Search Results (4,573)

Adolescents’ social development is shaped by everyday family interactions, yet evidence on whether routine family practices are associated with social and emotional skills remains limited, particularly in China. Using data from the 2016–2022 China Family Panel Studies, this study examined the association between family meal frequency and five CFPS-based proxy indicators of social and emotional skills among 3727 adolescent-wave observations from adolescents aged 10–16 years. Ordinary least squares models were estimated, with propensity score matching used as a robustness check and subgroup analyses supplemented by formal interaction tests by school stage, residence, and family socioeconomic status (SES). More frequent family meals were positively associated with the proxy indicators for agreeableness, extraversion, and emotional stability, while conscientiousness showed weaker but positive evidence of association; no significant association was found for openness. The subgroup and interaction analyses suggested some group-specific patterns, including tentative differences by school stage and somewhat broader positive associations among rural and low-SES adolescents, although the interaction evidence was limited. The findings suggest that regular family meals may represent a routine family interaction context modestly associated with selected proxy indicators of adolescents’ social and emotional skills. Full article

Urban green infrastructure (GI) is widely promoted for cooling, stormwater regulation, biodiversity support, and human health benefits; however, these benefits remain unevenly distributed across communities with different socio-economic status. Machine learning (ML) is increasingly used in GI planning and design through high-resolution mapping and demand and exposure modelling, enabling planners and landscape architects to explore scenarios and assess alternative solutions based on the benefits generated. However, ML risks generating or perpetuating spatial injustice through biassed training, opaque optimisation priorities, and epistemic exclusion of Indigenous and local knowledge when models are not developed and applied transparently and collaboratively. This perspective discusses recent GI and ML trends and debates to: (i) clarify how ML can support equity-oriented GI planning; (ii) identify technical and socio-economic risks; and (iii) outline ethical and governance pathways supportive of legitimate and accountable GI planning. We argue that ML should be treated as a component of socio-technical governance rather than a neutral technical tool and therefore should be applied through collaborative design and periodic re-evaluations. Full article

Rapid urbanization has intensified transportation challenges in many metropolitan areas, increasing reliance on private vehicles and contributing to congestion and environmental concerns. Although transit-oriented development strategies aim to promote sustainable mobility by improving public transport accessibility, the behavioral mechanisms linking built environment characteristics to travel behavior remain insufficiently explored. This study examines the influence of transit accessibility (TA) and parking availability on mode choice preference and travel behavior. A structured questionnaire survey was conducted, and the data were analyzed using covariance-based structural equation modeling after validating the measurement constructs through exploratory and confirmatory factor analyses. The results indicate that TA positively influences mode choice preferences, whereas parking availability negatively affects them. Furthermore, mode choice preferences significantly influence travel behavior, underscoring their mediating role between built environment factors and mobility outcomes. These findings provide empirical insights for urban planners seeking to promote sustainable transportation through enhanced TA and effective parking management strategies. Full article

(1) Background: Adolescents’ appraisals of family relationships play an important role in bridging family dynamics and maladaptive behavior in various contexts. However, the mechanism of adolescents’ appraisals remains unclear. This review aims to map the state of the art about adolescents’ appraisals of family relationships in intact family contexts from the existing global literature. (2) Methods: The article collection was performed in accordance with the PRISMA guideline and screening articles from 5 sources. Two reviewers independently screened to obtain 10 reported articles that met the inclusion criteria. (3) Results: Analyses identified that 90% of the previous study involved adolescents aged 8–19 years from the United States (USA) and predominantly White. The majority of the samples were also identified from middle to upper class socioeconomic status (n = 6), and relatively low conflict family structure (n = 5). The most commonly used variable term of adolescents’ appraisal was interparental conflict (IPC) appraisals (n = 7), and the Cognitive Contextual Framework (CCF) by Grych et al. was used as a theoretical framework. (4) Conclusions: Based on a global literature review, the findings of this review are limited, based on age, race, socioeconomic status, family structure, and certain geographical locations. The limited range of samples may affect the sensitivity of the theoretical framework and measurement tools in capturing variations in adolescents’ appraisals of family relationships in intact family contexts. Furthermore, the generalizability of these findings may be limited. Accordingly, future studies are encouraged to replicate the present research using larger samples from diverse ages, cultural and socioeconomic status, and family structure backgrounds. Future researchers could further advance this research area by incorporating a wider variety of theoretical perspectives, methodological approaches, and measurement instruments to promote the future health and well-being of adolescents. Full article

Background/Objectives: The spatial interaction between obesity, diet-related chronic diseases, premature mortality, food environments, and social determinants of health is a global concern. This study aimed to analyze the spatial distribution of healthy and unhealthy food outlets in two medium-sized cities in southern Chile. Methods: A cross-sectional observational study was conducted to characterize the food environment in two medium-sized cities in Chile. Food outlets were geolocated and classified as healthy, regular, or unhealthy, and into four food environment categories (institutional outlets, informal markets, formal markets, and restauration) using validated instruments. Results: Of 1972 identified sites, 1949 were geolocated. Among these, 246 (12.6%) were classified as healthy, 461 (23.7%) as unhealthy, and 1242 (63.7%) as regular. Food environments comprised 1441 stores (73.9%), 366 restauration (18.8%), 136 street food outlets (7.0%), and six institutional food outlets (0.3%). The two lowest socioeconomic quintiles (Q1–Q2) exhibited a lower proportion of healthy food outlets (39.4%). Significant positive spatial autocorrelation was observed for stores, restaurants, and street food outlets (p < 0.005). Conclusions: Food environments were unequally distributed, with a higher density of healthy food outlets in areas characterized by greater population density and higher socioeconomic status. The observed spatial autocorrelation highlights the need for targeted public health interventions to reduce inequalities in access to healthy foods. These findings provide evidence to support policies aimed at promoting more equitable and healthier food environments in medium-sized cities. Full article

Background: Education and employment are widely promoted as pathways to reducing intimate partner violence (IPV) through enhanced economic independence and bargaining power. However, evidence from settings characterised by entrenched gender inequalities suggests that these structural factors may not uniformly translate into protection. This study examines whether education and employment are associated with women’s experiences of IPV in South Africa. Methods: This study utilised nationally representative data from the South Africa Demographic and Health Survey (N = 2354). Education and employment were used as structural proxies for women’s socioeconomic positioning. Survey-adjusted logistic regression models were employed to estimate associations between these factors and lifetime IPV, controlling for key sociodemographic characteristics. Given the cross-sectional design and the use of lifetime IPV alongside contemporaneous measures of education and employment, findings are interpreted as associative rather than causal. Results: Education and employment were not significantly associated with women’s likelihood of experiencing IPV. Women with these characteristics were not less likely to report emotional, physical, or sexual violence compared to those without them. IPV prevalence was higher among women aged 25–34, those with secondary education, and those in lower wealth households. Marital status emerged as a strong correlate, with separated and divorced women facing substantially higher odds of IPV. Discussion: The absence of a significant association suggests that education and employment alone may be insufficient to reduce IPV risk in contexts where gender norms and relational power imbalances remain entrenched. These findings may also reflect the limitations of using structural indicators as proxies for empowerment, as such measures do not capture decision-making power, control over resources, or intra-household dynamics. Conclusions: Interventions to reduce IPV should extend beyond improving women’s access to education and employment to address relational, normative, and structural drivers of violence. Multidimensional approaches that incorporate gender-transformative strategies and strengthen women’s substantive agency are likely to be more effective. Full article

Background: Child malnutrition is a major public health problem worldwide, but the pathways through which socioeconomic status (SES) affects nutritional outcomes differ markedly between economic and welfare regimes. Differentiating whether these impacts are direct or through behavioural and structural factors is key to focused policy intervention. Objective: This study aimed to investigate the effects of socioeconomic inequalities, maternal knowledge and feeding practices, and food insecurity on preschool undernutrition in Hungary and Indonesia. Methods: The study employs a cross-national comparative design. Respondents were households with children 36 to 59 months old; the sample comprised 128 households in Budapest, Hungary and 535 households in Surabaya, Indonesia. The instruments were designed to fit within a survey for data collection. Data were analysed using Partial Least Squares Structural Equation Modelling (PLS-SEM) with Multi-Group Analysis (MGA). Results: In Hungary, SES and food insecurity are positively associated with malnutrition, whereas in Indonesia, SES and biological factors drive malnutrition. Intermediate factors such as maternal feeding practices (Hungary) and health coverage (Indonesia) did not directly affect malnutrition. Although the model identified significant socioeconomic pathways, its very low explanatory and predictive power for child malnutrition in both urban Hungary (R² = 0.024) and Indonesia (R² = 0.062), and the predictive relevance ((Q² Hungary: −0.009); Q² Indonesia: 0.016), which remained close to zero or negative, indicate that these variables only partially capture the complex, multifactorial mechanisms driving nutritional status. Conclusions: These findings indicate that a more targeted approach to food insecurity and behavioural screening within the Hungarian welfare system would be necessary to address malnutrition effectively. Findings in Indonesia underline the potential benefits of prioritising equity in health coverage and income support. Full article

This study presents and tests a model of vocational choice based on Gottfredson’s theory to explain the relatively low interest in teaching as a career and its underlying determinants. We propose that career choice criteria and vocational interests mediate the relationship between demographic and socio-economic factors and individuals’ perceived likelihood of choosing teaching as a profession. The study was conducted in Israel using a sample of 420 young adults at an early stage of vocational decision-making. Participants completed validated measures assessing career choice criteria, vocational interests, and a range of demographic and socio-economic variables. The findings provide partial support for the proposed model. Specifically, social vocational interests, along with prioritization of self-actualization and status as career choice criteria, were found to mediate the relationships between certain demographic factors, socio-economic status, prior academic achievement, and the perceived likelihood of choosing teaching as a career. Further analysis suggests that teaching is often perceived as a fallback option rather than a primary career choice. These findings are discussed in relation to current policies and ongoing personnel shortages in the education system. Full article

Objectives: This study investigated the sequential mediating roles of protein intake and handgrip strength (HGS) in the association between socioeconomic status (SES) and 10-year atherosclerotic cardiovascular disease (ASCVD) risk within the social determinants of health (SDOH) framework. Methods: We conducted a complex survey analysis using data from 6281 adults without baseline ASCVD from the Korea National Health and Nutrition Examination Survey (2016–2018), accounting for stratification, clustering, and weighting. The 10-year ASCVD risk was estimated using the pooled cohort risk equations. SES was classified into three groups based on educational attainment and household income. Relative HGS was calculated as the sum of maximal grip strength in both hands divided by body mass index. Indirect effects were assessed using bootstrap-based confidence intervals (CIs). Results: Compared with the low-SES group, the high-SES group showed a lower 10-year ASCVD risk in both the total effect model (B = −1.630, 95% CI: −2.250 to −1.010) and the direct effect model (B = −1.550, 95% CI: −2.170 to −0.927). The total indirect effect was also significant in both the high-versus-low and middle-versus-low SES comparisons. Protein intake and relative HGS partially mediated the association between SES and 10-year ASCVD risk, and the sequential mediation pathway was also significant. Conclusions: Within the SDOH framework, these findings suggest that nutritional and muscle-strength-related pathways may link socioeconomic disadvantage to ASCVD risk and support integrated interventions targeting nutritional support and muscle-strength improvement for life-course prevention. Full article

Background/Objectives: People with diabetes are more susceptible to viral respiratory infections and worse clinical outcomes related to COVID-19 and influenza. Vaccination is considered an important prevention strategy. This study aimed to analyze the vaccination status against COVID-19 and influenza among people with diabetes mellitus and associated factors. Methods: An analytical cross-sectional study was conducted between May 2024 and May 2025 in 42 Primary Health Care Units in a municipality in Minas Gerais, Brazil. A total of 316 individuals with type 1 or type 2 diabetes mellitus participated in the study. Data were collected using a structured instrument containing socioeconomic, cultural, behavioral, and clinical variables, in addition to verification of vaccination records through physical vaccination cards and information systems. Descriptive analyses and logistic regression models were performed to estimate crude and adjusted odds ratios, with respective 95% confidence intervals. Analyses were performed using Statistical Package for the Social Sciences and Stata. Results: Adherence to COVID-19 vaccination was 21.5%, whereas influenza vaccination adherence reached 85.4%. In the multivariable analysis of COVID-19 vaccination status, previous influenza vaccination (OR = 7.74; 95% CI: 1.81–33.2) and alcohol consumption (OR = 2.11; 95% CI: 1.13–3.89) were positively associated with vaccination. Conversely, access to social media or other communication channels (OR = 0.47; 95% CI: 0.24–0.92) and insulin use (OR = 0.42; 95% CI: 0.21–0.84) were associated with lower odds of COVID-19 vaccination. Regarding influenza vaccination, positive associations were identified for religious affiliation (OR = 6.46; 95% CI: 1.79–23.30), previous COVID-19 vaccination (OR = 10.2; 95% CI: 2.22–47.06), and longer duration of diabetes diagnosis (OR = 3.47; 95% CI: 1.32–9.20). In contrast, alcohol consumption (OR = 0.42; 95% CI: 0.21–0.86), insulin use (OR = 0.35; 95% CI: 0.16–0.76), and absence of medical follow-up (OR = 0.34; 95% CI: 0.13–0.85) were associated with lower odds of influenza vaccination. Conclusions: The findings revealed a heterogeneous vaccination pattern among individuals with diabetes mellitus, in which higher influenza vaccination coverage contrasted with low adherence to COVID-19 vaccination, reflecting not only differences in the historical consolidation of immunization strategies but also contemporary dynamics related to risk perception, trust, and information circulation. The strong association with previous vaccination history suggests that vaccine adherence is part of a continuum of preventive behaviors mediated by the relationship with healthcare services and by the internalization of healthcare practices over time. Full article

Industrial emissions are a central environmental concern, particularly with respect to the spatial distribution of major enterprises and the identification of key determinants. Traditional research has largely focused on characterizing the current status of these enterprises, but this approach exhibits several notable shortcomings. These include a lack of regional statistical analysis, an absence of a comprehensive industrial typology, inadequate cross-evaluation of enterprise scale and pollution emissions, and insufficient exploration of socioeconomic correlations. We introduce a multifaceted evaluation framework for Key Environmental Supervision Units (KESUs), focusing on key industrial classifications and their underlying development drivers. The analysis utilized a comprehensive dataset covering 153,107 individual KESUs across six categories from 2020 to 2024, incorporating distribution patterns across 31 provincial-level regions, 28 industrial classifications of national economic activities, and 18 socioeconomic impact factors. The results showed that KESUs in East China accounted for 41.7% of the total, with the highest concentrations in industrialized cities and economically developed zones. Manufacturing was identified as the dominant industrial classification, with chemical raw materials and products comprising the largest subcategory (13.0% of total KESUs in 2024). Atmosphere KESUs and water KESUs represented the largest proportions, accounting for 29.7% and 25.3% of single-type KESUs, respectively. This study provides a systematic analysis of KESUs, offering a detailed mapping of distribution patterns, emission characteristics, and control challenges for major pollution sources. The findings can provide critical insights to support decision-making aimed at improving regional pollution source management and advancing environmental protection practices. Full article

Background/Objectives: Human papillomavirus (HPV) is a well-established risk factor for oropharyngeal squamous cell carcinoma (OPSCC), with p16 expression serving as a reliable surrogate marker for HPV involvement and an important prognostic indicator. While data exist on the demographic and clinical features of p16-positive OPSCCs on a national scale, limited data exist for Nevada. Methods: This retrospective study evaluated the relationship between p16 positivity and OPSCC presentation in Northern Nevada, with specific attention to associations between p16 status, sex, socioeconomic factors, smoking history, and presenting symptoms. We reviewed medical records of 296 patients diagnosed with OPSCC with concomitant HPV testing at the Renown Regional Medical Center from 2014–2024. Variables of interest included sex, age at diagnosis, smoking pack-years, Nevada census-based income quintile, county of residence, and initial symptoms such as dysphagia and sore throat. Multivariate logistic regression was performed to assess associations between these variables and p16 status. Conclusions: We found that sex was the only variable significantly associated with p16 positivity: females had significantly lower odds of being p16-positive compared to males (OR: 0.36, 95% CI: 0.20–0.65, p = 0.001). This finding of sex-based disparity in HPV-related OPSCC is consistent with national trends. This study is limited by its regional focus and lack of data on other social determinants of health. Nonetheless, the results underscore the importance of gender-informed prevention strategies and highlight the need for further research into the biological and behavioral contributors to this disparity. Full article

Background: Obesity is a major public health concern and shows a clear social gradient, with higher prevalence among individuals with lower socioeconomic position. Educational level is a key indicator of socioeconomic status, but the extent to which lifestyle factors explain its association with obesity remains unclear. Objective: To examine the association between educational level and obesity in a working-age population and to evaluate how adjustment for lifestyle factors influences the magnitude of the association between educational level and obesity. Methods: A cross-sectional study was conducted among 3108 working-age adults undergoing occupational health assessments in Spain. Educational level was categorised into three groups (higher, intermediate, and primary or none). Obesity was defined as a body mass index ≥30 kg/m². Lifestyle variables included smoking status, physical activity assessed using the International Physical Activity Questionnaire (IPAQ-SF), and adherence to the Mediterranean diet evaluated with the MEDAS-14 score. Sequential logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CI), with progressive adjustment for demographic, behavioural, and clinical factors. Results: The overall prevalence of obesity was 16.6%, with a clear gradient across educational levels (11.5% in higher education vs. 19.8% in primary or no education). In crude analyses, individuals with the lowest educational level had higher odds of obesity (OR 1.89; 95% CI 1.46–2.45). Adjustment for age and sex attenuated the association (OR 1.72; 95% CI 1.32–2.24), with further reduction after inclusion of lifestyle factors (OR 1.63; 95% CI 1.24–2.13). In the fully adjusted model, the association remained statistically significant (OR 1.61; 95% CI 1.18–2.21), indicating that adjustment for lifestyle factors attenuated the association between educational level and obesity, although the association remained statistically significant. Conclusions: Lower educational level is associated with a higher risk of obesity. Adjustment for lifestyle factors attenuated this association, although a statistically significant relationship remained. These findings support the role of education as a fundamental determinant of health and highlight the need for strategies addressing broader social and structural determinants of obesity. Full article

Background: Seasonal influenza remains a major public health challenge worldwide, causing significant morbidity each year and imposing substantial burdens on individuals, healthcare systems, and national economies. Vaccination is considered the most effective available strategy for prevention; however, uptake rates vary considerably across countries, with many failing to achieve the recommended coverage levels. The aim of this umbrella review is to systematically synthesize and critically appraise the existing evidence on healthcare professionals’ beliefs, attitudes, and behaviors regarding seasonal influenza vaccination. Methods: This umbrella review was conducted in accordance with the PRISMA 2020 statement. A literature search was conducted in PubMed, the Cochrane Library, and Google Scholar. The following search terms were used: beliefs, attitudes, behaviors, influenza vaccination, flu vaccine, healthcare professionals and primary healthcare. The inclusion criteria were as follows: (1) Reviews, (2) Published after 1 January 2000, (3) English language, (4) Healthcare professionals as the target-population. Results: Twenty-five studies met the selection criteria and were included in this review. Twelve out of 25 studies were systematic reviews. Globally, vaccination uptake remains below recommended levels, with reported coverage ranging from approximately 2% to 44% in several settings, while rates can exceed 90% in countries with mandatory vaccination policies. North America demonstrates the highest vaccination coverage, while the lowest coverage is reported in Africa and South America. Overall, low- and middle-income countries show significantly lower vaccination behavior compared with high-income countries. Attitudes and beliefs appear to shape vaccination behavior in high-income countries. The main driver of acceptance is perceived protection of oneself and family, whereas hesitancy is mainly driven by concerns about side effects and vaccine safety. Across studies, non-physician healthcare professionals consistently demonstrated lower influenza vaccine acceptance compared with physicians, while pediatricians and general practitioners were found to receive the influenza vaccine more frequently. In addition, younger physicians and those with fewer years of professional experience showed higher vaccination coverage and a greater likelihood of recommending influenza vaccination to patients. Conclusions: Vaccination coverage, worldwide, is lower than what is recommended by the World Health Organization. Healthcare professionals working in hospital settings tend to be vaccinated at a higher rate compared with those working in primary care or community-based healthcare settings. The recommendations that healthcare professionals give are influenced by whether they accept influenza vaccines themselves. Beliefs and attitudes seem to influence behavior in countries where structural barriers, such as limited access to primary healthcare and socio-economic status are absent. Full article

Background/Objectives: Medication adherence is a critical determinant of therapeutic outcomes in type 2 diabetes mellitus (T2DM); however, its relationship with glycemic control remains inconsistent, particularly in real-world and socially vulnerable settings. This study aimed to evaluate medication adherence using multiple validated instruments, assess disease-related knowledge, and examine their relationship with glycemic control, with a focus on potential discordance between self-reported adherence and objective metabolic outcomes. Methods: A cross-sectional analytical study was conducted with 237 adults with T2DM receiving care in a primary health care (PHC) unit in the Brazilian Amazon. Medication adherence was assessed using the Almeida Adherence Scale, ARMS-12, and the Haynes–Sackett test, while disease-related knowledge was evaluated using the Batalla–Martínez questionnaire. Glycemic control was determined based on glycated hemoglobin (HbA1c) values obtained from clinical records within the previous three months. Descriptive and comparative analyses were performed. Results: The study population was predominantly female (64.1%) and aged 40–59 years (55.7%), with a high prevalence of socioeconomic vulnerability. Non-adherence was identified in 55.7% of participants using the Almeida Adherence Scale, whereas higher adherence rates were observed with ARMS-12 (91.1%) and the Haynes–Sackett test (72.2%). Inadequate disease-related knowledge was found in 77.2% of participants. Among individuals with available HbA1c data (n = 116), the mean HbA1c was 8.63% (SD = 1.65), and 81.9% presented inadequate glycemic control (HbA1c ≥ 7%). Notably, among participants classified as adherent by the ARMS-12 scale (91.1%), inadequate glycemic control was nonetheless present in 81.9% of those with available HbA1c data, illustrating the magnitude of the observed discordance between self-reported adherence and objective metabolic outcomes. Cross-tabulation of each adherence instrument against glycemic control showed no statistically significant associations (chi-square with Yates correction; ARMS-12: p = 0.631, φ = 0.045; Almeida Adherence Scale: p = 0.301, φ = 0.096; Haynes–Sackett: p = 0.800, φ = 0.024). Multivariable logistic regression (Nagelkerke R² = 0.321; AUC = 0.834) identified older age (aOR = 0.92; 95% CI: 0.87–0.96; p < 0.001) and higher income (aOR = 9.96; 95% CI: 2.05–48.32; p = 0.004) as independent predictors of glycemic outcome, while no adherence measure was independently associated with HbA1c ≥ 7%. A sensitivity analysis using HbA1c ≥ 8.0% revealed poor control in 59.5% of participants (n = 69/116). Conclusions: Despite varying levels of self-reported medication adherence, inadequate glycemic control was highly prevalent. The absence of statistically significant associations between self-reported adherence and HbA1c, combined with the high prevalence of poor glycemic control regardless of adherence status, is consistent with the hypothesis that adherence alone does not fully explain metabolic outcomes in T2DM. Given the cross-sectional design, no causal inferences can be drawn. These findings highlight the need for integrated care strategies in primary health care, including improved health literacy, structured pharmacotherapeutic follow-up, and the use of multiple adherence assessment tools to better inform clinical decision-making. Full article