International Journal of Environmental Research and Public Health

22 pages, 2237 KB

Open AccessArticle

Food Safety Practices and Behavior Drivers in Traditional Food Markets in Ethiopia: Assessing the Potential for Consumer-Driven Interventions

by Ariel V. Garsow, Smret Hagos, Eric Djimeu, Carrel Fokou, Haley Swartz, Genet Gebremedhin, Bisaku Chacha and Elisabetta Lambertini

Int. J. Environ. Res. Public Health 2025, 22(11), 1645; https://doi.org/10.3390/ijerph22111645 - 29 Oct 2025

Abstract

Introduction: Traditional food markets are a key node of resilient food systems worldwide. However, improper food handling and limitations in market structures may result in foodborne disease. This study assessed the decision-making of consumers and vendors in traditional markets to identify opportunities [...] Read more.

Introduction: Traditional food markets are a key node of resilient food systems worldwide. However, improper food handling and limitations in market structures may result in foodborne disease. This study assessed the decision-making of consumers and vendors in traditional markets to identify opportunities to reduce foodborne contamination and exposure. Methods: A cross-sectional survey of 150 consumers and 150 vendors was conducted in Sidama, Ethiopia, in July–August 2022 to investigate practices, behavior drivers, and enabling environment factors relevant to food safety. Descriptive statistics were used to summarize demographics and behavior variables, and the Poverty Probability Index for socioeconomic status. Results: Women consumers were the primary deciders for what food to buy. Of those surveyed, 26% of vendors and 19% of consumers lived below $3.20 USD/day. Consumers choose to purchase food based on price, food quality, vendor personality, and food safety (assessed using visual and sensory cues). Vendors were unconcerned about foodborne disease (73%) and attributed business success to food quality, their personality, and offering discounts. Conclusions: Salience and demand for food quality, as well as trusted relationships, could be leveraged as business incentives for vendors to adopt food safety practices and to increase consumers’ preference for safer food and ability to identify it. Full article

(This article belongs to the Section Global Health)

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13 pages, 1712 KB

Open AccessArticle

Adverse Childhood Experiences (ACEs) Screening in Pediatric Primary Care: Is “Social Drivers of Health (SDoH) Screening” Sufficient?

by Sylvia Zielinski, Jocelyn Valdez, Juliana James, Jennifer Gates, Bhavik Patel, Tre DeVon Gissandaner, Rachel Feurstein, Ryan Levy, Wanda Vargas and Evelyn Berger-Jenkins

Int. J. Environ. Res. Public Health 2025, 22(11), 1644; https://doi.org/10.3390/ijerph22111644 - 29 Oct 2025

Abstract

Adverse childhood experiences (ACEs) are established predictors of long-term health risks. While pediatric practices increasingly screen for social drivers of health (SDOH) and other family psycho-social stressors, routine ACEs screening is not recommended due to lack of evidence for long-term benefit and concerns [...] Read more.

Adverse childhood experiences (ACEs) are established predictors of long-term health risks. While pediatric practices increasingly screen for social drivers of health (SDOH) and other family psycho-social stressors, routine ACEs screening is not recommended due to lack of evidence for long-term benefit and concerns over stigmatization, re-traumatization, and non-standardized follow-up protocols. We piloted routine ACEs screening in Pediatric Primary Care practices that already routinely screen for SDOH, maternal depression and intimate partner violence (IPV). This retrospective chart review (2016–2020) explored the extent to which these family psycho-social screenings could serve as a relative proxy for ACEs identification. Among 1492 participants (738 children aged 0–5 and 690 caregivers mean age 30.3 ± 6.9), ACE and SDOH screening results were significantly associated (p < 0.002), particularly with housing insecurity (p < 0.014). However, 51.7% of individuals who reported a positive ACE screen were not flagged by the SDOH measure (false negatives), indicating relatively poor sensitivity. The negative predictive value for negative SDOH screens and negative ACEs was higher at 86%. These findings suggest that SDOH screening misses over half of true positives, and therefore reliance on SDOH screening alone may underestimate ACE exposure in pediatric primary care. Full article

(This article belongs to the Special Issue Mental Health Services in Primary Care Settings: Challenges, Opportunities and Best Practices)

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14 pages, 772 KB

Open AccessArticle

Occupations and Risk of Head and Neck Cancers: A Case–Control Study in Tanzania

by Luco Patson Mwelange, Israel Paul Nyarubeli, Gloria Sakwari, Simon Henry Mamuya and Bente Elisabeth Moen

Int. J. Environ. Res. Public Health 2025, 22(11), 1643; https://doi.org/10.3390/ijerph22111643 - 29 Oct 2025

Abstract

Cancer is a major global health concern. Head and neck cancers are the sixth most prevalent type of cancer globally; it has been suggested that these cancers can be caused due to pesticide exposure during agricultural activities. In this study, we aimed to [...] Read more.

Cancer is a major global health concern. Head and neck cancers are the sixth most prevalent type of cancer globally; it has been suggested that these cancers can be caused due to pesticide exposure during agricultural activities. In this study, we aimed to investigate whether agricultural labor is associated with an increased risk of head and neck cancers. A case–control study was performed in Ocean Road Cancer Institute in Tanzania: a national, specialized cancer hospital. A total of 298 head and neck cases and 305 controls were included. Occupational history and information about lifestyle factors and diet were obtained by interview. Using logistic regression analyses and adjusting for lifestyle and diet, an increased risk of head and neck cancer was found among workers with a history of agricultural work, with an odds ratio of 2.6 and a 95% confidence interval of 1.60–4.37. When including only non-smokers and non-alcohol users (n = 363), a similar estimate was found. Participants with over 10 years (n = 481) of agricultural work experience, after adjusting for lifestyle and diet, exhibited an odds ratio of 5.1, with a 95% confidence interval of 2.56–9.94. Our findings indicate that agricultural work is associated with the risk of head and neck cancer. Carcinogens in agriculture should be examined in future studies. Full article

(This article belongs to the Section Environmental Sciences)

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15 pages, 316 KB

Open AccessArticle

Post-Traumatic Stress Symptoms in Parents of Preschoolers First Diagnosed with Autism: Gender Differences and Correlations with Broad Autism Phenotypes

by Claudia Carmassi, Valerio Dell’Oste, Eugenia Conti, Sara Fantasia, Andrea Bordacchini, Berenice Rimoldi, Virginia Pedrinelli, Lorenzo Conti, Roberta Battini and Sara Calderoni

Int. J. Environ. Res. Public Health 2025, 22(11), 1642; https://doi.org/10.3390/ijerph22111642 - 28 Oct 2025

Abstract

(1) Background: A child’s new diagnosis of autism can represent a highly stressful event for parents. Subthreshold autistic traits (ATs) have been linked to higher vulnerability to psychopathology when exposed to stressful situations, and high rates of ATs have been reported among parents [...] Read more.

(1) Background: A child’s new diagnosis of autism can represent a highly stressful event for parents. Subthreshold autistic traits (ATs) have been linked to higher vulnerability to psychopathology when exposed to stressful situations, and high rates of ATs have been reported among parents of autistic children. This study aimed to evaluate post-traumatic stress spectrum symptoms (PTSS) in parents of preschool children newly diagnosed with autism and to explore differences between mothers and fathers, besides the correlations with ATs. (2) Methods: A total of 134 parents of children newly diagnosed with autism were assessed by trained psychiatrists from the University of Pisa using the Autism Spectrum Quotient (AQ), the Adult Autism Subthreshold Spectrum-Self Report (AdAS-SR), the Trauma and Loss Spectrum-Self Report (TALS-SR), and the Social and Occupational Functioning Assessment Scale (SOFAS). (3) Results: Approximately 10% of parents met DSM-5-TR criteria for symptomatologic PTSD, with nearly 40% experiencing partial PTSD symptoms related to their child’s diagnosis. Mothers showed higher PTSD rates than fathers. The ATs significantly correlated with elevated TALS-SR scores, and logistic regression revealed a positive association between ATs and PTSD (p < 0.001). Linear regression analysis indicated that higher TALS-SR scores predicted lower SOFAS scores (p = 0.004). (4) Conclusions: These findings highlight the potential traumatic impact of a child’s new autism diagnosis on parents, particularly mothers and individuals with ATs. The results underscore the importance of targeted support strategies for parents, considering their key role in early interventions. Further research is needed to better understand parental psychological responses and to enhance support systems, ultimately improving family wellbeing and child outcomes. Full article

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

14 pages, 263 KB

Open AccessArticle

Anti-Racist Practices in Health Care Organizations—A Qualitative Analysis

by Sidra Khan-Gökkaya, Faye McMillan and David R. Williams

Int. J. Environ. Res. Public Health 2025, 22(11), 1641; https://doi.org/10.3390/ijerph22111641 - 28 Oct 2025

Abstract

Introduction: A considerable body of evidence shows significant racial inequities in health and health care, affecting access, care and treatment for patients, as well as the wellbeing of employees. Many hospitals and health care organizations have committed to anti-racist change within their systems. [...] Read more.

Introduction: A considerable body of evidence shows significant racial inequities in health and health care, affecting access, care and treatment for patients, as well as the wellbeing of employees. Many hospitals and health care organizations have committed to anti-racist change within their systems. Still, there is limited systematic knowledge regarding organizational anti-racist practices, the conditions under which they can be implemented successfully and their effectiveness. This research aims to identify anti-racist practices within health care organizations with a special focus on three areas: (1) increasing workforce diversity, (2) reducing racial health disparities and (3) responding to discriminatory behavior. Moreover, the role of different stakeholders in implementing anti-racist change will be analyzed, as well as the challenges organizations have encountered and strategies they have utilized to implement change. Methods: Primary (n = 11) and secondary qualitative data (n = 26) were used to gain insights from anti-racism diversity experts and health equity officers within organizations across the US in the beginning of 2024. A qualitative content analysis was used to identify anti-racist practices in organizations. Results: Findings reveal a broad range of anti-racist practices in use across these organizations. These practices include (1) collecting patient and staff data, (2) actively normalizing and implementing anti-racist work standards and guidelines, (3) developing organizational policies and tools to address racism, (4) creating accountability procedures for addressing racist behavior and (5) building safe and culturally appropriate spaces for racialized communities. By embedding a structural anti-racist lens across these organizations, stakeholders acknowledge their role in (past) harms and commit to addressing disparities in health care and creating a vision for health equity. Conclusion: The identification of anti-racist practices makes solutions visible to a broader audience and identifies the potential influence and responsibility each stakeholder in health care has to address racism. In order to apply these practices to other health care organizations, there is a need to rigorously evaluate the interventions and analyze their effectiveness. Full article

12 pages, 936 KB

Open AccessProtocol

Using Citizen Science to Address Out-of-Pocket Healthcare Expenditure with Aboriginal Communities in the Far West of South Australia: A Protocol

by Courtney Ryder, Ray Mahoney, Patrick Sharpe, Georga Sallows, Karla Canuto, Andrew Goodman, Julieann Coombes, Odette Pearson, Jaquelyne T. Hughes, Marlien Varnfield, Candice Oster, Jonathan Karnon, Claire Drummond, James A. Smith, Shanti Omodei-James, Lavender Otieno, Ali Soltani and Billie Bonevski

Int. J. Environ. Res. Public Health 2025, 22(11), 1640; https://doi.org/10.3390/ijerph22111640 - 28 Oct 2025

Abstract

Out-of-pocket health expenditure (OOPHE) significantly impacts people with chronic and complex diseases (CCDs) and injuries. Aboriginal communities experience a higher burden of CCDs and injury, along with greater OOPHE inequities. This project aims to develop and implement a social prescribing digital platform (Web [...] Read more.

Out-of-pocket health expenditure (OOPHE) significantly impacts people with chronic and complex diseases (CCDs) and injuries. Aboriginal communities experience a higher burden of CCDs and injury, along with greater OOPHE inequities. This project aims to develop and implement a social prescribing digital platform (Web App) to reduce OOPHE. It is grounded in citizen science approaches that value the lived experience and knowledge of Aboriginal people in shaping solutions. The project uses a citizen science methodology adapted for these communities, using knowledge interface methodology to weave together Indigenous and Western knowledges. Research methods (Indigenous, quantitative, qualitative) explore the relational nature of OOPHE risks and protective factors through co-design and workshops with Aboriginal participants to develop the Web App. A community-centric developmental evaluation guides the trial and refinement of the platform, allowing for ongoing learning and adaptation. Process measures inform a national scale-up and evaluation framework. Addressing OOPHE is essential to improving health and wellbeing for Aboriginal and Torres Strait Islander individuals and families living with or at risk of CCDs. This initiative aims to reduce the impact of OOPHE through digital social prescribing, there by connecting people with essential community services to access healthcare, offering a scalable approach to addressing health inequities nationwide. Full article

(This article belongs to the Section Global Health)

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14 pages, 517 KB

Open AccessArticle

Pediatric Health, Climate Perceptions, and School Absenteeism Across Three Regions of Bangladesh: A Cross-Sectional Study

by Yoon Sik Jung, Sakila Afroz, Sadia Samad Mow, Xingyan Wang, Caroline Sarpy, Md Fuadul Islam, Md Nazmul Husain, Md Shahadat Hossain, Al Romana Sania, Md Golam Mostofa, Quazi Quamruzzaman and Maitreyi Mazumdar

Int. J. Environ. Res. Public Health 2025, 22(11), 1639; https://doi.org/10.3390/ijerph22111639 - 28 Oct 2025

Abstract

Children remain underrepresented in environmental health studies, and evidence on how climate-related exposures affect pediatric health and school absenteeism is limited. This pilot cross-sectional study reports pediatric symptoms, school attendance, and perceptions of climate change among 300 Bangladeshi children ages 6–12 years old [...] Read more.

Children remain underrepresented in environmental health studies, and evidence on how climate-related exposures affect pediatric health and school absenteeism is limited. This pilot cross-sectional study reports pediatric symptoms, school attendance, and perceptions of climate change among 300 Bangladeshi children ages 6–12 years old in three sites: Barhatta, Galachipa, and Sarankhola. Health status, climate-related perception, and educational disruption were assessed with validated questionnaires. Clinical staff measured peak expiratory flow rate, hemoglobin, and blood lead concentrations. Rash (48%), asthma (21%), and positive screening for epilepsy (17%) were most prevalent in Sarankhola. Mean hemoglobin was lower in Sarankhola (11.0 g/dL) than in the other sites. Awareness of climate change was 100% in Galachipa and Sarankhola, while 32% in Barhatta, with television and health workers being the common sources of information. Almost one in every three children missed at least three days of school in the last month with illness, climate-related emergencies, and unexpected school closures being frequent causes. These findings indicate that Bangladeshi children, especially those living in coastal areas, face the health and educational risks related to climate change, and that longitudinal and environmental monitoring studies are needed. Full article

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17 pages, 286 KB

Open AccessArticle

Factors Influencing Online Mental Health Forum Use for People from Ethnic Minority Backgrounds in the United Kingdom: A Mixed Methods Study

by Connor Heapy, Paul Marshall, Zoe Glossop, Suman Prinjha and Fiona Lobban

Int. J. Environ. Res. Public Health 2025, 22(11), 1638; https://doi.org/10.3390/ijerph22111638 - 28 Oct 2025

Abstract

Background: Ethnic minority groups are under-represented in their use of community mental health services in the UK. Online mental health forums could be a more appealing support option than traditional mental health services. Part one of this study investigated the level of online [...] Read more.

Background: Ethnic minority groups are under-represented in their use of community mental health services in the UK. Online mental health forums could be a more appealing support option than traditional mental health services. Part one of this study investigated the level of online forum use in people from ethnic minority groups. Part two investigated the factors influencing online mental health forum use for people from ethnic minority groups. Methods: Part one involved comparing data from a range of pre-existing national datasets, and datasets local to Berkshire, UK (i.e., on the general population, people experiencing common mental health problems, users of mental health forums, and NHS Talking Therapies services). Part two involved interviewing 14 individuals from ethnic minority backgrounds who had used, or considered using, online mental health forums. Results: In part one, nationally, Asian, Black, and Mixed ethnic groups appeared over-represented in their online mental health forum use based on their reporting of common mental health problems. In Berkshire, people from Asian and Black ethnic groups were under-represented in their use of Berkshire NHS Trust’s online mental health forum based on their representation in the Berkshire population. In Part Two, three themes were identified as influencing forum use: (1) sense of community in the online and offline worlds, (2) trust is crucial, and (3) barriers to accessing online forums. Conclusion: People from ethnic minority groups vary in their use and experiences of mental health forums. Whilst forums can offer a valued accessible space for anonymous sharing of often stigmatised experiences, pathways to access require trusted figures to promote their availability, and forum designers and moderators to co-create culturally sensitive spaces with people from these target communities. Full article

(This article belongs to the Special Issue Cross-Cultural Perspectives on Mental Health Personal Recovery)

12 pages, 931 KB

Open AccessArticle

Distribution of Hematologic Parameters of Complete Blood Count in Anemic and Nonanemic Children in a Mining-Exposed Highland Peruvian Community

by Gloria Cruz-Gonzales, Arístides Hurtado-Concha, Héctor Bejarano-Benites, Hernán Bedoya-Vílchez, Merly Sarabia-Tarrillo, Eliane A. Goicochea-Palomino and Jeel Moya-Salazar

Int. J. Environ. Res. Public Health 2025, 22(11), 1637; https://doi.org/10.3390/ijerph22111637 - 27 Oct 2025

Abstract

Exposure to heavy metals from mining activities has been consistently associated with disruptions in hematologic homeostasis, adversely affecting children’s overall development. We aimed to determine population-specific distributions of hematological markers and to compare anemic and nonanemic children in a mining-exposed highland community. A [...] Read more.

Exposure to heavy metals from mining activities has been consistently associated with disruptions in hematologic homeostasis, adversely affecting children’s overall development. We aimed to determine population-specific distributions of hematological markers and to compare anemic and nonanemic children in a mining-exposed highland community. A cross-sectional study was conducted with 156 children aged 3 to 7 years from the Peruvian highlands, using non-probability sampling and following CLSI C28-A3 guidelines for this population. Inclusion criteria were children with complete blood count results and residency in mining-contaminated areas. Blood samples were collected via venipuncture and analyzed with a 3-part Sysmex differential hematology analyzer. The mean WBC count was 10.42 ± 1.76 × 10³/µL, with no significant differences between males and females (p = 0.770). Hematological indices, including RBC, hemoglobin, and hematocrit levels, were consistent between sexes. However, significant differences were noted between anemic and nonanemic 3–4-year-old children for RBC (5.56 ± 0.47 vs. 7.06 ± 0.96 × 10⁶/µL) and HCT (33.97 ± 6.89 vs. 35.64 ± 5%) (each p < 0.00001), with lower values in anemic subjects. Also, anemic and nonanemic 5–7-year-old children had significant differences in RBC (5.87 ± 1.02 vs. 7.36 ± 0.79 × 10⁶/µL) and HCT (31.13 ± 1.73 vs. 36.54 ± 4) (each p < 0.00001). Our findings reveal variations in hematological parameter distributions, emphasizing the importance of personalized blood assessments for mining-exposed populations. This approach could enable earlier diagnosis and intervention for anemia among vulnerable pediatric groups. Full article

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14 pages, 337 KB

Open AccessArticle

The Relationship Between Emotion Regulation and Perceptions of Body Image, Health, and Eating in Food Science College Students

by Mari Aguilera, Claudia Soar, Ricard Celorio-Sardà, Oriol Comas-Basté, M. Carmen Vidal-Carou and Maria Clara de Moraes Prata Gaspar

Int. J. Environ. Res. Public Health 2025, 22(11), 1636; https://doi.org/10.3390/ijerph22111636 - 27 Oct 2025

Abstract

Emotional regulation plays a central role in shaping eating behaviors and body image, though few studies have examined this relationship in students of food sciences. A total of 297 undergraduates from Human Nutrition and Dietetics and Food Science and Technology completed surveys on [...] Read more.

Emotional regulation plays a central role in shaping eating behaviors and body image, though few studies have examined this relationship in students of food sciences. A total of 297 undergraduates from Human Nutrition and Dietetics and Food Science and Technology completed surveys on health, body image, and eating behaviors, along with the Difficulties in Emotion Regulation Scale (DERS). Exploratory factor analysis (EFA) identified four perception dimensions. Pearson correlations and multiple linear regression assessed their relationships with emotional regulation. EFA revealed four factors: (1) health perception, (2) body image and related emotions, (3) weight and diet control, and (4) individual responsibility for diet. No differences emerged by sex or degree. Correlations indicated that three factors were significantly associated with DERS scores, particularly body image and emotions. Multiple regression showed that body image and emotions and weight and diet control significantly predicted emotional regulation, while health perception and individual responsibility were not significant. These findings highlight the role of emotional regulation in shaping perceptions of health and eating, underscoring its relevance in the education of future food professionals. Training food professionals should integrate emotional competencies to support healthier self-perceptions and practices. Full article

16 pages, 1115 KB

Open AccessStudy Protocol

INdoor Home Air Level Exploration (INHALE) Study: Protocol to Monitor Indoor Pollution in British Dwellings

by Thiphanie P. Riveron, Rebecca L. Cordell and Anna L. Hansell

Int. J. Environ. Res. Public Health 2025, 22(11), 1635; https://doi.org/10.3390/ijerph22111635 - 27 Oct 2025

Abstract

Knowledge on indoor air pollution exposure is limited. Collecting high-quality measurements in home environments is challenging, owing to the complexity of sampling options, the cost and limiting disturbance to occupants. The protocol developed for the INdoor Home Air Level Exploration (INHALE) study is [...] Read more.

Knowledge on indoor air pollution exposure is limited. Collecting high-quality measurements in home environments is challenging, owing to the complexity of sampling options, the cost and limiting disturbance to occupants. The protocol developed for the INdoor Home Air Level Exploration (INHALE) study is designed to balance these factors by sampling indoor pollution as comprehensively as possible for a single week in the living room using non-obtrusive low-moderate cost sampling devices that are issued with easy-to-follow instructions, minimising the need for researcher visits. Indoor air pollutants included in the INHALE study were selected owing to their potential impacts on human health; these include volatile organic compounds, fungal spores, fine particulate matter, nitrogen oxides and ozone. Relevant indoor factors will also be monitored, such as temperature, relative humidity and carbon dioxide, as a proxy for ventilation, while questionnaires collect relevant information on local environment, building characteristics and participant activities, culture and social and economic status. The protocol for the INHALE study is suitable for exposure, epidemiology and intervention studies. It contributes to the development of standardised indoor sampling protocols that can be used at scale. Full article

(This article belongs to the Topic Environmental Exposure and Health Risks for Vulnerable Populations)

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22 pages, 1688 KB

Open AccessArticle

Terrorism, Perceived Threat, and Support for Surveillance: A Virtual Reality Experiment on Cyber vs. Conventional Terrorism

by Keren L. G. Snider, Amit Cohen, Giulia Dal Bello, Guy Baratz, Béatrice S. Hasler and Daphna Canetti

Int. J. Environ. Res. Public Health 2025, 22(11), 1634; https://doi.org/10.3390/ijerph22111634 - 27 Oct 2025

Abstract

Governments worldwide are increasingly adopting intrusive surveillance measures to counter terrorism. However, the psychological and public health consequences of exposure to terrorism remain underexplored. This study examines how exposure to cyber and conventional terrorism affects perceived national threat and support for surveillance policies, [...] Read more.

Governments worldwide are increasingly adopting intrusive surveillance measures to counter terrorism. However, the psychological and public health consequences of exposure to terrorism remain underexplored. This study examines how exposure to cyber and conventional terrorism affects perceived national threat and support for surveillance policies, using a controlled virtual reality experiment in which participants were immersed in realistic simulations of lethal terror attacks targeting critical railway infrastructure in Israel. Participants were randomly assigned to one of three conditions: cyber (N = 59), conventional (N = 59), or control (N = 45). Outcomes were standardized, but the framing differed by type of attack. Findings show that perceived national threat perceptions are a key mechanism linking exposure to terrorism to surveillance attitudes. At lower threat levels, participants differentiated between cyber and conventional attacks. In contrast, heightened threats led to uniform support for expansive surveillance regardless of the attack modality. Results demonstrate that exposure to terrorism, including cyberattacks on critical infrastructure, can activate psychological responses with implications for public resilience and policy attitudes, shaping preferences concerning privacy and security. These findings underscore the broader societal and public health relevance of understanding how people react to evolving security threats that disrupt essential systems such as transportation, energy, and healthcare. Full article

(This article belongs to the Special Issue Mental Health and Psychological Resilience: The Mental Health Burden of Terrorism, Epidemiology, Risk Factors and Global Disparities)

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29 pages, 792 KB

Open AccessArticle

Swimming for Children with Disability: Experiences of Rehabilitation and Swimming Professionals in Australia

by Karen Graham, Katarina Ostojic, Leanne Johnston, Iain Dutia, Elizabeth Barnes-Keoghan and Georgina L. Clutterbuck

Int. J. Environ. Res. Public Health 2025, 22(11), 1633; https://doi.org/10.3390/ijerph22111633 - 27 Oct 2025

Abstract

Background: Swimming is a common goal for children with disability, and the most popular sport for children in Australia. This study explored swimming and rehabilitation professionals’ perceptions of swimming for Australian children with disability. Methods: Rehabilitation and swimming professionals with recent experience working [...] Read more.

Background: Swimming is a common goal for children with disability, and the most popular sport for children in Australia. This study explored swimming and rehabilitation professionals’ perceptions of swimming for Australian children with disability. Methods: Rehabilitation and swimming professionals with recent experience working with children with disability completed an online survey. Quantitative data from binary and Likert-scale questions were analysed descriptively. Qualitative data from open-ended questions was evaluated using reflexive thematic analysis and mapped to the family of Participation-Related Constructs (fPRC). Results: Ninety-one swimming and 55 rehabilitation professionals (n = 146) responded. Most were confident supporting children with disability with swimming goals (rehabilitation = 71.6%, swimming = 73.8%) but had neutral–very low knowledge of para-swimming eligibility and classification (rehabilitation = 75%, swimming = 77.7%). Ten themes (33 code groups) covering all core elements of the fPRC were identified. Barriers/facilitators included pool accessibility (physical and sensory); program availability; affordability; acceptability (of content and culture); and having accommodating professionals and programs. Professionals believed that swimming programs should develop children’s confidence, water-safety, swimming skills, and fitness. Conclusion: Rehabilitation and swimming professionals should review existing programs to ensure they meet the needs of children with disability. Further research is needed to create an action plan to improve swimming participation for Australian children with disability. Full article

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16 pages, 971 KB

Open AccessArticle

Parkour and Intrinsic Motivation: An Exploratory Multimethod Analysis of Self-Determination Theory in an Emerging Sport

by Jacob Carson, Samantha Hurst, James F. Sallis, Sarah E. Linke, Eric B. Hekler, Katherina Nardo and Britta Larsen

Int. J. Environ. Res. Public Health 2025, 22(11), 1632; https://doi.org/10.3390/ijerph22111632 - 27 Oct 2025

Abstract

Self Determination Theory posits that individuals may be more likely to initiate and maintain behaviors tied to intrinsic (vs. extrinsic) motivations and may provide a useful framework for understanding youth participation in novel sports. Using the Intrinsic Motivation Inventory (IMI) and Patient-Centered Assessment [...] Read more.

Self Determination Theory posits that individuals may be more likely to initiate and maintain behaviors tied to intrinsic (vs. extrinsic) motivations and may provide a useful framework for understanding youth participation in novel sports. Using the Intrinsic Motivation Inventory (IMI) and Patient-Centered Assessment and Counseling for Exercise Plus Nutrition (PACE+) surveys, motivation and physical activity habits were explored in 27 children/adolescents (ages 7–16) enrolled in Parkour, an individual, non-competitive youth sport. Fifteen Parkour participants were also interviewed to gain an understanding of their motivations for participating. Study participants had high median IMI subscale scores related to interest/enjoyment (6.71/7) and perceived choice (6.40/7) compared to the whole scale. Similarly median sub-scale Pros and Self-Efficacy scores for physical activity from the PACE+ were high (4.25/5 and 3.91/5, respectively). The themes of autonomy and enjoyment were consistently reported in the qualitative interviews, expanding on the quantitative results. Other themes included appreciation for camaraderie, creativity, and a drive for improvement. These results provide early evidence that Parkour, and similar lifestyle sports, may be tied more to intrinsic than extrinsic motivations and could have potential for adoption and maintenance by youth with low motivation to engage in physical activity to promote healthy behaviors. Full article

(This article belongs to the Special Issue Lifestyle Behaviors and Health Promotion in Young People)

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20 pages, 1054 KB

Open AccessArticle

“Float[ing] in the Middle” Nurse Navigators and the Interface of Access to Care

by Clare Hannan-Jones, Lisa Fitzgerald, Geoffrey Mitchell and Allyson Mutch

Int. J. Environ. Res. Public Health 2025, 22(11), 1631; https://doi.org/10.3390/ijerph22111631 - 26 Oct 2025

Abstract

The Australian health care system continues to struggle to meet the needs of people experiencing multiple complex chronic conditions. Australians who report poorer health continue to report poorer access to health care. Inequities in access are attributed to a “mistmatch” between the health [...] Read more.

The Australian health care system continues to struggle to meet the needs of people experiencing multiple complex chronic conditions. Australians who report poorer health continue to report poorer access to health care. Inequities in access are attributed to a “mistmatch” between the health care system and individuals’ clinical and social needs. To address this misalignment at the interface of access, innovative approaches that consider both individual and system-level barriers to care need to be examined. Nurse navigation models designed to support people negotiating complex care and bridge systems and service gaps have been touted as a method to enhance access, but how nurse navigators work at the interface of access in practice is unclear. This qualitative study examined the mechanisms by which nurse navigators facilitate access to care for people experiencing complex care needs through an exploration of key stakeholder perspectives: nurse navigators, nurse navigator patients, and care professionals. Data collection involved in-depth semi-structured interviews, and analysis included reflexive thematic analysis and data triangulation processes. A conceptual framework of access to health care was used to explore nurse navigators’ roles at both system and patient levels. Nurse navigators supported both patients and care professionals by building relationships across the interface of access, challenging norms of care, and facilitating empowerment. Nurse navigators acted as intermediaries to negotiate access, work made possible through their knowledge of systems and capacity to identify and respond to multidimensional care needs and systems challenges. This research highlights the importance of holistic and relational approaches to overcome issues of access for all involved. Full article

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14 pages, 346 KB

Open AccessArticle

Characteristics of Participants Who Consented to Share Data with a Public Health Registry After an Environmental Disaster

by Marty Crawford, Diana K. Haggerty and Nicole Jones

Int. J. Environ. Res. Public Health 2025, 22(11), 1630; https://doi.org/10.3390/ijerph22111630 - 26 Oct 2025

Abstract

On 25 April 2014, the municipal water source in Flint, Michigan, was switched to the Flint River. Failure to properly treat the water for corrosion resulted in lead contamination of the water system. Resident concerns were dismissed by local, state, and federal government [...] Read more.

On 25 April 2014, the municipal water source in Flint, Michigan, was switched to the Flint River. Failure to properly treat the water for corrosion resulted in lead contamination of the water system. Resident concerns were dismissed by local, state, and federal government agencies until community participatory and clinical pediatric research demonstrated the contamination, and the water was restored to the original source 18 months later. Recovery efforts established a public health registry, funded by the Centers for Disease Control and Prevention. A grant of public health authority and registry funding were awarded to Michigan State University in August 2017 to establish a health surveillance system and public health intervention to refer exposed individuals to community services. Community feedback requested tiered data-sharing consent options. Participants who consented to join the registry were presented with four consent questions: to be contacted about future research opportunities, to use survey data to make referrals to services on their behalf, to share with the registry their State of Michigan Department of Health and Human Services (MDHHS) program data, and to share Michigan Medicaid administrative data. This descriptive study found that most participants consented to being contacted for future research (88%), sharing data for referrals (84%), and sharing data from MDHHS programs (77%) with the registry. Among participants with Medicaid insurance, 74% consented to sharing Medicaid data. Consent increased with age and decreased with income and education. Consent was higher among participants reporting food insecurity in the last 12 months. Consent to share data was unexpectedly high in the context of environmental disaster, trauma, and government distrust. Further work is needed to explore whether participation in public health activities is positively impacted by the implementation of a tiered consent process to share data. Full article

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29 pages, 4658 KB

Open AccessArticle

Development of Life Course Exposure Estimates Using Geospatial Data and Residence History

by Stuart Batterman, Md Kamrul Islam and Stephen Goutman

Int. J. Environ. Res. Public Health 2025, 22(11), 1629; https://doi.org/10.3390/ijerph22111629 - 26 Oct 2025

Abstract

Life course exposure estimates developed using geospatial datasets must address issues of individual mobility, missing and incorrect data, and incompatible scaling of the datasets. We propose methods to assess and resolve these issues by developing individual exposure histories for an adult cohort of [...] Read more.

Life course exposure estimates developed using geospatial datasets must address issues of individual mobility, missing and incorrect data, and incompatible scaling of the datasets. We propose methods to assess and resolve these issues by developing individual exposure histories for an adult cohort of patients with amyotrophic lateral sclerosis (ALS) and matched controls using residence history and PM_2.5, black carbon, NO₂, and traffic intensity estimates. The completeness of the residence histories was substantially improved by adding both date and age questions to the survey and by accounting for the preceding and following residence. Information for the past five residences fully captured a 20-year exposure window for 95% of the cohort. A novel spatial multiple imputation approach dealt with missing or incomplete address data and avoided biases associated with centroid approaches. These steps boosted the time history completion to 99% and the geocoding success to 92%. PM_2.5 and NO₂, but not black carbon, had moderately high agreement with observed data; however, the 1 km resolution of the pollution datasets did not capture fine scale spatial heterogeneity and compressed the range of exposures. This appears to be the first study to examine the mobility of an older cohort for long exposure windows and to utilize spatial imputation methods to estimate exposure. The recommended methods are broadly applicable and can improve the completeness, reliability, and accuracy of life course exposure estimates. Full article

(This article belongs to the Special Issue Environmental Exposures Across the Life Course: Methodological Innovations, Novel Applications and Implications for Risk and Equity)

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11 pages, 262 KB

Open AccessCommentary

Binding Multilateral Framework for South Asian Air Pollution Control: An Urgent Call for SAARC-UN Cooperation

by Shyamkumar Sriram and Saroj Adhikari

Int. J. Environ. Res. Public Health 2025, 22(11), 1628; https://doi.org/10.3390/ijerph22111628 - 26 Oct 2025

Abstract

South Asia’s worsening air pollution crisis represents one of the most urgent public health and environmental challenges of the 21st century. Nearly two billion people—over one-quarter of the global population—reside in this region, where air quality levels routinely exceed World Health Organization (WHO) [...] Read more.

South Asia’s worsening air pollution crisis represents one of the most urgent public health and environmental challenges of the 21st century. Nearly two billion people—over one-quarter of the global population—reside in this region, where air quality levels routinely exceed World Health Organization (WHO) guidelines by factors of 10 to 15. This has translated into an unprecedented health burden, with approximately two million premature deaths annually, widespread chronic respiratory and cardiovascular disease, and rising economic losses. According to recent World Bank estimates, welfare losses amount to over 5% of regional GDP, a figure far exceeding the projected costs of coordinated mitigation. Despite this, South Asia continues to lack a binding regional framework capable of addressing its shared airshed. Existing cooperative efforts—such as the Malé Declaration on Control and Prevention of Air Pollution (1998)—have provided a useful platform for dialog and pilot monitoring, but they remain voluntary, under-resourced, and insufficient to manage the transboundary nature of the crisis. National-level programs, including India’s National Clean Air Programme (NCAP), Bangladesh’s National Air Quality Management Plan (NAQMP), and Nepal’s National Air Quality Management Action Plan (AQMAP), demonstrate domestic commitment but are constrained by fragmentation, limited financing, and lack of regional integration. This gap represents the central knowledge and governance challenge that prompted the present commentary. To address it, we propose a dual-track architecture designed to institutionalize binding regional cooperation. Track A would establish a United Nations-anchored South Asian Transboundary Air Pollution Protocol, under the auspices of the United Nations Environment Programme, the World Health Organization (WHO), and the United Nations Economic and Social Commission for Asia and the Pacific (UNESCAP). This protocol would codify legally enforceable emission standards, compliance committees, financial mechanisms, and harmonized monitoring. Track B would establish a South Asian Association for Regional Cooperation (SAARC) Prime Ministers’ Council on Air Quality (SPMCAQ) to provide political leadership, align domestic implementation, and authorize rapid responses to cross-border haze events. Lessons from the Indian Ocean Experiment, the ASEAN Agreement on Transboundary Haze Pollution, and Europe’s Convention on Long-Range Transboundary Air Pollution demonstrate that legally binding agreements combined with high-level political ownership can achieve durable reductions in pollution despite geopolitical tensions. By situating South Asia within these global precedents, the proposed framework provides a pragmatic, enforceable, and politically resilient pathway to protect health, reduce economic losses, and deliver cleaner air for nearly one-quarter of humanity. Full article

(This article belongs to the Section Environmental Sciences)

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17 pages, 826 KB

Open AccessSystematic Review

The Effect of Maternal Antenatal Care Utilisation on Childhood Acute Respiratory Infection: A Systematic Review and Meta-Analysis

by Melash Asresie, Yibeltal Bekele, Don Vicendese, Mehak Batra and Bircan Erbas

Int. J. Environ. Res. Public Health 2025, 22(11), 1627; https://doi.org/10.3390/ijerph22111627 - 26 Oct 2025

Abstract

Background: Antenatal care (ANC) offers a valuable opportunity to reduce the risk of acute respiratory infections (ARIs) in children under five; however, its impact remains less understood and has not been comprehensively synthesised. This systematic review aimed to assess evidence on the association [...] Read more.

Background: Antenatal care (ANC) offers a valuable opportunity to reduce the risk of acute respiratory infections (ARIs) in children under five; however, its impact remains less understood and has not been comprehensively synthesised. This systematic review aimed to assess evidence on the association between ANC utilisation and ARIs in children under five. Methods: A systematic search was conducted in PubMed, CINAHL, Scopus, Web of Science, and Google Scholar for studies published between 2000 and 2025. PRISMA 2020 guidelines were followed in reporting. A qualitative synthesis was performed for all ARI outcomes, and a meta-analysis was conducted for pneumonia. Results: Eleven observational studies assessed the association between ANC utilisation and ARIs. Three ARI-related outcomes were identified: pneumonia (n = 4), pertussis (n = 2), and general ARIs (n = 5). ANC attendance was generally associated with reduced odds of respiratory infections across studies. The pooled analysis of two case–control studies (n = 2; total n = 956) showed a non-significant association between ANC attendance and pneumonia in children (pooled OR = 1.46; 95% CI: 0.91, 2.35; I² = 0%). Conclusion: Our review suggests a potential protective effect of ANC, though evidence from the pneumonia-focused meta-analysis was inconclusive. Improving access to quality ANC may reduce respiratory infections, but more studies are needed across different populations. Full article

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International Journal of Environmental Research and Public Health

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