses, thereby improving not only their job satisfaction but also the quality of patient care. Full article

Objectives: The objective was to investigate associations among oral hygiene behaviors, periodontal awareness, and self-reported periodontal symptoms among adults using a cross-sectional questionnaire and an internally consistent awareness scoring system. Materials and Methods: This cross-sectional questionnaire study was conducted between October 2025 and February 2026 among adults aged 18–65 years. Of 412 returned questionnaires, 386 complete and eligible forms were analyzed. The 42-item questionnaire assessed sociodemographic variables, oral-hygiene behavior, dental attendance, previous periodontal care, awareness of periodontal signs, and self-reported symptoms during the previous six months. Awareness was scored from 0 to 20. Descriptive statistics, chi-square tests, t tests, one-way ANOVA with Tukey post hoc tests, and multivariable logistic regression were used. Results: Mean age was 31.8 ± 9.6 years, and 58.0% of participants were women. Twice-daily toothbrushing was reported by 56.0%, and interdental cleaning by 38.6%. Mean awareness score was 12.7 ± 3.8. Awareness was higher among participants with university/postgraduate education, regular dental attendance, and interdental cleaning habits (all p < 0.001). Gingival bleeding was the most frequently reported symptom (47.4%). In the adjusted analysis, complaint-based dental attendance (OR = 2.43; 95% CI: 1.46–4.03; p = 0.001), current smoking (OR = 1.96; 95% CI: 1.17–3.29; p = 0.011), and no interdental cleaning (OR = 2.08; 95% CI: 1.31–3.30; p = 0.002) were independently associated with reporting at least one periodontal symptom. Conclusions: Within the limits of this observational survey, preventive attendance and interdental cleaning were associated with higher awareness and lower self-reported symptom burden. Full article

Background/Objectives: Determination of baseline predictors of longer-term quality of life (QOL) after autologous hematopoietic stem cell transplantation (Auto-HSCT) may identify patients with the greatest supportive care needs. We hypothesized that baseline older age, weight loss, and worse functional performance would negatively predict QOL over two years post-HSCT. Methods: Physical function, body composition, and QOL were assessed before (PRE) and one month (1MO) after Auto-HSCT in U.S. Veterans (N = 23). QOL and survival were also assessed approximately every six months for two years after Auto-HSCT (5MO, 1YR, 1.5YR, and 2YR). Changes over time were tested via Generalized Estimating Equation regression analyses (p < 0.05 = significant). The impact of PRE variables on QOL at each follow-up was tested via Spearman’s correlations (p < 0.01 = significant). Results: Relative to PRE, depression and anxiety significantly improved (p ≤ 0.039) at 1MO while fatigue and vitality significantly worsened (p ≤ 0.024) 1MO to 5MO post-HSCT. Vitality, depression, and anxiety returned to PRE levels thereafter, while fatigue trajectory varied depending on the survey used. Bone-Marrow-Transplant-related QOL significantly improved at 5MO (p = 0.014) while self-reported function (p ≤ 0.021) and physical activity (p ≤ 0.045) significantly improved 1-2YR post-HSCT. Greater PRE 30 s chair stand test performance consistently correlated with better self-reported function 1-2YR (r = 0.76–0.91, p ≤ 0.007) post-HSCT. Greater PRE 6 min walk test performance consistently correlated with better symptom burden 1-2YR (r = 0.71–0.81, p ≤ 0.01) post-HSCT. Conclusions: In support of our hypothesis, baseline functional performance was associated with QOL during two years of recovery after Auto-HSCT; older age and recent weight loss at baseline only predicted worse baseline QOL. Our data indicates that evaluation of the 30 s chair stand and 6 min walk tests as rehabilitation targets and/or predictors of QOL, fitness, or mortality after Auto-HSCT are warranted. Larger, controlled studies are needed to confirm the findings from this exploratory analysis. Full article

Background: Influenza vaccination uptake among healthcare professionals remains suboptimal despite their key role in influencing public vaccination behavior. This study investigated motivational and behavioral determinants of influenza vaccination uptake and advocacy among primary healthcare professionals in Greece. Methods: A cross-sectional study was conducted among 304 physicians and pharmacists using an anonymous online questionnaire. Vaccination uptake (2023–2024 season and annual) and motivational and advocacy constructs were assessed using the validated MoVac-flu and MovAd scales. Factor structure was evaluated using confirmatory and exploratory factor analyses. Multivariable logistic regression models were applied to identify predictors of vaccination uptake. Results: The study sample consisted of 304 healthcare professionals of whom 61.2% were physicians and 38.8% were pharmacists. More than half of the participants were female (52.6%) and aged 41–60 years (57.6%). Influenza vaccination uptake was 77.6% for the 2023–2024 season and 75.3% for annual vaccination. A two-factor structure was identified for the MoVac-flu scale (F1: Vax Self-Care, F2: Vax Awareness), whereas a four-factor structure was identified for the MovAd scale (F1: Vax Communication, F2: Vax Influence, F3: Vax Confidence, F4: Vax Choice). The overall scales demonstrated high internal consistency, while most subscales showed satisfactory to high reliability. Motivation toward influenza vaccination and vaccination advocacy were high among the participants. Vaccinated participants demonstrated higher motivation and vaccination advocacy scores compared with non-vaccinated participants. In multivariable analyses, higher scores on Vax Self-Care (aOR = 3.22, 95% CI: 2.08–4.96, p < 0.001) and Vax Communication (aOR = 1.64, 95% CI: 1.14–2.34, p = 0.007) subscales, reflecting higher motivation and vaccination advocacy, respectively, as well as male sex (aOR = 2.35, 95% CI: 1.14–4.83, p = 0.020) were associated with higher odds of annual vaccination. Higher scores on the Vax Self-Care subscale (aOR = 3.66, 95% CI: 2.33–5.77, p < 0.001) were also found to be associated with higher odds of 2023–2024 vaccination uptake, as well as living with vulnerable individuals (aOR = 2.95, 95% CI: 1.18–7.38, p = 0.020). Conclusions: Influenza vaccination uptake among primary healthcare professionals in Greece was relatively high; however, it was strongly driven by intrinsic motivational factors, particularly the perceived personal and public health benefits of vaccination. Communication-related competencies also independently contributed to vaccination behavior, highlighting the link between professional practice and personal uptake. In contrast, household-related contextual characteristics, such as cohabitation with vulnerable individuals, appeared to exert a less consistent influence on vaccination behavior. These findings suggest that interventions focusing on strengthening intrinsic motivation and communication skills may contribute to sustained improvements in both vaccination uptake and advocacy among healthcare professionals. Full article

Sexuality education is a key component of sexual and reproductive rights; however, important inequities persist across populations, particularly among people with disabilities. This study examines perceived quality of sexuality education in Chile, with a primary focus on disability-related inequities and a specific analytic emphasis on women with disabilities. We analysed data from the 2022–2023 National Survey on Health, Sexuality, and Gender (n = 17,679). The outcome was self-reported perceived quality of sexuality education. Survey-weighted descriptive analyses and ordinal logistic regressions were conducted. One model included the full sample, and a second focused on women with disabilities (n = 2324). Predicted probabilities were estimated for key interactions. Nearly half of participants reported poor sexuality education (47.2%). Predicted probabilities indicated consistently lower probabilities of reporting good sexuality education among people with disabilities across gender groups and most age groups. Among women with disabilities, higher education (secondary: odds ratio (OR) = 2.53, 95% Confidence Interval (CI): 1.84–3.49; tertiary: OR = 1.74, 95% CI: 1.12–2.72), foreign nationality (OR = 2.87, 95% CI: 1.27–6.50), and good self-rated health (OR = 1.74, 95% CI: 1.14–2.66) were associated with higher perceived quality, indicating heterogeneity within this population. These findings highlight consistent disability-related inequities in the perceived quality of sexuality education and underscore the need for inclusive, accessible, and gender-sensitive approaches grounded in human rights. Full article

Background: Adopting a healthy lifestyle through a balanced diet and regular physical activity is essential for chronic disease prevention, but healthcare workers face occupational constraints that may limit such behaviors. This study assessed perceived capability for healthy diet and physical activity among healthcare workers in the Jazan region of Saudi Arabia using the Capability Assessment for Diet and Activity (CADA) instrument and examined associated factors. Methods: A cross-sectional analytical study was conducted in 2026 in governmental healthcare facilities in the Jazan Health Cluster. A structured electronic questionnaire collected sociodemographic, occupational, and health-related data alongside the 34-item CADA. Total, Diet and Physical Activity CADA scores (1–5) were analyzed using descriptive statistics and multivariable ordinary least squares regression adjusted for sex, education, profession, and workplace; standardized coefficients and Cohen’s f² were reported. Results: A total of 601 healthcare workers participated. Internal consistency was good (Cronbach’s α = 0.84 for the full scale). Mean Total CADA was 3.28 ± 0.80 (scale midpoint 3.0); perceived Diet capability (3.45 ± 0.85) was higher than perceived Physical Activity capability (3.11 ± 0.85). Female sex was independently associated with lower Physical Activity CADA (β = −0.16; 95% CI −0.32 to −0.01; p = 0.042). Bachelor’s and board/doctoral qualifications were associated with higher Total CADA (β = 0.20; 95% CI 0.02 to 0.38; p = 0.026 and β = 0.33; 95% CI 0.07 to 0.58; p = 0.013, respectively). Compared with hospital-based participants, those in primary healthcare centers had lower Total (β = −0.19; 95% CI −0.32 to −0.05; p = 0.007), Diet (β = −0.17; 95% CI −0.31 to −0.02; p = 0.024) and Physical Activity (β = −0.21; 95% CI −0.35 to −0.06; p = 0.006) CADA scores. Effect sizes were small (|β*| ≤ 0.16; R² = 0.076–0.082; Cohen’s f² = 0.08–0.09). Conclusions: As CADA captures perceived capability, these findings reflect self-perception rather than objectively measured behavior; longitudinal studies combining CADA with validated behavioral instruments are warranted to clarify whether perceived capability translates into actual dietary and physical-activity behaviors in healthcare workers, and to evaluate whether workplace-based interventions targeting time pressure and access to supportive environments improve both perceived capability and measured behavior. Full article

This study aimed to describe the pre–post changes in intrinsic motivation observed following the implementation of a parkour-based Adventure Education (AE) program in primary school students, and to examine the role of enjoyment, self-confidence, and resilience as variables statistically associated with intrinsic motivation, considering differences according to time (pre-test–post-test) and gender. The sample consisted of 492 fifth- and sixth-grade primary education students (249 boys and 243 girls) with a mean age of 10.67 years, enrolled in 12 Spanish schools. A quasi-experimental design with pre-test and post-test measures was used following the implementation of a seven-session program based on the Pedagogical Model of Adventure Education. Data were collected using instruments validated in the Spanish population: the intrinsic motivation subscale of the Perceived Locus of Causality Scale, the Physical Activity Enjoyment Scale to measure enjoyment, the self-confidence subscale of the Competitive State Anxiety Inventory, and the Connor–Davidson Resilience Scale to assess resilience. Statistical analysis was performed using SPSS 28.0 software, conducting descriptive analyses, correlations, and hierarchical multiple linear regressions to examine the statistical associations among the variables at each measurement point, along with a 2 × 2 repeated-measures ANOVA (time × gender). Post-test scores were significantly higher than pre-test scores for intrinsic motivation, enjoyment, self-confidence and resilience. Enjoyment was the variable most strongly statistically associated with intrinsic motivation, followed by self-confidence and resilience. The ANOVA showed a significant main effect of time, while no significant time × gender interaction was detected, meaning that the study found no evidence that the pre–post change differed between boys and girls. Given the single-arm pre–post design and the absence of a control group, these findings should be interpreted as preliminary descriptive evidence of pre–post change and associations, and not as a causal test of the program’s effectiveness. Full article

Background/Objectives: Chronic low back pain (CLBP) affects approximately 20% of the global population and is a leading cause of years lived with disability. Long-term, real-world evidence for inhaled cannabis in patients refractory to conventional multimodal therapy remains scarce. We assessed the five-year efficacy and safety of inhaled cannabis in CLBP patients who had documented failure of ≥1 year of opioid analgesics, anticonvulsants, antidepressants, NSAIDs, and physiotherapy, with each patient serving as their own historical control. Methods: We analyzed prospectively collected clinical data from 241 consecutive adults with treatment-refractory CLBP (mean age 49.3 ± 14.9 years; 37.8% female; mean pain duration 15.1 years) initiated on inhaled medical cannabis (predominantly smoking, THC 4–22%, CBD 2–22%) in a single-center tertiary orthopedic clinic between 2020 and 2025 (Hasharon Hospital, Rabin Medical Center, Israel; IRB protocols 0807-21-RMC and 0634-25-RMC). Year-0 outcomes during conventional therapy were compared with outcomes at Years 1–5 on cannabis. Primary outcomes were the Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), and Brief Pain Inventory severity/interference (BPI-S/BPI-I). Concomitant-medication trajectories were a secondary outcome. The primary analysis was a mixed model for repeated measures (MMRM) with random intercept and slope, REML estimation, and time as a categorical fixed effect. Multiple imputation (MAR, m = 20, Rubin’s rules) was the primary missing-data approach; complete-case and tipping-point pattern-mixture sensitivity analyses were used. A multivariate Hotelling T² provided a joint test across the four correlated PROMs. Concomitant-medication discontinuation was modeled with GEE logistic regression and exact McNemar tests. Time to discontinuation was estimated by Kaplan–Meier and Cox regression. The Bonferroni-adjusted significance threshold for the four primary outcomes was α = 0.0125. BioWell gas-discharge-visualization (GDV) parameters were exploratory only. Results: Of 241 patients, 238 (98.8%) provided Year-5 data and 224 (92.9%) remained on cannabis at Year 5; only five patients (2.1%) discontinued for adverse events or inefficacy. All four primary PROMs improved markedly and durably. MMRM-estimated Year-5 minus Year-0 changes were: NRS −5.36 (95% CI −5.65, −5.07), ODI −17.68 (95% CI −19.73, −15.63), BPI-S −6.73 (95% CI −6.99, −6.47), and BPI-I −3.41 (95% CI −3.65, −3.16); all four contrasts had |z| ≥ 16.9 and p < 10⁻²⁰. MI-pooled estimates were within 0.05 of MMRM (FMI < 0.03 for all outcomes). Hotelling T² was F(4, 232) = 872.8, p < 10⁻²⁰. At Year 5, 89.2% achieved ≥30% NRS reduction, 77.2% ≥ 50%, and 93.4% met the NRS minimum clinically important difference (MCID); ODI MCID 65.6%, BPI-S MCID (≥1 pt) 98.3%, BPI-I MCID (≥1 pt) 91.3%. Concomitant opioid use fell from 100% at baseline to 4.6% at Year 5 (within-patient absolute risk reduction 95.4%, McNemar exact p = 1.16 × 10⁻⁶⁹), NSAID from 100% to 7.1%, SSRI/SNRI from 80.5% to 5.4%, and gabapentinoid from 38.6% to 2.5%. The ARR-derived NNT for opioid discontinuation was 1.05; this NNT is referenced to each patient’s own documented maximal-conventional-therapy state and is not equivalent to a between-arm randomized-trial NNT. Cannabis dose × time interaction was consistent with no pharmacological tolerance (β = −0.0044 per gram-month per year, p = 0.074). Across 1205 patient-years of cannabis exposure (calculated as 241 patients × 5 follow-up years from Year 1 through Year 5; baseline Year 0 represents pre-cannabis state and is not included in person-time on cannabis), 1338 organ-system AE events were recorded at 1.110/patient-year (Poisson 95% CI 1.05–1.17); 99.8% of graded events were mild (grade 1), with ocular (476 events, 0.40/PY), cognitive (460, 0.38/PY), and gastrointestinal (368, 0.31/PY) reactions predominating. The Year-3 retention dip reflected a documented telemedicine-clinic phenomenon during 2022–2024, with patients returning to in-person follow-up by Year 4–5. BioWell GDV discriminated NRS ≥ 4 only at chance level (BWS AUC 0.574, 95% CI 0.54–0.60; BWV AUC 0.51). Conclusions: In a treatment-refractory CLBP cohort with five-year longitudinal follow-up, inhaled cannabis was associated with large, sustained, and statistically robust improvements in pain, disability, and pain interference, accompanied by near-total displacement of opioids, NSAIDs, antidepressants, and gabapentinoids. These observational associations, although mechanically less susceptible to bias for the binary medication-discontinuation outcomes than for self-reported PROMs, cannot be interpreted causally in the absence of a concurrent randomized control arm and may reflect a combination of pharmacological effect, regression to the mean from a high pre-treatment baseline, expectancy and self-selection effects intrinsic to an actively chosen open-label therapy, and secular trends in pain reporting. The within-patient benefit-risk profile—ARR-derived NNT ≈ 1 for opioid sparing against a predominantly mild adverse-event burden—supports consideration of cannabis as a potentially clinically meaningful, opioid-sparing option in patients who have failed multimodal conventional therapy, pending confirmation in randomized comparative trials. Full article