International Journal of Environmental Research and Public Health

9 pages, 438 KiB

Open AccessArticle

Maternal Satisfaction with Perinatal Care and Breastfeeding at 6 Months Postpartum

by Caitlin M. Dressler, Karina M. Shreffler, Ingrid R. Wilhelm, Jameca R. Price and Karen P. Gold

Int. J. Environ. Res. Public Health 2025, 22(8), 1246; https://doi.org/10.3390/ijerph22081246 (registering DOI) - 9 Aug 2025

Abstract

Positive childbirth experiences increase breastfeeding in the early postpartum period. Using a diverse, clinic-based sample of predominately low-income women (n = 118) recruited at their first prenatal appointment in 2017–2018 and followed through six months postpartum, binary logistic regression analyses were used to [...] Read more.

Positive childbirth experiences increase breastfeeding in the early postpartum period. Using a diverse, clinic-based sample of predominately low-income women (n = 118) recruited at their first prenatal appointment in 2017–2018 and followed through six months postpartum, binary logistic regression analyses were used to examine the association between maternal satisfaction with perinatal care measured two weeks postpartum and breastfeeding at six months postpartum. Participants reported high satisfaction with perinatal care overall (mean = 25.7; range of 6–30), and 25% of participants reported breastfeeding at six months postpartum. Regression results found that greater satisfaction with perinatal care is associated with higher odds of breastfeeding at six months postpartum (OR = 1.19; p < 0.05), controlling for sociodemographic characteristics. These findings that have important implications for providers as they identify a group at risk for shorter breastfeeding duration: those who are less satisfied with their perinatal care. More research is needed to identify methods providers can use to increase satisfaction with care as well as to successfully encourage and assist mothers with breastfeeding despite challenges that might arise during pregnancy or childbirth that are associated with low satisfaction. Full article

(This article belongs to the Special Issue Advances in Maternal and Family Mental Health: Relational, Clinical, and Systemic Approaches Across the Reproductive and Perinatal Spectrum)

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15 pages, 1221 KiB

Open AccessArticle

Benefits of Multimodal Exercise Intervention for BDNF and Cytokines Levels, Cognitive Function, and Motor Functionality in Alzheimer’s Disease: A Preliminary Study

by Emmanuel Dias de Sousa Lopes, Flávia Gomes de Melo Coelho, Sheilla Tribess, Jonatas da Silva Catarino, Bruno Naves Ferreira, Marina de Melo Reis, Antônio Ribeiro Neto, Carlo José Freire Oliveira and Jair Sindra Virtuoso Júnior

Int. J. Environ. Res. Public Health 2025, 22(8), 1245; https://doi.org/10.3390/ijerph22081245 (registering DOI) - 9 Aug 2025

Abstract

Background: Physical exercise has been linked to improvements in motor and cognitive functions as well as to the modulation of neurotrophic and inflammatory factors, particularly in older adults. This aim of this study was to investigate the effects of a 12-week multimodal exercise [...] Read more.

Background: Physical exercise has been linked to improvements in motor and cognitive functions as well as to the modulation of neurotrophic and inflammatory factors, particularly in older adults. This aim of this study was to investigate the effects of a 12-week multimodal exercise program on cognitive function, motor performance, and plasma levels of brain-derived neurotrophic factor (BDNF) and cytokines in elderly individuals with Alzheimer’s disease (AD). Methods: A non-randomized controlled trial design was employed, involving 23 participants aged 62 to 85 years diagnosed with mild to moderate AD. The intervention group (n = 7) attended 60-minute sessions three times per week, incorporating aerobic, strength, flexibility, and motor coordination exercises, while the control group (n = 8) maintained usual activities. Methods: A non-randomized controlled trial design was used, involving 23 participants aged 62 to 85 years. Of these, 15 had a clinical diagnosis of mild to moderate AD and were allocated to either an intervention group (n = 7) or and AD control group (n = 8). The remaining eight participants were cognitively healthy and formed a control group matched for age and sex, used exclusively for baseline comparisons. The intervention group participated in 60-minute sessions three times per week, including aerobic, strength, flexibility, and motor coordination exercises. The AD control group (n = 8) maintained their usual daily routines. Results: Compared to baseline, the intervention group demonstrated significant improvements in executive and attentional functions, as measured by the Frontal Assessment Battery (FAB) and Clock Drawing Test (CDT); mobility, balance, gait speed, and lower limb strength also improved (p < 0.05). Additionally, plasma BDNF levels increased significantly, and interleukin-2 (IL-2) levels decreased. Conclusions: In conclusion, the multimodal exercise program resulted in cognitive and motor benefits and positively modulated biomarkers related to neuroplasticity and inflammation, supporting its potential as a complementary intervention in elderly individuals with AD. Full article

(This article belongs to the Special Issue Physical Activity Promotion and Exercise Intervention for Persons with Chronic Disease)

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22 pages, 812 KiB

Open AccessReview

Use of the Hypertension Self-Care Profile: A Scoping Review

by Hae-Ra Han, Chitchanok Benjasirisan, Faith E. Metlock, Yordanos Tesfai and Yvonne Commodore-Mensah

Int. J. Environ. Res. Public Health 2025, 22(8), 1244; https://doi.org/10.3390/ijerph22081244 - 8 Aug 2025

Abstract

Self-care is a critical component of chronic disease management and is linked to better health outcomes. The Hypertension Self-Care Profile (HBP SCP) is one of the few validated instruments designed to assess not only behaviors but also self-efficacy and motivation in HBP self-care. [...] Read more.

Self-care is a critical component of chronic disease management and is linked to better health outcomes. The Hypertension Self-Care Profile (HBP SCP) is one of the few validated instruments designed to assess not only behaviors but also self-efficacy and motivation in HBP self-care. This scoping review synthesized published research using the HBP SCP to examine its scope and utility across diverse populations. A total of 48 studies were reviewed—34 non-validation studies and 14 validation studies—spanning regions including Asia, the Middle East, and the Americas. The HBP SCP showed strong psychometric performance across multiple cultural adaptations, with Cronbach’s alpha values ranging from 0.73 to 0.99. Several correlates of HBP self-care emerged, including self-efficacy, social support, health literacy, and education. Findings also revealed that HBP self-care remains suboptimal, particularly among rural populations and low- and middle-income countries. The HBP SCP has proven to be a versatile and culturally adaptable instrument for evaluating HBP self-care behaviors, self-efficacy, and motivation. Its consistently demonstrated validity and reliability across diverse contexts, combined with its responsiveness in randomized controlled trials, affirm its value as both a clinical assessment tool and a research outcome measure in interventions aimed at improving cardiovascular health. Full article

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18 pages, 970 KiB

Open AccessArticle

Residential Outdoor Environments for Individuals with Multiple Chemical Sensitivity (MCS)

by Emilia Danuta Lausen, Marina Bergen Jensen and Victoria Linn Lygum

Int. J. Environ. Res. Public Health 2025, 22(8), 1243; https://doi.org/10.3390/ijerph22081243 - 8 Aug 2025

Abstract

Severe sensitivity to various environmental chemicals affects an increasing number of people—a condition referred to as Multiple Chemical Sensitivity (MCS). The responses are both physical and psychological, where avoidance of chemical triggers can lead to social isolation, thereby increasing the level of disability. [...] Read more.

Severe sensitivity to various environmental chemicals affects an increasing number of people—a condition referred to as Multiple Chemical Sensitivity (MCS). The responses are both physical and psychological, where avoidance of chemical triggers can lead to social isolation, thereby increasing the level of disability. There is a need for user supportive environments where people with MCS can thrive, both indoors and outdoors. The study resulted in three principles for designing outdoor housing areas: (1) using spatial analysis to create a site layout that minimizes exposure to external and confounding triggers (e.g., noise, visual disturbances); (2) using zoning to clearly delineate private from semi-private areas; and (3) selecting vegetation and materials carefully to avoid triggers. The principles were developed in an iterative process based on existing research combined with a survey involving 58 MCS respondents. Full article

(This article belongs to the Special Issue Healthy and Resilient Cities: Urban Spatial Planning, Design and Governance)

19 pages, 322 KiB

Open AccessArticle

Health Inequalities in Primary Care: A Comparative Analysis of Climate Change-Induced Expansion of Waterborne and Vector-Borne Diseases in the SADC Region

by Charles Musarurwa, Jane M. Kaifa, Mildred Ziweya, Annah Moyo, Wilfred Lunga and Olivia Kunguma

Int. J. Environ. Res. Public Health 2025, 22(8), 1242; https://doi.org/10.3390/ijerph22081242 - 8 Aug 2025

Abstract

Climate change has magnified health disparities across the Southern African Development Community (SADC) region by destabilizing the critical natural systems, which include water security, food production, and disease ecology. The IPCC (2007) underscores the disproportionate impact on low-income populations characterized by limited adaptive [...] Read more.

Climate change has magnified health disparities across the Southern African Development Community (SADC) region by destabilizing the critical natural systems, which include water security, food production, and disease ecology. The IPCC (2007) underscores the disproportionate impact on low-income populations characterized by limited adaptive capacity, exacerbating existing vulnerabilities. Rising temperatures, erratic precipitation patterns, and increased frequency of extreme weather events ranging from prolonged droughts to catastrophic floods have created favourable conditions for the spread of waterborne diseases such as cholera, dysentery, and typhoid, as well as the expansion of vector-borne diseases zone also characterized by warmer and wetter conditions where diseases like malaria thrives. This study employed a comparative analysis of climate and health data across Malawi, Zimbabwe, Mozambique, and South Africa examining the interplay between climatic shifts and disease patterns. Through reviews of national surveillance reports, adaptation policies, and outbreak records, the analysis reveals the existence of critical gaps in preparedness and response. Zimbabwe’s Matabeleland region experienced a doubling of diarrheal diseases in 2019 due to drought-driven water shortages, forcing communities to rely on unsafe alternatives. Mozambique faced a similar crisis following Cyclone Idai in 2019, where floodwaters precipitated a threefold surge in cholera cases, predominantly affecting children under five. In Malawi, Cyclone Ana’s catastrophic flooding in 2022 contaminated water sources, leading to a devastating cholera outbreak that claimed over 1200 lives. Meanwhile, in South Africa, inadequate sanitation in KwaZulu-Natal’s informal settlements amplified cholera transmission during the 2023 rainy season. Malaria incidence has also risen in these regions, with warmer temperatures extending the geographic range of Anopheles mosquitoes and lengthening the transmission seasons. The findings underscore an urgent need for integrated, multisectoral interventions. Strengthening disease surveillance systems to incorporate climate data could enhance early warning capabilities, while national adaptation plans must prioritize health resilience by bridging gaps between water, agriculture, and infrastructure policies. Community-level interventions, such as water purification programs and targeted vector control, are essential to reduce outbreaks in high-risk areas. Beyond these findings, there is a critical need to invest in longitudinal research so as to elucidate the causal pathways between climate change and disease burden, particularly for understudied linkages like malaria expansion and urbanization. Without coordinated action, climate-related health inequalities will continue to widen, leaving marginalized populations increasingly vulnerable to preventable diseases. The SADC region must adopt evidence-based, equity-centred strategies to mitigate these growing threats and safeguard public health in a warming world. Full article

(This article belongs to the Special Issue Health Inequalities in Primary Care)

31 pages, 513 KiB

Open AccessReview

The Intersection of Socioeconomic and Environmental Factors in Aging: Insights from a Narrative Review

by Shelby Vereecke, Kalia Bennett, Stephanie Schrempft, Michael Kobor, Michael Brauer and Silvia Stringhini

Int. J. Environ. Res. Public Health 2025, 22(8), 1241; https://doi.org/10.3390/ijerph22081241 - 8 Aug 2025

Abstract

(1) Background: Socioeconomic conditions and environmental exposures are well-established determinants of health and aging, yet the pathways through which they influence the aging process remain insufficiently understood. Clarifying these mechanisms is critical for developing effective, equity-focused public health interventions to support healthy aging; [...] Read more.

(1) Background: Socioeconomic conditions and environmental exposures are well-established determinants of health and aging, yet the pathways through which they influence the aging process remain insufficiently understood. Clarifying these mechanisms is critical for developing effective, equity-focused public health interventions to support healthy aging; (2) Methods: We conducted a narrative review examining the relationships between socioeconomic conditions, environmental exposures, and aging-related health outcomes. While the scope was intentionally broad to capture diverse exposures and outcomes, we applied a systematic search strategy to identify relevant peer-reviewed studies; (3) Results: The search populated over 4000 articles; 33 relevant papers were selected. The evidence suggests that environmental exposures may mediate or modify the effects of socioeconomic disadvantage on aging. Conversely, socioeconomic conditions can alter the association between environmental factors and aging outcomes. Disadvantaged populations consistently face higher environmental burdens and exhibit poorer aging outcomes, including accelerated biological aging and increased risk of age-related disease; (4) Conclusions: The complex interplay between social and environmental factors contributes to disparities in aging. Our integrative approach highlights the need for more intersectional, longitudinal research to inform interventions that address the social and environmental determinants of healthy aging. Full article

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9 pages, 266 KiB

Open AccessArticle

Residential and School Food Swamps and Overweight in Children and Adolescents: A Cross-Sectional Analysis in Urban Brazil

by Ingrid Werneck Linhares, Paula Martins Horta, Ariene Silva do Carmo, Luana Lara Rocha, Mariana Zogbi Jardim, Olivia Souza Honório and Larissa Loures Mendes

Int. J. Environ. Res. Public Health 2025, 22(8), 1240; https://doi.org/10.3390/ijerph22081240 - 8 Aug 2025

Abstract

The community food environment, which encompasses residential and school neighborhoods, is an important determinant of overweight in children and adolescents. This study aimed to investigate the relationship between the co-occurrence of food swamps in residential and school environments and overweight status. This cross-sectional [...] Read more.

The community food environment, which encompasses residential and school neighborhoods, is an important determinant of overweight in children and adolescents. This study aimed to investigate the relationship between the co-occurrence of food swamps in residential and school environments and overweight status. This cross-sectional study included 2601 children and adolescents (aged 5–14 years) from 47 schools in a medium-sized municipality in Brazil. The outcome was overweight status, defined as body mass index for age exceeding the mean by at least one z-score. Food swamps in residential and school surroundings were defined as buffers of 250 m with four or more establishments selling ultra-processed foods. The prevalence of being overweight was 30.4%. Food swamps were present in 22.5% and 22% of the residential and school areas, respectively, and 16.2% of the participants were exposed to food swamps in both residential and school environments. Children and adolescents simultaneously exposed to food swamps in both residential and school areas had a higher likelihood of being overweight (odds ratio: 1.22; 95% confidence interval: 1.02–1.45). The simultaneous presence of food swamps in residential and school environments is associated with overweight in children and adolescents. Full article

32 pages, 1194 KiB

Open AccessReview

Health and Safety Practices as Drivers of Business Performance in Informal Street Food Economies: An Integrative Review of Global and South African Evidence

by Maasago Mercy Sepadi and Tim Hutton

Int. J. Environ. Res. Public Health 2025, 22(8), 1239; https://doi.org/10.3390/ijerph22081239 - 8 Aug 2025

Abstract

Background: Street food vending provides vital employment and nutrition in low- and middle-income countries (LMICs), but poor health and safety compliance pose significant public health and business risks. Despite growing policy recognition, the link between hygiene practices and vendor performance remains underexplored. Objective: [...] Read more.

Background: Street food vending provides vital employment and nutrition in low- and middle-income countries (LMICs), but poor health and safety compliance pose significant public health and business risks. Despite growing policy recognition, the link between hygiene practices and vendor performance remains underexplored. Objective: This integrative review examines the influence of health and safety practices on the business performance of informal street food vendors, with a particular focus on both global and South African contexts. Methods: A total of 76 studies published between 2015 and 2025 were retrieved between June 2024 and May 2025 and analyzed using an integrative review methodology. Sources were identified through five major academic databases and grey literature repositories. Thematic synthesis followed PRISMA logic and was guided by the Health Belief Model (HBM) and Balanced Scorecard (BSC) frameworks. Results: There was a marked increase in publications post-2019, peaking in 2023. Sub-Saharan Africa accounted for the majority of studies, with South Africa (28%) and Ghana (14%) most represented. Among the 76 included studies, the most common designs were quantitative (38%), followed by qualitative (20%), case studies (14%), and mixed-methods (11%), reflecting a predominantly empirical and field-based evidence base. Thematic analysis showed that 26% of studies focused on food safety knowledge and practices, 14% focused on infrastructure gaps, and 13% focused on policy and regulatory challenges. Of the 76 studies included, 73% reported a positive relationship between hygiene compliance and improved business performance (such as customer trust, revenue, and operational resilience), based on vote-counting across qualitatively synthesized results and business outcomes. The review identifies a conceptual synergy between the HBM’s cues to action and the BSC’s customer dimension, highlighting how hygiene compliance simultaneously influences vendor behaviour and consumer trust. Conceptual saturation was observed in themes related to hygiene protocols, consumer trust indicators, and regulatory barriers. Conclusions: Health and safety practices function not only as compliance imperatives but also as strategic assets in the informal food economy. However, widespread adoption is impeded by structural barriers including limited infrastructure, education gaps, and uneven regulatory enforcement. The findings call for context-sensitive policy interventions and public health models that align with vendor realities and support sustainable, safe, and competitive informal food systems. Full article

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10 pages, 1010 KiB

Open AccessArticle

Welding Fume in the Western Australian Mining Industry: Impact of a Change to the Workplace Exposure Standard

by Matthew Oosthuizen, Kerry Staples, Adelle Liebenberg, Kiam Padamsey, Marcus Cattani, Andy McCarthy and Jacques Oosthuizen

Int. J. Environ. Res. Public Health 2025, 22(8), 1238; https://doi.org/10.3390/ijerph22081238 - 8 Aug 2025

Abstract

The aim of this study was to analyse the Western Australian (WA) Safety Regulatory System (SRS) database to assess compliance of the WA mining sector regarding workers exposure to welding fumes and to identify trends over time. De-identified data analysed to assess the [...] Read more.

The aim of this study was to analyse the Western Australian (WA) Safety Regulatory System (SRS) database to assess compliance of the WA mining sector regarding workers exposure to welding fumes and to identify trends over time. De-identified data analysed to assess the impact of reducing workplace exposure standards (WES) for general welding fumes on industry compliance. Historical trend analysis shows a shift from 100% compliance to 100% non-compliance, based on mean values and 95% confidence intervals, with exposure levels remaining consistent over time. These findings highlight the need for current, innovative engineering solutions, and raise questions about the validity of current sampling methods. Powered air-purifying respirators (PAPRs) integrated with welding helmets can reduce exposures by up to 99.96%, making their adoption as industry best practice critical, yet current sampling methodologies measure welding fume levels outside PAPRs, thus potentially misclassifying workers who are adequately protected as non-compliant. The sampling method is also influenced by other particulate matter present in the workplace that may be due to grinding or other dust generating activities in the vicinity of the welder. Lower WES values necessitate a review of exposure assessment and reporting methods to accurately reflect worker exposures. Full article

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12 pages, 580 KiB

Open AccessArticle

Weight Misperception, Weight Dissatisfaction, and Weight Change Among a Swiss Population-Based Adult Sample

by Lucy Manca and Pedro Marques-Vidal

Int. J. Environ. Res. Public Health 2025, 22(8), 1237; https://doi.org/10.3390/ijerph22081237 - 8 Aug 2025

Abstract

Background/Objectives: We investigated the effect of weight misperception or dissatisfaction among individuals of normal BMI on their long-term weight changes. Methods: Data from the three follow-ups of the CoLaus|PsyCoLaus study (2009–2012, 2014–2017, and 2018–2021) conducted in Lausanne, Switzerland. Participants with a BMI < [...] Read more.

Background/Objectives: We investigated the effect of weight misperception or dissatisfaction among individuals of normal BMI on their long-term weight changes. Methods: Data from the three follow-ups of the CoLaus|PsyCoLaus study (2009–2012, 2014–2017, and 2018–2021) conducted in Lausanne, Switzerland. Participants with a BMI < 25 kg/m² were eligible. Weight misperception/dissatisfaction was assessed by questionnaires. Weight change over a 5- or 10-year period was categorized as stable (±5 kg), loss (<−5 kg), or gain (>+5 kg). Results: Overall, 1826 (66.1% women, 55.9 ± 9.9 years) and 1089 (62.7% women, 61.2 ± 9.6 years) participants of surveys 2009–2012 and 2014–2017, respectively, were retained for analysis. Prevalence of weight misperception was 15.9% (95% CI: 14.2–17.6) and 11.5% (95% CI: 9.6–13.5) in 2009–2012 and 2014–2017, respectively. The corresponding values for weight dissatisfaction were 28.9% (95% CI: 26.8–31.0) and 20.9% (95% CI: 18.6–23.5). After multivariable analysis, participants with weight misperception/dissatisfaction had a higher likelihood (p < 0.05) of presenting with weight loss: for weight misperception, odds ratio and 95% CI: 2.29 (1.30–4.02) and 2.66 (1.24–5.69) for 2009–2012 and 2014–2017, respectively; the corresponding values for weight dissatisfaction were 2.02 (1.22–3.35) and 2.40 (1.23–4.65). No associations between weight misperception/dissatisfaction with weight gain were found. Conclusions: Our study found that weight misperception/dissatisfaction in normal-weight, middle-aged individuals was associated with weight loss over time. Full article

13 pages, 567 KiB

Open AccessArticle

Psychosocial Impact of the COVID-19 Pandemic Among Omanis with Multiple Sclerosis: Single Tertiary Center Experience

by Jihad Yaqoob Ali Al Kharbooshi, Abdullah Al-Asmi, Ronald Wesonga, Samir Al Adawi and Amal S. S. Al-Fahdi

Int. J. Environ. Res. Public Health 2025, 22(8), 1236; https://doi.org/10.3390/ijerph22081236 - 7 Aug 2025

Abstract

(1) Background: The COVID-19 pandemic presented unprecedented challenges for people with multiple sclerosis (PwMS) in Oman, necessitating targeted healthcare planning and patient support. This study aimed to investigate the impact of COVID-19 on MS management and disease course, incidence, and outcomes of COVID-19, [...] Read more.

(1) Background: The COVID-19 pandemic presented unprecedented challenges for people with multiple sclerosis (PwMS) in Oman, necessitating targeted healthcare planning and patient support. This study aimed to investigate the impact of COVID-19 on MS management and disease course, incidence, and outcomes of COVID-19, psychosocial and mental health effects of the pandemic, and demographic and clinical predictors of the effects related to COVID-19 among Omani PwMS. (2) Methods: This cross-sectional study was conducted from January to April 2021. Adult (18–60 years) Omani PwMS completed a structured interview along with the Expanded Disability Status Scale (EDSS) and World Health Organization Well-being Index (WHO-5). Clinical data on relapses and disease-modifying therapies and adherence were analyzed. The data was statistically analyzed. (3) Results: Of 104 PwMS (73.1% female), 22.1% contracted COVID-19, with fatigue being the most reported symptom (87%). Female sex (p = 0.042), younger age (18–34 vs. 35–45 years; p = 0.014), diagnosis of COVID-19 (p = 0.037), and low current mental well-being scores (p = 0.021) predicted greater COVID-19-related effects. (4) Conclusion: These findings highlight the need to study the mental resilience of this subgroup of PwMS and provide them with targeted support during crises. Full article

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14 pages, 514 KiB

Open AccessCase Report

Thallium Exposure Secondary to Commercial Kale Chip Consumption: California Case Highlights Opportunities for Improved Surveillance and Toxicological Understanding

by Asha Choudhury, Jefferson Fowles, Russell Bartlett, Mark D. Miller, Timur Durrani, Robert Harrison and Tracy Barreau

Int. J. Environ. Res. Public Health 2025, 22(8), 1235; https://doi.org/10.3390/ijerph22081235 - 7 Aug 2025

Abstract

Background: Thallium is a metal that is ubiquitous in our natural environment. Despite its potential for high toxicity, thallium is understudied and not regulated in food. The California Department of Public Health was alerted to a household cluster of elevated urine thallium levels [...] Read more.

Background: Thallium is a metal that is ubiquitous in our natural environment. Despite its potential for high toxicity, thallium is understudied and not regulated in food. The California Department of Public Health was alerted to a household cluster of elevated urine thallium levels noted among a mother (peak 5.6 µg/g creatinine; adult reference: ≤0.4 µg/g creatinine) and her three young children (peak 10.5 µg/g creatinine; child reference: ≤0.8 µg/g creatinine). Objectives: This case report identifies questions raised after a public health investigation linked a household’s thallium exposure to a commercially available food product. We provide an overview of the public health investigation. We then explore concerns, such as gaps in toxicological data and limited surveillance of thallium in the food supply, which make management of individual and population exposure risks challenging. Methods: We highlight findings from a cross-agency investigation, including a household exposure survey, sampling of possible environmental and dietary exposures (ICP-MS analysis measured thallium in kale chips at 1.98 mg/kg and 2.15 mg/kg), and monitoring of symptoms and urine thallium levels after the source was removed. We use regulatory and research findings to describe the challenges and opportunities in characterizing the scale of thallium in our food supply and effects of dietary exposures on health. Discussion: Thallium can bioaccumulate in our food system, particularly in brassica vegetables like kale. Thallium concentration in foods can also be affected by manufacturing processes, such as dehydration. We have limited surveillance data nationally regarding this metal in our food supply. Dietary reviews internationally show increased thallium intake in toddlers. Limited information is available about low-dose or chronic exposures, particularly among children, although emerging evidence shows that there might be risks associated at lower levels than previously thought. Improved toxicological studies are needed to guide reference doses and food safety standards. Promising action towards enhanced monitoring of thallium is being pursued by food safety agencies internationally, and research is underway to deepen our understanding of thallium toxicity. Full article

(This article belongs to the Section Environmental Health)

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11 pages, 255 KiB

Open AccessArticle

Prevalence and Factors Associated with HIV Testing Among Women of Reproductive Age in Liberia: A Cross-Sectional Study from the 2019/20 Demographic and Health Survey

by Mapei Mary Anna Kolane and Lumbani Tshotetsi

Int. J. Environ. Res. Public Health 2025, 22(8), 1234; https://doi.org/10.3390/ijerph22081234 - 7 Aug 2025

Abstract

Objective: This study explored HIV testing prevalence and its associated factors among reproductive-aged women in Liberia. Study Design: A secondary and descriptive cross-sectional study was performed among Liberian women aged 15–49 years using the 2019 Liberia Demographic and Health Survey (LDHS) data set. [...] Read more.

Objective: This study explored HIV testing prevalence and its associated factors among reproductive-aged women in Liberia. Study Design: A secondary and descriptive cross-sectional study was performed among Liberian women aged 15–49 years using the 2019 Liberia Demographic and Health Survey (LDHS) data set. Methods: Descriptive statistics were used to describe the characteristics of these women. Bivariate and multivariable logistic regression models were applied to determine factors associated with HIV testing. All analyses were adjusted for unequal probabilities of selection and non-response by use of survey weights. Results: Among the 8065 participants in this survey, 490 women had never had sex and were excluded, leading to the final sample size being 7575 women. The prevalence of HIV testing among Liberian women aged 15 to 49 years in 2020 was 57.17% (95% CI: 56.2 to 60.4). HIV testing among these women is associated with pregnancy history (aOR 6.40, 95% CI:4.99 to 8.22, p < 0.001), STI history (aOR 1.21, 95% CI:1.02 to 3.19, p < 0.001), knowledge of vertical transmission (aOR 1.65, 95% CI:1.23 to 2.21, p = 0.001), and highest educational level (primary (aOR 1.39, 95% CI:1.16 to 1.68, p < 0.001), secondary (aOR 2.10, 95% CI:1.73 to 2.53, p < 0.001), and higher education (aOR 6.80, 95% CI:3.75 to 12.32, p < 0.001)). Conclusions and Contribution: HIV testing prevalence of 57.17% demonstrates an unmet need for HIV testing among Liberian women aged 15 to 49 years and, thus, it is recommended that HIV testing and counseling services should mostly target these women in rural areas, with limited health services and less educated women. Full article

(This article belongs to the Special Issue HIV/AIDS Testing and Prevention)

24 pages, 813 KiB

Open AccessArticle

Youth Exposed to Armed Conflict: The Homeroom Teacher as a Protective Agent Promoting Student Resilience

by Lia Shur-Kraspin, Michelle Slone and Yaniv Kanat-Maymon

Int. J. Environ. Res. Public Health 2025, 22(8), 1233; https://doi.org/10.3390/ijerph22081233 - 7 Aug 2025

Abstract

Armed conflict poses a significant threat to the mental health of youth worldwide. This study focused on the role of teachers as protective agents fostering resilience among their students. The study examined the moderating effects of teachers’ personal well-being and their efficacy in [...] Read more.

Armed conflict poses a significant threat to the mental health of youth worldwide. This study focused on the role of teachers as protective agents fostering resilience among their students. The study examined the moderating effects of teachers’ personal well-being and their efficacy in the school on relations between their students’ armed conflict exposure and student psychiatric symptoms. Participants included 1260 students and their homeroom teachers from 62 8–11th grade classes. Using self-report standardized measures, teachers reported their life satisfaction and sense of efficacy while students reported their armed conflict exposure and psychiatric symptoms. Data were analyzed using a multilevel modeling (MLM) approach. Findings revealed positive correlations between student armed conflict exposure and psychiatric symptoms. In the between-class level of analysis, teacher personal life satisfaction and efficacy in participation in the school system emerged as protective factors for the students, significantly moderating relations between student exposure and their psychiatric symptoms. However, teacher efficacy in class management showed no significant moderating effect on student mental-health difficulties. Results highlight the importance of supporting teachers in conflict-affected environments and emphasize the need for preventive and therapeutic initiatives that prioritize teacher well-being and organizational resources to enhance teachers’ capacity to foster student resilience. Full article

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

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15 pages, 1973 KiB

Open AccessArticle

Infrastructure as Environmental Health Policy: Lessons from the Clean School Bus Program’s Challenges and Innovations

by Uchenna Osia, Bethany B. Cutts, Kristi Pullen Fedinick and Kofi Boone

Int. J. Environ. Res. Public Health 2025, 22(8), 1232; https://doi.org/10.3390/ijerph22081232 - 7 Aug 2025

Abstract

This study evaluates the 2022 rollout of the Clean School Bus Rebate Program (CSBRP) to understand how eligibility rules and data practices shape funding distribution across communities with varying needs. We ask whether more accurate maps can improve environmental funding outcomes or whether [...] Read more.

This study evaluates the 2022 rollout of the Clean School Bus Rebate Program (CSBRP) to understand how eligibility rules and data practices shape funding distribution across communities with varying needs. We ask whether more accurate maps can improve environmental funding outcomes or whether challenges stem from how agencies define and apply eligibility criteria. Using logistic regression and dasymetric mapping, we find that prioritization criteria helped direct funds to underserved areas, but reliance on school district boundaries introduced inconsistencies that affected program reach. Including charter schools as independent applicants increased competition and sometimes diverted funds from larger public systems serving more. Our geospatial analysis shows that while refined mapping approaches improve resource targeting and reduce goal-outcome mismatches, agency discretion and administrative rules remain key factors in ensuring equitable outcomes. Full article

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12 pages, 443 KiB

Open AccessReview

Comprehensive Communication for a Syndemic Approach to HIV Care: A Framework for Enhancing Health Communication Messages for People Living with HIV

by Sarah E. Sheff, Vanessa Boudewyns, Jocelyn Coleman Taylor, Hannah Getachew-Smith, Nivedita L. Bhushan and Jennifer D. Uhrig

Int. J. Environ. Res. Public Health 2025, 22(8), 1231; https://doi.org/10.3390/ijerph22081231 - 7 Aug 2025

Abstract

Despite the increasing adoption of a syndemic approach in HIV research, few health communication campaigns have used a syndemic approach in messaging to improve health outcomes for persons living with HIV (PWH). This paper introduces a framework for practitioners and researchers developing health [...] Read more.

Despite the increasing adoption of a syndemic approach in HIV research, few health communication campaigns have used a syndemic approach in messaging to improve health outcomes for persons living with HIV (PWH). This paper introduces a framework for practitioners and researchers developing health communication messages in support of a syndemic approach to HIV care for PWH in the United States. Grounded in insights from a review of counseling and psychosocial interventions that demonstrated significant positive effects on HIV clinical outcomes, the C4H Framework emphasizes four components: compassion, comprehensive messaging, capacity-building, and coordination. Compassion ensures that messages resonate with individuals experiencing the intertwined challenges of HIV, substance abuse, and mental health issues. Comprehensive messaging integrates a holistic view of the barriers faced by PWH. Capacity-building empowers individuals to effectively engage with and act upon health information. Coordination promotes alignment between stakeholders and resources to ensure consistent and supportive messaging. The C4H Framework bridges the gap between research and practice, offering a foundation for crafting effective communication messages that resonate with individuals facing the complex challenges inherent in HIV syndemics. Future research should explicitly test the effectiveness and acceptability of messages developed using the C4H Framework with people living with HIV. Full article

(This article belongs to the Special Issue A Global Call for Research Addressing Syndemics of Substance Use, Mental Health, and Structural Determinants in Disparities Related to HIV/STI in Minoritized Populations)

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13 pages, 694 KiB

Open AccessArticle

COVID-19 Pandemic Experiences and Hazardous Alcohol Use: Findings of Higher and Lower Risk in a Heavy-Drinking Midwestern State

by Justinian Wurtzel, Paul A. Gilbert, Loulwa Soweid and Gaurab Maharjan

Int. J. Environ. Res. Public Health 2025, 22(8), 1230; https://doi.org/10.3390/ijerph22081230 - 7 Aug 2025

Abstract

This study assessed whether COVID-19 pandemic experiences were associated with excessive alcohol use during the first year of the pandemic in Iowa, a heavy-drinking midwestern US state. We analyzed survey data from 4047 adult residents of Iowa collected in August 2020, focusing on [...] Read more.

This study assessed whether COVID-19 pandemic experiences were associated with excessive alcohol use during the first year of the pandemic in Iowa, a heavy-drinking midwestern US state. We analyzed survey data from 4047 adult residents of Iowa collected in August 2020, focusing on three pandemic-related stressors (e.g., emotional reactions to the pandemic; disruption of daily activities; and financial hardship) and salient social support. Using multiple logistic regression, we tested correlates of increased drinking, heavy drinking, and binge drinking, controlling for demographic characteristics and health status. We found that nearly half (47.6%) of respondents did not change their drinking compared to before the pandemic; however, 12.4% of respondents reported increasing their drinking and 5.3% reported decreasing their drinking. Emotional reactions to the pandemic and disruption of daily activities were associated with higher odds of increased drinking, and rurality was associated with lower odds of increased drinking. No pandemic-related stressor was associated with heavy or binge drinking, but social support was associated with lower odds of binge drinking. Thus, we concluded that some pandemic-related stressors may explain increased drinking but not heavy or binge drinking. Understanding the nuances of alcohol use can inform preventive interventions, policy decisions, and preparations for future catastrophic events. Full article

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

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23 pages, 371 KiB

Open AccessArticle

Trauma and Activism: Using a Postcolonial Feminist Lens to Understand the Experiences of Service Providers Who Support Racialized Immigrant Women’s Mental Health and Wellbeing

by Judith A. MacDonnell, Mahdieh Dastjerdi, Nimo Bokore and Wangari Tharao

Int. J. Environ. Res. Public Health 2025, 22(8), 1229; https://doi.org/10.3390/ijerph22081229 - 7 Aug 2025

Abstract

The global Black Lives Matter movement and COVID-19 pandemic drew attention to the urgency of addressing entrenched structural dynamics such as racialization, gender, and colonization shaping health inequities for diverse racialized people. Canadian community-based research with racialized immigrant women recognized the need to [...] Read more.

The global Black Lives Matter movement and COVID-19 pandemic drew attention to the urgency of addressing entrenched structural dynamics such as racialization, gender, and colonization shaping health inequities for diverse racialized people. Canadian community-based research with racialized immigrant women recognized the need to enhance service provider capacity using a strengths-based activism approach to support client health and wellbeing. In this study, we aimed to understand the impacts of this mental health promotion practice on service providers and strategies to support them. Through purposeful convenience sampling, three focus groups were completed with 19 service providers working in settlement and mental health services in Toronto, Canada. Participants represented varied ethnicities and work experiences; most self-identified as female and racialized, with experiences living as immigrant women in Canada. Postcolonial feminist and critical mental health promotion analysis illuminated organizational and structural dynamics contributing to burnout and vicarious trauma that necessitate a focus on trauma- and violence-informed care. Transformative narratives reflected service provider resilience and activism, which aligned with and challenged mainstream biomedical approaches to mental health promotion. Implications include employing a postcolonial feminist lens to identify meaningful and comprehensive anti-oppression strategies that take colonialism, racialization, gender, and ableism and their intersections into account to decolonize nursing practices. Promoting health equity for diverse racialized women necessitates focused attention and multilevel anti-oppression strategies aligned with critical mental health promotion practices. Full article

(This article belongs to the Special Issue Immigrant and Refugee Mental Health Promotion)

19 pages, 897 KiB

Open AccessArticle

The Impact of Climate Change Awareness on Fertility Intentions in Palestinian Society: Mediating Role of Threat Perception

by Maryam W. Fasfous, Mohamed N. Abdel-Fattah and Sarah A. Ibrahim

Int. J. Environ. Res. Public Health 2025, 22(8), 1228; https://doi.org/10.3390/ijerph22081228 - 6 Aug 2025

Abstract

Fertility is considered a significant demographic concern, especially in relation to climate change. This study examines how awareness of climate change, measured by five subscales—climate-friendly behavior, knowledge, personal concern, attitude, and multiplicative action—affects fertility intentions, emphasizing the mediating role of threat perception. Data [...] Read more.

Fertility is considered a significant demographic concern, especially in relation to climate change. This study examines how awareness of climate change, measured by five subscales—climate-friendly behavior, knowledge, personal concern, attitude, and multiplicative action—affects fertility intentions, emphasizing the mediating role of threat perception. Data were collected through an online survey administered to a sample of 817 Palestinian citizens aged 18–49 residing in the West Bank. Structural equation modeling (SEM) was utilized for the data analysis. The results revealed that climate change awareness does not directly affect fertility intentions. However, an indirect effect of climate change awareness on fertility intentions was observed, mediated by threat perception as an intervening variable. Individuals exhibiting increased awareness of climate change and perceptions of future risks demonstrated a greater likelihood of reducing their fertility intentions compared to others. Policymakers in the Palestinian territories should prioritize enhancing public awareness regarding climate change and its associated short- and long-term threats. Therefore, incorporating climate education and associated risks into fertility health programs is essential. Full article

(This article belongs to the Special Issue Environmental Factors Impacting Reproductive and Perinatal Health)

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