International Journal of Environmental Research and Public Health

11 pages, 260 KiB

Open AccessArticle

Participatory Development of Digital Innovations for Health Promotion Among Older Adults: Qualitative Insights on Individual, Contextual, and Technical Factors

by Katja A. Rießenberger, Karina Povse and Florian Fischer

Int. J. Environ. Res. Public Health 2025, 22(8), 1311; https://doi.org/10.3390/ijerph22081311 - 21 Aug 2025

Abstract

Location-based games offer innovative approaches for health promotion among older adults, but their effectiveness depends on understanding complex contextual factors beyond technological design. In our study, we aimed to adapt a location-based game in the form of a smartphone application which originally targeted [...] Read more.

Location-based games offer innovative approaches for health promotion among older adults, but their effectiveness depends on understanding complex contextual factors beyond technological design. In our study, we aimed to adapt a location-based game in the form of a smartphone application which originally targeted younger people. We employed ethnographic observations in a field test under real-world conditions for identifying the needs and preferences of older adults in this regard. Field notes of one co-creative workshop were analyzed using thematic analysis. Four key contextual factor categories emerged that significantly influenced user engagement: (1) temporal/spatial factors including weather conditions, topography, and traffic safety that impacted screen visibility and cognitive function; (2) virtual-physical orientation challenges requiring high cognitive load to transfer abstract digital maps to real environments; (3) individual factors such as technical competence, mobility levels, and prior accessibility experiences that shaped usage patterns; and (4) social dynamics that provided motivation and peer support while potentially creating exclusionary practices. Successful digital health innovations for older adults require a socio-technical systems approach that addresses environmental conditions, reduces cognitive transfer demands between virtual and physical navigation, leverages social elements while preventing exclusion, and accounts for heterogeneity among older adults as contextually interactive factors rather than merely individual differences. Full article

(This article belongs to the Special Issue Digital Innovations for Health Promotion)

18 pages, 1022 KiB

Open AccessArticle

The Influence of Therapist Adherence on Multisystemic Therapy Treatment Outcome for Adolescents with Antisocial Behaviours: A Retrospective Study in Western Australian Families

by Leartluk Nuntavisit and Mark Robert Porter

Int. J. Environ. Res. Public Health 2025, 22(8), 1310; https://doi.org/10.3390/ijerph22081310 - 21 Aug 2025

Abstract

Multisystemic Therapy (MST) is an intensive family and community-based treatment targeting antisocial behaviours in adolescents. Treatment fidelity has proved crucial for successful implementation of the MST intervention, with prior research demonstrating a strong association with positive and enduring treatment outcomes. The Therapist Adherence [...] Read more.

Multisystemic Therapy (MST) is an intensive family and community-based treatment targeting antisocial behaviours in adolescents. Treatment fidelity has proved crucial for successful implementation of the MST intervention, with prior research demonstrating a strong association with positive and enduring treatment outcomes. The Therapist Adherence Measure (TAM) is a standardised measure reported by caregivers and comprised of 28 items based on the nine treatment principles of MST. Several randomised control trials have confirmed that therapist adherence to the MST model is a valid predictor for a reduction of antisocial behaviours in adolescents. However, there is limited understanding of mechanisms by which therapist model adherence is related to positive changes in family relations and association with decreased adolescent behavioural problems. In this retrospective study, we evaluated effects of therapist adherence on changes in parental factors (e.g., parental mental well-being, monitoring and discipline approach) which in turn were associated with decreased behavioural problems in adolescents. We extracted data collected from 186 families engaged with the MST research program operating within the Western Australian Child and Adolescent Mental Health Service (CAMHS) during 2018–2024. Data for TAMs were collected monthly during treatment, and family outcome measures were collected at pre-treatment and post-treatment. The finding highlights the importance of therapists maintaining treatment fidelity and addressing treatment barriers throughout MST intervention to ensure the desired therapeutic outcomes. Full article

(This article belongs to the Special Issue Promoting Mental Health and Wellbeing in Children and Young People at Risk)

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16 pages, 327 KiB

Open AccessReview

Health Promotion and Support Grounded in Interconnected Influences on Alcohol Use in Pregnancy

by Nancy Poole, Lindsay Wolfson and Ella Huber

Int. J. Environ. Res. Public Health 2025, 22(8), 1309; https://doi.org/10.3390/ijerph22081309 - 21 Aug 2025

Abstract

There are a range of factors that influence alcohol use in pregnancy and create risk of fetal harm. However, limited research has articulated the multilevel nature of these influences and their entanglement. The purpose of this narrative review is to analyze the types [...] Read more.

There are a range of factors that influence alcohol use in pregnancy and create risk of fetal harm. However, limited research has articulated the multilevel nature of these influences and their entanglement. The purpose of this narrative review is to analyze the types of factors that influence alcohol use and consider what factors need to be addressed in future health promotion and intervention efforts. Six databases were searched using EBSCOhost articles published between January and December 2023 on alcohol use in pregnancy and Fetal Alcohol Spectrum Disorder (FASD) prevention. English-language articles were screened for relevance and a subset of articles exploring the prevalence, influences, and risk-factors associated with pregnancy were included for analysis. Thirty-two (n = 32) articles were included in the review and categorized into five key areas of influence on maternal alcohol use: (1) informational factors; (2) stress-related factors; (3) social determinant of health-related (SDoH) influences; (4) preconception- and prenatal-health-related factors; and (5) structural factors. Future efforts to reduce alcohol use in pregnancy should address these five categories of factors through non-judgmental, health-promoting, trauma-informed, harm-reduction-oriented, and culturally safe education, programming, and policy. Full article

(This article belongs to the Special Issue Health Promotion and Interventions for Marginalized Mothers and Children)

27 pages, 1210 KiB

Open AccessSystematic Review

Neurodevelopmental Outcomes Associated with Early-Life Exposure to Heavy Metals: A Systematic Review

by André Soares da Silva, Renata Maria Silva Santos, Patricia Gazire De Marco, Victhor Hugo Martins Rezende, Tamires Coelho Martins, Joyce Romano Silva, Marco Aurélio Romano-Silva and Débora Marques de Miranda

Int. J. Environ. Res. Public Health 2025, 22(8), 1308; https://doi.org/10.3390/ijerph22081308 - 21 Aug 2025

Abstract

Introduction: Globally, approximately 53 million children under the age of five live with some form of developmental disability. Exposure to heavy metals has been identified in the literature as a contributing factor in the etiology of neurodevelopmental disorders, however it usually is understudied. [...] Read more.

Introduction: Globally, approximately 53 million children under the age of five live with some form of developmental disability. Exposure to heavy metals has been identified in the literature as a contributing factor in the etiology of neurodevelopmental disorders, however it usually is understudied. Even at low concentrations, these toxicants pose a risk to neurodevelopment, when affecting children early as in the prenatal period. This study aims to systematically review the literature on the associations between exposure to toxic heavy metals and neurodevelopmental outcomes in children. Method: The review was registered at the International Prospective Register of Systematic Review-PROSPERO, under number CRD420250653229 and searches were conducted in the PubMed, Scopus, Web of Science, EMBASE, Lilacs and PsycInfo databases. Results: A total of 68 articles were included, comprising 48 longitudinal studies and 20 cross-sectional studies, published between 2006 and 2025, with a combined sample of 215,195 individuals from 23 countries. Lead was the most consistently investigated metal, appearing in 75% of the studies, followed by mercury, cadmium, and arsenic. Most findings referred to prenatal exposure. Cognitive and motor outcomes were predominantly affected by exposure to Pb and Hg, while behavioral outcomes showed negative associations mainly with Pb and As. Conclusions: The majority of the studies analyzed indicated adverse effects resulting from exposure to heavy metals during pregnancy, especially in the early months, highlighting the vulnerability of the developing brain. Full article

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16 pages, 285 KiB

Open AccessArticle

The Impacts of Parental Migration on the Mental and Physical Health, Daily Needs, and Social Lives of Indonesian Caregivers of Left-Behind Children: A Qualitative Study

by Nelsensius Klau Fauk, Alfonsa Liquory Seran and Paul Russell Ward

Int. J. Environ. Res. Public Health 2025, 22(8), 1307; https://doi.org/10.3390/ijerph22081307 - 20 Aug 2025

Abstract

Despite its positive impact on household income, parental labour migration negatively affects left-behind children (LBC) and their caregivers. Studies in various settings have reported different impacts on LBC, but less is known about the consequences faced by their caregivers. This qualitative study used [...] Read more.

Despite its positive impact on household income, parental labour migration negatively affects left-behind children (LBC) and their caregivers. Studies in various settings have reported different impacts on LBC, but less is known about the consequences faced by their caregivers. This qualitative study used in-depth interviews to collect data from caregivers of LBC whose parents migrated for employment. Participants were recruited using the snowball sampling technique, starting with the distribution of study information sheets through village offices in Belu and Malacca districts, Indonesia. Data analysis was guided by a qualitative data analysis framework, which involved several steps, including familiarisation with the data or transcripts, identification of a thematic framework, indexing the data, charting the data, and mapping and interpreting the entire data. The findings showed that despite some benefits, including monthly remittances and positive feelings of living with and receiving support from LBC experienced by some caregivers, parental labour migration negatively impacted most caregivers due to their caregiving roles and responsibilities. These challenges included (i) mental and physical health issues, (ii) impacts on daily food and healthcare needs, and (iii) difficulties in their social lives and overall well-being. The findings underscore the need for comprehensive support systems and interventions to address these challenges and improve caregiver well-being. Such support systems should include access to mental and physical health services, financial assistance, employment opportunities, and social support networks. Future large-scale studies are recommended to explore the various impacts of parental migration and caregiving roles and responsibilities on caregivers of LBC, as the findings can better inform the development of policies and interventions to support them. Full article

(This article belongs to the Special Issue Family Caregiving, Nursing and Health Promotion)

17 pages, 4801 KiB

Open AccessArticle

The Development of the CAIRDE General Awareness Training

by Jack Sweeney, Noel Richardson, Paula Carroll, P. J. White, Emilie Roche and Shane O’Donnell

Int. J. Environ. Res. Public Health 2025, 22(8), 1306; https://doi.org/10.3390/ijerph22081306 - 20 Aug 2025

Abstract

Suicide is a leading cause of death among construction workers, particularly younger and lower-skilled employees. Barriers such as stigma, low mental health literacy, and traditional masculine norms hinder help-seeking in this male-dominated sector. Few mental health interventions are tailored to this context. This [...] Read more.

Suicide is a leading cause of death among construction workers, particularly younger and lower-skilled employees. Barriers such as stigma, low mental health literacy, and traditional masculine norms hinder help-seeking in this male-dominated sector. Few mental health interventions are tailored to this context. This study developed a co-designed, theory-informed training to improve mental health literacy, reduce stigma, and increase help-seeking among construction workers in Ireland. Using the Medical Research Council’s framework, the training was developed with the Theory of Planned Behavior (TPB), Behavior Change Techniques, and extensive stakeholder co-design. Two systematic reviews, a broad literature review, and focus groups with industry managers informed the content and structure. The training will be pilot-tested using validated measures: the Literacy of Suicide Scale (LOSS), the Stigma of Suicide Scale (SOSS), and the General Help-Seeking Questionnaire (GHSQ), the results of which will be the subject of a separate study. CAIRDE is a promising, evidence-based training that addresses key mental health barriers in Irish construction. Embedding the TPB within a co-design methodology has resulted in the development of a training program that is underpinned by theoretical fidelity and cultural relevance and provides a framework for other male-dominated industries to draw upon. Future work should address remaining challenges related to stigma and help-seeking, and explore broader implementation through integration into mandatory safety training. Full article

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

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25 pages, 1928 KiB

Open AccessReview

Governance in Crisis: A Mixed-Methods Analysis of Global Health Governance During COVID-19

by Kadria Ali Abdel-Motaal and Sungsoo Chun

Int. J. Environ. Res. Public Health 2025, 22(8), 1305; https://doi.org/10.3390/ijerph22081305 - 20 Aug 2025

Abstract

Background: The COVID-19 pandemic exposed major structural deficiencies in global health governance, including stark inequities in vaccine access, intervention timing, and mortality outcomes. While economic resources played a role, the influence of governance performance remains insufficiently examined. This study addresses a significant gap [...] Read more.

Background: The COVID-19 pandemic exposed major structural deficiencies in global health governance, including stark inequities in vaccine access, intervention timing, and mortality outcomes. While economic resources played a role, the influence of governance performance remains insufficiently examined. This study addresses a significant gap by integrating governance metrics with pandemic response data to assess how governance quality, independent of income level, affected national outcomes. Although the Oxford COVID-19 Government Response Tracker (OxCGRT) dataset has been widely used to document policy responses, this study offers a novel contribution by linking these policy interventions with governance performance and evaluating their joint effect on health outcomes and vaccine equity. Methods: This mixed-methods study combines quantitative analysis of global datasets with a qualitative literature review. Quantitative data were mainly obtained from the Oxford COVID-19 Government Response Tracker (OxCGRT), the World Bank’s Worldwide Governance Indicators (WGIs), and World Bank/WHO databases. A governance performance index was constructed using two WGI components: Government Effectiveness and Regulatory Quality. Countries were grouped into high, medium, or low governance categories. Statistical tests included ANOVA, Kaplan Meier survival analysis, and multivariable OLS regression. The qualitative component reviewed 45 academic and institutional sources on governance performance during COVID-19. Results: Countries with high governance performance had earlier public health interventions, lower mortality, and broader vaccine coverage, independent of income level. Kaplan Meier analysis revealed faster school closures in these countries (p < 0.01). Multivariable regression showed governance remained a significant predictor after adjusting for income and health spending. Qualitative findings highlighted recurring weaknesses in legal enforceability, intergovernmental coordination, and global financing mechanisms. Conclusions: Governance performance had a decisive impact on pandemic outcomes. The COVID-19 crisis revealed the need for robust governance systems capable of responding to complex emergencies that extend beyond the health sector into institutional, economic, and social spheres. Full article

(This article belongs to the Special Issue Advancing Health Equity: Challenges and Opportunities)

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18 pages, 293 KiB

Open AccessArticle

Cultural Adaptation of the Mothers and Babies Online Course for Black Mothers with Preterm Infants: A Delphi Study

by Kobi V. Ajayi, Robin Page, Kelly Wilson, Carly McCord and Whitney Garney

Int. J. Environ. Res. Public Health 2025, 22(8), 1304; https://doi.org/10.3390/ijerph22081304 - 20 Aug 2025

Abstract

With persistent racial inequities, cultural adaptations of health programs can promote equitable maternal mental health. Despite the intersecting identities of Black mothers with preterm birth combined with racial discrimination, previous mental health programs in the neonatal intensive care unit (NICU) are void of [...] Read more.

With persistent racial inequities, cultural adaptations of health programs can promote equitable maternal mental health. Despite the intersecting identities of Black mothers with preterm birth combined with racial discrimination, previous mental health programs in the neonatal intensive care unit (NICU) are void of the sociocultural context that perpetuates racially motivated care. This study uses a two-round Delphi process to gather knowledge on the cultural appropriateness and content validity of the adapted Mothers and Babies Online Course, a United States Prevention Service Task Force-recommended intervention for managing mental health symptoms in pregnant and new mothers for Black mothers with preterm birth. The Black feminist theory and cultural adaptation strategies were used to conceptualize the adaptation process. Opinions were solicited from Black mothers and professionals based on predetermined criteria. Eleven participants, comprising eight mothers and three professionals, participated in Round One. Of these, only one professional did not participate in Round Two, totaling 10 participants who participated in Round Two. The participants rated the adapted program—eMB 4 Blackmamas, positively, and four themes emerged, substantiating the importance of culturally responsive mental health. The themes also offered additional feedback related to improving the program delivery. Including diverse stakeholders in mental health research offers unique and balanced insights into designing culturally appropriate programs to promote and protect Black maternal mental health in the NICU. Full article

16 pages, 293 KiB

Open AccessArticle

Using a Community-Based Participatory Research Approach to Study the Mental Health of Older Adults with a Refugee Life Experience

by Rochelle L. Frounfelker, Puja Thapa and Tej Mishra

Int. J. Environ. Res. Public Health 2025, 22(8), 1303; https://doi.org/10.3390/ijerph22081303 - 20 Aug 2025

Viewed by 6

Abstract

Older adults with a refugee life experience have a disproportionate burden of mental health problems compared to non-refugee aging populations. Community-based participatory research (CBPR) is a promising approach to identify the challenges and strengths of older refugee adults and identify solutions to mental [...] Read more.

Older adults with a refugee life experience have a disproportionate burden of mental health problems compared to non-refugee aging populations. Community-based participatory research (CBPR) is a promising approach to identify the challenges and strengths of older refugee adults and identify solutions to mental health disparities. We present a case study of one such CBPR program of research with older ethnic Nepali Bhutanese adults resettled in North America, Project Bhalakushari. We highlight the many opportunities to integrate older adults and members of the broader Bhutanese community in activities throughout the research process, starting with forming academic–community partnerships, identifying the needs and strengths of the community, conducting research, and sharing study findings with a broad audience of community members, health practitioners, policy-makers, and academics. Our case study emphasizes that a successful, culturally informed partnership should consider the involvement of the entire community, regardless of age, in the initiative to secure buy-in and support and maximize the positive impact of the work. We identify concrete strategies to overcome challenges specific to conducting research, with a focus on recruitment, outreach, and data collection. Full article

(This article belongs to the Special Issue Global Migrants and Refugees: Recent Trends, Health Inequities and Aging)

20 pages, 380 KiB

Open AccessArticle

Predictors of COVID-19 Pandemic-Related Pregnancy Stress: Prenatal and Postpartum Experiences in Canada

by Sigourney Shaw-Churchill and Karen P. Phillips

Int. J. Environ. Res. Public Health 2025, 22(8), 1302; https://doi.org/10.3390/ijerph22081302 - 20 Aug 2025

Viewed by 27

Abstract

The COVID-19 pandemic and related public health and hospital restrictions directly influenced Canadian perinatal healthcare. This study aimed to evaluate predictors of pandemic-related pregnancy and postpartum stress in Canada. A sample of 398 women with Canadian pandemic pregnancy experiences completed an online cross-sectional [...] Read more.

The COVID-19 pandemic and related public health and hospital restrictions directly influenced Canadian perinatal healthcare. This study aimed to evaluate predictors of pandemic-related pregnancy and postpartum stress in Canada. A sample of 398 women with Canadian pandemic pregnancy experiences completed an online cross-sectional survey between September 2021 and February 2022. Demographic factors, perinatal healthcare characteristics, and psychometric measures including Oslo Social Support Scale (OSSS-3) and Brief COPE were analyzed by independent hierarchical generalized linear models (GLM) to identify predictive variables associated with prenatal and postpartum pandemic-related pregnancy stress scales (PREPS). Respondents reported low social support, low–moderate Problem-Focused and Emotion-Focused Coping scores, with low Avoidant Coping. Middle income and canceled prenatal care appointments were associated with prenatal PREPS-Preparedness Stress, with provider satisfaction negatively associated. Avoidant Coping was positively associated with both prenatal and postpartum Preparedness Stress and Infection Stress scores, whereas Problem-Focused Coping was associated with both prenatal and postpartum Positive Appraisal. High COVID-19 rates and region of healthcare were associated with prenatal and postpartum Infection Stress. Our findings that perinatal healthcare characteristics and psychometric measures, rather than demographic characteristics, were greater predictors of pandemic-related stress reflect the broad societal disruptions that shaped Canadian pregnancy experiences in our sample of mostly high income, well-educated, non-racialized women. Full article

11 pages, 246 KiB

Open AccessArticle

Assessing Public Health Capacity for Infectious Disease Modeling: A Qualitative Study of State and Local Agencies

by Skyler J. Crouch, Katie S. Allen, Delaney Thornton, Joel Hartsell, Elizabeth H. Weybright, Julia E. Szymczak and Kimberley I. Shoaf

Int. J. Environ. Res. Public Health 2025, 22(8), 1301; https://doi.org/10.3390/ijerph22081301 - 20 Aug 2025

Viewed by 33

Abstract

Infectious disease modeling and forecasting tools are crucial for outbreak management. However, variability exists in the capacity of state and local health departments to effectively utilize these tools, influenced by factors such as infrastructure, funding, staff capacity, and data access. This study aims [...] Read more.

Infectious disease modeling and forecasting tools are crucial for outbreak management. However, variability exists in the capacity of state and local health departments to effectively utilize these tools, influenced by factors such as infrastructure, funding, staff capacity, and data access. This study aims to identify the current priorities, needs, and capacities of state and local public health departments regarding infectious disease modeling and forecasting tools. Key informant interviews were conducted with epidemiologists, informaticists, and leadership across state and local health departments from Montana, Utah, and Washington. Thematic coding and axial coding were used for thematic analysis. Three themes emerged: (1) models and tools must be adaptable based on the jurisdiction type (rural, urban, state); (2) building trust in models and tools is an important precursor to adoption; and (3) there are concerns about the availability and quality of data. This study highlights the need for adaptable modeling tools that are tailored to specific public health jurisdictions. Building trust in modeling and forecasting tools and addressing data quality issues are essential for successful tool implementation and adoption across diverse public health settings. Full article

10 pages, 241 KiB

Open AccessProtocol

Pre-Exposure Prophylaxis Uptake, Implementation and Barriers in Africa: A Scoping Review Protocol

by Silingene Joyce Ngcobo and Tracy Zhandire

Int. J. Environ. Res. Public Health 2025, 22(8), 1300; https://doi.org/10.3390/ijerph22081300 - 20 Aug 2025

Viewed by 45

Abstract

Background: Despite significant advancements in HIV prevention, Africa continues to bear a disproportionately high burden of new infections. Pre-exposure prophylaxis (PrEP) has demonstrated over 90% efficacy in preventing HIV acquisition when taken consistently; however, its implementation and uptake across African countries remain suboptimal. [...] Read more.

Background: Despite significant advancements in HIV prevention, Africa continues to bear a disproportionately high burden of new infections. Pre-exposure prophylaxis (PrEP) has demonstrated over 90% efficacy in preventing HIV acquisition when taken consistently; however, its implementation and uptake across African countries remain suboptimal. Objective: This scoping review aims to systematically map existing literature on PrEP uptake and implementation in Africa, identify key barriers and facilitators influencing access and adherence, examine targeted population groups, and explore policy and programmatic approaches to PrEP delivery across diverse African contexts. Methods: The review will follow the methodological framework proposed by Arksey and O’Malley, refined by Levac et al., and will include comprehensive searches of electronic databases, grey literature, and official reports. Data will be thematically synthesized to identify research trends, gaps, and contextual variations. Expected Outcomes: The findings will provide a comprehensive overview of the current landscape of PrEP implementation in Africa, highlighting research trends, contextual variations across countries, and gaps in service delivery and policy frameworks. This will inform future implementation strategies, guide evidence-based approaches to enhance PrEP uptake, and support policymaking to scale up effective interventions across diverse African settings, ultimately contributing to HIV prevention efforts on the continent. Full article

(This article belongs to the Section Infectious Diseases, Chronic Diseases, and Disease Prevention)

28 pages, 2422 KiB

Open AccessReview

Chemical Hazards in Products of Animal Origin in Cambodia from 2000 to 2023: A Systematic Review and Meta-Analysis

by Shwe Phue San, Linda Nicolaides, Delia Grace, Tumnoon Charaslertrangsi, Chhoun Chamnan, Shetty Seetharama Thombathu, Ra Thorng, Leab Kong, Sreymom Noeurn, Kuok Fidero, Che Ratana, Nazanin Zand and Rortana Chea

Int. J. Environ. Res. Public Health 2025, 22(8), 1299; https://doi.org/10.3390/ijerph22081299 - 19 Aug 2025

Viewed by 253

Abstract

Chemical hazards in food present a significant health risk. The objective of our review is to understand health risks associated with chemical contaminants in products of animal origin (POAO) in Cambodia, where there is no known published study. We followed the “Preferred Reporting [...] Read more.

Chemical hazards in food present a significant health risk. The objective of our review is to understand health risks associated with chemical contaminants in products of animal origin (POAO) in Cambodia, where there is no known published study. We followed the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines. A total of 23 reports were included for review. The findings are presented according to the PRISMA guidelines. The studies mostly focused on fishery products, with arsenic and mercury being the most frequently studied hazards. The evidence of banned substances such as chloramphenicol and certain organochlorine pesticides (OCPs), including chlordane and Mirex, was reported in fish and meat. Additionally, mercury levels were measured in beef, pork, viscera, and eggs, but the average concentration remained significantly below the hazard index. The average concentration of polycyclic aromatic hydrocarbons (PAH) in smoked fish exceeded the EU limits, ranging from 0.034 to 17.2 mg/kg, with an average mean concentration of 1.92 mg/kg. The pooled geometric means of arsenic and mercury in fish were 0.40 mg/kg (95% CI: 0.25–0.66) and ~0.14 mg/kg (95% CI: 0.087 to 0.223), respectively. The health risk of mercury contamination in fishery products needs the attention of the risk managers. However, industrial contaminants such as polybrominated diphenyl ethers (PBDEs) and butyl tin in marine fishes were lower than those reported elsewhere, such as Japan. We discuss the implications of the findings for human health and national food control systems (NFCS), the capacity of different agencies to undertake chemical risk assessment, the utility of systematic literature reviews (SLRs) for risk assessment and communication in low- and middle-income countries (LMICs), and the need for further research. Full article

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32 pages, 2403 KiB

Open AccessArticle

Beyond Storytime: Oklahoma Public Libraries’ Comprehensive Approach to the Resilience of Refugee Children and Their Families Support

by Salma Akter and Suchismita Bhattacharjee

Int. J. Environ. Res. Public Health 2025, 22(8), 1298; https://doi.org/10.3390/ijerph22081298 - 19 Aug 2025

Viewed by 107

Abstract

Public libraries serve as vital community hubs that foster engagement, empowerment, and education, particularly for vulnerable populations, including refugee children and families. This study examines how Oklahoma’s public libraries contribute to refugee resilience and identifies challenges they face in providing these essential services. [...] Read more.

Public libraries serve as vital community hubs that foster engagement, empowerment, and education, particularly for vulnerable populations, including refugee children and families. This study examines how Oklahoma’s public libraries contribute to refugee resilience and identifies challenges they face in providing these essential services. Using a qualitative method approach, including 20 semi-structured interviews with library staff, questionnaire surveys, and observations conducted across three Oklahoma library systems (Metropolitan, Pioneer, and Tulsa City-County) the study explored programs, services, and strategies that support refugee adaptation and integration. Findings reveal that libraries excel in three key areas: cognitive services (language literacy, digital access, educational resources), socio-cultural services (community building, cultural exchange), and physiological services (safe spaces, welcoming environments). These services contribute to building human, social, and economic capital, with human capital consistently ranked as most crucial for refugee resilience. However, libraries face significant challenges, with language barriers, program gaps, and outreach limitations being the most prevalent obstacles. Additional barriers include facility constraints, transportation difficulties, resource limitations, and privacy concerns. The study proposes nine comprehensive guidelines for creating sustainable pathways to refugee resilience through enhanced library services, emphasizing proactive community engagement, staff training, multilingual resources, advocacy, strategic partnerships, tailored programming, transportation solutions, cultural competence, and welcoming environments. This study contributes to understanding how public libraries can function as inclusive institutions that support refugee children’s successful integration and development in their new communities. Full article

(This article belongs to the Special Issue Refugee Health and Well-Being: Psychological, Behavioral and Biochemical Insights)

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19 pages, 4882 KiB

Open AccessArticle

“Slowly but Steadily, You’re Running Out of Steam”: Aging Parents’ Caregiving Experiences Through Photovoice

by Martin Nagl-Cupal, Marlene Werner, Daniela Haselmayer and Thomas Falkenstein

Int. J. Environ. Res. Public Health 2025, 22(8), 1297; https://doi.org/10.3390/ijerph22081297 - 19 Aug 2025

Viewed by 174

Abstract

Aging parents caring for adult children with disabilities or other care needs face significant challenges and health-related issues over extended periods. The aim of this study was to explore the experiences of aging parents with caregiving responsibilities. This qualitative participatory study followed the [...] Read more.

Aging parents caring for adult children with disabilities or other care needs face significant challenges and health-related issues over extended periods. The aim of this study was to explore the experiences of aging parents with caregiving responsibilities. This qualitative participatory study followed the research process of a photovoice study. Thirteen parents, aged 51 to 76 years, of adult children with care needs, aged 20 to 49 years, participated in this study. The parents captured photographs depicting their daily lives which were contextualized and coded during group discussions. The data were analyzed using thematic analysis and reviewed collaboratively with the participants. Six key themes emerged in the data analysis. 1. mastering complexity, 2. being an expert and advocate, 3. balancing autonomy and care, 4. care as a lifelong journey, 5. standing on the margins of society, and 6. worrying about the future. This study underscores the urgent need for comprehensive and coordinated support systems that ensure the well-being of aging caregivers while addressing the evolving needs of their adult children. Full article

(This article belongs to the Special Issue Family Caregiving of Older Adults)

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22 pages, 3489 KiB

Open AccessArticle

Assessing Annoyance and Sleep Disturbance Related to Changing Aircraft Noise Context: Evidence from Tan Son Nhat Airport

by Thulan Nguyen, Tran Thi Hong Nhung Nguyen, Makoto Morinaga, Yasuhiro Hiraguri and Takashi Morihara

Int. J. Environ. Res. Public Health 2025, 22(8), 1296; https://doi.org/10.3390/ijerph22081296 - 19 Aug 2025

Viewed by 132

Abstract

This study examines the impact of aircraft noise on annoyance and sleep disturbances among residents near Tan Son Nhat Airport in Ho Chi Minh City, Vietnam, from 2019 to 2023. It aims to assess the specific effects of aircraft noise exposure on sleep [...] Read more.

This study examines the impact of aircraft noise on annoyance and sleep disturbances among residents near Tan Son Nhat Airport in Ho Chi Minh City, Vietnam, from 2019 to 2023. It aims to assess the specific effects of aircraft noise exposure on sleep quality, as well as changes in exposure due to reduced air traffic during the COVID-19 pandemic. Surveys conducted before and during the pandemic revealed that, despite lower noise levels, residents continued to report high levels of annoyance, indicating a complex exposure-response relationship. This study evaluates both the impact of aircraft noise levels and the role of non-acoustic factors in mitigating sleep disturbances and shaping residents’ responses over time. The study’s findings support the applicability of WHO guidelines in this context and emphasize the importance of considering both noise reduction and community engagement in noise management strategies. Full article

(This article belongs to the Special Issue Community Response to Environmental Noise)

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14 pages, 632 KiB

Open AccessArticle

“If You Haven’t Slept a Lot (…) You Don’t Want to Go Out for a Run, You Don’t Want to Ride a Bike, You Just Kind of Sit and You Just (…) Do Nothing”—Perceptions of 24-Hour Movement Behaviours Among Adolescents Living with Type 1 Diabetes

by Mhairi Patience, Alison Kirk, Xanne Janssen, James Sanders and Megan Crawford

Int. J. Environ. Res. Public Health 2025, 22(8), 1295; https://doi.org/10.3390/ijerph22081295 - 19 Aug 2025

Viewed by 154

Abstract

The importance of physical activity, sedentary behaviour, and sleep behaviour in adolescents with type 1 diabetes (T1D) has been explored in isolation. However, adolescents experience health benefits when these behaviours are balanced appropriately throughout the day, and are considered to be interconnected rather [...] Read more.

The importance of physical activity, sedentary behaviour, and sleep behaviour in adolescents with type 1 diabetes (T1D) has been explored in isolation. However, adolescents experience health benefits when these behaviours are balanced appropriately throughout the day, and are considered to be interconnected rather than isolated. The aim of this study was to investigate the perspectives of adolescents living with T1D towards these behaviours collectively. The participants were 15 adolescents (aged 11–18 years) with T1D, recruited using online methods and word of mouth. Online semi-structured interviews were transcribed using intelligent verbatim and analysed using thematic analysis. We identified the following four central themes and five subthemes: (1) sleep and physical activity are understood and valued above sedentary behaviour; (2) recognition of movement behaviours’ interconnection; (3) movement behaviours’ interaction with health outcomes (mood, glycaemic control, and glycaemic control as a barrier to movement behaviours); and (4) movement behaviours within the environmental context of the adolescent (school and caregivers). Adolescents with T1D are aware of the interconnectedness of each movement behaviour and the positive influence a balanced approach can have on mood and T1D management. The findings provide important information for future holistic interventions promoting healthy behaviours that target the adolescent, their school environment, and their caregivers. Full article

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15 pages, 706 KiB

Open AccessArticle

Using Functional Near-Infrared Spectroscopy to Elucidate Neurophysiological Mechanism of Action of Equine-Assisted Services: Proof-of-Concept Study

by Beth A. Lanning, Cory M. Smith, Cierra Ugale, Elena Nazarenko and William R. Marchand

Int. J. Environ. Res. Public Health 2025, 22(8), 1294; https://doi.org/10.3390/ijerph22081294 - 19 Aug 2025

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Abstract

Equine-assisted services (EAS) are used for civilian and military trauma survivors to reduce depression and posttraumatic stress symptoms. While early scientific evidence supports the benefits of EAS, the neurophysiological mechanisms underlying these benefits are unknown. The specific aims of this exploratory study were [...] Read more.

Equine-assisted services (EAS) are used for civilian and military trauma survivors to reduce depression and posttraumatic stress symptoms. While early scientific evidence supports the benefits of EAS, the neurophysiological mechanisms underlying these benefits are unknown. The specific aims of this exploratory study were to determine (1) whether functional near-infrared spectroscopy (fNIRS) neuroimaging can be used to explore neural responses of EAS veteran participants and (2) the correlation between neural responses and psychological outcomes of the participants interacting with equines. Fifteen veterans participated in a 2-day EAS program consisting of four randomized activities. An fNIRS sensor cap was used to measure the oxygenated (O₂Hb), deoxygenated (hHb), and total hemoglobin (tHb) of the participants during each activity. The results indicated no significant differences for O₂Hb and tHb across the visits or activities, however, a significant difference in hHb was observed. There was an increase in hHb during the activities that included an equine, which indicated a greater cognitive load and attention. Further, data from pre-/post-psychometric assessments showed a significant improvement in participants’ trait anxiety, psychological flexibility, and positive and negative affect after interacting with the horse. Preliminary data revealed a potential association between the cognitive attention and psychological health of participants during an EAS session. Full article

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13 pages, 516 KiB

Open AccessArticle

Perception of Concern and Associated Factors During the COVID-19 Pandemic: An Epidemiological Survey in a Brazilian Municipality

by Adriano Pires Barbosa and Marília Jesus Batista

Int. J. Environ. Res. Public Health 2025, 22(8), 1293; https://doi.org/10.3390/ijerph22081293 - 19 Aug 2025

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Abstract

The COVID-19 pandemic impacted mental health. This cross-sectional study analyzed the perception of concern related to the pandemic in Jundiaí-SP, June 2020. Participants consisted of residents of households selected by probability sampling and individuals with respiratory symptoms who sought Basic Health Units (UBS). [...] Read more.

The COVID-19 pandemic impacted mental health. This cross-sectional study analyzed the perception of concern related to the pandemic in Jundiaí-SP, June 2020. Participants consisted of residents of households selected by probability sampling and individuals with respiratory symptoms who sought Basic Health Units (UBS). The participants underwent rapid testing for SARS-CoV-2 and answered a questionnaire. The outcome was the perception of concern about pandemic and the independent variables were socioeconomic characteristics, behavioral variables, signs and symptoms, and rapid test results. Bivariate analysis was performed and variables with p < 0.20 were included in a binary logistic regression model (p < 0.05) using SPSS 20.0. A total of 2432 individuals participated in the study, including 1181 from UBS and 1251 from households. Females (OR: 1.42; CI: 1.18–1.71), black and mixed race participants (OR: 1.40; CI: 1.15–1.71), participants with an income up to 3 minimum wages (MW) (up to 1 MW: OR: 2.58; CI: 1.80–3.70; 1 to 3 MW: OR: 1.64; CI: 1.35–1.98), and younger participants (18–39 years: OR: 3.07; CI: 2.39–3.94; 40–59 years: OR: 2.42; CI: 1.89–3.10) were more concerned. Greater concern was perceived by more vulnerable individuals, regardless of testing positive for COVID-19 which is important to subsidize public mental health policies and crisis interventions, focusing on reducing race, gender and socioeconomic inequalities. Full article

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14 pages, 307 KiB

Open AccessArticle

Self-Reported Oral Health Among Elderly Immigrants Residing in Norway: A Cross-Sectional Study

by Wegdan Hasha, Stein Atle Lie, Anne N. Åstrøm and Manal Mustafa

Int. J. Environ. Res. Public Health 2025, 22(8), 1292; https://doi.org/10.3390/ijerph22081292 - 18 Aug 2025

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Abstract

Immigrants represent 20.8% of Norway’s population, with 22.2% aged 50+. This study aimed to assess oral health-related behaviors and perceived oral health in relation to sociodemographic factors among elderly immigrants aged 50+. Methods: 174 participants (94% response rate). Data on sociodemographic, oral hygiene, [...] Read more.

Immigrants represent 20.8% of Norway’s population, with 22.2% aged 50+. This study aimed to assess oral health-related behaviors and perceived oral health in relation to sociodemographic factors among elderly immigrants aged 50+. Methods: 174 participants (94% response rate). Data on sociodemographic, oral hygiene, diet, snus use, xerostomia, and halitosis were collected using the self-reported questionnaire. p-value < 0.05 indicates statistical significance. Results: Participants’ mean age was 60.7, with 60% reporting poor self-perceived oral health, and over 64% had missing teeth. Participants reported poor oral hygiene habits (35.1%, n = 61), frequent sugar consumption (51.1%, n = 89), and smoking (16.1%, n = 28). Poor oral health was more common in those aged 60 and over (OR = 2.5, CI: 1.1–5.8) and with a narrow social network (OR = 3.8, CI: 1.7–8.5). Women had lower odds of sugar consumption (OR = 0.38, CI: 0.18–0.8) and smoking (OR = 0.27, CI: 0.09–0.7), but living in Norway for less than 3 years increased smoking odds (OR = 4.5, CI: 1.2–15.8). Moreover, being unmarried (OR = 5.5, p = 0.008), recent immigration (OR = 24.3, p < 001), and a narrow social network (OR = 4.7, p = 0.004) were associated with higher odds of missing teeth. Conclusions: Elderly immigrants in Norway reported poor oral health, tooth loss, and unhealthy dietary and hygiene habits, highlighting the need for targeted interventions. Full article

(This article belongs to the Section Global Health)

10 pages, 257 KiB

Open AccessArticle

Prevalence and Factors Associated with HIV Testing Among Men Aged 15–54 Years in Kenya—Evidence from the 2022 Demographic and Health Survey

by Ipeleng Caroline Victoria Melato, Alfred Musekiwa and Siphesihle Robin Nxele

Int. J. Environ. Res. Public Health 2025, 22(8), 1291; https://doi.org/10.3390/ijerph22081291 - 18 Aug 2025

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Abstract

Sub-Saharan Africa bears the heaviest burden of HIV/AIDS. Kenya alone has an estimated 1.4 million people living with HIV. Therefore, this study determined HIV testing prevalence and associated factors among men aged 15–54 years in Kenya. The study is a secondary data analysis [...] Read more.

Sub-Saharan Africa bears the heaviest burden of HIV/AIDS. Kenya alone has an estimated 1.4 million people living with HIV. Therefore, this study determined HIV testing prevalence and associated factors among men aged 15–54 years in Kenya. The study is a secondary data analysis of the 2022 Kenya Demographic and Health Survey, a nationally representative population-based cross-sectional survey. A multivariable logistic regression model was used to determine factors associated with HIV testing. Survey weights were used to adjust analyses for unequal sampling probabilities. Out of 14,453 men included in the study, the prevalence of self-reported HIV testing was 73.5%, which was higher among men aged 30–34 years old compared to the 15–19 years (90.2% vs. 33.3%), married or living with a partner (89.1% vs. 55.5%), residing in urban areas (82.5% vs. 67.8%), with higher education (90.6% vs. 58.4%), employed (80.5% vs. 43.1%), richest (83.8% vs. 60.4%), and those with three or more sexual partners (81.7% vs. 68.0%) groups. Targeted interventions to encourage more men to participate in regular HIV testing are needed. This can be achieved by bringing HIV testing sites closer to males through HIV self-testing and community testing, particularly home-based testing. Full article

(This article belongs to the Special Issue Progress Toward the UNAIDS 95-95-95 Targets for HIV Care Cascade)

12 pages, 1704 KiB

Open AccessArticle

Socioeconomic Disparities and Risk of Papillary Thyroid Cancer Associated with Environmental Exposure to Per- and Polyfluoroalkyl Substances (PFAS) in Florida

by Laura E. Wild, Nicholas DiStefano, Garrett Forman, Bianca I. Arocha, Ming S. Lee, Peter A. Borowsky, Elizabeth Franzmann, Natasha Solle, Alberto J. Caban-Martinez and Erin Kobetz

Int. J. Environ. Res. Public Health 2025, 22(8), 1290; https://doi.org/10.3390/ijerph22081290 - 18 Aug 2025

Viewed by 120

Abstract

The existing literature suggests that exposure to Per- and Polyfluoroalkyl Substances (PFAS) can increase Papillary Thyroid Cancer (PTC) risk by interfering with thyroid hormone signaling, leading to hormonal imbalances that promote carcinogenesis. In addition, significant disparities exist in environmental exposure. However, ecological evidence [...] Read more.

The existing literature suggests that exposure to Per- and Polyfluoroalkyl Substances (PFAS) can increase Papillary Thyroid Cancer (PTC) risk by interfering with thyroid hormone signaling, leading to hormonal imbalances that promote carcinogenesis. In addition, significant disparities exist in environmental exposure. However, ecological evidence of these associations has not been established within a statewide database of cancer outcomes. Therefore, this study investigated the relationship between socioeconomic conditions, environmental PFAS exposure, and PTC incidence in Florida using the state’s cancer registry. Data on facilities potentially releasing PFAS and ZIP codes with known PFAS drinking water contamination were retrieved from the EPA’s PFAS Analytic Tool. Proximity to PFAS sites and age-adjusted incidence by patient race/ethnicity were calculated by census tract. Lower socioeconomic status was associated with greater exposure to environmental PFAS. Census tracts with closer proximity to PFAS sites were more likely to have public water systems with PFAS contamination. Lastly, residential proximity to PFAS sites was positively associated with age-adjusted PTC incidence in Non-Hispanic Whites and Hispanics. These results demonstrate disparities in environmental exposure and suggest that exposure to PFAS may be an important factor for PTC risk at the population level and should be considered in the development of public health policies. Full article

(This article belongs to the Special Issue Environmental Epidemiology and Spatial Analysis)

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11 pages, 335 KiB

Open AccessArticle

Out-of-Pocket Expenditure (OOPE) Among COVID-19 Patients by Insurance Status in a Quaternary Hospital in Karnataka, India

by Rajesh Kamath, Chris Sebastian, Varshini R. Jayapriya, Siddhartha Sankar Acharya, Ashok Kamat, Helmut Brand, Reshma Maria Cocess D’Souza, Prajwal Salins, Aswin Sugunan, Sagarika Kamath, Sangita G. Kamath and Sanjay B. Kini

Int. J. Environ. Res. Public Health 2025, 22(8), 1289; https://doi.org/10.3390/ijerph22081289 - 18 Aug 2025

Viewed by 180

Abstract

Out-of-pocket expenditure (OOPE) comprises 62% of national health expenditure in India. This heavy reliance on direct payments has engendered economic vulnerability and catastrophic financial pressures (typically defined as out-of-pocket spending exceeding a certain threshold of household income, leading to financial hardship) on households [...] Read more.

Out-of-pocket expenditure (OOPE) comprises 62% of national health expenditure in India. This heavy reliance on direct payments has engendered economic vulnerability and catastrophic financial pressures (typically defined as out-of-pocket spending exceeding a certain threshold of household income, leading to financial hardship) on households in a country where public health spending remains below targeted levels. The onset of the COVID-19 pandemic intensified these financial hardships further, as both total healthcare spending and OOPE experienced significant escalations due to the increased need for emergency care, vaccination efforts, and expanded health infrastructure. A retrospective, single-center study was conducted using data from COVID-19 patients admitted between June 2020 and June 2022. Patient data were collected from the Medical Records, IT, and Finance departments. A validated proforma was used for data extraction. Descriptive statistics were calculated, and the Shapiro–Wilk test was applied to assess normality of billing and OOPE data. Patients were stratified into three groups based on their insurance status, allowing for comparative analysis of OOPE percentages and absolute expenditures. The 2715 COVID-19 patients were categorized into three groups according to their health financing: those covered under AB-PMJAY (42.76%), private health insurance (22.16%), and the uninsured (35%). While the median billing amounts were comparable across these groups (ranging between INR 85,000 and INR 90,000), a substantial disparity was observed in terms of financial burden. All patients covered under AB-PMJAY incurred no OOPE, whereas privately insured patients had a median OOPE that constituted approximately 21% of their total billing amounts, with significant variability among different insurers. The uninsured group represented 35% of the cases and experienced the highest median OOPE, indicating substantial financial risk. The COVID-19 pandemic has revealed critical gaps in India’s health financing framework. This study emphasizes the strong financial protection provided by AB-PMJAY, while also exposing the limitations of private health insurance in shielding patients from substantial healthcare costs. As the country progresses toward universal health coverage, there is a pressing need to expand public health insurance schemes that are inclusive, equitable, and effectively implemented. Additionally, strengthening regulation and accountability in the private insurance sector is essential. The study findings reinforce that AB-PMJAY has been highly successful in reducing OOPE and enhancing financial risk protection. Although private insurance reduced OOPE, patients still faced considerable expenses. The stark difference in OOPE of 100% for uninsured patients, 21.16% for privately insured, and 0% for AB-PMJAY beneficiaries underscores the importance of further expanding AB-PMJAY to reach more vulnerable populations. Full article

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11 pages, 755 KiB

Open AccessArticle

Acute Glycemic and Hemodynamic Responses to Single- and Multi-Joint Resistance Exercises in Individuals with Type 2 Diabetes: A Pilot Randomized Crossover Study

by Rodrigo Sudatti Delevatti, Fábio Duarte da Silva, Filipe De Lucca Braga, Lucineia Orsolin Pfeifer and Maria Eduarda de Moraes Sirydakis

Int. J. Environ. Res. Public Health 2025, 22(8), 1288; https://doi.org/10.3390/ijerph22081288 - 18 Aug 2025

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Abstract

Introduction: There is a lack of knowledge regarding the acute glycemic and blood pressure responses to resistance exercises that involve different amounts of muscle mass. Objective: To analyze the acute effects of single- and multi-joint resistance exercises on glycemic control and blood pressure [...] Read more.

Introduction: There is a lack of knowledge regarding the acute glycemic and blood pressure responses to resistance exercises that involve different amounts of muscle mass. Objective: To analyze the acute effects of single- and multi-joint resistance exercises on glycemic control and blood pressure in individuals with type 2 diabetes (T2DM). Methods: This is a pilot randomized crossover trial, including adults with T2DM of both genders. The participants performed three sessions (two experimental sessions: one with single-joint exercises (SIN) and the other with multi-joint exercises (MULTI); and a control session (CON)) in a randomized order, with outcomes being evaluated pre-exercise, immediately, 15 and 30 min after the sessions. Both sessions consisted of five exercises performed in three sets of 10 to 12 maximum repetitions. Analyses were performed by generalized estimation equations. Results: Fifteen adults (including eleven women) participated in this study. Both experimental sessions showed glycemic reductions immediately after the sessions (MULTI: −17 mg/dL; SIN: −29 mg/dL; p < 0.001), and these values were kept similar up to 30 min after the session. The control session presented a glycemic reduction immediately after the session (−18 mg/dL), which increased 15 min later (−29 mg/dL), stabilizing up to 30 min after the session. Systolic blood pressure was increased immediately after both experimental sessions, retuning to baseline values 15 min post-session. Diastolic blood pressure increased in the control session with time, without any alterations in the experimental sessions. Conclusions: Similar glycemic reductions were found in the experimental sessions, without superiority over the control session. Minimal changes were found in blood pressure. Full article

(This article belongs to the Special Issue New Advances in Diabetes)

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9 pages, 243 KiB

Open AccessArticle

Association of Financial Distress and Monthly Income with Smoking During the COVID-19 Pandemic Recession in Thailand: A Nationwide Cross-Sectional Study

by Chutarat Sathirapanya, Wit Wichaidit, Vijj Kasemsup, Vasin Pipattanachat and Rassamee Chotipanvithayakul

Int. J. Environ. Res. Public Health 2025, 22(8), 1287; https://doi.org/10.3390/ijerph22081287 - 18 Aug 2025

Viewed by 177

Abstract

(1) Background: Psychological distress causes increased smoking frequency. Thus, financial distress (FD), a type of psychological distress, during the COVID-19 pandemic recession is possibly associated with increased smoking frequency. We studied the association between disrupted employment or earnings-associated FD and the number of [...] Read more.

(1) Background: Psychological distress causes increased smoking frequency. Thus, financial distress (FD), a type of psychological distress, during the COVID-19 pandemic recession is possibly associated with increased smoking frequency. We studied the association between disrupted employment or earnings-associated FD and the number of cigarettes smoked daily, as well as the effects of pre-pandemic regular monthly incomes on the association. (2) Methods: We retrieved the collected data from a former nationwide and community-based study regarding the psycho-socio-economic characteristics of Thai people during the third wave of the COVID-19 pandemic in Thailand in 2021. The participants for this study were current smokers aged ≥ 18 years. General demographics, perceived FD, and pre-pandemic regular monthly incomes were analyzed. Descriptive statistics and multivariate logistic regression with sampling weight adjustments were the analyses used (p < 0.05). (3) Results: 849 current smokers were suitable for statistical analyses. We found that 664 (12.9%) of participants experienced FD, but it did not significantly affect smoking frequency. However, those who had FD and regularly earning ≥ THB 10,000 ($271.11 US) per month was significantly associated with increased daily cigarette use, after adjusting for age and sex (adjusted OR = 2.74; 95% CI = 1.18, 6.37, p = 0.020). (4) Conclusion: FD alone did not affect daily smoking frequency. Understanding the psycho-socio-economic factors is necessary for smoking control during the COVID-19 economic recession. Full article

15 pages, 633 KiB

Open AccessReview

Rehabilitating Soldiers for Load Carriage Tasks: An International Perspective

by Robin Orr, Joseph J. Knapik, Rachel Rodgers, Robyn Cassidy, Jacques Rousseau, Damien Van Tiggelen and Rodney Pope

Int. J. Environ. Res. Public Health 2025, 22(8), 1286; https://doi.org/10.3390/ijerph22081286 - 17 Aug 2025

Viewed by 969

Abstract

Soldiers are likely to suffer an injury and require rehabilitation at some stage of their career. Load carriage, whilst a fundamental requirement, is also a source of injury risk. To optimize the rehabilitation of soldiers and prepare them for a full return to [...] Read more.

Soldiers are likely to suffer an injury and require rehabilitation at some stage of their career. Load carriage, whilst a fundamental requirement, is also a source of injury risk. To optimize the rehabilitation of soldiers and prepare them for a full return to operational duty, load carriage requirements need to be considered throughout their rehabilitation pathway. In addition, injury risks associated with load carriage need to be considered to inform mitigation of reinjury. During the initial injury treatment stage, loss of key fitness elements associated with load carriage performance, being aerobic fitness and relative strength, need to be minimized. Any losses of these same elements of fitness then need to be considered in the overall reconditioning stage. Finally, with injury being a predictor of future load carriage injury, the conditioning stage must move beyond general occupational conditioning to include load carriage-specific conditioning to make the soldier physically resilient against future injury and confident of their capability. By synthesizing evidence from the latest research in load carriage, this narrative review provides pragmatic considerations and guidelines for optimizing soldier load carriage capability following injury. Full article

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

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15 pages, 700 KiB

Open AccessArticle

Promotion of Health-Harming Products on Instagram: Characterizing Strategies Boosting Audience Engagement with Cigar Marketing Messages

by Ganna Kostygina, Hy Tran, Chandler C. Carter and Sherry L. Emery

Int. J. Environ. Res. Public Health 2025, 22(8), 1285; https://doi.org/10.3390/ijerph22081285 - 17 Aug 2025

Viewed by 285

Abstract

Social media promotion of harmful products (e.g., combustible tobacco) poses a public health threat. However, strategies that amplify exposure to and engagement with such content remain understudied. This study aims to characterize strategies boosting cigar, little cigar, and cigarillo (CLCC) marketing visibility, referrals, [...] Read more.

Social media promotion of harmful products (e.g., combustible tobacco) poses a public health threat. However, strategies that amplify exposure to and engagement with such content remain understudied. This study aims to characterize strategies boosting cigar, little cigar, and cigarillo (CLCC) marketing visibility, referrals, and engagement on Instagram. Using keyword rules, we collected publicly available CLCC-related Instagram posts from CrowdTangle for a six-year period from August 2016 to October 2021. Posts were categorized as commercial (e.g., posts by tobacco brands or vendors) or organic and were coded for consumer engagement (CE) strategies (e.g., presence of prompts to like/share) using a combination of machine learning methods and human coding. Temporal engagement trends were analyzed using metadata. A total of 320,488 CLCC-related public posts were collected, with 44.6% (n = 142,875) identified as overtly commercial. Of these, 33.5% (n = 47,832) contained CE cues, including discounts and giveaways for tagging peers, liking, commenting, or following CLCC brands and spokesperson/influencers accounts, as well as calls to participate in contests and polls. Overtly commercial CE messages consistently garnered more comments per post and likes per post than non-CE commercial posts. There was a significant upward trend in the rate of comments on CE posts, suggesting growing effectiveness in eliciting user interaction. The proliferation of and high level of engagement with cigar-related promotional messages on Instagram demonstrate the need for public health surveillance and regulation of the evolving strategies promoting CLCC marketing exposure, reach, and engagement on social media. Full article

(This article belongs to the Special Issue Evolving Role of Social Media in Health Communication)

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20 pages, 642 KiB

Open AccessArticle

Brazilian Clinical Psychologists’ Perceptions of Online Psychotherapy for Patients with Suicidal Behavior During the COVID-19 Pandemic: A Grounded Theory Study

by Natália Gallo Mendes Ferracioli, Elaine Campos Guijarro Rodrigues and Manoel Antônio dos Santos

Int. J. Environ. Res. Public Health 2025, 22(8), 1284; https://doi.org/10.3390/ijerph22081284 - 17 Aug 2025

Viewed by 305

Abstract

Online psychotherapy for patients with suicidal behavior was considered inappropriate by the Brazilian Federal Psychology Council prior to the COVID-19 pandemic. Due to the need for physical distancing, this restriction was temporarily suspended. This study aims to analyze the perceptions of Brazilian clinical [...] Read more.

Online psychotherapy for patients with suicidal behavior was considered inappropriate by the Brazilian Federal Psychology Council prior to the COVID-19 pandemic. Due to the need for physical distancing, this restriction was temporarily suspended. This study aims to analyze the perceptions of Brazilian clinical psychologists regarding online psychotherapy for patients with suicidal behavior in the context of the COVID-19 pandemic, to generate a theoretical understanding of this experience. It is a qualitative, exploratory, longitudinal study based on the Constructivist Grounded Theory framework. Ten clinical psychologists who conducted online psychotherapy for patients with suicidal behavior during the pandemic were interviewed at two moments, with an interval of approximately two years: the first round was conducted from December 2020 to March 2021, followed by a second round between November and December 2022. Data analysis led to four categories: (1) Reflecting on suicidal behavior; (2) Addressing specificities of online interventions; (3) Managing suicidal behavior in online psychotherapy; (4) Evaluating online psychotherapy for patients with suicidal behavior. The theoretical model “Pathways of care: main roads and access routes in online psychotherapy for suicidal behavior” was constructed. It was concluded that online psychotherapy for patients with suicidal behavior is complex and requires caution but is feasible and can be important in specific circumstances. This makes it an additional resource for suicide prevention and mental health promotion. Full article

(This article belongs to the Special Issue Mental Health in Healthcare: Challenges and Perspectives from the Past to the Future)

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19 pages, 614 KiB

Open AccessArticle

Effects of Outdoor and Household Air Pollution on Hand Grip Strength in a Longitudinal Study of Rural Beijing Adults

by Wenlu Yuan, Xiaoying Li, Collin Brehmer, Talia Sternbach, Xiang Zhang, Ellison Carter, Yuanxun Zhang, Guofeng Shen, Shu Tao, Jill Baumgartner and Sam Harper

Int. J. Environ. Res. Public Health 2025, 22(8), 1283; https://doi.org/10.3390/ijerph22081283 - 16 Aug 2025

Viewed by 331

Abstract

Background: Outdoor and household PM_2.5 are established risk factors for chronic disease and early mortality. In China, high levels of outdoor PM_2.5 and solid fuel use for cooking and heating, especially in winter, pose large health risks to the country’s aging [...] Read more.

Background: Outdoor and household PM_2.5 are established risk factors for chronic disease and early mortality. In China, high levels of outdoor PM_2.5 and solid fuel use for cooking and heating, especially in winter, pose large health risks to the country’s aging population. Hand grip strength is a validated biomarker of functional aging and strong predictor of disability and mortality in older adults. We investigated the effects of wintertime household and outdoor PM_2.5 on maximum grip strength in a rural cohort in Beijing. Methods: We analyzed data from 877 adults (mean age: 62 y) residing in 50 rural villages over three winter seasons (2018–2019, 2019–2020, and 2021–2022). Outdoor PM_2.5 was continuously measured in all villages, and household (indoor) PM_2.5 was monitored for at least two months in a randomly selected ~30% subsample of homes. Missing data were handled using multiple imputation. We applied multivariable mixed effects regression models to estimate within- and between-individual effects of PM_2.5 on grip strength, adjusting for demographic, behavioral, and health-related covariates. Results: Wintertime household and outdoor PM_2.5 concentrations ranged from 3 to 431 μg/m³ (mean = 80 μg/m³) and 8 to 100 μg/m³ (mean = 49 μg/m³), respectively. The effect of a 10 μg/m³ within-individual increase in household and outdoor PM_2.5 on maximum grip strength was 0.06 kg (95%CI: −0.01, 0.12 kg) and 1.51 kg (95%CI: 1.35, 1.68 kg), respectively. The household PM_2.5 effect attenuated after adjusting for outdoor PM_2.5, while outdoor PM_2.5 effects remained robust across sensitivity analyses. We found little evidence of between-individual effects. Conclusions: We did not find strong evidence of an adverse effect of household PM_2.5 on grip strength. The unexpected positive effects of outdoor PM_2.5 on grip strength may reflect transient physiological changes following short-term exposure. However, these findings should not be interpreted as evidence of protective effects of air pollution on aging. Rather, they highlight the complexity of air pollution’s health impacts and the value of longitudinal data in capturing time-sensitive effects. Further research is needed to better understand these patterns and their implications in high-exposure settings. Full article

(This article belongs to the Section Environmental Health)

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6 pages, 249 KiB

Open AccessBrief Report

Do Medical Students Suffer from Chronic Diseases? A Secondary Cross-Sectional Analysis of a Medical School in Portugal

by Filipe Prazeres, Diogo Maia and Marta Duarte

Int. J. Environ. Res. Public Health 2025, 22(8), 1282; https://doi.org/10.3390/ijerph22081282 - 16 Aug 2025

Viewed by 242

Abstract

Background/Objectives: There is still debate about students’ health in medical schools. The aim of this study was to assess the proportion of chronic diseases among medical students and analyze their predictors. Methods: We performed a secondary cross-sectional analysis using a database from a [...] Read more.

Background/Objectives: There is still debate about students’ health in medical schools. The aim of this study was to assess the proportion of chronic diseases among medical students and analyze their predictors. Methods: We performed a secondary cross-sectional analysis using a database from a single Portuguese university. The sociodemographic/clinical variables of 309 medical students were included. Logistic regression was performed to ascertain the effects of sex, age, medical course year, financial situation, and family history of chronic diseases on the likelihood of medical students having chronic disease. Results: Median age (Q1, Q3) was 21 (17, 43) years, with females comprising 79.9% of the sample. The distribution of students by school year was similar. The majority (65.7%) reported having sufficient money. Twenty-three percent suffered from chronic disease, and around forty percent had parents or siblings with chronic disease. In the regression model, only a family history of chronic disease was associated with a personal history of chronic disease. Medical students with parents or siblings who have a chronic disease are 3.3 times more likely to have a chronic disease themselves. Conclusions: Future interventions targeting the medical student population will be needed in Portugal to reduce the prevalence and burden of chronic diseases, particularly among those with a positive family history. Full article

(This article belongs to the Special Issue Multimorbidity in Primary Care: Prevalence, Management, and Health System Challenges)

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Int. J. Environ. Res. Public Health, Volume 22, Issue 8 (August 2025) – 153 articles

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