International Journal of Environmental Research and Public Health

16 pages, 440 KiB

Open AccessEditor’s ChoiceArticle

The Contribution of Social and Structural Determinants of Health Deficits to Mental and Behavioral Health Among a Diverse Group of Young People

by Kimberly J. Mitchell, Victoria Banyard and Deirdre Colburn

Int. J. Environ. Res. Public Health 2025, 22(7), 1013; https://doi.org/10.3390/ijerph22071013 - 26 Jun 2025

Cited by 1 | Viewed by 457

Abstract

A growing knowledge base highlights the importance of accounting for a variety of social and structural determinants of health (SDOH) when understanding mental and behavioral health among adolescents and young adults. The objective of the current study is to examine patterns of self-reported [...] Read more.

A growing knowledge base highlights the importance of accounting for a variety of social and structural determinants of health (SDOH) when understanding mental and behavioral health among adolescents and young adults. The objective of the current study is to examine patterns of self-reported SDOH deficits and characterize participant health indicators and social identity across classes. Data is from a cross-sectional national study of young people who were recruited through study advertisements on social media and surveyed online. Data were collected between June 2022 and October 2023. Eligibility included (1) ages 13–22 years, (2) living in the United States, and (3) proficient in English. Health indicators included suicide attempts, suicidal ideation, drug overdose, perceived likelihood of living to age 35, non-suicidal self-injury, recent alcohol use, and depression. Five classes of SDOH deficits were identified: (1) Economic Instability, (2) Low Overall SDOH Deficits, (3) High Social SDOH Deficits (adversity and discrimination), (4) High Economic SDOH Deficits, and (5) High Overall SDOH Deficits. Differences across class by health indicators and marginalized identity were found, with high proportions of gender minority and sexual minority youth in both the High Overall SDOH Deficit group and the High Social SDOH Deficit classes. Black youth were more likely to be part of the High Economic SDOH Deficits class. The findings encourage a public health approach that recognizes that improving the health of today’s young people must be connected to policies that reduce poverty, improve neighborhoods, and increase access to basic goods, services, and healthcare. Full article

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

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26 pages, 1387 KiB

Open AccessEditor’s ChoiceArticle

Academic Self-Pressure and Physiological Responses in Adolescents: A Pilot Experimental Study on the Moderating Role of an Escape Room-Based Physical Activity Intervention on Cognitive and Academic Outcomes

by Francesca Latino, Domenico Tafuri and Francesco Tafuri

Int. J. Environ. Res. Public Health 2025, 22(6), 948; https://doi.org/10.3390/ijerph22060948 - 17 Jun 2025

Viewed by 775

Abstract

Academic self-pressure is a significant source of stress for students, with physiological and cognitive implications that can influence academic performance. This study investigated the impact of academic self-pressure on heart rate variability (HRV) and cognitive performance, exploring the moderating role of physical activity [...] Read more.

Academic self-pressure is a significant source of stress for students, with physiological and cognitive implications that can influence academic performance. This study investigated the impact of academic self-pressure on heart rate variability (HRV) and cognitive performance, exploring the moderating role of physical activity through an experimental intervention. A randomized controlled trial (RCT) was conducted on a sample of 50 secondary school students, divided into an experimental group and a control group. The intervention, lasting 16 weeks, integrated physical activity based on escape room challenges with the traditional school curriculum. The results show that the experimental group recorded a significant improvement in HRV, a reduction in perceived stress, and an increase in cognitive performance, working memory, and academic achievement. Correlational and regression analyses highlighted the key role of physiological stress regulation in academic success. The findings emphasize the potential of integrating movement-based learning activities, such as escape room interventions, into school curricula as an effective strategy to enhance students’ stress regulation, executive functioning, and academic performance. By improving physiological self-regulation and cognitive efficiency, this approach supports a more holistic educational model that addresses both academic outcomes and student well-being. These results suggest that incorporating physically active, cognitively engaging tasks into the classroom may foster resilience, motivation, and adaptive coping skills, offering practical value for educational policy and classroom practice. Full article

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16 pages, 320 KiB

Open AccessEditor’s ChoiceArticle

Determining Associations Between Levels of Ethylene Oxide Gas Exposure and Neurocognitive Performance for Older U.S. Adults

by Linda O’Kelley, Barbara Swanson, Jessica Bishop-Royse, Joyce W. Tam, Christopher Forsyth and Susan Buchanan

Int. J. Environ. Res. Public Health 2025, 22(6), 852; https://doi.org/10.3390/ijerph22060852 - 29 May 2025

Viewed by 583

Abstract

Ethylene oxide (EtO) gas is a widely used industrial chemical and known health hazard. Multiple studies have determined that EtO exposure can be measured via hemoglobin adduct levels, and EtO exposure increases the risk of cancer and neurocognitive deficits, especially with occupational exposure. [...] Read more.

Ethylene oxide (EtO) gas is a widely used industrial chemical and known health hazard. Multiple studies have determined that EtO exposure can be measured via hemoglobin adduct levels, and EtO exposure increases the risk of cancer and neurocognitive deficits, especially with occupational exposure. Emerging studies indicate that neighboring communities are also at risk. The purpose of this study is to explore the relationship of known covariates and EtO hemoglobin adduct levels to neurocognitive performance in older U.S. adults. This exploratory study drew its sample from the publicly available NHANES dataset. The 2013–2014 NHANES measured EtO exposure via hemoglobin adducts and the cognitive domain of neurocognitive function using the CERAD, Animal Fluency, and Digit Symbol Substitution (DSST) tests. Motor function was measured using grip strength. Participants were grouped into background (≤27.36 pmol/gHb) or elevated (>27.36 pmol/gHb) EtO exposure. Hierarchical linear regression, independent t-tests, and logistic regression analyses were performed. A total of 10,175 individuals were sampled: 489 were included in the cognitive analyses, and 436 were included in the motor analyss. Elevated EtO adduct levels significantly predicted low Animal Fluency, DSST, CERAD, and combined grip strength scores. Our findings are supported by the extant literature citing neurotoxic EtO exposure effects. Further study in known EtO-exposed communities is warranted. Full article

(This article belongs to the Special Issue Environmental and Occupational Health: Exposure to Volatile Organic Compounds (VOC) and Gases)

14 pages, 281 KiB

Open AccessEditor’s ChoiceArticle

DSM-5 Criteria for Alcohol and Cannabis Use Disorders: Are Older Adults Less Likely to Endorse Certain Criteria?

by Namkee G. Choi, Jeffrey A. Morris and C. Nathan Marti

Int. J. Environ. Res. Public Health 2025, 22(6), 843; https://doi.org/10.3390/ijerph22060843 - 28 May 2025

Viewed by 1356

Abstract

With increasing substance misuse among older adults, we examined the question of whether older adults may be less likely to endorse certain DSM-5 criteria for alcohol and cannabis use disorders (AUD and CUD). We used the 2021–2023 National Surveys on Drug Use and [...] Read more.

With increasing substance misuse among older adults, we examined the question of whether older adults may be less likely to endorse certain DSM-5 criteria for alcohol and cannabis use disorders (AUD and CUD). We used the 2021–2023 National Surveys on Drug Use and Health (N = 17,494 for AUD and N = 12,264 for CUD) and descriptive statistics to compare the 65+ and under 65 age groups in their endorsements of 11 DSM-5 criteria. A multivariable logistic regression model was fitted for each criterion as the dependent variable with the age group as the independent variable and other characteristics as covariates. For AUD, the 65+ age group was associated with lower odds of endorsing seven out of eleven DSM-5 criteria, including social impairments (e.g., failure to fulfill role obligations (aOR = 0.30, 95% CI = 0.16–0.56); social problems (aOR = 0.46, 95% CI = 0.30–0.71); given-up activities (aOR = 0.66, 95% CI = 0.47–0.94); hazardous use (aOR = 0.53, 95% Yes CI = 0.34–0.81); and physical/psychological problems (aOR = 0.51, 95% CI = 0.37–0.70). For CUD, the 65+ age group was less likely than the under 65 age group to endorse hazardous use (aOR = 0.04, 95% CI = 0.01–0.17) and withdrawal (aOR = 0.39, 95% CI = 0.20–0.73 for criterion A and aOR = 0.16, 95% CI = 0.05–0.48 for criterion B). Clinicians should be aware that older adults might not express the full range of symptoms in the same way as the younger age groups. A more nuanced understanding of older adults’ social context may be needed for accurate diagnosis. Full article

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

12 pages, 282 KiB

Open AccessEditor’s ChoiceArticle

State Preemption and Local Tobacco Control: Constraints and Opportunities for Innovation in the US

by Rishika Chakraborty, Micah L. Berman, Y. Tony Yang, Yan Li, Yan Wang, Debra Bernat, Sabrina Zhang and Carla J. Berg

Int. J. Environ. Res. Public Health 2025, 22(6), 827; https://doi.org/10.3390/ijerph22060827 - 23 May 2025

Viewed by 464

Abstract

State preemption of local laws may impede tobacco control, yet little research has examined local policy activity before, during, and after preemption. This study addresses this gap. We summarized state laws preempting local smoke-free workplace, youth access, and licensure laws (CDC’s STATE) and [...] Read more.

State preemption of local laws may impede tobacco control, yet little research has examined local policy activity before, during, and after preemption. This study addresses this gap. We summarized state laws preempting local smoke-free workplace, youth access, and licensure laws (CDC’s STATE) and local legislative activity before, during, and after preemption (Americans for Nonsmokers’ Rights Foundation) across 1999–2021. Preemption existed for smoke-free workplaces in 18 states, youth access in 21, and licensure in 13. Regarding smoke-free workplace laws, local laws were passed in 5 of 11 states with preemption throughout; among seven states with partial-period preemption, local laws were enacted before preemption or after repeal in three states but during preemption in two. Regarding youth access, localities adopted laws (e.g., addressing purchase/use/possession or e-cigarettes) in 11 of 18 states with preemption throughout; among the three states with partial-period preemption, localities passed laws before preemption in one state and during preemption in two. For licensure, localities passed laws (e.g., licensing requirements/penalties) in eight of nine states with preemption throughout and three of four states with partial-period preemption. Although state preemption reduced local activity, some localities advanced tobacco control during preemption, underscoring the need for localities to exercise autonomy permitted under preemption. Full article

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

15 pages, 276 KiB

Open AccessEditor’s ChoiceArticle

Mother–Infant Relational Quality Following a NICU Stay: Investigating the Role of Maternal Childhood Experiences

by Corinna C. Klein, Camila A. Ferrario, Ying Yan and Nicole M. McDonald

Int. J. Environ. Res. Public Health 2025, 22(5), 732; https://doi.org/10.3390/ijerph22050732 - 3 May 2025

Viewed by 755

Abstract

A Neonatal Intensive Care Unit (NICU) stay complicates the transition to parenthood for new mothers. Women respond differently to perinatal stressors, which can impact their mental health and relationship with their new baby. Mothers’ own histories of adverse and benevolent childhood experiences can [...] Read more.

A Neonatal Intensive Care Unit (NICU) stay complicates the transition to parenthood for new mothers. Women respond differently to perinatal stressors, which can impact their mental health and relationship with their new baby. Mothers’ own histories of adverse and benevolent childhood experiences can also shape their early parenting experiences. This study investigated the relationship between mothers’ adverse and benevolent childhood experiences and the observed and reported quality of interactions with their infant at 1 year following a NICU stay. Somewhat unexpectedly, we found that more maternal childhood adversity predicted less intrusive behavior and more responsiveness during a free play interaction at 12 months, while more benevolent childhood experiences predicted higher levels of observed intrusive mothering. Childhood experiences were not related to maternal perceptions of parent–child interaction quality. The length of the NICU stay was positively associated with maternal responsiveness. Findings highlight that childhood risk and protective factors may interact uniquely with a stay in the NICU, with greater adversity and a longer stay predicting more maternal responsiveness and sensitivity. Our study offers evidence that mothers can overcome their own early life challenges, and that overcoming childhood adversity may build resilience that uniquely prepares mothers for the challenge of a NICU stay. Full article

(This article belongs to the Special Issue How Reproductive Life Events Influence Women's Mental Health)

13 pages, 529 KiB

Open AccessEditor’s ChoiceArticle

Hearing Loss and Social Isolation in Community-Dwelling Older Adults: The Role of Neighborhood Disorder and Perceived Social Cohesion

by Sol Baik and Kyeongmo Kim

Int. J. Environ. Res. Public Health 2025, 22(4), 583; https://doi.org/10.3390/ijerph22040583 - 8 Apr 2025

Viewed by 795

Abstract

Hearing loss is one of the most common sensory impairments acquired with aging. This condition causes communication difficulties, leading to social isolation, dependence on others, and a reduced quality of life. However, less is known about the influence of environmental factors on the [...] Read more.

Hearing loss is one of the most common sensory impairments acquired with aging. This condition causes communication difficulties, leading to social isolation, dependence on others, and a reduced quality of life. However, less is known about the influence of environmental factors on the experiences of older adults with hearing loss. This study utilized three waves of the National Health and Aging Trends Study (2011–2013), analyzing data from 3950 community-dwelling older adults. Survey-weighted random intercept models were used to investigate whether hearing loss is associated with social isolation over the three waves and whether this relationship is moderated by neighborhood disorder and perceived neighborhood social cohesion. The study found that older adults with hearing loss were significantly less socially isolated, while the perceived social cohesion significantly moderated the effect of hearing loss on social isolation. Given that hearing function deteriorates with age and hearing aids or other devices are rarely covered by third-party payers, except for some state Medicaid plans or rehabilitation services for veterans, addressing modifiable neighborhood factors may be the most effective way to help individuals remain socially engaged and avoid isolation. Full article

(This article belongs to the Special Issue Hearing Health in Vulnerable Groups)

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13 pages, 2747 KiB

Open AccessEditor’s ChoiceArticle

A Geospatial Analysis of the Lung Cancer Burden in Philadelphia, Using Pennsylvania Cancer Registry Data from 2008–2017

by Russell K. McIntire, Katherine Senter, Christine Shusted, Rickisa Yearwood, Julie Barta, Scott W. Keith and Charnita Zeigler-Johnson

Int. J. Environ. Res. Public Health 2025, 22(3), 455; https://doi.org/10.3390/ijerph22030455 - 20 Mar 2025

Cited by 1 | Viewed by 1987

Abstract

(1) Background: Lung cancer is the deadliest and second most prevalent cancer in Pennsylvania (PA), and African American patients are disproportionately affected. Lung cancer morbidity and mortality in Philadelphia County are among the highest in PA. Geographic information systems (GIS) are useful to [...] Read more.

(1) Background: Lung cancer is the deadliest and second most prevalent cancer in Pennsylvania (PA), and African American patients are disproportionately affected. Lung cancer morbidity and mortality in Philadelphia County are among the highest in PA. Geographic information systems (GIS) are useful to explore geospatial variations in the cancer burden and risk factors. Therefore, we used GIS to analyze the lung cancer burden in Philadelphia to assess which areas of the city have the highest morbidity and mortality, identify potential clusters, and determine which census tract-level characteristics were associated with higher tract-level cancer burden. (2) Methods: Using secondary data from the Pennsylvania Cancer Registry, age-adjusted standardized incidence and mortality ratios (SIR and SMR) were calculated by census tract, and choropleth maps were created to visualize geographic variations in the disease burden. Two geostatistical methods were used to determine the presence of lung cancer clusters. Multivariable regression analyses were performed to identify which census-tract level characteristics correlated with a higher lung cancer burden. (3) Results: Three distinct geographical lung cancer clusters were identified. After controlling for demographics and other covariates, adult smoking prevalence, prevalence of chronic obstructive pulmonary disease, and percentage of residential addresses vacant were positively associated with higher lung cancer SIR and SMR. (4) Conclusions: Our findings may inform cancer control efforts within the region and guide future municipal-level GIS analyses of the lung cancer burden. Full article

(This article belongs to the Special Issue Cancer Causes and Control)

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19 pages, 1474 KiB

Open AccessEditor’s ChoiceArticle

“Understand the Way We Walk Our Life”: Indigenous Patients’ Experiences and Recommendations for Healthcare in the United States

by Melissa E. Lewis, Ivy Blackmore, Martina L. Kamaka, Sky Wildcat, Amber Anderson-Buettner, Elizabeth Modde, Laurelle Myhra, Jamie B. Smith and Antony L. Stately

Int. J. Environ. Res. Public Health 2025, 22(3), 445; https://doi.org/10.3390/ijerph22030445 - 17 Mar 2025

Viewed by 1115

Abstract

Background: The quality of healthcare experiences for Indigenous communities is worse when compared to non-Indigenous patients. Bias and discrimination within healthcare systems relate to worsened care and worsened health outcomes for Indigenous patients. The purpose of this study was to learn about the [...] Read more.

Background: The quality of healthcare experiences for Indigenous communities is worse when compared to non-Indigenous patients. Bias and discrimination within healthcare systems relate to worsened care and worsened health outcomes for Indigenous patients. The purpose of this study was to learn about the experiences of Indigenous people within healthcare settings, as well as their viewpoints for improving healthcare delivery to this population. Methods: Indigenous research methods were employed in this study as clinic administrators and staff, elders, and Indigenous researchers collaborated on the study purpose, design, and analysis. Twenty Indigenous patients participated in one of four focus groups regarding their experiences with healthcare systems. Results: Seven main themes emerged, highlighting participants’ experiences during health encounters, in relation to healthcare systems, and Indigenous health beliefs. Participants discussed challenges and barriers in each area and offered recommendations for care delivery to this population. Conclusions: Participants in this study highlighted that biased care results in poor quality of healthcare delivery and that there are actionable steps that providers and systems of healthcare can take to reduce bias within healthcare systems. The provision of culturally congruent care is imperative in improving the health and well-being of Indigenous communities. Full article

(This article belongs to the Special Issue Advances in Indigenous and American Indian and Alaska Native Health and Wellness)

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15 pages, 514 KiB

Open AccessEditor’s ChoiceArticle

Social Inequities in Cardiovascular Disease Risk Factors at Multiple Levels Persist Among Mothers in Texas

by Catherine Cubbin, Quynh Nhu (Natasha) B. La Frinere-Sandoval and Elizabeth M. Widen

Int. J. Environ. Res. Public Health 2025, 22(3), 404; https://doi.org/10.3390/ijerph22030404 - 10 Mar 2025

Viewed by 961

Abstract

The life stage between the ages of 30–45 years for women is critical, given the competing demands of occupational advancement, intimate partner relationships, and childcare responsibilities. Cardiovascular disease (CVD) is the leading cause of death among women in the US, which is experienced [...] Read more.

The life stage between the ages of 30–45 years for women is critical, given the competing demands of occupational advancement, intimate partner relationships, and childcare responsibilities. Cardiovascular disease (CVD) is the leading cause of death among women in the US, which is experienced inequitably by race/ethnicity/nativity and socioeconomic status and is embedded within geographic contexts. The objective of the current study was to examine social inequities in pre-pregnancy risk factors for cardiovascular disease. We analyzed 16 years of geocoded natality data in Texas (N = 2,089,588 births between 2005 and 2020 to mothers aged 30–45 years) linked with census tract- and county-level data. Dependent variables included pre-pregnancy diabetes, hypertension, obesity, and smoking. Independent variables included individual-level race/ethnicity/nativity and educational attainment, tract-level poverty and racial/ethnic concentrations, and county-level urban/rural status, with controls for other sociodemographic characteristics and time trend. Two-level, random intercept hierarchical generalized logistic models were used to estimate associations and model fit. Significant social inequities at the individual-, tract-, and county-levels in each risk factor were found. For example, tract-level variables had substantial and significant association with the four CVD risk factors, ranging from 13% to 72% higher odds in adjusted models. For all four risk factors, the more rural the county of residence was, the higher the odds of having the risk factor (24% to 256% higher odds). Individual-level social inequalities by race/ethnicity/nativity (ORs ranging from 0.04 to 2.12) and education (ORs ranging from 1.25 to 5.20) were also observed. Enhancing our understanding of this important period of life may enable policy and interventions to better support women through this critical life stage. Full article

(This article belongs to the Special Issue Advances in Gender Inequality and Women's Health)

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21 pages, 1352 KiB

Open AccessEditor’s ChoiceArticle

Mapping the Vulnerability of Older-Adult Neighborhoods: An Ecological Study of New York State

by Samantha Friedman, Chunxu Fang, Tse-Chuan Yang, Rui Li, Imran Hossain Mithu, Jennifer A. Manganello, Xiaobo Romeiko and Shao Lin

Int. J. Environ. Res. Public Health 2025, 22(3), 332; https://doi.org/10.3390/ijerph22030332 - 24 Feb 2025

Viewed by 1402

Abstract

We examined neighborhood-level demographic, economic, and social characteristics and food and health-services access to gauge the vulnerability of older-adult neighborhoods in New York State (NYS), which is understudied and is significant given the rapid aging of populations worldwide. We conducted descriptive ecological analyses [...] Read more.

We examined neighborhood-level demographic, economic, and social characteristics and food and health-services access to gauge the vulnerability of older-adult neighborhoods in New York State (NYS), which is understudied and is significant given the rapid aging of populations worldwide. We conducted descriptive ecological analyses using data from the American Community Survey, historical redlining maps, Social Capital Instruments, U.S. Department of Agriculture food access atlas, ESRI businesses, and Social Determinants of Health. We compared census tracts classified as having high and low levels of older-adult population; among those identified as high-older-adult neighborhoods, we then examined tracts with high and low levels of adult population living alone and in poverty. Our results showed that NYS neighborhoods with large shares of the older adult population are generally faring well in terms of their socioeconomic status, social capital, lack of social isolation, and health services access. However, the older-adult neighborhoods with larger shares of the population living alone and in poverty fare worse, living in areas with poorer socioeconomic status, lower social capital, and considered medically underserved. NYS older adult communities are projected to increase by 2030. Resources should be invested in such areas with vulnerable groups so populations may age in equitable and accessible communities. Full article

(This article belongs to the Special Issue Social Inequalities in Later Life: Care Services in the Future)

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15 pages, 495 KiB

Open AccessEditor’s ChoiceArticle

HPV Self-Sampling Promotion Among African American (AA) and Sub-Saharan African (SAI) Immigrant Women: Adaptation and Usability Testing

by Adebola Adegboyega, Gia Mudd-Martin, Nancy E. Schoenberg and Mark Dignan

Int. J. Environ. Res. Public Health 2025, 22(3), 317; https://doi.org/10.3390/ijerph22030317 - 20 Feb 2025

Viewed by 848

Abstract

Background: Cervical cancer (CC) rates have declined nationally but rates remain high in Black women with most cases occurring among unscreened and under-screened women. This paper describes the adaptation, acceptability, and useability of an education intervention, “Health is Wealth: A Cervical Health Intervention”, [...] Read more.

Background: Cervical cancer (CC) rates have declined nationally but rates remain high in Black women with most cases occurring among unscreened and under-screened women. This paper describes the adaptation, acceptability, and useability of an education intervention, “Health is Wealth: A Cervical Health Intervention”, to promote cervical screening and reduce perceived barriers to CC screening among two subgroups of Black women: African American (AA) and sub-Saharan African immigrant (SAI) women. Methods: In this paper, we describe the process of adapting the Health is Wealth intervention using the Barrera and Castro adaptation framework. The iterative adaptation process included formative focus groups (n = 30 participants) to gather information, expert feedback (n = 4), and usability testing (n = 7). Results: The systematic process resulted in the modification of educational intervention components. Several aspects of the intervention were modified, and core elements of the original intervention were preserved. The usability testing findings suggest the intervention would support the objective of promoting cervical cancer screening uptake among AA and SAI women. Conclusions: Adaptation of an evidence-based intervention is necessary to ensure contextually and culturally appropriateness for target populations, particularly for minoritized populations. We demonstrated that an evidence-based intervention for Pap screening can be adapted for HPV-self-sampling promotion with target community input. Full article

(This article belongs to the Section Global Health)

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12 pages, 864 KiB

Open AccessEditor’s ChoiceArticle

Healthy Behavior for Preventing Cognitive Disability in Older Persons

by Fulvio Lauretani, Antonio Marcato and Crescenzo Testa

Int. J. Environ. Res. Public Health 2025, 22(2), 262; https://doi.org/10.3390/ijerph22020262 - 12 Feb 2025

Viewed by 1305

Abstract

Sufficient levels of physical activity are fundamental for preventing cardiovascular disease, dementia, and ultimately disability in older persons, yet this protective factor is nullified when excessive hours are spent in continuous sitting. Balancing physical activity and sedentary behavior is crucial for influencing metabolic [...] Read more.

Sufficient levels of physical activity are fundamental for preventing cardiovascular disease, dementia, and ultimately disability in older persons, yet this protective factor is nullified when excessive hours are spent in continuous sitting. Balancing physical activity and sedentary behavior is crucial for influencing metabolic parameters and vascular patterns, both central and peripheral, thereby reducing the risk of cardiovascular diseases, vascular dementia, and cognitive impairment. The primary goal of geriatric medicine is to improve quality of life and prevent disability by promptly identifying frail older individuals, thus mitigating both cognitive and motor impairments. Achieving this objective requires not only the optimization of pharmacological treatments but also the active promotion of a healthy lifestyle. In this context, investigating preclinical stages of disability, such as Motoric Cognitive Risk (MCR) Syndrome, which integrates physical and cognitive components of decline, becomes essential. However, despite robust evidence supporting these interventions, greater efforts are needed from the geriatric medical community to bridge the gap between scientific recommendations and everyday clinical practice. Integrating these guidelines into routine care is pivotal for delivering personalized interventions that address both physical inactivity and prolonged sedentary behavior. More research should aim to strengthen this balance, providing clearer, actionable strategies for clinicians to implement, thereby fostering the formation of evidence-based public health guidelines on physical activity specifically tailored for older persons. Full article

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17 pages, 1330 KiB

Open AccessEditor’s ChoiceArticle

Physical and Mental Health of Caregivers and Educators of Preschool-Aged Children: Identifying Benefits and Barriers to Outdoor Time, How Outdoor Time Can Make a Difference for Health Equity, and Why Income Matters

by Amber L. Fyfe-Johnson, Carolyn J. Noonan, Maria B. Butcher and Magdalena K. Haakenstad

Int. J. Environ. Res. Public Health 2025, 22(2), 236; https://doi.org/10.3390/ijerph22020236 - 7 Feb 2025

Viewed by 1278

Abstract

Outdoor time is positively associated with improved physical and mental health in adults. Little is known about the specific effects of outdoor time on health outcomes for parents and educators of preschool-aged children. Early childhood is a critical window for growth and development, [...] Read more.

Outdoor time is positively associated with improved physical and mental health in adults. Little is known about the specific effects of outdoor time on health outcomes for parents and educators of preschool-aged children. Early childhood is a critical window for growth and development, as parental and educator stress negatively impacts young children; thus, it is of paramount importance to systematically support parents and educators during these developmental years. The objectives of this research were to use a cross-sectional natural experiment to (1) evaluate the association between outdoor time and physical and mental health in caregivers and educators who engage with preschool-aged children; (2) evaluate the association between income and physical and mental health in caregivers and educators who engage with preschool-aged children; and (3) identify benefits and barriers of outdoor time and the importance, availability, and accessibility of community resources for outdoor time. Participants were recruited from three stakeholder groups: preschool educators, parents of children attending an outdoor preschool, and parents of preschool-aged children in the local community. Participants completed a health needs assessment (n = 46) to assess demographics, mental and physical health outcomes, and benefits, barriers, and resources for outdoor time. Caregivers and educators in the higher income group (≥USD 70,000) were 41% (95% CI: 12%, 70%) more likely to report very good or excellent self-reported health. Mean anxiety, depression, and perceived stress were lower in the higher-income group. Caregivers and educators in the higher outdoor time group had lower body mass index (−5.5 kg/m²; 95% CI: −11.6, 0.7), and outdoor time appeared to be protective for general health independent of income. Thus, outdoor time may be a critical protective factor to enhance biological resilience for caregivers and educators, especially for those facing financial adversity. Full article

(This article belongs to the Special Issue The Impact of Health-Promoting Built Environments on Public Health)

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12 pages, 279 KiB

Open AccessEditor’s ChoiceReview

Mental and Physical Well-Being of Partners of People Living with Chronic Pain: A Narrative Review

by Toby R. O. Newton-John, Shari Cave and Debbie J. Bean

Int. J. Environ. Res. Public Health 2025, 22(2), 205; https://doi.org/10.3390/ijerph22020205 - 31 Jan 2025

Cited by 1 | Viewed by 1666

Abstract

This narrative review aims to explore the mental and physical well-being of partners of individuals living with chronic pain. Chronic pain not only affects those who suffer from it, but also significantly impacts the lives of their partners; however, the impacts on partners [...] Read more.

This narrative review aims to explore the mental and physical well-being of partners of individuals living with chronic pain. Chronic pain not only affects those who suffer from it, but also significantly impacts the lives of their partners; however, the impacts on partners are not well recognised, despite extensive evidence indicating that their quality of life can be equally affected. This review synthesises current literature to identify the psychological and physical challenges faced by these partners, including increased stress, anxiety, depression, and the potential for developing chronic health conditions themselves. A search of Medline for “chronic pain” and “partner/spouse” from January 1990 to the present was performed, and relevant articles were selected for review. The main findings were that while partners often experience a range of negative physical and psychosocial impacts on their quality of life, dyadic coping strategies can mitigate these effects. This review underscores the importance of future research to develop targeted interventions that address the unique needs of this population, promoting better health outcomes and fostering resilience in the face of chronic pain. Full article

(This article belongs to the Special Issue The Mental Well-Being of Caregivers: Impacts, Benefits and Advancements)

17 pages, 995 KiB

Open AccessEditor’s ChoiceArticle

Associations Between Traumatic Brain Injury Characteristics and Memory Outcomes: Insights from the Health and Retirement Study

by Eric S. Cerino, Monica R. Lininger, Thomasina J. Seaton, Gillian Porter and Julie A. Baldwin

Int. J. Environ. Res. Public Health 2025, 22(2), 150; https://doi.org/10.3390/ijerph22020150 - 23 Jan 2025

Cited by 1 | Viewed by 1164

Abstract

Traumatic brain injury (TBI) is an established risk factor for accelerated cognitive decline and increased dementia risk. The specific characteristics of TBI (e.g., type of head trauma, presence of a gap in memory, age of onset) that confer the greatest risk to cognitive [...] Read more.

Traumatic brain injury (TBI) is an established risk factor for accelerated cognitive decline and increased dementia risk. The specific characteristics of TBI (e.g., type of head trauma, presence of a gap in memory, age of onset) that confer the greatest risk to cognitive health remain comparatively less clear. Using data from the 2014 Health and Retirement Study (HRS) experimental module, we examined associations between TBI characteristics and memory outcomes in a national adult lifespan sample. We tested whether the age of onset and presence of a memory gap in TBI resulting from a vehicle accident, from a fall or being hit, or from playing sports or playing on a playground were associated with self-rated memory and recall memory performance in a subsample of HRS respondents across the adult lifespan (N = 414, mean age = 66.28, SD = 9.70, 52% female). In cases where participants reported TBI from three different types of injury (vehicle accident, fall, and playing sports or playing on a playground), they shared whether they experienced a gap in their memory and their age when the head trauma occurred. Participants also reported on self-rated memory and performed a recall memory task. Hierarchical linear regression models were adjusted for age, sex, race, ethnicity, education, and self-rated health. Older age of onset for TBI from a fall was associated with worse self-rated memory (Est. = −0.11, SE = 0.04, p = 0.01) and recall performance (Est. = −0.33, SE = 0.15, p = 0.03). Encountering a memory gap from the TBI that resulted from a vehicle accident (Est. = −0.22, SE = 0.10, p = 0.03), a fall (Est. = −0.23, SE = 0.09, p = 0.01), and from playing sports or playing on a playground (Est. = −0.40, SE = −0.13, p < 0.01) were all significantly associated with worse self-rated memory. Links between encountering a memory gap and recall performance were comparatively scant. Results indicate the impact of TBI on memory varies as a function of type of trauma, age of onset, and presence of memory gap from the head trauma. Our study takes a preclinical, preventative approach to inform public health efforts that target the mitigation of specific types of head trauma at different developmental phases of the lifespan. Full article

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33 pages, 4831 KiB

Open AccessEditor’s ChoiceReview

Microplastics in Agricultural Crops and Their Possible Impact on Farmers’ Health: A Review

by Eva Masciarelli, Laura Casorri, Marco Di Luigi, Claudio Beni, Massimiliano Valentini, Erica Costantini, Lisa Aielli and Marcella Reale

Int. J. Environ. Res. Public Health 2025, 22(1), 45; https://doi.org/10.3390/ijerph22010045 - 31 Dec 2024

Cited by 5 | Viewed by 4293

Abstract

The indiscriminate use of plastic products and their inappropriate management and disposal contribute to the increasing presence and accumulation of this material in all environmental zones. The chemical properties of plastics and their resistance to natural degradation lead over time to the production [...] Read more.

The indiscriminate use of plastic products and their inappropriate management and disposal contribute to the increasing presence and accumulation of this material in all environmental zones. The chemical properties of plastics and their resistance to natural degradation lead over time to the production of microplastics (MPs) and nanoplastics, which are dispersed in soil, water, and air and can be absorbed by plants, including those grown for food. In agriculture, MPs can come from many sources (mulch film, tractor tires, compost, fertilizers, and pesticides). The possible effects of this type of pollution on living organisms, especially humans, increase the need to carry out studies to assess occupational exposure in agriculture. It would also be desirable to promote alternative materials to plastic and sustainable agronomic practices to protect the safety and health of agricultural workers. Full article

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20 pages, 3022 KiB

Open AccessEditor’s ChoiceArticle

Sociodemographic and Population Exposure to Upstream Oil and Gas Operations in Canada

by Martin Lavoie, David Risk and Daniel Rainham

Int. J. Environ. Res. Public Health 2024, 21(12), 1692; https://doi.org/10.3390/ijerph21121692 - 19 Dec 2024

Cited by 1 | Viewed by 4994

Abstract

Canada, as one of the largest oil and gas producer in the world, is responsible for large emissions of methane, a powerful greenhouse gas. At low levels, methane is not a direct threat to human health; however, human health is affected by exposure [...] Read more.

Canada, as one of the largest oil and gas producer in the world, is responsible for large emissions of methane, a powerful greenhouse gas. At low levels, methane is not a direct threat to human health; however, human health is affected by exposure to pollutants co-emitted with methane. The objectives of this research were to estimate and map pollutants emitted by the oil and gas industry, to assess the demographic of the population exposed to oil and gas activities, and to characterize the impact of well density on cardiovascular- and respiratory-related outcomes with a focus on Alberta. We estimated that ~13% and 3% people in Alberta reside, respectively, within 1.5 km of an active well and 1.5 km of a flare. Our analysis suggests that racial and socioeconomic disparities exist in residential proximity to active wells, with people of Aboriginal identity and people with less education being more exposed to active wells than the general population. We found increased odds of cardiovascular-related (1.13–1.29 for low active well density) and respiratory-related (1.07–1.19 for low active well density) outcomes with exposure to wells. Close to 100 countries produce oil and gas, making this a global issue. There is an important need for additional studies from other producing jurisdictions outside the United States. Full article

(This article belongs to the Section Environmental Health)

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14 pages, 472 KiB

Open AccessEditor’s ChoiceArticle

Lifestyle Factors and Associations with Individual and Comorbid Cardiometabolic and Pulmonary Disease Among U.S. Adults

by Osayande Agbonlahor, Delvon T. Mattingly, Maggie K. Richardson, Joy L. Hart, Alison C. McLeish and Kandi L. Walker

Int. J. Environ. Res. Public Health 2024, 21(12), 1674; https://doi.org/10.3390/ijerph21121674 - 16 Dec 2024

Viewed by 1132

Abstract

Background: Although lifestyle factors have been linked to chronic diseases among adults, their association with diagnosed individual and comorbid cardiometabolic (CMD) and pulmonary disease (PD) is not fully known. This study aimed to examine the associations between lifestyle factors and individual and comorbid [...] Read more.

Background: Although lifestyle factors have been linked to chronic diseases among adults, their association with diagnosed individual and comorbid cardiometabolic (CMD) and pulmonary disease (PD) is not fully known. This study aimed to examine the associations between lifestyle factors and individual and comorbid CMD and PD among U.S. adults. Methods: We used cross-sectional data from the 2017–2020 National Health and Nutrition Examination Survey (n = 7394). Health care provider’s diagnosis of CMD and PD and lifestyle factors (i.e., past 5-day tobacco use, past 12-month alcohol use, diet, sleep troubles, and physical activity) were assessed. Adjusted odds ratios were estimated using logistic and multinomial logistic regression. Results: Trouble sleeping was associated with increased odds of CMD (OR: 2.47) and PD (OR: 2.29) individually, while physical activity was associated with lower odds (OR: 0.75, OR: 0.77). Past 5-day tobacco (OR: 2.36) and past year alcohol (OR: 1.61) use were associated with increased PD odds. Lifestyle factors were associated with increased odds of comorbid CMD and PD. Conclusions: Lifestyle factors were associated with increased odds of individual and comorbid CMD and PD among adults. CMD and PD prevention should involve promoting lifestyle modification and implementation of policies that eliminate structural barriers to healthy lifestyle adoption. Full article

(This article belongs to the Special Issue The 20th Anniversary of IJERPH)

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17 pages, 1254 KiB

Open AccessEditor’s ChoiceArticle

Early Family Conflict and Behavioral Outcomes in Children from Low-Income Families: The Indirect Effects of Parental Depression and Parenting Practices

by Rong Huang, Rachel Chazan-Cohen and Delaina Carlson

Int. J. Environ. Res. Public Health 2024, 21(12), 1664; https://doi.org/10.3390/ijerph21121664 - 13 Dec 2024

Viewed by 3324

Abstract

Family conflict has been demonstrated as a risk factor impacting children’s mental health and behaviors; however, the mechanisms underlying these connections are unclear. Focusing on 1622 children from low-income families (51.4% boys, 38.3% White, 35.5% Hispanic/Latino, 22.1% African American, 4.1% other), the current [...] Read more.

Family conflict has been demonstrated as a risk factor impacting children’s mental health and behaviors; however, the mechanisms underlying these connections are unclear. Focusing on 1622 children from low-income families (51.4% boys, 38.3% White, 35.5% Hispanic/Latino, 22.1% African American, 4.1% other), the current study examines the role that maternal depression and parenting behaviors play in the associations between family conflict in early childhood and children’s internalizing and externalizing behaviors in early adolescence. Family conflict was positively associated with maternal depression at age 3 and detached parenting at age 5; however, maternal depression was linked to increased child internalizing and externalizing behaviors, and detached parenting was associated with decreased behavioral outcomes. Maternal depression at age 3 and intrusive parenting at age 5 successively mediated the association between family conflict and child externalizing. Multi-group analysis indicated different indirect paths of parenting behaviors in boys and girls. Specifically, in boys, the indirect effect of detached parenting on the links between family conflict and externalizing and internalizing behaviors was sustained. In girls, maternal depression and intrusive parenting sequentially explained the link between family conflict and externalizing behaviors. The findings highlighted the importance of addressing family well-being and parenting support, especially for children from low-income families. Full article

(This article belongs to the Special Issue The Influence of Parenting Styles on Children's Mental Health)

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13 pages, 321 KiB

Open AccessEditor’s ChoiceArticle

What’s the Matter? Alcohol Use Risk Among Relatives of People with Mental Illness

by Suzanne A. McKeag, Gordon L. Flett and Joel O. Goldberg

Int. J. Environ. Res. Public Health 2024, 21(12), 1637; https://doi.org/10.3390/ijerph21121637 - 9 Dec 2024

Viewed by 1707

Abstract

Family members who live with relatives with serious mental illness face unique mental health risks, which become worse with alcohol use and without social support. Research has highlighted the damaging effects of harmful substance use among people who feel like they do not [...] Read more.

Family members who live with relatives with serious mental illness face unique mental health risks, which become worse with alcohol use and without social support. Research has highlighted the damaging effects of harmful substance use among people who feel like they do not matter to others, but few studies have assessed links between mattering and alcohol use within marginalized populations. In the present study, a sample of family members who reside with a relative with mental illness completed an online survey. Using the AUDIT alcohol screening measure, participants were classified into a No–Low Risk Alcohol Use (n = 52) or a Hazardous Drinking (n = 28) group. Hazardous alcohol use was alarmingly high, reaching triple the rate of the general population and categorized at the most severe level of harm. Those who drank hazardously felt like they mattered less to others (p < 0.001), felt like they mattered less to their relative with mental illness (p = 0.035), had greater anti-mattering (e.g., they felt invisible and unheard) (p = 0.008), experienced more hopelessness (p < 0.001), felt less supported by significant others (p = 0.003), endorsed having more problems with mental health services (p = 0.017), had higher stigma (p < 0.001), and had lower psychological well-being (p < 0.001). Findings highlight under-recognized public health risks, implications for public health initiatives, and the need for tailored interventions that boost mattering and reduce harmful alcohol use in this vulnerable family member population. Full article

(This article belongs to the Special Issue Alcohol Use in Disadvantaged Populations: Health Equalities and Appropriate Intervention)

20 pages, 4318 KiB

Open AccessEditor’s ChoiceReview

Enhancing Inner Area Revaluation Through Optional Control Programmes for Infectious Bovine Rhinotracheitis and Ruminant Paratuberculosis Potentially Linked to Crohn’s Disease in Humans

by Alessandra Mazzeo, Nicola Rossi, Vincenzo Di Chiro, Lucia Maiuro, Sebastiano Rosati, Siria Giorgione and Elena Sorrentino

Int. J. Environ. Res. Public Health 2024, 21(12), 1595; https://doi.org/10.3390/ijerph21121595 - 30 Nov 2024

Cited by 1 | Viewed by 1559

Abstract

Regulation (EU) 2016/429 introduces comprehensive guidelines for managing transmissible animal diseases, including zoonoses. The subsequent Commission Implementing Regulation 2018/1882 categorizes these diseases into five groups, each with specific responses, ranging from mandatory eradication to optional eradication or surveillance. Key regulatory priorities include enhanced [...] Read more.

Regulation (EU) 2016/429 introduces comprehensive guidelines for managing transmissible animal diseases, including zoonoses. The subsequent Commission Implementing Regulation 2018/1882 categorizes these diseases into five groups, each with specific responses, ranging from mandatory eradication to optional eradication or surveillance. Key regulatory priorities include enhanced animal traceability, biosecurity, wildlife pathogen control, sustainable farming practices, and minimizing the impact of diseases on public health, animal health, and the environment. These objectives align with the European Green Deal, the Farm to Fork Strategy, the One Health approach, and the ongoing revaluation of European Inner Areas. They, including the Molise Region in Italy, are often remote, face service accessibility challenges, and suffer from depopulation and farm abandonment. Nonetheless, they hold significant potential for agropastoral and agri-food activities that can support tourism, the commercialization of local products, and recreational pursuits. Implementing optional programmes for animal diseases and zoonoses not subject to mandatory eradication could help the farms of these areas to mitigate productivity losses due to diseases like Infectious Bovine Rhinotracheitis and Paratuberculosis. The latter is a suspected zoonosis potentially linked to Crohn’s disease in humans. Optional programmes could enhance economic returns, counteract depopulation, support animal welfare and pasture conservation, and reduce the risk of exposure to zoonotic diseases for residents and tourists attracted by the ecological appeal of these areas. Full article

(This article belongs to the Special Issue The Role of Environmental Aspects in the Maintenance of Human Health)

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17 pages, 376 KiB

Open AccessEditor’s ChoiceArticle

Environmental Health Attitudes, Practices, and Educational Preferences: A National Survey of Reproductive-Aged Women in Canada

by Eric J. Crighton, Erica Phipps, Graeme N. Smith, Rukhsana Ahmed, Jocelynn L. Cook, Jeffrey R. Masuda, Alvaro R. Osornio-Vargas, Margaret Sanborn, Lesley J. Brennan, Karen P. Phillips and on behalf of the PEHE Collaboration

Int. J. Environ. Res. Public Health 2024, 21(11), 1397; https://doi.org/10.3390/ijerph21111397 - 23 Oct 2024

Cited by 1 | Viewed by 1523

Abstract

Prenatal exposures to environmental toxicants can adversely affect fetal and child development and lead to increased risk of chronic disease. While regulatory action is essential to reduce sources of environmental toxicants, prenatal care presents an opportunity to educate, mobilize, and support prospective parents [...] Read more.

Prenatal exposures to environmental toxicants can adversely affect fetal and child development and lead to increased risk of chronic disease. While regulatory action is essential to reduce sources of environmental toxicants, prenatal care presents an opportunity to educate, mobilize, and support prospective parents to reduce exposures to such hazards. As the first phase of an interdisciplinary research collaboration to inform the development of prenatal environmental health education strategy in Canada, we surveyed reproductive-aged female individuals. The online survey (July–September 2021) yielded a nationally representative sample of 1914 reproductive-aged females living in Canada. The questionnaire topics addressed the respondents’ knowledge and perceptions of environmental health risks, preventive actions and related facilitators and barriers, information sources and preferences, reproductive history, and demographics. The analysis included bivariate and multivariate techniques. Our results suggest broad awareness among reproductive-aged females that exposure to toxicants can be harmful, and that reducing prenatal exposures can benefit child health. However, fewer than half of respondents felt that they had enough knowledge to take protective measures. Despite high levels of preference for prenatal care as an ideal context for learning about environmental health risks and protective measures, fewer than one in four respondents had ever discussed environmental health concerns with a healthcare provider. Our findings reveal a knowledge–action gap and a corresponding opportunity to improve environmental health education and advocacy in prenatal care in the Canadian context. Full article

12 pages, 1880 KiB

Open AccessEditor’s ChoiceArticle

The Impacts of COVID-19 Lockdowns on Road Transport Air Pollution in London: A State-Space Modelling Approach

by Hajar Hajmohammadi and Hamid Salehi

Int. J. Environ. Res. Public Health 2024, 21(9), 1153; https://doi.org/10.3390/ijerph21091153 - 30 Aug 2024

Viewed by 1514

Abstract

The emergence of the COVID-19 pandemic in 2020 led to the implementation of legal restrictions on individual activities, significantly impacting traffic and air pollution levels in urban areas. This study employs a state-space intervention method to investigate the effects of three major COVID-19 [...] Read more.

The emergence of the COVID-19 pandemic in 2020 led to the implementation of legal restrictions on individual activities, significantly impacting traffic and air pollution levels in urban areas. This study employs a state-space intervention method to investigate the effects of three major COVID-19 lockdowns in March 2020, November 2020, and January 2021 on London’s air quality. Data were collected from 20 monitoring stations across London (central, ultra-low emission zone, and greater London), with daily measurements of NO_x, PM₁₀, and PM_2.5 for four years (January 2019–December 2022). Furthermore, the developed model was adjusted for seasonal effects, ambient temperature, and relative humidity. This study found significant reductions in the NO_x levels during the first lockdown: 49% in central London, 33% in the ultra-low emission zone (ULEZ), and 37% in greater London. Although reductions in NO_x were also observed during the second and third lockdowns, they were less than the first lockdown. In contrast, PM₁₀ and PM_2.5 increased by 12% and 1%, respectively, during the first lockdown, possibly due to higher residential energy consumption. However, during the second lockdown, PM₁₀ and PM_2.5 levels decreased by 11% and 13%, respectively, and remained unchanged during the third lockdown. These findings highlight the complex dynamics of urban air quality and underscore the need for targeted interventions to address specific pollution sources, particularly those related to road transport. The study provides valuable insights into the effectiveness of lockdown measures and informs future air quality management strategies. Full article

(This article belongs to the Section Environmental Health)

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14 pages, 1226 KiB

Open AccessEditor’s ChoiceArticle

Quantitative Definition of Low-Health-Interest Populations by Using Regression Trees: A Nationwide Internet Survey in Japan

by Yoko Nishizawa, Takuya Yamada, Kumi Sugimoto, Chie Ozawa, Takahiro Tabuchi, Hirono Ishikawa and Yoshiharu Fukuda

Int. J. Environ. Res. Public Health 2024, 21(8), 1049; https://doi.org/10.3390/ijerph21081049 - 9 Aug 2024

Cited by 1 | Viewed by 1501

Abstract

Background: Reducing health disparities is a public health issue. Identification of low-health-interest populations is important, but a definition of people with low health interest has not yet been established. We aimed to quantitatively define low-health-interest populations. Methods: A nationwide cross-sectional internet survey was [...] Read more.

Background: Reducing health disparities is a public health issue. Identification of low-health-interest populations is important, but a definition of people with low health interest has not yet been established. We aimed to quantitatively define low-health-interest populations. Methods: A nationwide cross-sectional internet survey was conducted in 2022. We compiled regression tree (RT) analyses with/without adjustment for age, sex, and socioeconomic status with the 12-item Interest in Health Scale (IHS, score range 12–48) as an explanatory variable and the 10 composite health behaviors as a dependent variable. We defined the first IHS branching condition from the root node as a lower-health-interest group and the terminal node with the lowest health behaviors as the lowest-health-interest group. Results: The mean IHS value of 22,263 analyzed participants was 32.1 ± 5.6; it was higher in females and in those who were aged over 45 years, had a high education, a high income, or a spouse. The first branching condition was IHS 31.5, and the terminal node branched at 24.5, before/after adjustment for covariates. Conclusions: We determined the cutoff values of the IHS as <32 for a lower-health-interest group and <25 for the lowest-health-interest group. Using these cutoffs might enable us to reveal the characteristics of low-health-interest populations. Full article

(This article belongs to the Collection Health Behaviors, Risk Factors, NCDs and Health Promotion)

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31 pages, 580 KiB

Open AccessEditor’s ChoiceReview

Breast Cancer Screening among African Immigrants in the United States: An Integrative Review of Barriers, Facilitators, and Interventions

by Julian I. Rauch, Joseph Daniels, Alyssa Robillard and Rodney P. Joseph

Int. J. Environ. Res. Public Health 2024, 21(8), 1004; https://doi.org/10.3390/ijerph21081004 - 30 Jul 2024

Cited by 5 | Viewed by 3633

Abstract

The purpose of this review was to synthesize the available literature on breast cancer-screening barriers, facilitators, and interventions among U.S. African immigrants. Following the integrative review framework and PRISMA guidelines for reporting systemic reviews, five electronic databases were searched: PubMed, CINAHL, PsycINFO, Medline, [...] Read more.

The purpose of this review was to synthesize the available literature on breast cancer-screening barriers, facilitators, and interventions among U.S. African immigrants. Following the integrative review framework and PRISMA guidelines for reporting systemic reviews, five electronic databases were searched: PubMed, CINAHL, PsycINFO, Medline, and Google Scholar. Studies were included if they were published in English language journals after 1 January 2000 and reported data on breast cancer-screening barriers, facilitators, or interventions among U.S. African immigrants. Barriers and facilitators reported by studies were descriptively examined and synthesized by two authors and classified as aligning with one of the three levels of influences based on the social–ecological model (intrapersonal, interpersonal, and community). Interventions promoting breast cancer screening were narratively summarized. Search procedures retrieved 1011 articles, with 12 meeting the criteria for inclusion in the review (6 qualitative and 6 quantitative). Intrapersonal barriers included limited awareness, fear of pain, language barriers, health concerns, transportation issues, costs, and negative past experiences. Interpersonal barriers involved modesty, spiritual beliefs, and lack of support, while community-level barriers included provider and healthcare-system challenges. Regarding facilitators, past screening experiences and health insurance were the most commonly reported intrapersonal facilitators. The only interpersonal facilitator identified was observing other women experience a breast cancer diagnosis and undergo treatment. Community-level facilitators included appointment reminders, scheduling assistance, culturally congruent interpreters, transportation to screening facilities, and patient navigators. Three articles reported outcomes of breast cancer-screening interventions. All three were pilot studies and reported increased knowledge and attitudes regarding breast cancer screening following the respective interventions. One study examined the uptake of breast cancer screening following the intervention, with results indicating an increase in screening. Findings provide a comprehensive synthesis of factors influencing breast cancer screening among African immigrants and highlight the need for future research on the topic. This review was registered with Prospero (CRD42024502826) before the initiation of search procedures. Full article

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16 pages, 336 KiB

Open AccessEditor’s ChoiceArticle

Leukemia Incidence by Occupation and Industry: A Cohort Study of 2.3 Million Workers from Ontario, Canada

by Konrad Samsel, Tanya Navaneelan, Nathan DeBono, Louis Everest, Paul A. Demers and Jeavana Sritharan

Int. J. Environ. Res. Public Health 2024, 21(8), 981; https://doi.org/10.3390/ijerph21080981 - 27 Jul 2024

Cited by 1 | Viewed by 2559

Abstract

Although a significant body of evidence has attributed certain occupational exposures with leukemia, such as benzene, formaldehyde, 1,3-butadiene and ionizing radiation, more research is needed to identify work environments at increased risk for this disease. Our study aimed to identify occupational and industry [...] Read more.

Although a significant body of evidence has attributed certain occupational exposures with leukemia, such as benzene, formaldehyde, 1,3-butadiene and ionizing radiation, more research is needed to identify work environments at increased risk for this disease. Our study aimed to identify occupational and industry groups associated with an elevated incidence of leukemia using a diverse cohort of workers’ compensation claimants from Ontario, Canada. A total of 2,363,818 workers in the Occupational Disease Surveillance System (ODSS) cohort, with claims between 1983–2019, were followed for malignant leukemia diagnoses up to 31 December 2019. We used a Cox proportional-hazards model to estimate the relative incidence of leukemia in specific occupation and industry groups. After adjusting for age and birth year, males in protective services (HR = 1.17, 95% CI = 1.02–1.35), metal machining (HR = 1.23, 95% CI = 1.07–1.41), transport (HR = 1.15, 95% CI = 1.06–1.25), and mining occupations (HR = 1.28, 95% CI = 1.02–1.60) had elevated risks of leukemia compared to other workers in the ODSS, with comparable findings by industry. Among female workers, slight risk elevations were observed among product fabricating, assembling, and repairing occupations, with other increased risks seen in furniture and fixture manufacturing, storage, and retail industries. These findings underscore the need for exposure-based studies to better understand occupational hazards in these settings. Full article

(This article belongs to the Special Issue Cancer Causes and Control)

13 pages, 1100 KiB

Open AccessEditor’s ChoiceArticle

Temporal Trends in Air Pollution Exposure across Socioeconomic Groups in The Netherlands

by Niklas Hlubek, Yvonne Koop, Alfred Wagtendonk and Ilonca Vaartjes

Int. J. Environ. Res. Public Health 2024, 21(8), 976; https://doi.org/10.3390/ijerph21080976 - 26 Jul 2024

Cited by 1 | Viewed by 1913

Abstract

Air pollution exposure has been linked to detrimental health outcomes. While cross-sectional studies have demonstrated socioeconomic disparities in air pollution exposure, longitudinal evidence on these disparities remains limited. The current study investigates trends in residential air pollution exposure across socioeconomic groups in the [...] Read more.

Air pollution exposure has been linked to detrimental health outcomes. While cross-sectional studies have demonstrated socioeconomic disparities in air pollution exposure, longitudinal evidence on these disparities remains limited. The current study investigates trends in residential air pollution exposure across socioeconomic groups in the Netherlands from 2014 to 2019. Our dataset includes over 12.5 million individuals, aged 18 years and above, who resided in the Netherlands between 2014 and 2019, using Statistics Netherlands data. The address-level air pollution concentrations were estimated by dispersion models of the National Institute of Public Health and the Environment. We linked the exposure estimations of particulate matter < 10 or <2.5 μm (PM₁₀, PM_2.5) and nitrogen dioxide (NO₂) to household-level socioeconomic data. In highly urbanized areas, individuals from both the lowest and highest socioeconomic groups were exposed to higher air pollution concentrations. Individuals from the lowest socioeconomic group were disproportionally located in highly urbanized and more polluted areas. The air pollution concentrations of PM₁₀, PM_2.5, and NO₂ decreased between 2014 and 2019 for all the socioeconomic groups. The decrease in the annual average air pollution concentrations was the strongest for the lowest socioeconomic group, although differences in exposure between the socioeconomic groups remain. Further research is needed to define the health and equity implications. Full article

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12 pages, 353 KiB

Open AccessEditor’s ChoiceArticle

Prevalence and Determinants of Changes in Physical Activity and Sedentary Behavior during and after the COVID-19 Pandemic: A Swedish Repeated Cross-Sectional Study

by Birgitta Kerstis, Maria Elvén, Kent W. Nilsson, Petra von Heideken Wågert, Jonas Stier, Micael Dahlen and Daniel Lindberg

Int. J. Environ. Res. Public Health 2024, 21(8), 960; https://doi.org/10.3390/ijerph21080960 - 23 Jul 2024

Viewed by 1699

Abstract

Physical activity (PA) and sedentary behavior (SB) changed during the COVID-19 pandemic; hence, this study examined PA and SB at four time points between December 2019 and December 2022. The participants’ PA decreased during the pandemic and did not recover afterwards. Among women, [...] Read more.

Physical activity (PA) and sedentary behavior (SB) changed during the COVID-19 pandemic; hence, this study examined PA and SB at four time points between December 2019 and December 2022. The participants’ PA decreased during the pandemic and did not recover afterwards. Among women, PA increased slightly in 2022 but not at all in men. From 2019 to 2020, SB increased and then decreased to near the pre-pandemic level in both sexes. Regarding age, PA decreased in the oldest age group (65–79 years) across all time points, while SB increased in all age groups during 2019–2020 and then returned close to pre-pandemic levels among the two middle age groups (30–64 years), but not among the youngest and oldest groups. Considering occupation, PA decreased from 2020 to December 2022 among retired and “other” participants, while SB decreased among nonmanual workers and retired participants. The regression models associated better self-reported health, male sex, and those born overseas with higher PA. Higher age, better self-reported health, poor education, and later survey time points were associated with lower SB. These findings highlight the need to return PA and SB to at least pre-pandemic levels and that subgroups may need different interventions. Full article

13 pages, 312 KiB

Open AccessEditor’s ChoiceArticle

Mental Health, Declining Physical Activity and Social Connection during Transitions into Fatherhood in the UK

by Emily Lovett and Andy Smith

Int. J. Environ. Res. Public Health 2024, 21(7), 890; https://doi.org/10.3390/ijerph21070890 - 9 Jul 2024

Cited by 2 | Viewed by 2311

Abstract

This paper addresses an under-explored area of sociologically oriented health research, namely, the mental health and physical activity (PA) experiences of new fathers. Drawing upon responses to an online qualitative survey from 32 fathers, aged 18 or over, and living in the UK, [...] Read more.

This paper addresses an under-explored area of sociologically oriented health research, namely, the mental health and physical activity (PA) experiences of new fathers. Drawing upon responses to an online qualitative survey from 32 fathers, aged 18 or over, and living in the UK, we show how the decline in these fathers’ overall PA was associated with poor mental health and the changing constraints that characterised their increasingly complex networks of interdependence. These constraints corresponded with shifts in fathers’ PA engagement from team sports towards individualised, flexible, and more recreationally oriented lifestyle activities like running and the gym. Fathers’ engagement in these activities appeared to exacerbate the complex feelings of guilt and isolation that they already encountered as new fathers. These experiences were simultaneously associated with feelings of shame associated with being insufficiently active and fearing judgement about their engagement in fathering responsibilities. The paper has important policy implications, highlighting the need for tailored support for new fathers in the perinatal period, and implications for practice, suggesting that co-produced community-based PA programmes are potentially effective settings for engaging new fathers in PA and promoting their mental health. Full article

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

21 pages, 3940 KiB

Open AccessEditor’s ChoiceArticle

Random Forest and Feature Importance Measures for Discriminating the Most Influential Environmental Factors in Predicting Cardiovascular and Respiratory Diseases

by Francesco Cappelli, Gianfranco Castronuovo, Salvatore Grimaldi and Vito Telesca

Int. J. Environ. Res. Public Health 2024, 21(7), 867; https://doi.org/10.3390/ijerph21070867 - 2 Jul 2024

Cited by 14 | Viewed by 3960

Abstract

Background: Several studies suggest that environmental and climatic factors are linked to the risk of mortality due to cardiovascular and respiratory diseases; however, it is still unclear which are the most influential ones. This study sheds light on the potentiality of a data-driven [...] Read more.

Background: Several studies suggest that environmental and climatic factors are linked to the risk of mortality due to cardiovascular and respiratory diseases; however, it is still unclear which are the most influential ones. This study sheds light on the potentiality of a data-driven statistical approach by providing a case study analysis. Methods: Daily admissions to the emergency room for cardiovascular and respiratory diseases are jointly analyzed with daily environmental and climatic parameter values (temperature, atmospheric pressure, relative humidity, carbon monoxide, ozone, particulate matter, and nitrogen dioxide). The Random Forest (RF) model and feature importance measure (FMI) techniques (permutation feature importance (PFI), Shapley Additive exPlanations (SHAP) feature importance, and the derivative-based importance measure (

κ^{A L E}

)) are applied for discriminating the role of each environmental and climatic parameter. Data are pre-processed to remove trend and seasonal behavior using the Seasonal Trend Decomposition (STL) method and preliminary analyzed to avoid redundancy of information. Results: The RF performance is encouraging, being able to predict cardiovascular and respiratory disease admissions with a mean absolute relative error of 0.04 and 0.05 cases per day, respectively. Feature importance measures discriminate parameter behaviors providing importance rankings. Indeed, only three parameters (temperature, atmospheric pressure, and carbon monoxide) were responsible for most of the total prediction accuracy. Conclusions: Data-driven and statistical tools, like the feature importance measure, are promising for discriminating the role of environmental and climatic factors in predicting the risk related to cardiovascular and respiratory diseases. Our results reveal the potential of employing these tools in public health policy applications for the development of early warning systems that address health risks associated with climate change, and improving disease prevention strategies. Full article

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15 pages, 783 KiB

Open AccessEditor’s ChoiceSystematic Review

The Effect of Community-Based Exercise on Health Outcomes for Indigenous Peoples with Type 2 Diabetes: A Systematic Review

by Lauren Hurst, Morwenna Kirwan, Vita Christie, Cara Cross, Sam Baylis, Liam White and Kylie Gwynne

Int. J. Environ. Res. Public Health 2024, 21(3), 290; https://doi.org/10.3390/ijerph21030290 - 1 Mar 2024

Viewed by 4577

Abstract

Indigenous peoples globally experience a high burden of type 2 diabetes in comparison to non-Indigenous peoples. While community-based exercise interventions designed for type 2 diabetes (T2D) management have garnered success in non-Indigenous populations, they likely require adjustments to meet the needs of Indigenous [...] Read more.

Indigenous peoples globally experience a high burden of type 2 diabetes in comparison to non-Indigenous peoples. While community-based exercise interventions designed for type 2 diabetes (T2D) management have garnered success in non-Indigenous populations, they likely require adjustments to meet the needs of Indigenous people. This systematic review aims to determine if health outcomes in Indigenous peoples with T2D could be improved by community-based exercise programmes and the features of those programmes that best meet their needs. The CINAHL, Embase, Informit Indigenous Collection, Medline, PubMed, Scopus, SportDiscus, and Web of Science databases have been searched to identify peer-reviewed literature with original outcome data that report on the health effects of community-based exercise interventions for the management of T2D among Indigenous peoples. The Mixed Methods Appraisal Tool and Indigenous Community Engagement Tool were implemented to assess methodological quality. Three moderate-to-high-quality studies were selected for review, including participants of Polynesian or Native American Zuni Indian descent. Results indicated positive effects of group exercise on glycated haemoglobin (HbA1c), body mass index, body weight, total cholesterol, blood pressure, quality of life, and patient activation levels in high-adhering participants. This review concludes that community-based exercise interventions may improve health outcomes for Indigenous adults with T2D when conducted with strong community engagement. Full article

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15 pages, 3622 KiB

Open AccessEditor’s ChoiceArticle

Towards Resilient Healthcare Systems: A Framework for Crisis Management

by Seyedeh Gelareh Emami, Valentina Lorenzoni and Giuseppe Turchetti

Int. J. Environ. Res. Public Health 2024, 21(3), 286; https://doi.org/10.3390/ijerph21030286 - 29 Feb 2024

Cited by 13 | Viewed by 9937

Abstract

This study addresses the crucial need for resilient healthcare systems, highlighted by recent global health emergencies such as the Ebola and COVID-19 crises. It identifies a significant gap in the current literature: a lack of practical, actionable frameworks for healthcare resilience. To bridge [...] Read more.

This study addresses the crucial need for resilient healthcare systems, highlighted by recent global health emergencies such as the Ebola and COVID-19 crises. It identifies a significant gap in the current literature: a lack of practical, actionable frameworks for healthcare resilience. To bridge this gap, the research introduces an innovative framework that blends theoretical resilience concepts with heuristic approaches. This framework, rooted in the principles of monitoring, anticipation, recognition, and learning, is designed to enhance the crisis management capabilities of healthcare systems. The methodology involves a comprehensive literature review, combined with heuristic methods, culminating in a framework that is both academically sound and practically applicable. This framework guides healthcare systems through various stages of crisis management, including data collection, situation analysis, risk anticipation, and response evaluation. It provides a holistic approach to enhancing resilience in healthcare settings. Overall, this paper makes a significant contribution to the field of healthcare system resilience, offering a strategic blueprint for improved crisis response and recovery. It marks an important advancement in aligning theoretical resilience concepts with practical implementation strategies, essential for tackling current and future healthcare challenges. Full article

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18 pages, 1292 KiB

Open AccessEditor’s ChoiceArticle

Sibling Violence and Bullying Behaviors in Peers: The Mediational Role of Self-Esteem

by Catarina Pinheiro Mota, Joana Rita Sousa and Inês Carvalho Relva

Int. J. Environ. Res. Public Health 2024, 21(2), 227; https://doi.org/10.3390/ijerph21020227 - 15 Feb 2024

Cited by 2 | Viewed by 3757

Abstract

In the context of the existing research on families, sibling violence is a less explored area. However, it has seemingly received more attention recently, and it can assume a relevant role in understanding the maladaptive behavior of youngsters and bullying. Additionally, adolescents involved [...] Read more.

In the context of the existing research on families, sibling violence is a less explored area. However, it has seemingly received more attention recently, and it can assume a relevant role in understanding the maladaptive behavior of youngsters and bullying. Additionally, adolescents involved in bullying and self-esteem are associated with disruptive violence inside the family context. This study’s sample consisted of 286 students, aged between 12 and 17 years, from both sexes. This study intends to explore the association between sibling violence and bullying behavior in peers and the mediator effect of self-esteem. The measures for data collection were a demographic questionnaire, the Social Exclusion and School Violence Questionnaire, The Revised Conflict Tactics Scales (Portuguese version for siblings), and the Rosenberg Self-Esteem Scale. The results show a negative effect between negotiation in the sibling relationship (victimization) and social exclusion and verbal aggression related to bullying behavior. Self-esteem represents a total and negative mediator in this connection. Our results also show a variety of indirect outcomes amongst the negotiation dimension, psychological aggression and injury between siblings, and the social exclusion and verbal aggression dimensions (on the aggression and victimization scales). The results will be discussed according to the attachment theory but considering the importance of affective bonds with siblings as a predisposing factor to an adaptive development course. Full article

(This article belongs to the Section Adolescents)

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19 pages, 1560 KiB

Open AccessEditor’s ChoiceSystematic Review

Benzene Exposure and Lung Cancer Risk: A Systematic Review and Meta-Analysis of Human Studies

by Manuela Chiavarini, Patrizia Rosignoli, Beatrice Sorbara, Irene Giacchetta and Roberto Fabiani

Int. J. Environ. Res. Public Health 2024, 21(2), 205; https://doi.org/10.3390/ijerph21020205 - 9 Feb 2024

Cited by 29 | Viewed by 7649

Abstract

Lung cancer is a leading cause of death with nearly 1.8 million deaths estimated worldwide in 2020. Although benzene is classified as a human carcinogen (Group 1) on the basis of its association with acute myeloid/non-lymphocytic leukaemia, there is still limited evidence that [...] Read more.

Lung cancer is a leading cause of death with nearly 1.8 million deaths estimated worldwide in 2020. Although benzene is classified as a human carcinogen (Group 1) on the basis of its association with acute myeloid/non-lymphocytic leukaemia, there is still limited evidence that it may influence lung cancer risk. This study examined the potential link between benzene exposure and risk of lung cancer using a systematic review of epidemiological studies and meta-analysis. We searched through PubMed, Web of Science and Scopus databases up to 10 February 2023 to identify all articles on the association between benzene exposure and lung cancer (incidence or prevalence) and/or mortality. We extracted the risk estimates of the highest and the lowest reported categories of benzene exposure and conducted a meta-analysis using a random-effects model. Heterogeneity and publication bias were analysed using an I² test and funnel plots asymmetry, respectively. Twenty-one studies were included in the final analysis, with a total of 10,750 lung cancer cases and 2899 lung cancer deaths. Overall, risk estimates of lung cancer prevalence and mortality in association with benzene exposure were 1.20 (n = 14; 95% CI 1.05–1.37) and 1.15 (n = 13; 95% CI 1.02–1.30), respectively. In all cases, heterogeneity was quite large, while no significant publication bias was observed. When only studies that adjusted for smoking habit were selected, the risk for lung cancer increased by up to 34% (n = 9; 95% CI 1.10–1.64). Our data, which show a strong association between benzene exposure and lung cancer risk, may have important public health implications. However, further studies are needed to identify the lung cancer risk associated with benzene exposure considering different smoking conditions. Full article

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14 pages, 590 KiB

Open AccessEditor’s ChoiceArticle

Trends in Mental Wellbeing of US Children, 2019–2022: Erosion of Mental Health Continued in 2022

by Neeraj Bhandari and Shivani Gupta

Int. J. Environ. Res. Public Health 2024, 21(2), 132; https://doi.org/10.3390/ijerph21020132 - 25 Jan 2024

Cited by 5 | Viewed by 4513

Abstract

We provide fresh estimates of a change in the nationwide prevalence of mental health symptoms among US children during the COVID-19 pandemic using National Health Interview Survey data (2019–22) on children aged 2–17 years (n = 27,378; age subgroups 2–5, 6–11, and 12–17) [...] Read more.

We provide fresh estimates of a change in the nationwide prevalence of mental health symptoms among US children during the COVID-19 pandemic using National Health Interview Survey data (2019–22) on children aged 2–17 years (n = 27,378; age subgroups 2–5, 6–11, and 12–17) to assess overall mental distress and 19 specific outcomes related to developmental, communicative, cognitive, affective, and behavioral domains. Raw and adjusted (for socio-demographics) linear regressions estimated the change in prevalence for each outcome between 2019 (baseline year) and three succeeding years (2020–2022). Summary scores for mental distress rose between 2019 and 2020 (1.01 to 1.18 points, range of 0–15), declined slightly in 2021 (1.09), and climbed sharply again in 2022 (1.25). The declines primarily affected adolescents (1.11 at baseline, 1.24 in 2020, 1.30 in 2021, and 1.49 in 2022). Specific outcomes belonging to all domains of mental health showed similar increases in prevalence. US children suffered significant erosion of mental health during the COVID-19 pandemic that continued into 2022. Expansion of mental health programs aimed at school-going children will likely be needed to respond effectively to the ongoing crisis. Full article

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44 pages, 9502 KiB

Open AccessEditor’s ChoiceReview

Natural Background and the Anthropogenic Enrichment of Mercury in the Southern Florida Environment: A Review with a Discussion on Public Health

by Thomas M. Missimer, James H. MacDonald, Jr., Seneshaw Tsegaye, Serge Thomas, Christopher M. Teaf, Douglas Covert and Zoie R. Kassis

Int. J. Environ. Res. Public Health 2024, 21(1), 118; https://doi.org/10.3390/ijerph21010118 - 22 Jan 2024

Cited by 2 | Viewed by 4190

Abstract

Mercury (Hg) is a toxic metal that is easily released into the atmosphere as a gas or a particulate. Since Hg has serious health impacts based on human exposure, it is a major concern where it accumulates. Southern Florida is a region of [...] Read more.

Mercury (Hg) is a toxic metal that is easily released into the atmosphere as a gas or a particulate. Since Hg has serious health impacts based on human exposure, it is a major concern where it accumulates. Southern Florida is a region of high Hg deposition in the United States. It has entered the southern Florida environment for over 56 MY. For the past 3000 to 8000 years, Hg has accumulated in the Everglades peatlands, where approximately 42.3 metric tons of Hg was deposited. The pre-industrial source of mercury that was deposited into the Everglades was from the atmosphere, consisting of combined Saharan dust and marine evasion. Drainage and the development of the Everglades for agriculture, and other mixed land uses have caused a 65.7% reduction in the quantity of peat, therefore releasing approximately 28 metric tons of Hg into the southern Florida environment over a period of approximately 133 years. Both natural and man-made fires have facilitated the Hg release. The current range in mercury release into the southern Florida environment lies between 994.9 and 1249 kg/yr. The largest source of Hg currently entering the Florida environment is from combined atmospheric sources, including Saharan dust, aerosols, sea spray, and ocean flux/evasion at 257.1–514.2 kg/yr. The remobilization of Hg from the Everglades peatlands and fires is approximately 215 kg/yr. Other large contributors include waste to energy incinerators (204.1 kg/yr), medical waste and crematory incinerators (159.7+ kg/yr), and cement plant stack discharge (150.6 kg/yr). Minor emissions include fuel emissions from motorized vehicles, gas emissions from landfills, asphalt plants, and possible others. No data are available on controlled fires in the Everglades in sugar farming, which is lumped with the overall peatland loss of Hg to the environment. Hg has impacted wildlife in southern Florida with recorded excess concentrations in fish, birds, and apex predators. This bioaccumulation of Hg in animals led to the adoption of regulations (total maximum loads) to reduce the impacts on wildlife and warnings were given to consumers to avoid the consumption of fish that are considered to be contaminated. The deposition of atmospheric Hg in southern Florida has not been studied sufficiently to ascertain where it has had the greatest impacts. Hg has been found to accumulate on willow tree leaves in a natural environment in one recent study. No significant studies of the potential impacts on human health have been conducted in southern Florida, which should be started based on the high rates of Hg fallout in rainfall and known recycling for organic sediments containing high concentrations of Hg. Full article

(This article belongs to the Special Issue Environmental Geochemistry of Toxic Elements in the Environment)

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23 pages, 1279 KiB

Open AccessEditor’s ChoiceArticle

Palliative Care in the Ageing European Population: A Cross-Country Comparison

by Giovanni Cerullo, Teodora Figueiredo, Constantino Coelho, Cláudia Silva Campos, António Videira-Silva, Joana Carrilho, Luís Midão and Elísio Costa

Int. J. Environ. Res. Public Health 2024, 21(1), 113; https://doi.org/10.3390/ijerph21010113 - 19 Jan 2024

Cited by 2 | Viewed by 4204

Abstract

With Europe’s ageing population and rising demand for palliative care, it is crucial to examine the use of palliative care among older adults during their last years of life and understand the factors influencing their access and end-of-life circumstances. This study employed a [...] Read more.

With Europe’s ageing population and rising demand for palliative care, it is crucial to examine the use of palliative care among older adults during their last years of life and understand the factors influencing their access and end-of-life circumstances. This study employed a cohort of SHARE participants aged 65 years or older who had passed away between Wave 6 (2015) and Wave 7 (2017). Information on death circumstances, palliative care utilization, and associated variables were analysed. The study revealed that nearly 13.0% of individuals across these countries died under palliative care, with Slovenia having the lowest rate (0.3%) and France the highest (30.4%). Palliative care utilization in the last 30 days before death was observed in over 24.0% of participants, with the Czech Republic having the lowest rate (5.0%) and Greece the highest (48.8%). A higher risk of using or dying in palliative care was significantly associated with cognitive impairment (low verbal fluency), physical inactivity, and good to excellent self-perceived health. This work highlights the urgent need for enhanced global access to palliative care and advocates for the cross-country comparison of effective practices within Europe, tailored to the unique healthcare needs of older adults. Full article

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

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28 pages, 2890 KiB

Open AccessEditor’s ChoiceArticle

Geochemical Modeling Source Provenance, Public Health Exposure, and Evaluating Potentially Harmful Elements in Groundwater: Statistical and Human Health Risk Assessment (HHRA)

by Abdur Rashid, Muhammad Ayub, Zahid Ullah, Asmat Ali, Seema Anjum Khattak, Liaqat Ali, Xubo Gao, Chengcheng Li, Sardar Khan, Hamed A. El-Serehy and Prashant Kaushik

Int. J. Environ. Res. Public Health 2022, 19(11), 6472; https://doi.org/10.3390/ijerph19116472 - 26 May 2022

Cited by 28 | Viewed by 3868

Abstract

Groundwater contamination by potentially harmful elements (PHEs) originating from the weathering of granitic and gneissic rock dissolution poses a public health concern worldwide. This study investigated physicochemical variables and PHEs in the groundwater system and mine water of the Adenzai flood plain region, [...] Read more.

Groundwater contamination by potentially harmful elements (PHEs) originating from the weathering of granitic and gneissic rock dissolution poses a public health concern worldwide. This study investigated physicochemical variables and PHEs in the groundwater system and mine water of the Adenzai flood plain region, in Pakistan, emphasizing the fate distribution, source provenance, chemical speciation, and health hazard using the human health risk assessment HHRA-model. The average concentrations of the PHEs, viz., Ni, Mn, Cr, Cu, Cd, Pb, Co, Fe, and Zn 0.23, were 0.27, 0.07, 0.30, 0.07, 0.06, 0.08, 0.68, and 0.23 mg/L, respectively. The average values of chemical species in the groundwater system, viz., H⁺, OH⁻, Ni²⁺, Mn²⁺, Mn³⁺, Cr³⁺, Cr⁶⁺, Cu⁺, Cu²⁺, Cd²⁺, Pb²⁺, Pb⁴⁺, Co²⁺, Co³⁺, Fe²⁺, Fe³⁺, and Zn²⁺, were 1.0 × 10⁻⁴ ± 1.0 × 10⁻⁶, 1.0 × 10⁻⁴ ± 9.0 × 10⁻⁷, 2.0 × 10⁻¹ ± 1.0 × 10⁻³, 3.0 × 10⁻¹ ± 1.0 × 10⁻³, 1.0 × 10⁻²² ± 1.0 × 10⁻²³, 4.0 × 10⁻⁶ ± 2.0 × 10⁻⁶, 4.0 × 10⁻¹¹ ± 2.0 × 10⁻¹¹, 9.0 × 10⁻³ ± 1.0 × 10⁻², 2.0 × 10⁻¹ ± 2.0 × 10⁻³, 7.0 × 10⁻² ± 6.0 × 10⁻², 5.0 × 10⁻² ± 5.0 × 10⁻², 2.0 × 10⁻² ± 1.5 × 10⁻², 6.0 × 10⁻² ± 4.0 × 10⁻², 8.0 × 10⁻³¹ ± 6.0 × 10⁻³¹, 3.0 × 10⁻¹ ± 2.0 × 10⁻⁴, 4.0 × 10⁻¹⁰ ± 3.0 × 10⁻¹⁰, and 2.0 × 10⁻¹ ± 1.0 × 10⁻¹. The mineral compositions of PHEs, viz. Ni, were bunsenite, Ni(OH)₂, and trevorite; Mn viz., birnessite, bixbyite, hausmannite, manganite, manganosite, pyrolusite, and todorokite; Cr viz., chromite and eskolaite; Cu viz., CuCr₂O₄, cuprite, delafossite, ferrite-Cu, and tenorite; Cd viz., monteponite; Pb viz, crocoite, litharge, massicot, minium, plattnerite, Co viz., spinel-Co; Fe viz., goethite, hematite, magnetite, wustite, and ferrite-Zn; and Zn viz., zincite, and ZnCr₂O₄ demarcated undersaturation and supersaturation. However, EC, Ca²⁺, K⁺, Na⁺, HCO₃⁻, Cr, Cd, Pb, Co, and Fe had exceeded the WHO guideline. The Nemerow’s pollution index (NPI) showed that EC, Ca²⁺, K⁺, Na⁺, HCO₃⁻, Mn, Cd, Pb, Co, and Fe had worse water quality. Principal component analysis multilinear regression (PCAMLR) and cluster analysis (CA) revealed that 75% of the groundwater contamination originated from geogenic inputs and 18% mixed geogenic-anthropogenic and 7% anthropogenic sources. The HHRA-model suggested potential non-carcinogenic risks, except for Fe, and substantial carcinogenic risks for evaluated PHEs. The women and infants are extremely exposed to PHEs hazards. The non-carcinogenic and carcinogenic risks in children, males, and females had exceeded their desired level. The HHRA values of PHEs exhibited the following increasing pattern: Co > Cu > Mn > Zn > Fe, and Cd > Pb > Ni > Cr. The higher THI values of PHEs in children and adults suggested that the groundwater consumption in the entire region is unfit for drinking, domestic, and agricultural purposes. Thus, all groundwater sources need immediate remedial measures to secure health safety and public health concerns. Full article

(This article belongs to the Special Issue Water Pollution: Human Health and Ecological Risks)

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30 pages, 6489 KiB

Open AccessEditor’s ChoiceSystematic Review

Nature-Based Early Childhood Education and Children’s Social, Emotional and Cognitive Development: A Mixed-Methods Systematic Review

by Avril Johnstone, Anne Martin, Rita Cordovil, Ingunn Fjørtoft, Susanna Iivonen, Boris Jidovtseff, Frederico Lopes, John J. Reilly, Hilary Thomson, Valerie Wells and Paul McCrorie

Int. J. Environ. Res. Public Health 2022, 19(10), 5967; https://doi.org/10.3390/ijerph19105967 - 13 May 2022

Cited by 60 | Viewed by 35661

Abstract

This systematic review synthesised evidence on associations between nature-based early childhood education (ECE) and children’s social, emotional, and cognitive development. A search of nine databases was concluded in August 2020. Studies were eligible if: (a) children (2–7 years) attended ECE, (b) ECE integrated [...] Read more.

This systematic review synthesised evidence on associations between nature-based early childhood education (ECE) and children’s social, emotional, and cognitive development. A search of nine databases was concluded in August 2020. Studies were eligible if: (a) children (2–7 years) attended ECE, (b) ECE integrated nature, and (c) assessed child-level outcomes. Two reviewers independently screened full-text articles and assessed study quality. Synthesis included effect direction, thematic analysis, and results-based convergent synthesis. One thousand three hundred and seventy full-text articles were screened, and 36 (26 quantitative; 9 qualitative; 1 mixed-methods) studies were eligible. Quantitative outcomes were cognitive (n = 11), social and emotional (n = 13), nature connectedness (n = 9), and play (n = 10). Studies included controlled (n = 6)/uncontrolled (n = 6) before-after, and cross-sectional (n = 15) designs. Based on very low certainty of the evidence, there were positive associations between nature-based ECE and self-regulation, social skills, social and emotional development, nature relatedness, awareness of nature, and play interaction. Inconsistent associations were found for attention, attachment, initiative, environmentally responsible behaviour, and play disruption/disconnection. Qualitative studies (n = 10) noted that nature-based ECE afforded opportunities for play, socialising, and creativity. Nature-based ECE may improve some childhood development outcomes, however, high-quality experimental designs describing the dose and quality of nature are needed to explore the hypothesised pathways connecting nature-based ECE to childhood development (Systematic Review Registration: CRD42019152582). Full article

(This article belongs to the Special Issue Outdoor Play and Learning for Health, Wellbeing, and Development in Early Childhood)

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22 pages, 3845 KiB

Open AccessEditor’s ChoiceArticle

Effects of Environmental Features in Small Public Urban Green Spaces on Older Adults’ Mental Restoration: Evidence from Tokyo

by Shan Lu, Wonseok Oh, Ryozo Ooka and Lijun Wang

Int. J. Environ. Res. Public Health 2022, 19(9), 5477; https://doi.org/10.3390/ijerph19095477 - 30 Apr 2022

Cited by 31 | Viewed by 6052

Abstract

Exposure to small public urban green spaces (SPUGS) has been demonstrated to have mental benefits for older adults. However, studies on identifying the objective environmental features of SPUGS and their effects on mental restoration for older adults remain limited. This study employed a [...] Read more.

Exposure to small public urban green spaces (SPUGS) has been demonstrated to have mental benefits for older adults. However, studies on identifying the objective environmental features of SPUGS and their effects on mental restoration for older adults remain limited. This study employed a multilevel regression model to investigate the restorative and vitalizing effects of the environmental features of 11 SPUGS in Tokyo. Onsite measurements were conducted in Kita-Ku, and 202 older adults were surveyed. The results showed that: (1) The fitting curve of the green view index and Restoration Outcome Scale (ROS) score showed an inverted U shape—both green view index and boundary enclosure had a strong impact on the mental restoration of older adults; (2) The colorfulness index showed the strongest relationship with the vitalizing effect. (3) The sky view factor and number of seats only influenced the ROS score, while the results of revitalization suggest that large areas of water should be avoided. (4) Physiological Equivalent Temperature (PET) was also confirmed to have negative effects on the mental restoration of older adults in autumn. These empirical findings can be used as a resource to promote the mental health of older adults in the design of SPUGS in high-density Asian countries. Full article

(This article belongs to the Special Issue Urban Spaces, Environmental Exposures, Public Health, and Human Wellbeing)

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18 pages, 648 KiB

Open AccessEditor’s ChoiceArticle

Quality of Life and Mental Health in Children and Adolescents after the First Year of the COVID-19 Pandemic: A Large Population-Based Survey in South Tyrol, Italy

by Verena Barbieri, Christian Josef Wiedermann, Anne Kaman, Michael Erhart, Giuliano Piccoliori, Barbara Plagg, Angelika Mahlknecht, Dietmar Ausserhofer, Adolf Engl and Ulrike Ravens-Sieberer

Int. J. Environ. Res. Public Health 2022, 19(9), 5220; https://doi.org/10.3390/ijerph19095220 - 25 Apr 2022

Cited by 45 | Viewed by 6431

Abstract

Background: Methodological heterogeneity of studies and geographical variation limit conclusions about the impact of the COVID-19 pandemic on the mental health of youth. This study aimed to explore the health-related quality of life and mental health of children and adolescents in the second [...] Read more.

Background: Methodological heterogeneity of studies and geographical variation limit conclusions about the impact of the COVID-19 pandemic on the mental health of youth. This study aimed to explore the health-related quality of life and mental health of children and adolescents in the second year of the pandemic in South Tyrol, Italy. Methods: An online survey representative for the age and gender of the children and adolescents in South Tyrol was conducted among 5159 families with children and adolescents aged 7–19 years, between 28 May and 16 June 2021. The survey collecting parental ratings and self-rated questionnaires from children and adolescents aged 11–19 years included instruments to measure health-related quality of life (KIDSCREEN-10), mental health problems (SDQ), anxiety (SCARED), and depression (CES-DC). The results were compared with data from corresponding studies conducted in Germany. Results: Decreased health-related quality of life and increased conduct problems, peer-related mental health problems, anxiety, and depressive and psychosomatic symptoms in children and adolescents observed in the second year of the pandemic in Germany were confirmed in the second year in South Tyrol. Children and adolescents with low socioeconomic status, a migration background, and limited living space were significantly affected. Female sex and older age were associated with increased psychosocial problems and a positive family climate supported the mental health of children and adolescents during the pandemic. Conclusions: Confirmation of findings of decreased health-related quality of life and increased emotional problems after the first year of the pandemic supports the ongoing call for low-threshold health promotion, prevention, and early intervention programs to support children and adolescents who have been severely affected by the pandemic. Full article

(This article belongs to the Special Issue Advances in Child and Adolescent Mental Health)

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14 pages, 1782 KiB

Open AccessEditor’s ChoiceArticle

Increased Physical Activity at School Benefits Arterial Blood Pressure in Children—A Prospective Follow-Up Cohort Study

by Wojciech Kolanowski, Katarzyna Ługowska and Joanna Trafialek

Int. J. Environ. Res. Public Health 2022, 19(8), 4662; https://doi.org/10.3390/ijerph19084662 - 12 Apr 2022

Cited by 9 | Viewed by 3987

Abstract

(1) Background: A sedentary lifestyle and low physical activity (PA) increase the risk of hypertension in children. The aim of this study was to assess the impact of increased PA at school by elevation of the number of compulsory physical education (PE) lessons [...] Read more.

(1) Background: A sedentary lifestyle and low physical activity (PA) increase the risk of hypertension in children. The aim of this study was to assess the impact of increased PA at school by elevation of the number of compulsory physical education (PE) lessons on arterial blood pressure in children during a two-year follow-up. (2) Methods: Children (n = 245) born in 2007 attending a standard or elevated number of PE lessons in the school timetable (4 and 10 h a week, respectively) took part in the study. Blood pressure was measured starting from age approx. 10 to 12. (3) Results: Starting from a similar level, after 2 years, the percentage of children with normal blood pressure decreased in the standard-PE children from 83.25% to 78.03% but increased in the elevated-PE ones from 83.15% to 86.13%. The prevalence of both prehypertension and hypertension increased by one-third in the standard-PE children from 16.74% to 21.97% but decreased by one-sixth in the elevated-PE ones from 16.85% to 13.87%. The prevalence of hypertension itself increased by one-third in the standard-PE children from 9.82% to 13.12% but decreased in the elevated-PE ones by one-fifth from 9.60% to 7.75% (4) Conclusions: An increase in PA at school by the elevation of the number of PE lessons benefits children’s arterial blood pressure. Early prevention of hypertension in children can be supported by an adequate number of PE lessons in the school timetable. Full article

(This article belongs to the Special Issue Child Physical Activity and Health)

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15 pages, 350 KiB

Open AccessEditor’s ChoiceArticle

Tocolytic Treatment for the Prevention of Preterm Birth from a Taiwanese Perspective: A Survey of Taiwanese Obstetric Specialists

by Howard Hao Lee, Chang-Ching Yeh, Szu-Ting Yang, Chia-Hao Liu, Yi-Jen Chen and Peng-Hui Wang

Int. J. Environ. Res. Public Health 2022, 19(7), 4222; https://doi.org/10.3390/ijerph19074222 - 1 Apr 2022

Cited by 11 | Viewed by 4718

Abstract

Preterm birth represents a great burden to the healthcare system, resulting in the consideration for the use of tocolytic therapy to provide a “better time” for delivery in order to buy time to accelerate fetal lung maturity, thereby minimizing prematurity-related morbidity and mortality. [...] Read more.

Preterm birth represents a great burden to the healthcare system, resulting in the consideration for the use of tocolytic therapy to provide a “better time” for delivery in order to buy time to accelerate fetal lung maturity, thereby minimizing prematurity-related morbidity and mortality. However, the benefits and potential side effects and risks of tocolytic treatment for preterm birth should be carefully balanced. Although many countries and societies provide guidelines or consensuses for the management for preterm birth, there is no standardized national guideline or consensus in Taiwan. As such, great heterogeneity is suspected in preterm labor management, contributing to the uncertainty of attitudes and practice patterns of obstetric specialists in Taiwan. This study attempts to understand the attitudes and practice patterns regarding tocolytic therapy in Taiwan. A paper-based survey was conducted at the 2020 Taiwan Society of Perinatology Conference on 8 December 2020, exploring how obstetric specialists would use tocolytics under nine different clinical scenarios, such as a short cervix, preterm labor, maintenance tocolysis, preterm premature rupture of membranes, etc. Three hundred ten specialists attended the conference, and 77 responded to the survey with a response rate of 24.8%. According to the survey, many of these specialists would prescribe tocolytics for less evidence-based indications, including 22% for abdominal tightness, 46% for a short cervix, 60% for maintenance tocolysis, and 89% for repeat tocolysis, with the preferred first line medication being ritodrine and nifedipine. We concluded that tocolysis is widely accepted and practiced in Taiwan. More research is needed to include Taiwan-specific economic and cultural factors as well as associated adverse effects and patients’ outcomes. Full article

(This article belongs to the Special Issue Emerging Research in Maternal and Child Healthcare)

17 pages, 1562 KiB

Open AccessEditor’s ChoiceReview

Literature Cases Summarized Based on Their Polysomnographic Findings in Rett Syndrome

by Xin-Yan Zhang and Karen Spruyt

Int. J. Environ. Res. Public Health 2022, 19(6), 3422; https://doi.org/10.3390/ijerph19063422 - 14 Mar 2022

Cited by 10 | Viewed by 3580

Abstract

Rett syndrome (RTT) is a severe and rare neurodevelopmental disorder affecting mostly girls. In RTT, an impaired sleep pattern is a supportive criterion for the diagnosis, yet little is known regarding the sleep structure and sleep respiratory events. Aiming to delineate sleep by [...] Read more.

Rett syndrome (RTT) is a severe and rare neurodevelopmental disorder affecting mostly girls. In RTT, an impaired sleep pattern is a supportive criterion for the diagnosis, yet little is known regarding the sleep structure and sleep respiratory events. Aiming to delineate sleep by aggregating RTT case (series) data from published polysomnographic studies, seventy-four RTT cases were collected from eleven studies up until 6 February 2022 (PROSPERO: CRD 42020198099). We compared the polysomnographic data within RTT stratifications and to a typically developing population. MECP2 cases demonstrated shortened total sleep time (TST) with increased stage N3 and decreased REM sleep. In cases with CDKL5 mutations, TST was longer and they spent more time in stage N1 but less in stage N3 than those cases affected by MECP2 mutations and a typically developing population. Sleep-disordered breathing was confirmed by the abnormal apnea/hypopnea index of 11.92 ± 23.67/h TST in these aggregated cases. No association of sleep structure with chronological age was found. In RTT, the sleep macrostructure of MECP2 versus CDKL5 cases showed differences, particularly regarding sleep stage N3. A severe REM sleep propensity reduction was found. Aberrant sleep cycling, possibly characterized by a poor REM ‘on switch’ and preponderance in slow and high-voltage sleep, is proposed. Full article

(This article belongs to the Special Issue Exclusive Papers Collection of Editorial Board Members in Section Children's Health)

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13 pages, 344 KiB

Open AccessEditor’s ChoiceConcept Paper

Sex, Gender and Health: Mapping the Landscape of Research and Policy

by Lorraine Greaves and Stacey A. Ritz

Int. J. Environ. Res. Public Health 2022, 19(5), 2563; https://doi.org/10.3390/ijerph19052563 - 23 Feb 2022

Cited by 44 | Viewed by 9188

Abstract

Including sex and gender considerations in health research is considered essential by many funders and is very useful for policy makers, program developers, clinicians, consumers and other end users. While longstanding confusions and conflations of terminology in the sex and gender field are [...] Read more.

Including sex and gender considerations in health research is considered essential by many funders and is very useful for policy makers, program developers, clinicians, consumers and other end users. While longstanding confusions and conflations of terminology in the sex and gender field are well documented, newer conceptual confusions and conflations continue to emerge. Contemporary social demands for improved health and equity, as well as increased interest in precision healthcare and medicine, have made obvious the need for sex and gender science, sex and gender-based analyses (SGBA+), considerations of intersectionality, and equity, diversity and inclusion initiatives (EDI) to broaden representation among participants and diversify research agendas. But without a shared and precise understanding of these conceptual areas, fields of study, and approaches and their inter-relationships, more conflation and confusion can occur. This article sets out these areas and argues for more precise operationalization of sex- and gender-related factors in health research and policy initiatives in order to advance these varied agendas in mutually supportive ways. Full article

(This article belongs to the Special Issue Sex, Gender, and Health)

22 pages, 1585 KiB

Open AccessEditor’s ChoiceReview

Family Adjustment to Hereditary Cancer Syndromes: A Systematic Review

by Pedro Gomes, Giada Pietrabissa, Eunice R. Silva, João Silva, Paula Mena Matos, Maria Emília Costa, Vanessa Bertuzzi, Eliana Silva, Maria Carolina Neves and Célia M. D. Sales

Int. J. Environ. Res. Public Health 2022, 19(3), 1603; https://doi.org/10.3390/ijerph19031603 - 30 Jan 2022

Cited by 26 | Viewed by 6912

Abstract

Hereditary cancer syndromes are inherited pathogenic genetic variants that significantly increase the risk of developing cancer. When individuals become aware of their increased probability of having cancer, the whole family is affected by this new reality and needs to adjust. However, adjustment to [...] Read more.

Hereditary cancer syndromes are inherited pathogenic genetic variants that significantly increase the risk of developing cancer. When individuals become aware of their increased probability of having cancer, the whole family is affected by this new reality and needs to adjust. However, adjustment to hereditary cancer syndromes has been mainly studied at an individual level, and research about familial adjustment remains dispersed and disorganized. To overcome this gap, this review aims to understand how families adjust to genetic testing and risk management, and to what extent the family’s adjustment influences the psychological response and risk management behaviors of mutation carriers. We conducted searches on the PubMed/Med Line, PsycInfo, SCOPUS, and Google Scholar databases and used the Mixed Methods Appraisal Tool (MMAT-v2018) to assess the methodological quality of each selected study. Thirty studies met the inclusion criteria. Most results highlighted the interdependent nature of adjustment of pathogenic variant carriers and their families. The way carriers adjust to the syndrome is highly dependent on family functioning and related to how family members react to the new genetic information, particularly partners and siblings. Couples who share their worries and communicate openly about cancer risk present a better long-term adjustment than couples who use protective buffering (not talking about it to avoid disturbing the partner) or emotional distancing. Parents need help dealing with disclosing genetic information to their children. These findings reinforce the importance of adopting a family-centered approach in the context of genetic counseling and the necessity of involving family members in research. Full article

(This article belongs to the Special Issue Psychosocial Impact of Chronic Disease on Patients, Families and Caregivers)

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24 pages, 1292 KiB

Open AccessEditor’s ChoiceReview

Powering Research through Innovative Methods for Mixtures in Epidemiology (PRIME) Program: Novel and Expanded Statistical Methods

by Bonnie R. Joubert, Marianthi-Anna Kioumourtzoglou, Toccara Chamberlain, Hua Yun Chen, Chris Gennings, Mary E. Turyk, Marie Lynn Miranda, Thomas F. Webster, Katherine B. Ensor, David B. Dunson and Brent A. Coull

Int. J. Environ. Res. Public Health 2022, 19(3), 1378; https://doi.org/10.3390/ijerph19031378 - 26 Jan 2022

Cited by 51 | Viewed by 8825

Abstract

Humans are exposed to a diverse mixture of chemical and non-chemical exposures across their lifetimes. Well-designed epidemiology studies as well as sophisticated exposure science and related technologies enable the investigation of the health impacts of mixtures. While existing statistical methods can address the [...] Read more.

Humans are exposed to a diverse mixture of chemical and non-chemical exposures across their lifetimes. Well-designed epidemiology studies as well as sophisticated exposure science and related technologies enable the investigation of the health impacts of mixtures. While existing statistical methods can address the most basic questions related to the association between environmental mixtures and health endpoints, there were gaps in our ability to learn from mixtures data in several common epidemiologic scenarios, including high correlation among health and exposure measures in space and/or time, the presence of missing observations, the violation of important modeling assumptions, and the presence of computational challenges incurred by current implementations. To address these and other challenges, NIEHS initiated the Powering Research through Innovative methods for Mixtures in Epidemiology (PRIME) program, to support work on the development and expansion of statistical methods for mixtures. Six independent projects supported by PRIME have been highly productive but their methods have not yet been described collectively in a way that would inform application. We review 37 new methods from PRIME projects and summarize the work across previously published research questions, to inform methods selection and increase awareness of these new methods. We highlight important statistical advancements considering data science strategies, exposure-response estimation, timing of exposures, epidemiological methods, the incorporation of toxicity/chemical information, spatiotemporal data, risk assessment, and model performance, efficiency, and interpretation. Importantly, we link to software to encourage application and testing on other datasets. This review can enable more informed analyses of environmental mixtures. We stress training for early career scientists as well as innovation in statistical methodology as an ongoing need. Ultimately, we direct efforts to the common goal of reducing harmful exposures to improve public health. Full article

(This article belongs to the Special Issue Combined Environmental Exposures/ Chemical Mixtures)

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27 pages, 405 KiB

Open AccessFeature PaperEditor’s ChoiceReview

Recycling Plastics from WEEE: A Review of the Environmental and Human Health Challenges Associated with Brominated Flame Retardants

by Cecilia Chaine, Andrew S. Hursthouse, Bruce McLean, Iain McLellan, Brian McMahon, Jim McNulty, Jan Miller and Evi Viza

Int. J. Environ. Res. Public Health 2022, 19(2), 766; https://doi.org/10.3390/ijerph19020766 - 11 Jan 2022

Cited by 60 | Viewed by 8865

Abstract

Waste electrical and electronic equipment (WEEE) presents the dual characteristic of containing both hazardous substances and valuable recoverable materials. Mainly found in WEEE plastics, brominated flame retardants (BFRs) are a component of particular interest. Several actions have been taken worldwide to regulate their [...] Read more.

Waste electrical and electronic equipment (WEEE) presents the dual characteristic of containing both hazardous substances and valuable recoverable materials. Mainly found in WEEE plastics, brominated flame retardants (BFRs) are a component of particular interest. Several actions have been taken worldwide to regulate their use and disposal, however, in countries where no regulation is in place, the recovery of highly valuable materials has promoted the development of informal treatment facilities, with serious consequences for the environment and the health of the workers and communities involved. Hence, in this review we examine a wide spectrum of aspects related to WEEE plastic management. A search of legislation and the literature was made to determine the current legal framework by region/country. Additionally, we focused on identifying the most relevant methods of existing industrial processes for determining BFRs and their challenges. BFR occurrence and substitution by novel BFRs (NBFRs) was reviewed. An emphasis was given to review the health and environmental impacts associated with BFR/NBFR presence in waste, consumer products, and WEEE recycling facilities. Knowledge and research gaps of this topic were highlighted. Finally, the discussion on current trends and proposals to attend to this relevant issue were outlined. Full article

(This article belongs to the Special Issue Advances in Hazardous Waste and Human Health)

14 pages, 2382 KiB

Open AccessEditor’s ChoiceArticle

Association between Asthma Control and Exposure to Greenness and Other Outdoor and Indoor Environmental Factors: A Longitudinal Study on a Cohort of Asthmatic Children

by Giovanna Cilluffo, Giuliana Ferrante, Salvatore Fasola, Velia Malizia, Laura Montalbano, Andrea Ranzi, Chiara Badaloni, Giovanni Viegi and Stefania La Grutta

Int. J. Environ. Res. Public Health 2022, 19(1), 512; https://doi.org/10.3390/ijerph19010512 - 4 Jan 2022

Cited by 21 | Viewed by 3914

Abstract

Achieving and maintaining asthma control (AC) is the main goal of asthma management. Indoor and outdoor environmental factors may play an important role on AC. The aim of this longitudinal study was to evaluate the association between AC and exposure to greenness and [...] Read more.

Achieving and maintaining asthma control (AC) is the main goal of asthma management. Indoor and outdoor environmental factors may play an important role on AC. The aim of this longitudinal study was to evaluate the association between AC and exposure to greenness and other outdoor or indoor environmental factors in a cohort of asthmatic children. This study involved 179 asthmatic children (5–16 years). Parents were interviewed through a modified version of the SIDRIA questionnaire. AC was assessed at each visit. Exposure to greenness was measured using the normalized difference vegetation index (NDVI). A logistic regression model was applied for assessing risk factors for uncontrolled asthma (UA). Low NDVI exposure was a risk factor for UA (OR: 2.662, 95% CI (1.043–6.799)); children exposed to passive smoke during pregnancy had a higher risk of UA than those non-exposed to passive smoke during pregnancy (OR: 3.816, 95% CI (1.114–13.064)); and a unit increase in the crowding index was associated with an increased risk of UA (OR: 3.376, 95% CI (1.294–8.808)). In conclusion, the current study provided a comprehensive assessment of urban-related environmental exposures on asthma control in children, using multiple indicators of greenness and other outdoor or indoor environmental factors. Full article

(This article belongs to the Collection Feature Papers in Children's Health)

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