International Journal of Environmental Research and Public Health

19 pages, 2564 KB

Open AccessArticle

Beyond the Take-Home Pathway: Community-Level Pesticide Exposure Among Children Living in an Intensively Cultivated Agricultural Landscape

by Humberto González

Int. J. Environ. Res. Public Health 2026, 23(5), 664; https://doi.org/10.3390/ijerph23050664 (registering DOI) - 18 May 2026

Abstract

Children living in agricultural regions are exposed to pesticides through multiple environmental and occupational exposure processes; however, the relative contribution of these processes remains insufficiently characterised in many rural contexts of the Global South. This study assessed pesticide exposure among children residing in [...] Read more.

Children living in agricultural regions are exposed to pesticides through multiple environmental and occupational exposure processes; however, the relative contribution of these processes remains insufficiently characterised in many rural contexts of the Global South. This study assessed pesticide exposure among children residing in an agricultural community in western Mexico characterised by close spatial proximity between residential areas and intensively cultivated fields. Urine samples were collected from children at two points in the agricultural cycle (March and December 2018). Pesticide concentrations were determined using liquid chromatography coupled with tandem mass spectrometry (LC–MS/MS). Paired longitudinal analyses were conducted to evaluate intra-individual changes in detection frequencies and urinary concentrations across sampling periods. Multiple pesticides were detected, including compounds with near-universal presence across both sampling periods. Significant increases in urinary concentrations were observed between March and December for several pesticides, consistent with seasonal agricultural dynamics, while no systematic differences were identified between children from agricultural and non-agricultural households. These findings indicate that pesticide exposure in this setting operates as a community-level exposure regime that is both structurally produced and territorially embedded. Exposure patterns reflect the convergence of agricultural practices, environmental dispersion processes, and spatial configurations that extend beyond occupational boundaries. The results highlight the limitations of risk models focused exclusively on individual or occupational exposure and underscore the need for public health strategies that address pesticide exposure as a structurally produced and territorially embedded condition. Full article

(This article belongs to the Special Issue Agricultural Health and Sustainability: Addressing Occupational, Mental, and Environmental Challenges)

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19 pages, 336 KB

Open AccessArticle

Patient Perspectives on Quantified Self Technologies and Healthcare Costs Among Patients with Diabetes in Zimbabwe

by Belinda Mutunhu and Baldreck Chipangura

Int. J. Environ. Res. Public Health 2026, 23(5), 663; https://doi.org/10.3390/ijerph23050663 (registering DOI) - 18 May 2026

Abstract

The growing use of quantified self-technologies (QST) in chronic disease management is linked to better self-monitoring and patient engagement. However, little is known about how patients in resource-constrained settings fund and sustain the use of QST in diabetes self-management. This study asked: “How [...] Read more.

The growing use of quantified self-technologies (QST) in chronic disease management is linked to better self-monitoring and patient engagement. However, little is known about how patients in resource-constrained settings fund and sustain the use of QST in diabetes self-management. This study asked: “How do patients with diabetes perceive and experience the economic burden of using QST in Zimbabwe?” Using a qualitative design, 20 patients with diabetes participated in semi-structured interviews. The reflexive thematic analysis of Braun and Clarke generated three interrelated themes: technology investment costs, conventional healthcare costs, and socio-economic constraints. The findings show that the economic experience of QST adoption is context-dependent and is shaped by the financial realities of patients with diabetes and their access to technology. By focusing on patient-level cost experiences, the study adds qualitative evidence to public health debates on digital health affordability and highlights the need to assess perceived financial implications within a third-world socio-economic context. It is concluded that, although QST is available in third-world countries, sustained use depends on the financial capacity of patients with diabetes. Full article

19 pages, 1150 KB

Open AccessArticle

Upper Arm to Upper Leg Length Ratio and Dyslipidemia: A Novel Application of a Fixed Skeletal Proportion Metric in a Nationally Representative U.S. Sample

by Tanvir Ahmed, Akhi Nath, Nusrat Jahan, Nargis Hoque, Mobashera Jahan, Mst Sabrina Kaniz, Shovit Dutta, Swapnil Saha, Md. Ashraful Haque and Rodney G. Bowden

Int. J. Environ. Res. Public Health 2026, 23(5), 662; https://doi.org/10.3390/ijerph23050662 (registering DOI) - 16 May 2026

Abstract

Conventional anthropometric measures used to predict dyslipidemia, such as body mass index and waist circumference, vary over time and may not fully capture early-life influences on metabolic risk. Fixed skeletal proportions, including limb length ratios, remain stable after physical maturity and may reflect [...] Read more.

Conventional anthropometric measures used to predict dyslipidemia, such as body mass index and waist circumference, vary over time and may not fully capture early-life influences on metabolic risk. Fixed skeletal proportions, including limb length ratios, remain stable after physical maturity and may reflect developmental exposures relevant to lipid metabolism. This study examined the association between the upper arm–to–upper leg length ratio (UA/UL), a fixed skeletal proportion metric with established links to diabetes risk and dyslipidemia; this represents an application not previously reported in a nationally representative U.S. population. We conducted a cross-sectional analysis of adults aged ≥20 years using data from the National Health and Nutrition Examination Survey (NHANES) 2017–March 2020 (n = 7569). The UA/UL ratio was calculated from standardized upper arm and upper leg length measurements and categorized into quartiles based on the weighted sample distribution. Dyslipidemia was defined according to National Cholesterol Education Program Adult Treatment Panel III criteria or current lipid-lowering medication use. Survey-weighted logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) across progressively adjusted models. Dyslipidemia prevalence increased across UA/UL quartiles (58.4% in Q1 to 81.3% in Q4; p < 0.001). In unadjusted analyses, individuals in the highest UA/UL quartile had greater odds of dyslipidemia compared with the lowest quartile (OR 3.10, 95% CI 2.49–3.86). Associations remained significant after adjustment for demographic factors and for anthropometric measures considered separately. However, the association was attenuated and no longer statistically significant in fully adjusted models that included demographics, adiposity measures, hypertension, and diabetes. In sex-stratified analyses, the association was attenuated and no longer statistically significant in either sex after full adjustment; formal interaction testing confirmed no significant effect modification by sex (p-for-interaction = 0.943). Full article

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13 pages, 574 KB

Open AccessArticle

From Willingness to Readiness: Caregiver Activation for Cancer Care in Singapore

by Safora Johansen, Melissa Gaik Ming Ooi and Alice F. S. Chua

Int. J. Environ. Res. Public Health 2026, 23(5), 661; https://doi.org/10.3390/ijerph23050661 (registering DOI) - 15 May 2026

Abstract

Background: Family caregivers are essential partners in the outpatient care of older adults with cancer, yet the knowledge, skills, and confidence, collectively, of caregiver activation are not well characterized in Asian settings. Understanding activation can inform tailored support to sustain effective caregiving. Accordingly, [...] Read more.

Background: Family caregivers are essential partners in the outpatient care of older adults with cancer, yet the knowledge, skills, and confidence, collectively, of caregiver activation are not well characterized in Asian settings. Understanding activation can inform tailored support to sustain effective caregiving. Accordingly, this study assessed the overall activation levels among cancer caregivers in the three most common cancer diagnoses in Singapore by using the Caregiver-Patient Activation Measure (CG-PAM). Methods: A total of 103 informal caregivers of patients ≥60 years (lung, GI, or myeloma) at Singapore’s largest public cancer hospitals completed the 13-item CG-PAM, scored 0–100 and classified into four activation levels. Descriptive statistics summarized characteristics and CG-PAM responses, and logistic regression analyses assessed the degree of activation for individual demographic and other characteristics (p < 0.05). Results: Caregivers showed moderate–high activation (mean 65.9 ± 16.1) and the following levels: L1, 4.9%; L2, 23.3%; L3, 38.8%; L4, 31.1%. They strongly endorsed personal responsibility and active engagement, reporting confidence in key self-management tasks, but struggled to sustain behaviors under stress. Activation was not significantly associated with demographic factors or any other measured characteristics. Conclusion: Caregivers of older adults with cancer in Singapore included in this study showed moderate–high activation and strong self-management confidence but struggled to sustain behaviors under stress. Routine activation assessment and tailored support (education, coaching) could strengthen outpatient care. Longitudinal and interventional research, alongside follow-up interviews, is needed to identify unmet needs, existing support systems, and inform scalable, sustainable models. Full article

(This article belongs to the Section Health Care Sciences)

17 pages, 2167 KB

Open AccessArticle

Bayesian Multivariate Modelling of Lone Star (Amblyomma americanum) Tick Life Stage Abundance and Temporal Trends to Inform Public Health Risk in Virginia

by Thabo Lephoto, Henry Mwambi, Oliver Bodhlyera and Holly Gaff

Int. J. Environ. Res. Public Health 2026, 23(5), 660; https://doi.org/10.3390/ijerph23050660 (registering DOI) - 15 May 2026

Abstract

The increasing abundance of ticks poses a growing public health concern due to heightened human exposure to tick bites. The lone star tick (Amblyomma americanum: Ixodida: Ixodidae), a common human-biting species in the United States, has expanded its range in recent [...] Read more.

The increasing abundance of ticks poses a growing public health concern due to heightened human exposure to tick bites. The lone star tick (Amblyomma americanum: Ixodida: Ixodidae), a common human-biting species in the United States, has expanded its range in recent years. However, how its different life stages vary across time, habitats, and locations remains insufficiently understood. We analyzed tick abundance data collected in southeastern Virginia between 2009 and 2018, focusing on larval, nymphal, and adult life stages. A Bayesian multivariate modelling framework was used to examine seasonal patterns, habitat effects, spatial variation, and biological links between life stages. Two commonly used count models were compared to determine which best described the observed tick abundance patterns. Tick abundance showed strong and distinct seasonal patterns across life stages. Adult ticks were most abundant in late spring to early summer (May–June), nymphs peaked in early to mid-summer (June–July), and larvae peaked later in summer (August). Wooded habitats consistently supported higher tick abundance than grassy areas. Although both models captured these trends, the negative binomial model provided a more stable and biologically meaningful representation of tick dynamics. Several counties, including Chesapeake, York, Portsmouth, and Northampton, were identified as areas of elevated tick abundance, indicating increased tick bite exposure risk. This study highlights clear seasonal and habitat-specific windows of increased tick activity that are relevant for surveillance and control planning. By clarifying when and where different tick life stages are more abundant, the findings support targeted public health interventions aimed at reducing human exposure to tick bites in Virginia. The modelling approach is also applicable to other regions, including settings where ticks affect livestock health and food security. Full article

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13 pages, 584 KB

Open AccessArticle

Burden of Disease Due to Consumption of Alcohol and Other Drugs in Colombia, 2016–2022: A Subnational Regional Analysis

by Oscar Alexander Gutiérrez-Lesmes, Emilce Salamanca Ramos and Karen Julieth Quintero Díaz

Int. J. Environ. Res. Public Health 2026, 23(5), 659; https://doi.org/10.3390/ijerph23050659 (registering DOI) - 15 May 2026

Abstract

Alcohol and psychoactive substance use represent a major burden for global public health, increasing the risk of non-communicable diseases, violence, road traffic injuries, dependence, and mental disorders, and generating impacts on productivity and social welfare. This study aimed to estimate the burden of [...] Read more.

Alcohol and psychoactive substance use represent a major burden for global public health, increasing the risk of non-communicable diseases, violence, road traffic injuries, dependence, and mental disorders, and generating impacts on productivity and social welfare. This study aimed to estimate the burden of disease attributable to alcohol and other psychoactive substances in the departments of Colombia from 2016 to 2022. A burden-of-disease study was conducted using the Disability-Adjusted Life Years (DALYs) indicator, following the methodology of the World Health Organization Global Health Estimates. Official morbidity and mortality databases were used. An estimated 236,154.42 DALYs were attributable to alcohol and psychoactive substance use in Colombia during the study period, increasing from 14,158.7 DALYs in 2016 to 40,190.7 DALYs in 2022. The burden was heterogeneous across departments, with values above 1000 DALYs in Quindío (1779.5), Nariño (1624.3), and Norte de Santander (1008.0) and below 132 DALYs in La Guajira, Casanare, and Vaupés. Men accounted for 73.5% of total DALYs. The mean age of morbidity records associated with alcohol and psychoactive substance use disorders was 30.67 years in men and 32.37 years in women. The burden associated with psychoactive substance use is increasing in Colombia, with differences by sex and department of residence. Full article

(This article belongs to the Section Global Health)

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16 pages, 325 KB

Open AccessArticle

Primary Care Career Perceptions: Comparing Temperament and Character Inventory Profiles of Medical Students with General Practitioners

by Anna Nánási, Viktor Rekenyi, Csongor István Szepesi, Eszter Kovács, Nóra Horváth, Armand Kun and László Róbert Kolozsvári

Int. J. Environ. Res. Public Health 2026, 23(5), 658; https://doi.org/10.3390/ijerph23050658 (registering DOI) - 15 May 2026

Abstract

The structural integrity of the Hungarian healthcare system is threatened by a systemic shortage of General Practitioners (GPs), with 1021 districts remaining vacant as of March 2026. This study assessed demographic characteristics, perceived career attributes, and temperament and character traits of 144 medical [...] Read more.

The structural integrity of the Hungarian healthcare system is threatened by a systemic shortage of General Practitioners (GPs), with 1021 districts remaining vacant as of March 2026. This study assessed demographic characteristics, perceived career attributes, and temperament and character traits of 144 medical students and 72 practicing GPs, achieving an overall response rate of 91.5%, using the TCI-55 inventory to identify factors influencing professional pathways. Statistical analysis utilized Mann–Whitney U, Chi-square, and Fisher’s exact tests. Results showed only 6 students indicated family medicine as their first choice, compared to 49 GPs (p < 0.001). Students frequently perceived the field as “boring” (82 students vs. 1 GP, p < 0.001) and burdened by “trivial patient problems” (44 students vs. 7 GPs, p = 0.001), while GPs highlighted “stress” (15 GPs vs. 4 students, p < 0.001) as a primary disadvantage. Students scored significantly higher in the temperament dimensions of Novelty Seeking (p < 0.001) and Reward Dependence (p < 0.001). Addressing these educational misperceptions and urgently mitigating the structural drivers of occupational stress and workforce fatigue are critical public health priorities required to ensure the sustainability of primary care, maintain the continuity of preventive services, and safeguard equitable population health outcomes. Full article

24 pages, 339 KB

Open AccessArticle

Strategies to Raise Awareness About Screening and Vaccination for the Human Papillomavirus Among Women in Limpopo Province, South Africa

by Matodzi Pertunia Mushasha and Lebitsi Maud Modiba

Int. J. Environ. Res. Public Health 2026, 23(5), 657; https://doi.org/10.3390/ijerph23050657 (registering DOI) - 15 May 2026

Abstract

Background: Human papillomavirus (HPV) is a serious infection which is primarily transmitted through sexual intercourse. Almost 100% of cervical cancers are caused by HPV. Limited awareness of HPV leads to delayed cancer diagnoses, significantly increasing mortality and morbidity rates. Aim: The purpose of [...] Read more.

Background: Human papillomavirus (HPV) is a serious infection which is primarily transmitted through sexual intercourse. Almost 100% of cervical cancers are caused by HPV. Limited awareness of HPV leads to delayed cancer diagnoses, significantly increasing mortality and morbidity rates. Aim: The purpose of this study was to develop strategies to increase awareness of human papillomavirus screening and vaccination among women in Limpopo Province, South Africa. Setting: This study was carried out in the Vhembe District of the Thulamela Municipality of Limpopo Province. Methods: The E-Delphi method was used, and the researcher used a quantitative approach. A total population of 15 nursing managers was part of the study. Questionnaires were used to collect data. Data were analysed using the statistical package for the social sciences version 26. Results: In Round 1, 8 (53.3%) of the 15 participants strongly supported the strategy of updating women with the most recently revised HPV screening guidelines. In Round 2, consensus was achieved, with 14 (93.3%) of the participants strongly agreeing that the development of teaching programmes in healthcare facilities is necessary. This indicates a strong convergence of expert opinion on the importance of structured educational interventions to support the implementation of the strategy. The consensus in this study was defined as ≥70% agreement between participants on each item. Conclusions: The lack of awareness of HPV is concerning because early detection and treatment can prevent serious health problems. The study used the E-Delphi method to assess the effectiveness of strategies to increase awareness of HPV screening and vaccination in women. Contribution: Health policy initiatives may improve public awareness of HPV and vaccination, especially by focusing on educating nurses, which could improve women’s awareness and encourage HPV screening and vaccination. Full article

15 pages, 593 KB

Open AccessPerspective

Preservation-to-Precision in Severe Early Childhood Caries: A Narrative Review of Silver Diamine Fluoride—When “Buying Time” Must Not Become “Selling Time”

by Ziad D. Baghdadi

Int. J. Environ. Res. Public Health 2026, 23(5), 656; https://doi.org/10.3390/ijerph23050656 (registering DOI) - 14 May 2026

Abstract

Severe early childhood caries (SECC) in preschool children is a progressive, multifactorial disease with far-reaching consequences for child health, family functioning, and health systems. Minimally invasive dentistry (MID), particularly 38% silver diamine fluoride (SDF), is increasingly used to arrest lesions and “buy time” [...] Read more.

Severe early childhood caries (SECC) in preschool children is a progressive, multifactorial disease with far-reaching consequences for child health, family functioning, and health systems. Minimally invasive dentistry (MID), particularly 38% silver diamine fluoride (SDF), is increasingly used to arrest lesions and “buy time” when definitive restorative care is delayed. This narrative review synthesizes current evidence-based guidelines and real-world utilization data to clarify the appropriate role and limits of SDF in SECC management. Professional guidance supports SDF for lesion arrest within an ongoing caries management plan, but does not endorse it as a universal long-term substitute for durable restorative care. Observational studies show that many SDF-treated primary teeth receive additional intervention within approximately 2 years, and any delay in sedation/general anesthesia is typically measured in weeks to months. A large recent private practice study found that 35% of children with caries progressed to higher-intensity treatment (restoration or extraction) over a median of 547 days, reinforcing the time-limited nature of interim stabilization. We propose a “preservation-to-precision” framework that prioritizes child-centered outcomes—freedom from pain and infection, durable function, and acceptable psychosocial impact—through risk-based, tooth- and child-specific planning, realistic follow-up assessment, and clear exit criteria for transition to definitive care. In high-income settings, the ethical value of “buying time” depends on whether systems use that time to advance children toward timely, definitive care rather than normalizing prolonged temporization as routine practice. Full article

(This article belongs to the Special Issue 2nd Edition of Oral Diseases: Prevention, Diagnosis and Treatment)

16 pages, 296 KB

Open AccessArticle

Prevalence of Use, Impact on Oral Health, and Knowledge Regarding Tobacco Smoking: Findings from a Cross-Sectional Survey in Military Marines

by Siti Sopiatin, Yun Mukmin Akbar, Irvan Nur Wachid, Sharifa Ezat Wan Puteh, Neily Zakiyah, Amaliya Amaliya and Achmad Syawqie

Int. J. Environ. Res. Public Health 2026, 23(5), 655; https://doi.org/10.3390/ijerph23050655 (registering DOI) - 14 May 2026

Abstract

Background: Despite well-documented adverse impact on both systemic and oral health, tobacco smoking remains a persistent issue in military populations. It contributes to the global burden of tobacco use and is often perceived as a means of coping with stress in military [...] Read more.

Background: Despite well-documented adverse impact on both systemic and oral health, tobacco smoking remains a persistent issue in military populations. It contributes to the global burden of tobacco use and is often perceived as a means of coping with stress in military settings. Purpose: This study aimed to assess the prevalence of tobacco use among military marines, its impact on oral health, and their level of knowledge regarding smoking, as well as to identify variables associated with their smoking habits. Thus, it provides a basis for implementing appropriate tobacco cessation and harm reduction strategies, particularly within the military. This study demonstrated a high prevalence of tobacco use among military marines, despite generally high levels of knowledge regarding tobacco smoking. A knowledge gap was still evident in relation to smoking behavior. The most frequently reported oral health impacts among smokers were tooth staining, halitosis, and taste impairment. Duration of military service and level of knowledge were significantly associated with smoking behavior. Materials and methods: A validated and reliable online survey was administered to collect socio-demographic data, including age, education level, and length of military service. The survey also assessed smoking status, smoking behavior, its impact on oral health, and participants’ knowledge of smoking-related risks. Data were analyzed descriptively, and associated factors were examined using multivariate analysis. Results: A total of 475 military marines participated in the study. Of these, 44.8% were current smokers, 25.7% were former smokers, and 29.5% had never smoked. Overall, 71% of participants demonstrated good knowledge of smoking-related risks. The most commonly reported oral health impacts were halitosis, tooth staining, and impaired taste. Smoking status did not differ significantly by age (p = 0.095) or education level (p = 0.610), but differed significantly by length of military service (p < 0.05) and level of knowledge (p < 0.05). Multivariate analysis using multinomial logistic regression indicated that length of military service was a significant predictor of smoking behavior (p = 0.005; 95% CI: 0.282–0.800), with 1–5 years of service emerging as the most influential category. Based on the odds ratio, individuals with 11–15 years of service had a 1.8-fold higher likelihood of smoking. Conclusions: Despite a generally good level of knowledge regarding the health risks of smoking, the prevalence of tobacco use remains high among military marines. The most commonly reported oral health impacts were tooth staining, halitosis, and impaired taste. Length of military service and level of knowledge regarding smoking were identified as significant factors associated with smoking status. Full article

(This article belongs to the Section Global Health)

13 pages, 287 KB

Open AccessArticle

Predictors of Depression and Death Anxiety Among Filipino Older Adults: The Roles of Meaning in Life, Self-Esteem, and Life Satisfaction

by Gil P. Soriano, Mark Edllin R. Rafol, Ezekiel Zachary C. Samonte, Reena C. Asturias, Carissa Juliana R. Balaria, Mars Ian A. Silud, Feni Betriana and Kathyrine A. Calong Calong

Int. J. Environ. Res. Public Health 2026, 23(5), 654; https://doi.org/10.3390/ijerph23050654 (registering DOI) - 14 May 2026

Abstract

In sociocultural situations where aging is firmly associated with family roles, spirituality, and reliance, depression and death anxiety are prevalent mental health issues among older individuals. Although their functions may vary depending on the situation, psychological resources, such as purpose in life, self-worth, [...] Read more.

In sociocultural situations where aging is firmly associated with family roles, spirituality, and reliance, depression and death anxiety are prevalent mental health issues among older individuals. Although their functions may vary depending on the situation, psychological resources, such as purpose in life, self-worth, and life satisfaction, are often considered protective in later life. This descriptive–correlational study examined the relationships between meaning in life, self-esteem, life satisfaction, depression, and death anxiety among 119 community-dwelling older Filipinos aged 60 years and older. Data were analyzed using descriptive statistics, Pearson correlation, and multiple linear regression in JAMOVI version 2.7.6. The standardized instruments included the Meaning in Life Questionnaire, Rosenberg Self-Esteem Scale, Satisfaction with Life Scale, Revised Death Anxiety Scale, and Beck Depression Inventory. Regression analysis revealed that while meaning in life and life satisfaction independently predicted higher death anxiety, they independently predicted lower depression. After adjustment, self-esteem predicted neither outcome. These results suggest that psychological resources have distinct effects on mental health in later life, acting as protective factors against depressive symptoms and raising awareness of mortality. To promote healthy aging among older individuals, culturally responsive therapies that address existential factors and emotional well-being are necessary. Full article

20 pages, 1089 KB

Open AccessArticle

Facing Dementia in Primary Care: Applying the COM-B Model to Develop a Complex Intervention to Improve Dementia Diagnosis Rates in General Practice

by Caroline Gibson, Mark Yates, Constance Dimity Pond, Stephanie Daly, Jessica Jebramek, Lyn Phillipson, Kate Laver, Meredith Gresham, Edwin Tan, Henry Brodaty, Jamie Swann, Shahana Ferdousi and Lee-Fay Low

Int. J. Environ. Res. Public Health 2026, 23(5), 653; https://doi.org/10.3390/ijerph23050653 (registering DOI) - 14 May 2026

Abstract

As the population ages and new therapies become available, general practitioners will have a significant role in the early detection, diagnosis, and management of dementia. However, both in Australia and globally, dementia remains under-recognised and under-diagnosed in primary care. The aim of this [...] Read more.

As the population ages and new therapies become available, general practitioners will have a significant role in the early detection, diagnosis, and management of dementia. However, both in Australia and globally, dementia remains under-recognised and under-diagnosed in primary care. The aim of this study is to develop a complex intervention, informed by behaviour change theory, to improve rates of dementia diagnoses in Australian primary care. Co-design participants included GPs, general practice nurses, practice managers and reception staff. A program logic model was used to describe the essential activities and mechanisms of the intervention. Six behaviour changes—education, training, enablement, modelling, persuasion, and environmental restructuring—were identified to address the identified barriers to dementia diagnosis in primary care. The intervention comprises seven activities—peer-led online dementia education and training, geriatrician ‘drop-in’ online support sessions, quality improvement in dementia care sessions, stand-alone videos, auditing and benchmarking, a dementia risk alert tool and a set of dementia diagnosis and management decision-making resources. Using behaviour change theory can assist in the development of complex interventions aimed at changing clinical practice and may assist in their evaluation. Full article

(This article belongs to the Special Issue Interventions to Improve the Care of People Living with Dementia)

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15 pages, 298 KB

Open AccessArticle

Cultural, Societal, and Behavioral Contributors to Delays in Seeking Care for Postmenopausal Bleeding Among Disaggregated Populations of Black Women

by Maurice J. Chery, Wilmar B. Mondestin, LaShae D. Rolle, Alejandra Casas, Sara M. St. George, Frank J. Penedo, Kallia O. Wright, Patricia I. Moreno, Nadine Philogene-Vincent, Sophia H. L. George and Matthew P. Schlumbrecht

Int. J. Environ. Res. Public Health 2026, 23(5), 652; https://doi.org/10.3390/ijerph23050652 (registering DOI) - 14 May 2026

Abstract

Background: Endometrial cancer outcomes differ among Black women when examined by nativity, and timely evaluation of postmenopausal bleeding (PMB), the most common presenting symptom, may contribute to these disparities. Methods: This qualitative study explored cultural, societal, and behavioral factors shaping PMB appraisal and [...] Read more.

Background: Endometrial cancer outcomes differ among Black women when examined by nativity, and timely evaluation of postmenopausal bleeding (PMB), the most common presenting symptom, may contribute to these disparities. Methods: This qualitative study explored cultural, societal, and behavioral factors shaping PMB appraisal and anticipated care-seeking among US-born Black, Caribbean-born Black, and Haitian Creole-speaking women in South Florida, guided by the Safer–Andersen Model of Total Patient Delay. Ten focus groups were conducted with 55 Black women aged ≥50 years recruited through purposive and snowball sampling. Discussions were held in English or Haitian Creole, audio-recorded, professionally transcribed, translated when needed, and analyzed thematically using a hybrid deductive–inductive approach. Reporting followed the Consolidated Criteria for Reporting Qualitative Research. Results: Three themes emerged: limited awareness and information-seeking regarding menopause and PMB; cultural and societal influences, including faith-based coping, traditional remedies, and limited family discussion of health history; and healthcare system barriers, including cost, lack of insurance, distrust, and communication challenges with providers. Subgroup differences were noted in preferred information sources, perceived susceptibility, and the role of religion in care-seeking. Conclusions: Findings suggest that PMB appraisal and anticipated care-seeking vary by nativity and language among Black women. Nativity- and language-tailored community education and navigation strategies may improve symptom recognition and support timely evaluation, but future quantitative studies are needed to test whether these approaches reduce pre-diagnostic intervals for endometrial cancer. Full article

(This article belongs to the Special Issue Cancer Health Disparities in Prevention and Care)

12 pages, 670 KB

Open AccessArticle

Clinical Workload, Demographic Patterns, and Correlations in Neurology Ambulatory Care: A Single-Center Study from Bulgaria

by Christiyan Kirilov Naydenov and Antoaneta Petrova Yordanova

Int. J. Environ. Res. Public Health 2026, 23(5), 651; https://doi.org/10.3390/ijerph23050651 (registering DOI) - 14 May 2026

Abstract

Background: Neurological disorders are a leading cause of disability worldwide, placing increasing strain on healthcare systems. In Eastern Europe, and specifically Bulgaria, there is a significant lack of granular data regarding how ambulatory neurology services are utilized and how clinical workloads are distributed [...] Read more.

Background: Neurological disorders are a leading cause of disability worldwide, placing increasing strain on healthcare systems. In Eastern Europe, and specifically Bulgaria, there is a significant lack of granular data regarding how ambulatory neurology services are utilized and how clinical workloads are distributed across different diagnostic groups. Objective: In this study, we aimed to analyze the clinical workload, demographic patterns, and diagnostic distribution within a single-center ambulatory neurology setting in Bulgaria, while identifying the primary determinants of patient age stratification. Methods: We conducted a retrospective observational study of 518 consecutive clinical encounters recorded over a one-year period in a specialized outpatient neurology clinic. Data on age, gender, visit type (ambulatory vs. dispensary), and ICD-10 diagnostic groups were analyzed. Inferential analyses included a one-way ANOVA for age differences and multivariable linear regression to identify independent predictors of age patterns, with age modeled as a continuous variable. Results: The clinical workload was highly concentrated, with spine-related disorders accounting for over 40% of all visits, and primary consultative examinations were the predominant service type (65.4%). Statistical analysis revealed significant age differences across diagnostic categories (p < 0.001), with neurodegenerative and cerebrovascular diseases associated with the highest mean age, while spine and headache syndromes involved significantly younger populations. Multivariable modeling confirmed that diagnostic category is the sole independent determinant of age distribution (p < 0.001), whereas gender and visit type showed no significant independent associations. Conclusions: Ambulatory neurology utilization in this setting is characterized by a high-turnover primary consultation model and a heavy concentration of musculoskeletal neurological conditions. These findings suggest that outpatient neurology functions as a critical diagnostic filter and pain management hub. The study underscores the need for diagnosis-specific clinical pathways and targeted resource allocation to optimize service efficiency and improve long-term management of chronic neurological morbidity in a public insurance-driven framework. Full article

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13 pages, 578 KB

Open AccessArticle

Visible Helmet Presence Among Motorcycle Riders and Passengers at a Thai University: A CCTV-Based Cross-Sectional Observational Study

by Pakpoom Chaisiriprasit, Manaporn Chatchumni, Nuengruthai Petmeedee, Duangnapha Bunsong, Wassana Chaeypinij, Tanakon Asasing, Uma Khumwong and Nitthanet Natthakunlanan

Int. J. Environ. Res. Public Health 2026, 23(5), 650; https://doi.org/10.3390/ijerph23050650 (registering DOI) - 13 May 2026

Abstract

Motorcycle-related injuries remain a major public health concern in Thailand, particularly among adolescents and young adults, yet evidence on actual helmet-related behavior in university settings remains limited. This study assessed visible helmet presence among motorcycle riders and passengers at a Thai university using [...] Read more.

Motorcycle-related injuries remain a major public health concern in Thailand, particularly among adolescents and young adults, yet evidence on actual helmet-related behavior in university settings remains limited. This study assessed visible helmet presence among motorcycle riders and passengers at a Thai university using real-world CCTV observations. A cross-sectional observational study was conducted at a large private university in Thailand using CCTV footage from two campus gates over seven consecutive days during peak commuting periods (07:00–09:00 and 16:00–18:00). Motorcycle-user observation events were coded for visible helmet presence, rider/passenger role, university affiliation, and time of observation. Descriptive statistics, chi-square tests, and 95% confidence intervals were used. A total of 19,363 motorcycle-user observation events were recorded. Overall visible helmet presence was 18.8% (3646/19,363). Visible helmet presence was 21.8% (1956/8985) among student riders, 3.1% (230/7505) among student passengers, 58.6% (1299/2217) among staff riders, and 24.5% (161/656) among staff passengers. Morning observation periods showed higher values than evening periods across most groups. Visible helmet presence was low overall and especially low among student passengers. These findings should be interpreted as event-based estimates rather than person-based prevalence or verified protective helmet use, and they support universities as priority settings for targeted road-safety interventions. Full article

(This article belongs to the Topic Smart Multi-Modal Sensing for Environmental Health: Integrating Smart Technologies, IoT, and the Human Exposome for Public Health Advancement)

26 pages, 2686 KB

Open AccessArticle

Climate Change Perceptual Awareness, Climate-Related Anxiety, and Perceived Impacts of Climate Change Among University Students in Jordan: Findings from a Multi-University Cross-Sectional Study

by Ala’a B. Al-Tammemi, Hindya O. Al-Maqableh, Mohammad Aljarrah, Sami A. Alhallaq, Ahmad W. A. AlKhyat, Hanan Hasan, Dua’a Al Tamimi, Malak T. Alnatsheh, Hedaya R. Hina, Eman Mohammad Qudah, Baraa Joudeh, Muayyad Islam Abusido, Mus’ab Banat, Abrar Omari, Dana Jamal Suboh, Sahar H. AlAhmad, Redab Al-Ghawanmeh, Dalia Kashef Zayed, Salam Momani, Haitham Khatatbeh, Ibrahim Ayasreh, Rabaa Y. Athamneh, Moawiah Khatatbeh, Muna Barakat, Fayez Abdulla, Mohammad Al-Qudah and Tareq L. Mukattash Show full author list Hide full author list

Int. J. Environ. Res. Public Health 2026, 23(5), 649; https://doi.org/10.3390/ijerph23050649 (registering DOI) - 13 May 2026

Abstract

Background: Jordan is increasingly recognized as a climate-vulnerable setting in the region, yet evidence on the psychosocial dimensions of climate change among young adults remains limited. Led by the Jordan Center for Disease Control, this study assessed climate change perceptual awareness and [...] Read more.

Background: Jordan is increasingly recognized as a climate-vulnerable setting in the region, yet evidence on the psychosocial dimensions of climate change among young adults remains limited. Led by the Jordan Center for Disease Control, this study assessed climate change perceptual awareness and climate-related anxiety among university students and explored perceptions of climate impacts at global and national levels. Methods: In a cross-sectional survey conducted between April and May 2025, 1305 students were recruited from universities across Jordan using a questionnaire incorporating the 15-item Climate Change Perceptual Awareness Scale and the 13-item Climate Change Anxiety Scale. Results: Awareness of climate change and global warming was high (87% and 96%, respectively), yet only 23% were familiar with Jordan’s National Climate Change Policy 2022–2050. In regression analyses, higher climate anxiety was associated with female sex, married status, larger household size, diagnosed mental health conditions, and central-region university enrolment. Higher perceptual awareness was associated with female sex, older age, and the recognition of multidimensional climate impacts. Students identified heatwaves, drought, and forest fires as principal environmental threats, and respiratory and heat-related illnesses as foremost health concerns. Conclusions: Our findings position climate change as not only an environmental concern, but also as an educational, psychological, and public health priority. To support effective adaptation and resilience, climate awareness must be translated into informed engagement and action. Integrating climate and climate-health education into university curricula, improving youth-responsive communication of national climate strategies, and creating formal pathways for youth participation in climate governance are essential investments in Jordan’s climate resilience, health security, and long-term sustainable development. Full article

(This article belongs to the Section Environmental Health)

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22 pages, 4171 KB

Open AccessArticle

From Waste to Health: Landfill Biogas Recovery as a Strategy for Greenhouse Gas Mitigation and Public Health Co-Benefits in Brazil

by Estefane Caetano Nazzari, Gredson Keiff Souza, Fernanda Nayara Campos de Almeida, Anderson Rafael Igarashi, Alexandre Diorio, Djeine Cristina Schiavon Maia and Nehemias Curvelo Pereira

Int. J. Environ. Res. Public Health 2026, 23(5), 648; https://doi.org/10.3390/ijerph23050648 (registering DOI) - 13 May 2026

Abstract

Biogas from municipal solid waste is a promising pathway for renewable energy production while mitigating environmental pollution and public health risks. In this study, biogas emissions from a sanitary landfill in Maringá, southern Brazil, were evaluated using three models (IPCC, LandGEM, and CETESB [...] Read more.

Biogas from municipal solid waste is a promising pathway for renewable energy production while mitigating environmental pollution and public health risks. In this study, biogas emissions from a sanitary landfill in Maringá, southern Brazil, were evaluated using three models (IPCC, LandGEM, and CETESB tool) to estimate methane generation and energy recovery potential. Experimental analysis revealed methane concentrations from 51.10 ± 8.89% to 57.06 ± 1.19% across collection drains, indicating favorable conditions for energy utilization. Methane generation was estimated under different scenarios, reaching up to 1.30 × 10⁴ tonnes of CH₄, with peak production projected over 25–26 years depending on the model. Beyond energetic relevance, controlled biogas recovery can substantially reduce methane emissions, a key precursor of tropospheric ozone, and limit hazardous trace gas release, improving air quality and reducing population exposure to harmful pollutants. These findings are particularly relevant in developing countries, where insufficient waste management infrastructure leads to uncontrolled emissions, posing elevated environmental and health risks. This study supports integrating landfill biogas recovery into waste management and climate strategies, contributing to Sustainable Development Goals related to clean energy (SDG 7), climate action (SDG 13), and health (SDG 3), demonstrating it as a scalable solution for sustainable urban development. Full article

(This article belongs to the Special Issue Energy Sector Pollution and Health Promotion)

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21 pages, 329 KB

Open AccessArticle

Improving Health Outcomes in Women Who Use Traditional Open Fire Cookstoves by Addressing Cooking Behaviors: A Longitudinal Cohort Study

by Amy C. Buckenmeyer, Kevin L. Jantzi, Deanna Marriott, Jeri M. Antilla, Vanesa Abad, Emily Barnes, Katelyn Blackmon, Claire E. Burman, Carly Crave, Christina E. Roembke, Tricia Stathakis, Paige A. Takalamingan, Madison M. Wood, Eve Goddard and Beatrice Hunt

Int. J. Environ. Res. Public Health 2026, 23(5), 647; https://doi.org/10.3390/ijerph23050647 (registering DOI) - 13 May 2026

Abstract

Approximately one-third of the global population cooks over open fires in the home, which are responsible for millions of deaths per year globally. The aim of this longitudinal cohort study was to develop, implement, and evaluate an intervention to improve the cooking behaviors [...] Read more.

Approximately one-third of the global population cooks over open fires in the home, which are responsible for millions of deaths per year globally. The aim of this longitudinal cohort study was to develop, implement, and evaluate an intervention to improve the cooking behaviors of women in a rural Nicaraguan community. The study employed the Community Health Action Model for Participatory Behavior Change (CHAMP-BC) framework to develop a novel approach to improving cooking behaviors and reducing symptoms associated with household air pollution. The study was conducted from October 2007 to March 2018. Community health needs assessments and community forums were conducted. Readiness to change surveys were administered. Pre- and post-test cookstove implementation surveys were conducted. One hundred sixty-seven primary cooks, primarily women (99%), consented to participate in the improved cookstove program and were followed from baseline for up to seven years post-intervention. There were significant improvements in cough (p < 0.0001), chest illness (p < 0.0001), shortness of breath (p < 0.0001), headaches (p < 0.0001), and eye irritation (p < 0.0001). The novel CHAMP-BC framework enhanced the research approach by empowering women to change their cooking behaviors while providing them with the autonomy and agency necessary for decision-making regarding evidence-based methods to improve their health. Full article

18 pages, 1047 KB

Open AccessArticle

African American Food Environments and Anti-Inflammatory Intake in Pregnancy

by Najjuwah Walden, Rachel Tabak, Derek S. Brown, Joan Luby, Barbara Warner, Tara Smyser, Cynthia Rogers, Deanna Barch, Sarah K. England, Tonni Oberly, Christopher Smyser and Lora Iannotti

Int. J. Environ. Res. Public Health 2026, 23(5), 646; https://doi.org/10.3390/ijerph23050646 (registering DOI) - 13 May 2026

Abstract

Understanding the spatial determinants of food intake is crucial for establishing links between maternal food environments, diet, and health outcomes. Therefore, this study aimed to identify how the distance and density of built food environments in proximity to African American pregnant women living [...] Read more.

Understanding the spatial determinants of food intake is crucial for establishing links between maternal food environments, diet, and health outcomes. Therefore, this study aimed to identify how the distance and density of built food environments in proximity to African American pregnant women living in urban settings are associated with nutrient-dense, anti-inflammatory food intake. We hypothesized that living closer to grocery stores and farther from fast-food restaurants and convenience stores is associated with increased intake. We also hypothesized that higher grocery-store density and a lower density of fast-food restaurants and convenience stores is associated with increased intake. Using cross-sectional data from the Early Life Adversity, Biological Embedding (eLABE) and Risk for Developmental Precursors of Mental Disorders Study, as well as geographic information system (GIS) data and linear regression analyses, we examined the relationships between the built food environment and food intake in the St. Louis metropolitan area, adjusting for covariates. This analysis revealed that shorter distance to fast-food restaurants and longer distance to grocery stores were associated with higher legume intake in adjusted models. These findings highlight nuanced and counterintuitive associations, underscoring the need for additional research to understand why more distant grocery stores and closer fast-food restaurants are linked to higher legume intake among African Americans. Full article

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