International Journal of Environmental Research and Public Health

17 pages, 748 KB

Open AccessArticle

Opportunities and Challenges in the Care of Patients with Somatic Complaints and Patients with Additional Work-Related Anxiety—A Mixed Methods Study

by Lara Kleist, Franziska Weißenstein, Beate Muschalla, Lukas Kühn, Eileen Wengemuth and Kyung-Eun (Anna) Choi

Int. J. Environ. Res. Public Health 2026, 23(1), 125; https://doi.org/10.3390/ijerph23010125 - 20 Jan 2026

Abstract

Background: Work-related anxiety can result in prolonged work incapacity and reduce return-to-work probabilities. Despite the prevalence of work-related anxiety in somatic rehabilitation settings, there has been little research examining the experiences of affected patients from a public health perspective. This research project aims [...] Read more.

Background: Work-related anxiety can result in prolonged work incapacity and reduce return-to-work probabilities. Despite the prevalence of work-related anxiety in somatic rehabilitation settings, there has been little research examining the experiences of affected patients from a public health perspective. This research project aims to address this gap by providing initial insights into the care provided to patients with somatic complaints and patients with additional work-related anxiety. Methods: A sequential mixed methods approach was employed, beginning with semi-structured interviews (2022, n = 18 orthopedic rehabilitation patients), followed by questionnaire distribution (2023, n = 53). Qualitative analysis distinguished between patients with higher (JA) and lower (nJA) Job Anxiety Scale scores (cut-off 2.5). Results: The findings highlight notable differences between JA and nJA patients. JA patients often report that they face unmet psychological needs, limited work-related treatment focus, financial barriers, and inadequate occupational support, relying more on self-initiative for reliable information. In contrast, nJA patients appear to benefit from stronger social networks, stable financial resources, and improved access to healthcare. Both groups report mixed experiences with workplace support. For professionals the findings underline that JA patients are specifically in need of work-related interventions, even patients themselves remind about this. Conclusions: The findings illustrate significant differences between JA and nJA patients in terms of their experiences, challenges, and support needs within healthcare, workplace, and rehabilitation contexts. While qualitatively insightful, these findings are pilot and explorative and warrant further research. Trial registration: DRKS00029004 (25 May 2022). Full article

► Show Figures

Figure 1

24 pages, 832 KB

Open AccessArticle

Exploring Inclusion in Austria’s Breast Cancer Screening:A Dual-Perspective Study of Women with Intellectual Disabilities and Their Caregivers

by Theresa Wagner, Nourhan Makled, Katrina Scior, Laura Maria König, Matthias Unseld and Elisabeth Lucia Zeilinger

Int. J. Environ. Res. Public Health 2026, 23(1), 124; https://doi.org/10.3390/ijerph23010124 - 19 Jan 2026

Abstract

Women with intellectual disabilities (IDs) face persistent health inequities, particularly in preventive services such as breast cancer screening, where participation rates remain disproportionately low. These disparities contribute to higher mortality and poorer survivorship outcomes, often linked to later-stage diagnoses. To better understand these [...] Read more.

Women with intellectual disabilities (IDs) face persistent health inequities, particularly in preventive services such as breast cancer screening, where participation rates remain disproportionately low. These disparities contribute to higher mortality and poorer survivorship outcomes, often linked to later-stage diagnoses. To better understand these challenges and inform the development of inclusive screening programs, this qualitative study conducted in Austria explored barriers, facilitators, and needs related to breast cancer screening from the dual perspectives of 17 women with mild-to-moderate IDs aged 45 and older and 10 caregivers. Semi-structured focus groups and interviews were analyzed thematically within a constructivist framework, integrating perspectives from both groups. Barriers included social taboos around sexuality, psychological distress, exclusion through standardized procedures, and unclear responsibility among stakeholders. Facilitators involved person-centered communication, accessible information, emotional and practical support, and familiar healthcare environments. Women with IDs expressed a strong desire for education, autonomy, and inclusion, while caregivers played a pivotal role in enabling access. These findings demonstrate that low screening participation among women with IDs is driven by systemic and organizational barriers rather than lack of health awareness or willingness to participate. Without structurally inclusive design, organized screening programs risk perpetuating preventable inequities in early detection. Embedding accessibility, clear accountability, and person-centered communication as standard features of breast cancer screening is therefore a public health priority to reduce avoidable late-stage diagnoses and narrow survival disparities for women with IDs. Full article

(This article belongs to the Special Issue Breast Health and Cancer Awareness: Addressing Breast Cancer Disparities from Etiology to Survivorship)

18 pages, 1034 KB

Open AccessArticle

Unmet Needs and Service Priorities for ADHD in Australia: AI-Assisted Analysis of Senate Inquiry Submissions

by Blair Hudson, Sam Connell, Anie Kurumlian, Anjali Fernandes, Habib Bhurawala and Alison Poulton

Int. J. Environ. Res. Public Health 2026, 23(1), 123; https://doi.org/10.3390/ijerph23010123 - 19 Jan 2026

Abstract

Objective: To analyse written submissions from individuals and families with lived experience of attention-deficit hyperactivity disorder (ADHD) to the 2023 Australian Senate Inquiry, using artificial intelligence (AI)-assisted thematic analysis. The aim was to identify priority concerns, service needs, and community-proposed solutions. Methods: A [...] Read more.

Objective: To analyse written submissions from individuals and families with lived experience of attention-deficit hyperactivity disorder (ADHD) to the 2023 Australian Senate Inquiry, using artificial intelligence (AI)-assisted thematic analysis. The aim was to identify priority concerns, service needs, and community-proposed solutions. Methods: A mixed-methods study of 505 publicly available submissions from individuals with ADHD and their families. Submissions were analysed using large language model (LLM)-assisted data extraction and thematic clustering, with human validation and review. Main Outcome Measures: Frequency and thematic distribution of (1) problems experienced; (2) services wanted; and (3) solutions suggested. Results: Thematic analysis of 480 eligible submissions revealed high costs and long wait times for assessment and treatment (each cited by 46%), lack of specialised care (39%), diagnostic delays (36%), and gender bias (27%). The most common service request was for affordable and accessible ADHD-specific care (71%), followed by services tailored to diverse populations and life stages. Proposed solutions focused on Medicare-funded access to psychological and psychiatric services (68%), expanded roles for general practitioners, improved provider training (39%), and recognition of ADHD under the National Disability Insurance Scheme. Submissions also highlighted misalignment between current clinical guidelines and public expectations. Conclusions: The findings highlight substantial unmet needs and systemic barriers in ADHD diagnosis and care in Australia. The AI-assisted analysis of consumer submissions offers a scalable method for integrating lived experience into policy development, providing numerical weighting to the individuals’ responses. Coordinated reforms in access, funding, and workforce training are needed to align services with both clinical evidence and community expectations. Full article

► Show Figures

Figure 1

18 pages, 347 KB

Open AccessArticle

Lean Six Sigma for Sharps Waste Management and Occupational Biosafety in Emergency Care Units

by Marcos Aurélio Cavalcante Ayres, Andre Luis Korzenowski, Fernando Elemar Vicente dos Anjos, Taisson Toigo and Márcia Helena Borges Notarjacomo

Int. J. Environ. Res. Public Health 2026, 23(1), 122; https://doi.org/10.3390/ijerph23010122 - 19 Jan 2026

Abstract

Occupational exposure to sharps waste represents a critical challenge for public health systems, directly affecting healthcare workers’ safety, institutional costs, and environmental sustainability. This study aimed to analyze sharps waste management practices and to structure improvement actions for biosafety governance in Brazilian Emergency [...] Read more.

Occupational exposure to sharps waste represents a critical challenge for public health systems, directly affecting healthcare workers’ safety, institutional costs, and environmental sustainability. This study aimed to analyze sharps waste management practices and to structure improvement actions for biosafety governance in Brazilian Emergency Care Units (ECUs) through the application of the Lean Six Sigma (LSS) and DMAIC method (Define, Measure, Analyze, Improve, and Control). A single multiple-case study was conducted across three public units in different regions of Brazil, combining direct observation, regulatory checklists based on ANVISA Resolution No. 222/2018 (RDC), and cause–and–effect (5M) analysis. The diagnostic phase identified recurrent nonconformities in labeling, documentation, and internal transport routes, primarily due to managerial and behavioral gaps. Based on these findings, the DMAIC framework supported the development of a low-cost, evidence-based action plan that outlined proposed interventions, including visual checklists, standardized internal routes, and key performance indicators (KPIs), intended to strengthen biosafety traceability and occupational safety. The se proposed actions are expected to support continuous learning, staff engagement, and a culture of shared responsibility for safe practices. Overall, the study provides a structured basis for future implementation and empirical validation of continuous improvement initiatives, aimed at enhancing public health governance and occupational safety in resource-constrained healthcare environments. Full article

(This article belongs to the Section Environmental Health)

21 pages, 1423 KB

Open AccessSystematic Review

Diagnosis-Specific Links Between Physical Activity and Sleep Duration in Youth with Disabilities: A Systematic Review with Quantitative Synthesis

by Janette M. Watkins, Martin E. Block, Janelle M. Goss, Emily M. Munn and Devan X. Antczak

Int. J. Environ. Res. Public Health 2026, 23(1), 121; https://doi.org/10.3390/ijerph23010121 - 19 Jan 2026

Abstract

Children and adolescents with disabilities experience disproportionate challenges in achieving recommended levels of physical activity (PA) and adequate sleep, two core determinants of health and functional well-being. This systematic review examined associations between meeting PA guidelines and sleep duration among youth with disabilities. [...] Read more.

Children and adolescents with disabilities experience disproportionate challenges in achieving recommended levels of physical activity (PA) and adequate sleep, two core determinants of health and functional well-being. This systematic review examined associations between meeting PA guidelines and sleep duration among youth with disabilities. Following PRISMA guidelines, MEDLINE, PsycARTICLES, and SPORTDiscus were searched through Spring 2024 for studies assessing PA and sleep in children and adolescents (<18 years) with disabilities using subjective or objective measures. Data were extracted from 28 studies (N = 138,016) and synthesized using qualitative methods and regression-based quantitative analyses to examine the effects of diagnosis category and PA guideline adherence on sleep duration. The diagnosis type was associated with sleep duration, with youth with autism spectrum disorder (ASD) exhibiting shorter sleep than those with physical disabilities. Meeting PA guidelines (≥60 min/day) was associated with longer sleep duration among youth with ASD, but not consistently across other diagnostic groups. Qualitative findings further indicated diagnosis-specific variability, with PA positively associated with sleep outcomes in ASD, attention deficit/hyperactivity disorder, and epilepsy, and mixed associations observed for cerebral palsy and intellectual disability. These findings suggest that PA may support sleep health in specific disability groups. Given persistently low PA participation among youth with disabilities, integrating accessible, diagnosis-specific PA opportunities within school, community, and clinical settings may represent a feasible strategy to improve sleep and overall health. Full article

► Show Figures

Figure 1

19 pages, 1537 KB

Open AccessReview

Upper Crossed Syndrome in the Workplace: A Narrative Review with Clinical Recommendations for Non-Pharmacologic Management

by Nina Hanenson Russin, Carson Robertson and Alicia Montalvo

Int. J. Environ. Res. Public Health 2026, 23(1), 120; https://doi.org/10.3390/ijerph23010120 - 19 Jan 2026

Abstract

Problem Statement: Upper crossed syndrome (UCS), as first described by Janda, refers to a group of muscle imbalances in which tightness in the upper trapezius and levator scapulae dorsally cross with tightness in the pectoralis major and minor muscles, and weakness of deep [...] Read more.

Problem Statement: Upper crossed syndrome (UCS), as first described by Janda, refers to a group of muscle imbalances in which tightness in the upper trapezius and levator scapulae dorsally cross with tightness in the pectoralis major and minor muscles, and weakness of deep cervical flexors cross ventrally with weakness of the middle and lower trapezius. Postural alterations from this dysfunction, including forward head, rounded shoulders, and scapular dyskinesis, contribute to upper-back and shoulder pain, particularly among office workers who spend long periods of the workday on a computer. Upper crossed syndrome is a significant contributor to both neck pain and shoulder pain among computer users, which have been rated at 55–69%, and 15–52%, respectively. Despite its prevalence, knowledge about UCS and its treatment remains spotty among primary care physicians. In addition, improvements in workstation ergonomics along with hourly work breaks may be considered as primary prevention strategies for UCS. Objectives: This narrative review examines and synthesizes evidence about the epidemiology and diagnosis of UCS, along with clinical recommendations for physiotherapeutic approaches to treatment. Ergonomic measures in the workplace, including changes in the design of computer workstations so that both the keyboard and monitor are at the proper heights to minimize the risk of long-term musculoskeletal disorders, are also critical. Methods: The first author, a Doctor of Behavioral Health, performed the initial literature search, which was reviewed by the second author, a PhD in sports injury epidemiology. The third author, a chiropractor and practice owner, provided clinical recommendations for stretching and strengthening exercises, which were also described in the literature. Discussion: While easily treatable when caught early, UCS may become resistant to noninvasive approaches over time, and more severe pathologies of the neck and shoulder, including impingement, thoracic outlet syndrome, and cervicogenic headaches may result. Because there is no specific ICD code for UCS, it is important for physicians to recognize the early signs, consider them in the context of workplace-related injuries, and understand physiotherapeutic strategies for symptom resolution. Full article

(This article belongs to the Special Issue New Trends in Work-Related Musculoskeletal Disorders and Health-Related Quality of Life)

► Show Figures

Figure 1

25 pages, 1342 KB

Open AccessReview

Social Perception, Trust, and Reluctance Towards Vaccines: A Bibliometric Analysis (2019–2025)

by Johanna Valeria Caranqui-Encalada, Grecia Elizabeth Encalada-Campos, Joceline Damaris Caranqui-Encalada, Carmen Azucena Yancha-Moreta and Dennis Alfredo Peralta-Gamboa

Int. J. Environ. Res. Public Health 2026, 23(1), 119; https://doi.org/10.3390/ijerph23010119 - 18 Jan 2026

Abstract

The objective of this study was to analyze social perception, trust, and vaccine hesitancy through a combined approach of bibliometric analysis and qualitative synthesis, based on the most cited articles in the recent scientific literature. A systematic search was conducted in indexed databases, [...] Read more.

The objective of this study was to analyze social perception, trust, and vaccine hesitancy through a combined approach of bibliometric analysis and qualitative synthesis, based on the most cited articles in the recent scientific literature. A systematic search was conducted in indexed databases, identifying patterns of production, collaboration, citation, thematic networks, and conceptual trends associated with the study of public trust in vaccines. The results reveal a marked geographic concentration of scientific production, dominated by the United States and the United Kingdom, as well as a strong articulation of thematic clusters linked to digital disinformation, health communication, risk perception, and psychosocial determinants of vaccine acceptance. The qualitative synthesis of the most influential studies reveals that vaccine hesitancy is a multidimensional phenomenon, determined by sociocultural, cognitive, emotional, and structural factors that interact dynamically according to each context. Disinformation, institutional trust, community narratives, and the credibility of sources emerge as central components in individual decision-making. Together, the integrated results enable a deeper understanding of vaccine hesitancy beyond traditional cognitive models, highlighting the need for contextualized communication strategies, intercultural approaches, and health policies based on trust and social participation. This study provides an integral view of the scientific landscape and establishes priority lines for future research and the design of effective public health interventions. Full article

(This article belongs to the Section Global Health)

► Show Figures

Figure 1

31 pages, 4193 KB

Open AccessReview

Challenges and Practices in Perishable Food Supply Chain Management in Remote Indigenous Communities: A Scoping Review and Conceptual Framework for Enhancing Food Access

by Behnaz Gharakhani Dehsorkhi, Karima Afif and Maurice Doyon

Int. J. Environ. Res. Public Health 2026, 23(1), 118; https://doi.org/10.3390/ijerph23010118 - 17 Jan 2026

Abstract

Remote Indigenous communities experience persistent inequities in access to fresh and nutritious foods due to the fragility of perishable food supply chains (PFSCs). Disruptions across procurement, transportation, storage, retail, and limited local production restrict access to perishable foods, contributing to food insecurity and [...] Read more.

Remote Indigenous communities experience persistent inequities in access to fresh and nutritious foods due to the fragility of perishable food supply chains (PFSCs). Disruptions across procurement, transportation, storage, retail, and limited local production restrict access to perishable foods, contributing to food insecurity and diet-related health risks. This scoping literature review synthesizes evidence from 84 peer-reviewed, grey, and unpublished sources across fourteen countries to map PFSC management (PFSCM) challenges affecting food access in remote Indigenous communities worldwide and to synthesize reported practices implemented to address these challenges. PFSCM challenges were identified across all supply chain levels, and five categories of reported practices emerged: PFSC redesign strategies, forecasting and decision-support models, technological innovations, collaboration and coordination mechanisms, and targeted investments. These findings informed the development of a multi-scalar conceptual framework comprising seven interconnected PFSCM clusters that organize how reported practices are associated with multiple food access dimensions, including quantity, affordability, quality, safety, variety, and cultural acceptability. This review contributes an integrative, system-oriented synthesis of PFSCM research and provides a conceptual basis to support future scholarly inquiry, comparative inquiry, and policy-relevant discussion of food access and health equity in remote Indigenous communities. Full article

► Show Figures

Figure 1

16 pages, 586 KB

Open AccessArticle

Rethinking Gaming Disorder Prevention: A Socio-Ecological Model Based on Practitioner Insights

by Maya Geudens, Rozane De Cock, Bieke Zaman and Bruno Dupont

Int. J. Environ. Res. Public Health 2026, 23(1), 117; https://doi.org/10.3390/ijerph23010117 - 17 Jan 2026

Abstract

Current approaches to gaming disorder prevention remain comparatively narrow, and prevention efforts are frequently underdeveloped and fragmented. Using the socio-ecological model (SEM), this qualitative study mapped frontline practitioners’ perceived obstacles and opportunities to develop a multi-level, practice-grounded framework for policy and implementation. Semi-structured [...] Read more.

Current approaches to gaming disorder prevention remain comparatively narrow, and prevention efforts are frequently underdeveloped and fragmented. Using the socio-ecological model (SEM), this qualitative study mapped frontline practitioners’ perceived obstacles and opportunities to develop a multi-level, practice-grounded framework for policy and implementation. Semi-structured interviews were conducted with 18 prevention professionals in Flanders (Dutch-speaking Belgium), recruited via purposive and snowball sampling. A hybrid inductive–deductive analysis—iterative coding guided by Layder’s adaptive theory—organized findings across SEM levels. At the public policy level, participants highlighted insufficient sustainable funding but saw potential in coordinated frameworks moving prevention beyond substance-focused agendas. At the community level, a clear knowledge gap emerged, with opportunities in integrating gaming within broader digital well-being efforts. Institutionally, the absence of practical tools and clear referral pathways was noted, in addition to high participation barriers, whereas accessible programs with targeted outreach were viewed as promising. Interpersonally, parental disengagement was common, but early involvement and pedagogical guidance were seen as key levers. At the intrapersonal level, limited self-insight and emotion regulation impeded change, while resilience, self-confidence, and offline activities were protective. This first empirical application of the SEM to gaming disorder prevention highlights the need for a multi-level, context-sensitive framework that bridges public health and digital media perspectives. Full article

(This article belongs to the Section Behavioral and Mental Health)

► Show Figures

Figure 1

20 pages, 529 KB

Open AccessArticle

Training and Recruitment to Implement the CASA Psychosocial Intervention in Cancer Care

by Normarie Torres-Blasco, Stephanie D. Torres-Marrero, Ninoshka Rivera-Torres, Denise Cortés-Cortés and Sabrina Pérez-De Santiago

Int. J. Environ. Res. Public Health 2026, 23(1), 116; https://doi.org/10.3390/ijerph23010116 - 17 Jan 2026

Abstract

Practical training and recruitment strategies are critical for the sustainable implementation of psychosocial interventions. However, few studies have examined how to prepare community partners and doctoral students to support culturally adapted psycho-oncology interventions. This pre-pilot study aims first to evaluate two distinct training [...] Read more.

Practical training and recruitment strategies are critical for the sustainable implementation of psychosocial interventions. However, few studies have examined how to prepare community partners and doctoral students to support culturally adapted psycho-oncology interventions. This pre-pilot study aims first to evaluate two distinct training programs and recruitment procedures, and second to explore preliminary pre-post outcomes of the Caregiver-Patients Support to Cope with Advanced Cancer (CASA) intervention, using the Consolidated Framework for Implementation Research (CFIR). Three clinical psychology graduate students received CASA training, and two community partners completed Recruitment training. We present descriptive pre- and post-assessments, along with qualitative feedback, for both training and institutional (Puerto Rico Biobank) and community-based recruitment outcomes. A related-samples nonparametric analysis examined pre- and post-CASA intervention signals. Results indicated knowledge gains among doctoral students (pre-test M = 3.3; post-test M = 9.3) and community partners (pre-test M = 4.5; post-test M = 9.5). Preliminary outcomes revealed significant improvements in spiritual well-being (Z = −2.618, p = 0.009) and quality of life (Z = −2.957, p = 0.003) and a reduction in depressive (Z = −2.764, p = 0.006), anxiety (Z = −2.667, p = 0.008), and distress (Z = −2.195, p = 0.028) symptoms following CASA. Of 26 recruited dyads, institutional referrals enrolled 16 dyads (61.5%), while community partners referred 10 dyads with a 90.9% success rate. Findings support the feasibility of both training and CASA exploratory outcomes suggest meaningful psychosocial benefits for Latino dyads coping with advanced cancer. Combining institutional infrastructure with community engagement may enhance sustainability and equitable access to psycho-oncology care. Full article

(This article belongs to the Special Issue Proceedings of the 2024 and 2025 Research Centers in Minority Institutions (RCMI) Consortium National Conferences)

► Show Figures

Figure 1

35 pages, 692 KB

Open AccessSystematic Review

The Experiences of LGBTQ+ Pre-Service and Qualified Teachers and Their Mental Health: A Systematic Review of International Research

by Jonathan Glazzard and Scott Thomas

Int. J. Environ. Res. Public Health 2026, 23(1), 115; https://doi.org/10.3390/ijerph23010115 - 17 Jan 2026

Abstract

Existing research highlights that Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ+) teachers are often exposed to additional stressors in schools which adversely affect their mental health. Some mitigate the effects of these stressors by separating their personal and professional identities while others choose [...] Read more.

Existing research highlights that Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ+) teachers are often exposed to additional stressors in schools which adversely affect their mental health. Some mitigate the effects of these stressors by separating their personal and professional identities while others choose to integrate their identities so that they can be authentic, advance social justice in school contexts or be visible and vocal role models. Less is known about the experiences of pre-service teachers who are undertaking teacher preparation programmes. This systematic literature review presents the results of 20 published papers which represent the global experiences of both pre-service teachers and serving teachers. The findings highlight identity management, experiences of discrimination, agency and lack of confidence of teacher educators. Two new frameworks are presented that lay the foundations for embedding LGBTQ+ inclusion and proposed mandatory elements of curricula for initial teacher training. This systematic literature review has been informed by the following research questions RQ1. What are the experiences of LGBTQ+ pre-service teachers? RQ2. How do LGBTQ+ pre-service teachers negotiate their identities? RQ3. How do LGBTQ+ pre-service teachers disrupt hetero/cis-normative cultures in schools? RQ4: How well does the teacher education programme prepare pre-service teachers for teaching LGBTQ+ inclusive education? Full article

(This article belongs to the Special Issue Mental Health Challenges Affecting LGBTQ+ Individuals and Communities)

► Show Figures

Figure 1

17 pages, 954 KB

Open AccessArticle

Standardizing Recreational Cannabis Excise Tax Rates in the United States: New Retail Price-Based Measurements by Product Category

by Bing Han, Michael Cooper, Ce Shang and Yuyan Shi

Int. J. Environ. Res. Public Health 2026, 23(1), 114; https://doi.org/10.3390/ijerph23010114 - 16 Jan 2026

Abstract

Background: Cannabis excise tax structures vary widely across the states in the United States. Standardizing taxes may improve cross-state comparisons and strengthen evaluations of how taxes and prices influence public health outcomes. This study developed category-specific standardized tax metrics for flower, vaping, and [...] Read more.

Background: Cannabis excise tax structures vary widely across the states in the United States. Standardizing taxes may improve cross-state comparisons and strengthen evaluations of how taxes and prices influence public health outcomes. This study developed category-specific standardized tax metrics for flower, vaping, and edible products by incorporating price and tax structure variations using retail scanner data. Methods: We analyzed cannabis retail scanner data from dispensary point-of-sale systems for flower, vaping, and edible products in 12 states with legal recreational markets from Q1 2020 to Q4 2024. Using retail prices and excise tax policies, we converted taxes in different forms across the supply chain into standardized measures and estimated tax incidence (ratio of standardized taxes to retail prices) for each category. We also evaluated the association between standardized taxes and retail prices. Results: Mean standardized excise taxes were USD 32.58/ounce for flower, USD 180.21/ounce for vaping, and USD 0.024/milligram THC for edible products. Corresponding tax incidences were 13.03%, 13.59%, and 13.09%. Standardized taxes and tax incidences varied considerably across states. Category-specific standardized taxes strongly predicted retail prices, supporting their use as an instrumental variable candidate. Conclusions: Category-specific standardized measures of cannabis excise taxes derived from retail scanner data may support cross-state comparisons and pricing policy evaluation. Full article

► Show Figures

Figure 1

19 pages, 1142 KB

Open AccessArticle

Impact of Lignite Combustion Air Pollution on Acute Coronary Syndrome and Atrial Fibrillation Incidence in Western Macedonia, Greece

by Vasileios Vasilakopoulos, Ioannis Kanonidis, Christina-Ioanna Papadopoulou, George Fragulis and Stergios Ganatsios

Int. J. Environ. Res. Public Health 2026, 23(1), 113; https://doi.org/10.3390/ijerph23010113 - 16 Jan 2026

Abstract

Air pollution from lignite combustion represents a major environmental and public health concern, particularly for cardiovascular disease. This study investigated the relationship between ambient air pollution and hospital admissions for Acute Coronary Syndromes (ACS) and Atrial Fibrillation (AF) in Western Macedonia, Greece—a region [...] Read more.

Air pollution from lignite combustion represents a major environmental and public health concern, particularly for cardiovascular disease. This study investigated the relationship between ambient air pollution and hospital admissions for Acute Coronary Syndromes (ACS) and Atrial Fibrillation (AF) in Western Macedonia, Greece—a region historically dominated by lignite mining and power generation. Air quality data for PM₁₀, SO₂, and NO_x from 2011–2014 and 2021 were analyzed alongside hospital admission records from four regional hospitals (Kozani, Ptolemaida, Florina, Grevena). Spatial analyses revealed significantly higher pollutant concentrations and cardiovascular admissions in high-exposure areas near power plants compared with the control area. Temporal analyses demonstrated a pronounced decline in pollutant levels between 2014 and 2021, coinciding with lignite phase-out and accompanied by a marked reduction in ACS and AF hospitalizations, particularly in the high-exposure areas of Ptolemaida and Florina. Correlation analyses indicated modest but significant positive associations between monthly pollutant concentrations and cardiovascular admissions. These findings provide real-world evidence that reductions in air pollution following lignite decommissioning were associated with improved cardiovascular outcomes. The study underscores the medical importance of air quality improvement and highlights emission reduction as a critical strategy for cardiovascular disease prevention in transitioning energy regions. Full article

► Show Figures

Figure 1

13 pages, 494 KB

Open AccessSystematic Review

Caries and Socioeconomic Factors in Adults (19–60 Years Old): An Updated Systematic Review of Observational Studies

by Maria Aparecida Gonçalves de Melo Cunha, Alex Junio Silva da Cruz, Carolina Martins-Pfeifer, Simone de Melo Costa and Mauro Henrique Nogueira Guimarães de Abreu

Int. J. Environ. Res. Public Health 2026, 23(1), 112; https://doi.org/10.3390/ijerph23010112 - 16 Jan 2026

Abstract

Dental caries remains a major global public health problem characterized by pronounced social inequalities. This study aimed to identify, critically appraise, and synthesize the most recent evidence on the relationship between socioeconomic indicators and dental caries among adults aged 19–60 years, providing an [...] Read more.

Dental caries remains a major global public health problem characterized by pronounced social inequalities. This study aimed to identify, critically appraise, and synthesize the most recent evidence on the relationship between socioeconomic indicators and dental caries among adults aged 19–60 years, providing an updated systematic review that builds upon our previous reviews from 2012 and 2018. Reported following the PRISMA 2020 guidelines, we conducted a systematic search of eight electronic databases for observational studies published between March 2017 and April 2024 (PROSPERO: CRD42017074434). Two independent reviewers performed study selection, data extraction, and risk of bias assessment using the Newcastle–Ottawa Scale. Due to substantial methodological heterogeneity across the 22 included studies, a narrative synthesis was undertaken. The findings demonstrated a strong inverse association between socioeconomic position and caries experience. Lower income, lower educational attainment, and unemployment or employment in manual/unskilled occupations were associated with a higher overall caries experience. Advanced analytical approaches in recent studies, including life-course, reinforced that education and income are key contributors of these oral health inequalities, with persistent social disadvantage conferring the greatest risk. In conclusion, dental caries in adults aged 19–60 years is a social condition reflecting the cumulative effects of socioeconomic inequality across the life course. Addressing adult dental caries requires integrated approaches that combine clinical prevention with social and public policies aimed at reducing structural inequalities. Full article

► Show Figures

Figure 1

19 pages, 1942 KB

Open AccessArticle

An Integrated Cervical Stabilization Exercise and Thai Self-Massage Approach for Managing Chronic Nonspecific Neck Pain in Young Adults: A Single-Blind Randomized Controlled Trial

by Vitsarut Buttagat, Warathon Mathong, Metira Kongchana, Kanittha Lowprasert, Sujittra Kluayhomthong and Pattanasin Areeudomwong

Int. J. Environ. Res. Public Health 2026, 23(1), 111; https://doi.org/10.3390/ijerph23010111 - 16 Jan 2026

Abstract

Background: Chronic nonspecific neck pain (CNNP) is a widespread musculoskeletal condition affecting individuals across all age groups. Although cervical stabilization exercises (CSE) and Thai self-massage have each demonstrated therapeutic potential, evidence regarding the effectiveness of the combined applications of CSE and Thai self-massage [...] Read more.

Background: Chronic nonspecific neck pain (CNNP) is a widespread musculoskeletal condition affecting individuals across all age groups. Although cervical stabilization exercises (CSE) and Thai self-massage have each demonstrated therapeutic potential, evidence regarding the effectiveness of the combined applications of CSE and Thai self-massage remains limited. This study aimed to investigate the effects of a combined program of CSE and Thai self-massage (CSTM) on pain intensity (PI), pressure pain threshold (PPT), and neck disability (ND) in young adults with CNNP. Methods: This single-blind randomized controlled trial was conducted at the Department of Physical Therapy, School of Integrative Medicine, Mae Fah Luang University, Thailand. Fifty young adults with CNNP were randomly assigned into two groups. The CSTM group performed CSE integrated with Thai self-massage, whereas the control group practiced stretching exercises exclusively. Both groups engaged in their respective programs three times per week for a duration of four weeks. PI, PPT, and ND were assessed at baseline, after four weeks (Week 4), and at a two-week follow-up (Week 6). Results: Both groups showed significant improvements in PI, PPT, and ND (p < 0.05), representing within-group comparisons, at Week 4 and Week 6. Furthermore, between-group comparisons at Week 4 and Week 6 indicated that the CSTM group achieved significantly greater improvements in PI and ND than the control group (p < 0.05). Conclusion: A four-week program combining CSE with Thai self-massage was effective in reducing pain intensity and neck disability in young adults with CNNP, with benefits maintained at short-term follow-up. Trial registration: Thai Clinical Trials Registry (TCTR20231102008), registered on 2 November 2023. Full article

(This article belongs to the Special Issue Physical Therapy Across the Continuum of Care: Integrating Health Promotion, Treatment, and Rehabilitation)

► Show Figures

Figure 1

8 pages, 240 KB

Open AccessArticle

Psychological Impact of Treatment-Induced Erectile Dysfunction on Masculinity: A Study of a Group of Black Elderly Men Undergoing Prostate Cancer Treatment at a Tertiary Hospital in Limpopo Province, South Africa

by Shai Nkoana, Tholene Sodi, Antonio Lentoor, Mokoena Maepa and Kgadi Thobejane

Int. J. Environ. Res. Public Health 2026, 23(1), 110; https://doi.org/10.3390/ijerph23010110 - 16 Jan 2026

Abstract

With emerging improvement in screening and treatment, most patients with prostate cancer (PCa) live for a long period beyond their diagnosis. Erectile dysfunction (ED) and bowel and urinary incontinence have been shown to be the most bothersome side-effects of most PCa treatment options [...] Read more.

With emerging improvement in screening and treatment, most patients with prostate cancer (PCa) live for a long period beyond their diagnosis. Erectile dysfunction (ED) and bowel and urinary incontinence have been shown to be the most bothersome side-effects of most PCa treatment options for patients. With increasing long-term survival, most PCa patients face the prospect of experiencing symptoms, side-effects of available treatment options, and diminished quality of life. The objective of the study was to explore the impact of treatment-induced ED on masculinity among Black South African PCa patients. Twenty (20) prostate cancer patients, selected through purposive sampling and receiving some form of treatment at Pietersburg tertiary Hospital, with ages ranging from 67 to 85 years (mean age = 76 years; SD = 5.3), participated in the study. In-depth, individual semi-structured interviews were used to collect data and analyzed through Interpretative Phenomenological Analysis (IPA). The findings indicate that ED threatens or adversely impacts the participants’ perceptions of their sense of masculinity leading to diminished quality of life. The results demonstrate that loss of masculinity brought about by PCa treatment-induced ED is experienced both physically as well as psychologically. The results highlight a need for collaboration between medical and psychological professionals in the management of PCa patients. This is crucial for improving the overall health related quality of life for patients. Full article

(This article belongs to the Section Behavioral and Mental Health)

33 pages, 756 KB

Open AccessArticle

Parental Perceptions of Healthy Eating and Actual Nutrient Intake: Analysis of the Nutritional Status of Children Aged 1–6 Years in Urban Areas of Central Kazakhstan

by Svetlana Plyassovskaya, Yelena Pozdnyakova and Xeniya Mkhitaryan

Int. J. Environ. Res. Public Health 2026, 23(1), 109; https://doi.org/10.3390/ijerph23010109 - 15 Jan 2026

Abstract

Parental perceptions of healthy eating often diverge from children’s actual diets, but this gap is poorly documented in Central Asia. We examined how parents’ priorities for key food groups relate to nutrient intakes in 390 urban children aged 1–6 years in Central Kazakhstan. [...] Read more.

Parental perceptions of healthy eating often diverge from children’s actual diets, but this gap is poorly documented in Central Asia. We examined how parents’ priorities for key food groups relate to nutrient intakes in 390 urban children aged 1–6 years in Central Kazakhstan. In a cross-sectional study, parents completed a 24 h multiple-pass dietary recall and rated the importance of fats and sweets, meat and fish, dairy, vegetables and fruits, and bread and potatoes on 5-point scales. Nutrient intakes were calculated using software, compared with national DRIs, and analyzed using rank-based tests and Spearman correlations. Parents reported near-ceiling priority for restricting fats and sweets and consistently high priority for bread and potatoes, whereas vegetables, fruits, meat/fish, and dairy were rated moderately important, with dairy under-prioritized in 1–2-year-olds. On the recalled day, median intakes of fat, dietary fiber, vitamin C, and calcium were below national recommendations at all ages, and median intakes of iron, thiamine, and niacin were particularly low at 3–4 years, while sodium intake exceeded recommended levels; the 3–4-year group showed the most pronounced clustering of shortfalls. Prevalence estimates indicated that most children had intakes below recommendations for dietary fiber and calcium and above recommendations for sodium, underscoring population-wide nutritional imbalance. Across all scales, parental priorities showed only weak, non-significant associations with nutrient intakes (|r| < 0.11). These findings indicate a perception–intake gap and support interventions that ensure adequate fats, fiber, vitamin C, calcium, and bioavailable iron in preschool diets. Full article

► Show Figures

Figure 1

11 pages, 281 KB

Open AccessArticle

The Intergenerational Impact of Parental Immigration Status: Educational and Health Outcomes Among Children of Undocumented Immigrants

by Igor Ryabov

Int. J. Environ. Res. Public Health 2026, 23(1), 108; https://doi.org/10.3390/ijerph23010108 - 14 Jan 2026

Abstract

This study examines how parental legal status operates as a fundamental social determinant of health and educational equity, focusing on long-term outcomes among U.S.-born and foreign-born children of immigrants. We hypothesized that intergenerational stress and institutional exclusion associated with undocumented status would lead [...] Read more.

This study examines how parental legal status operates as a fundamental social determinant of health and educational equity, focusing on long-term outcomes among U.S.-born and foreign-born children of immigrants. We hypothesized that intergenerational stress and institutional exclusion associated with undocumented status would lead to lower educational attainment and poorer health. Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative cohort, participants were classified by inferred parental legal status: native-born, documented immigrant, and undocumented immigrant. Outcomes included high school graduation, college enrollment, depression scores, and chronic health conditions. Children of undocumented parents exhibited the most adverse outcomes—lower graduation (63.8%) and college enrollment rates (39.9%), higher depression, and greater chronic illness. In models controlling for socioeconomic factors, parental undocumented status independently predicted reduced odds of college enrollment (OR = 0.61, p < 0.001) and increased odds of reporting fair/poor health (OR = 2.10, p < 0.001). Findings highlight legal precarity as a potent driver of intergenerational disadvantage and underscore the need for policies addressing the barriers faced by children in undocumented families to promote health and educational equity. Full article

(This article belongs to the Special Issue Addressing Risk Behavior in Children and Adolescents)

13 pages, 617 KB

Open AccessArticle

Neuromuscular and Functional Adaptations Promoted by Lower Limb Isometric Training with NMES Conditioning Contractions in Older Adults

by Jacopo Stafuzza, Federica Gonnelli, Mattia D’Alleva, Maria De Martino, Lara Mari, Simone Zaccaron, Mirco Floreani, Alessio Floreancig, Davide Padovan, Giacomo Ursella, Gabriele Brugnola, Enrico Rejc and Stefano Lazzer

Int. J. Environ. Res. Public Health 2026, 23(1), 107; https://doi.org/10.3390/ijerph23010107 - 13 Jan 2026

Abstract

Aging induces sarcopenia and reduces bone mineral density, altering body composition. These modifications contribute to physical decline, increase non-communicable disease risk and increase the likelihood of hospitalization, thereby representing a substantial public health burden. In this study, we assessed the effects of isometric [...] Read more.

Aging induces sarcopenia and reduces bone mineral density, altering body composition. These modifications contribute to physical decline, increase non-communicable disease risk and increase the likelihood of hospitalization, thereby representing a substantial public health burden. In this study, we assessed the effects of isometric training with neuromuscular electrical stimulation conditioning contractions (ISO-NMES) and dynamic resistance training (DRT) on physical and functional capacities. Moreover, we investigated the impact of ISO-NMES training on the force and power of the trained and untrained leg. Eighteen sessions of ISO-NMES training for knee extensors were performed by 10 older adults (age: 70.1 ± 4.9 years; ISO-NMES group). The DRT group (n = 12; age: 70.5 ± 2.8 years) performed 18 sessions of dynamic resistance training at a local fitness center. Maximum voluntary contraction (MVC) and peak power (P) of lower limbs as well as functional capacities assessed with the 5 Sit to Stand, Timed Up and Go and 6 Minutes Walking Tests were examined in both groups before and after the related training protocols. At the end of the training period, only the ISO-NMES group had improved MVC (+30.4%, p < 0.001) and bilateral force (ISO-NMES: +6.3%, p = 0.032). Moreover, both groups had significantly improved functional capacities. Finally, in the ISO-NMES group, MVC, force and power significantly increased in both legs with a greater effect for MVC in the trained than untrained leg (+30.4 vs. +13.5%, p < 0.001). These findings suggest that ISO-NMES training was an effective strategy to improve physical and functional capacities in older adults. Thus, it could be considered as a potential intervention, particularly when the mobility to perform physical training is limited. Full article

► Show Figures

Figure 1

Journal Description

International Journal of Environmental Research and Public Health

Latest Articles

Journal Menu

Journal Browser

Highly Accessed Articles

Latest Books

E-Mail Alert

News

Topics

Conferences

Special Issues

Topical Collections

Further Information

Guidelines

MDPI Initiatives

Follow MDPI