International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010051

Authors: Brian Morris Jenna Tauber Anvit Rai Cassandra Thiel Tiana J. Geringer Umar K. Mian

(1) Background: Healthcare is a major contributor to global greenhouse gas (GHG) emissions, especially within the surgical suite. Ophthalmologists play a role, since they frequently perform high-volume procedures, such as cataract surgery. This review aims to summarize the current literature on surgical waste and GHG emissions in ophthalmology and proposes a framework to standardize future studies. (2) Methods: Protocol and reporting methods were based on PRISMA guidelines for scoping reviews. Articles that reported any quantitative measurement of waste or GHGs produced from ophthalmic surgeries were eligible for inclusion. Commentaries, opinion papers, reviews and articles in a non-English language were excluded. (3) Results: A total of 713 articles were reviewed, with 10 articles found to meet inclusion criteria. Six studies produced level 3 evidence, two level 4 evidence, and one level 5 evidence. According to studies, most of the GHGs came from procurement of surgical materials, followed by travel emissions and building energy. (4) Conclusions: Research on waste and GHGs produced in ophthalmic surgery is limited, and existing studies utilize varied approaches to quantify this waste. We propose a standardized waste-lifecycle framework for researchers to organize future research. Such standardization will help in comparing studies and may uncover more opportunities to implement impactful waste reduction strategies in ophthalmology.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010052

Authors: Evan Stoddard Siddharth Bhandari Fred Sherratt Lauren Bone Sloan Russell

The construction industry faces a significant crisis with rising suicide rates and mental health issues among workers. Addressing these challenges requires both systemic changes in work practices and improved access to mental wellness resources. However, there is limited research on the perceptions of both workers and senior management towards proposed solutions to reducing psychological distress experienced in occupational settings. Understanding these perceptions is crucial to determining the needs and acceptability of different wellness interventions. Thus, this study aimed to uncover preferences for validated wellness interventions in occupational settings by exploring the attitudes of 12 senior managers and 15 frontline workers using Q-Methodology. Findings revealed that frontline workers favored personalized wellness interventions tailored to their unique situations. Additionally, notable differences were identified between frontline workers and senior managers in their views on policies and practices aimed at reducing workload pressures and enhancing accountability and communication. The data also showed that current contracting and work practices potentially hinder the implementation of interventions perceived to be most beneficial by workers and senior managers. These results provide valuable insights for future research and offer guidance to organizations on designing, implementing, and communicating effective wellness interventions.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010050

Authors: Wendy R. Winnall Ashleigh Haynes Walther Klerx Ingrid M. E. Bakker-‘t Hart Caroline Versluis Niels M. Leijten Emily Brennan Reinskje Talhout Melanie A. Wakefield

Cigarette brand variant names and characteristics such as the taste and feel of the smoke can mislead consumers into believing some products are less harmful. We assessed the characteristics of three common cigarette variants sold in Australia, “gold”, “blue” and “red”, to determine which characteristics differed by color, and which affected tar, nicotine and carbon monoxide (TNCO) yields. TNCO yields, physical parameters, expanded tobacco and filter ventilation were measured in cigarette color variants from eight brands. Filter ventilation and expanded tobacco were common across brands and variants. Compared to blue and red variants, gold variants had slightly shorter tobacco rods and greater filter ventilation. Gold variants had lower TNCO when measured using the industry-favored International Organization for Standardization (ISO) protocol. ISO-measured TNCO yields were associated with filter ventilation and tobacco rod length, but not use of expanded tobacco. When measured using the Health Canada Intensive (HCI) protocol, which better emulates human smoking behavior, TNCO emissions were markedly higher, and the emission differences by extent of filter ventilation were minimized, indicating that ISO measurements are misleading. These findings confirm that cigarette color names, and the filter ventilation levels they signify, remain misleading more than a decade after plain packaging eliminated pack colors in Australia, as higher levels of filter ventilation are not associated with reduced TNCO emissions measured using the HCI protocol. Consumer education and communication campaigns could amplify the impacts of Australia’s newly passed tobacco legislation banning color and other variant names that imply reduced harm.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010049

Authors: Camila Miriam Suemi Sato Barros do Amaral Jefferson Valente Cássia da Luz Goulart Bernardo Maia da Silva Alexandre Silva Neto Nadia Cubas-Vega Anna Gabriela Rezende Eduardo Fernandes Mayla Gabriela Silva Borba Vanderson Sampaio Wuelton Monteiro Gisely Cardoso de Melo Marcus Lacerda Guilherme Peixoto Tinoco Arêas Fernando Almeida-Val

Post-acute COVID-19 syndrome (PACS) is characterized by the persistence of one or more symptoms after the acute phase, leading to physical disabilities. This study aims to investigate whether the functional capacity and respiratory function 120 days post-COVID-19 differed according to the level of respiratory support needed during hospitalization in acute COVID-19 in the pre-vaccine rollout period. We followed up with 118 COVID-19 hospitalized patients in the acute phase until 120 days post-acute disease, with patients split into a Non-Invasive Oxygen Therapy Group (OTG, n = 72), Invasive Mechanical Ventilation Group (IMV, n = 12), and Room Air Group (RAG, n = 34), assessing the body composition, respiratory muscle strength, pulmonary function, functional capacity, and muscle strength at the follow-up visit. In total, 54 individuals (45.8%) were female, with a median age of 48 years old (IQR: 41–58). We found that the group with IMV was older (p < 0.001), had more admissions to the ICU (p < 0.001), and had longer hospital stays (p < 0.001). There were no statistically significant differences between groups (OTG, IMV, and RAG) for the spirometry function (p = 0.31), DASI score (p = 0.77), manovacuometry (MIP p = 0.74; MEP p = 0.23), 6MWT (p = 0.43), and handgrip (p = 0.19) outcomes. At D120, the IMV group had an important loss of body muscle mass (BMM) and a higher BMM than RAG (p = 0.02). Reduction in MIP (p = 0.01) and MEP (p = 0.02) in the IMV group and OTG group when compared to the RAG was also observed. Functional outcomes at 120 days from COVID-19 hospitalization were not found to be associated with the levels of oxygen supplementation during acute disease in this group of participants.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010048

Authors: LaKeisha Williams Leslie S. Craig Erin Peacock Tynesia Fields Sara Al-Dahir Frances Hawkins Christopher Gillard Brittany Singleton Katherine Theall Michelle Wilson Gene D’Amour Mai Vu Christopher Sylvain Lishunda Franklin Kathryn Caldwell Marie Krousel-Wood Daniel Sarpong

Given the increasing integration of trusted leaders in public health science, including vaccination programs, context-specific understandings of community perceptions and levels of trust are critical to intervention. This study aimed to understand the perspectives and attitudes of the southeastern Louisiana community and inform the development of a community-engaged action plan. A cross-sectional survey of 555 southeastern Louisianans—including faith-based organization (FBO) members, community pharmacy (CommRx) customers, community-based organization (CBO) contacts, and Louisiana community-dwelling residents—was conducted from November 2020 to March 2021. Multivariable logistic regression was used to explore factors associated with COVID-19 vaccination likelihood. Of the participants, 89.9% were Black and 56.9% were women (mean age = 53.3 years). Doctors/healthcare providers (HCPs) were the most trusted COVID-19 information sources. Vaccination likelihood was associated with increasing age (odds ratio (OR) = 1.47; 95% confidence interval (CI): 1.27–1.72), trust in doctors/HCPs (OR = 2.83; 95% CI: 1.64–4.88), trust in government (OR = 4.26; 95% CI: 2.44–7.43), and motivations to keep one’s community safe (OR = 1.52; 95% CI: 1.36–1.70). CommRx customers (OR = 1.93; 95% CI: 1.02–3.65) and CBO contacts (OR = 2.57; 95% CI: 1.37–4.83) were more likely to receive a COVID-19 vaccine than FBO members. Engaging underserved communities and trusted stakeholders through collaborative Community–Academic—Public health—Practice (CAPP) partnerships such as the Louisiana Community Engagement Alliance can promote health and wellness and optimize health interventions.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010047

Authors: Carles Rubio Maturana Allisson Dantas de Oliveira Francesc Zarzuela Alejandro Mediavilla Patricia Martínez-Vallejo Aroa Silgado Lidia Goterris Marc Muixí Alberto Abelló Anna Veiga Daniel López-Codina Elena Sulleiro Elisa Sayrol Joan Joseph-Munné

The gold standard diagnosis for malaria is the microscopic visualization of blood smears to identify Plasmodium parasites, although it is an expert-dependent technique and could trigger diagnostic errors. Artificial intelligence (AI) tools based on digital image analysis were postulated as a suitable supportive alternative for automated malaria diagnosis. A diagnostic evaluation of the iMAGING AI-based system was conducted in the reference laboratory of the International Health Unit Drassanes-Vall d’Hebron in Barcelona, Spain. iMAGING is an automated device for the diagnosis of malaria by using artificial intelligence image analysis tools and a robotized microscope. A total of 54 Giemsa-stained thick blood smear samples from travelers and migrants coming from endemic areas were employed and analyzed to determine the presence/absence of Plasmodium parasites. AI diagnostic results were compared with expert light microscopy gold standard method results. The AI system shows 81.25% sensitivity and 92.11% specificity when compared with the conventional light microscopy gold standard method. Overall, 48/54 (88.89%) samples were correctly identified [13/16 (81.25%) as positives and 35/38 (92.11%) as negatives]. The mean time of the AI system to determine a positive malaria diagnosis was 3 min and 48 s, with an average of 7.38 FoV analyzed per sample. Statistical analyses showed the Kappa Index = 0.721, demonstrating a satisfactory correlation between the gold standard diagnostic method and iMAGING results. The AI system demonstrated reliable results for malaria diagnosis in a reference laboratory in Barcelona. Validation in malaria-endemic regions will be the next step to evaluate its potential in resource-poor settings.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010046

Authors: Chelsi E. Scott Mary D. Fry Troy O. Wineinger Susumu Iwasaki Haiying Long Theresa C. Brown

In the Spring of 2020, Coronavirus 2019 (COVID-19) was officially declared a global pandemic, which prompted an unprecedented number of changes to societal functioning. Amongst those who experienced significant life alterations were collegiate athletes within the United States (US). The purpose of this study was to examine the relationship between US athletes’ perceptions of their team motivational climate, perceived support from coaches and teammates, and their optimistic thoughts during the COVID-19 pandemic. US collegiate athletes (N = 756; 56.3% female; Mage = 20.07 years, SDage = 1.57 years) across a variety of levels (e.g., Division I) and sports (e.g., basketball) were invited to participate in this study. Structural equation modeling analyses revealed significant positive associations between a caring and task-involving climate, athletes’ feeling supported by their coaches and teammates, and athletes’ optimistic thoughts during the COVID-19 pandemic. In addition, an ego-involving climate was significantly negatively associated with athletes’ feeling supported by their coaches and teammates. The final results suggest that the supportive actions of coaches and teammates during difficult times can mediate the positive connection between perceptions of a caring-task-involving climate on athletic teams and an athlete’s ability to stay optimistic during difficult life stressors.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010045

Authors: Eva Masciarelli Laura Casorri Marco Di Luigi Claudio Beni Massimiliano Valentini Erica Costantini Lisa Aielli Marcella Reale

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.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010044

Authors: Alp Tural Elif Tural

Given the increasing prevalence of anxiety and depression, this research aims to identify design features that enhance the sense of restoration, with the goal of supporting mental and behavioral healthcare facility design. This study employed both screen-based and virtual reality (VR) stimuli to evaluate the perceived restorativeness of different interior settings. The key variables analyzed included window view access, view content, materiality, and room geometry. Thirty-five undergraduate and graduate students assessed 16 distinct interior environments. Findings indicate that the VR presentations generally produced higher restorativeness scores compared with screen-based presentations, though this effect varied across stimuli. Repeated-measures ANOVA revealed that larger windows consistently correlated with higher restorativeness scores in both presentation modes. Views of water were rated as most restorative, followed by wooded areas. Natural materials were perceived as significantly more restorative than other materials, particularly in VR presentations. Varied ceiling designs, especially vaulted ceilings, were associated with evaluations of higher restorativeness compared with flat ceiling designs, with this effect more pronounced in VR. This research underscores the potential of VR technology to simulate and assess interior design interventions, offering insights into creating more effective and personalized restorative environments in mental health treatment facilities. The findings can inform evidence-based design strategies for healthcare spaces, supporting treatment processes and patient well-being.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010043

Authors: Lynn Mad Plume Danya Carroll Melanie Nadeau Nicole Redvers

Indigenous wellness has been defined in varying contexts by diverse Indigenous Peoples. The existing indicators used to measure wellness are often defined from a Western perspective. Despite the rich conceptualizations of Indigenous wellness, there exists a notable gap in how it can be measured in contemporary contexts through an Indigenous lens. A scoping review methodology with the aim of identifying measures of wellness developed through Indigenous partnerships was carried out. We completed a systematic search in the following electronic databases: PubMed, CINAHL, Psych Info Academic Search Complete, SocIndex, and the Native Health Database. We then carried out a two-stage article screening process to identify eighteen relevant papers. Content analysis was then used to identify (1) the major categories for the partnership contexts utilized in the process for measuring Indigenous wellness and (2) the kinds of measures developed. Five main categories were characterized, including the following: (1) building relationships that uphold Indigenous worldviews is important, (2) a call for co-development protocols that weave multiple worldviews, (3) the need to increase awareness of the limitations in measuring Indigenous wellness, (4) community-specific context is important, and (5) a call for strengths-based indicators. Governments, organizations, and research partners are called upon to support the co-development of meaningful engagement protocols that privilege and reflect Indigenous voices and perspectives when measuring Indigenous wellness.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010042

Authors: Justin Chew Zhiwei Zeng Toh Hsiang Benny Tan Pamela Chew Noorhazlina Ali Hao Wang Melissa Ong Roslyn Raymond Kalene Pek Di Wang Liang Zhang Zhiqi Shen Cyril Leung Jing Jih Chin Wee Shiong Lim Chunyan Miao

Background: Current research highlights the importance of addressing multiple risk factors concurrently to tackle the complex etiology of dementia. However, limited evidence exists on the efficacy of technology-driven, multidomain community-based interventions for preventing cognitive decline. Objectives: To evaluate the efficacy of ADL+, an artificial intelligence (AI)-enabled digital toolkit integrating cognitive assessments and multidomain interventions, on outcomes of cognitive function, activity levels, and quality of life in older adults at risk of cognitive decline. Adherence and usability were also evaluated. Methods: We conducted a quasi-experimental study including community-dwelling older adults aged 60 years and above without dementia, but with subjective memory complaints (AD8 score ≥ 2). Participants received a six-month intervention (app-based cognitive training, personalized nutritional, physical, and social activities recommendations) or a control group treatment (cognitive health educational package). The primary outcome was a change in neuropsychological test battery (NTB) Z-scores (NTB composite and its individual domains: attention, processing speed, memory, and executive function). Secondary outcomes were activity levels (Frenchay Activities Index, FAI), and quality of life (EQ-5D). Outcomes were assessed at the end of the intervention and three months post-intervention using linear mixed-effects models. Results: 96% of participants in the intervention and 89% in the control group completed the study. At six months, the intervention group showed a significant NTB composite score improvement (mean change: 0.086 (95% CI 0.020 to 0.15)), with a between-group difference of 0.17 (95% CI 0.071 to 0.27). Significant differences in attention, processing speed, and memory domains were observed, with benefits sustained in the processing speed domain at nine months. The control group’s FAI scores declined at six months (mean change: −1.04 (95% CI −1.83 to −0.26)), while the intervention group’s scores remained stable. The intervention group’s EQ-5D visual analogue scale (VAS) scores improved at both six and nine months, with between-group differences of 4.06 (95% CI 0.23 to 7.90) at six months and 5.12 (95% CI 0.81 to 9.43) at nine months. Adherence was high, while average usability scores were obtained. Conclusions: The ADL+ toolkit shows potential beneficial effects on cognitive function, activity levels, and quality of life for older adults at risk of cognitive decline. Findings will guide future randomized controlled trials and implementation efforts.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010041

Authors: Tanvi V. Padalkar Keyonsis Hildreth Gabrielle B. Rocque Stacey A. Ingram Omari Whitlow Dan Chu Connie C. Shao Courtney P. Williams Claudia M. Hardy Chao-Hui Sylvia Huang Nicole L. Henderson

As healthcare and health services become increasingly digitized, individuals with low digital health literacy (DHL) may experience inequitable care and outcomes. We explored factors impacting DHL and recommendations for improvement from community health coordinators and advisors (CHAs) in Alabama and Mississippi in United States. Semi-structured interviews were conducted with CHAs to gather insights on their perspectives on and experiences with DHL. Interviews were transcribed and analyzed using a grounded coding schema, with key barriers and recommendations mapped onto the Taplin Multi-Level Intervention model to help identify influences across various levels. Thirty-two CHAs participated, predominantly female (94%) and Black or African American (94%). At the individual level, factors involved demographic characteristics, increased patient workload, and attitudes towards technology. Social support was captured at the relationships level. At the provider level, provider–patient communication and injustices were involved, compounded by health system infrastructure and culture at the practice-setting level. Resource landscape and shared knowledge and beliefs were significant at the community level. The COVID-19 pandemic further highlighted these challenges at the societal level. CHAs provided targeted recommendations for addressing barriers at each level. CHAs identified multi-level factors contributing to DHL and emphasized levels based on comprehensive interventions.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010040

Authors: William Nelson Mwakalasya Simon Henry Mamuya Bente Elisabeth Moen Aiwerasia Vera Ngowi

Women constitute most of the global horticulture workforce, where pesticide use is prevalent. Protecting their health, particularly during pregnancy, is essential. However, knowledge about practices among pregnant employees that cause exposure to pesticides is limited. This study aims to identify such practices and assess the impact of pesticide-handling knowledge on exposure. A cross-sectional survey was conducted among 432 small-scale horticulture women workers in Tanzania from October 2022 to April 2023. The women were interviewed using a self-report questionnaire, with descriptive statistics, Pearson’s chi-square tests, and T-tests used for data analysis. In total, 86% of participants worked in horticulture during pregnancy, with 47.5% continuing into the third trimester. Many engaged in weeding within 24 h of spraying (58.4%) and washing pesticide-contaminated clothes (51.7%). Most of the women (93.1%) had limited knowledge of pesticide handling, though some understood mixing (62.5%) and spraying (64.1%) instructions on labels. This study suggests that women working in horticulture are exposed to pesticides during pregnancy partly due to limited knowledge of safe pesticide handling. These exposures are largely shaped by the working conditions, which may place both pregnant women and their offspring at risk of hazardous pesticide exposure. Hence, there is a need for guidelines and policies towards protecting women working in agriculture.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010037

Authors: Huaqiong Zhou Fatch Kalembo Ambili Nair Eric Lim Xiang-Yu Hou Linda Ng

The international tertiary education sector was significantly affected by the COVID-19 pandemic due to the risk of negative learning and psychosocial experiences. Most international students who remained in the host countries demonstrated admirable resilience and adaptability during those challenging times. An integrative review of factors shaping international students’ learning and mental wellbeing during the COVID-19 pandemic was conducted. Five electronic databases—CINAHL, MEDLINE, ProQuest, PsycINFO, and Web of Science—were searched from 2020 to 2023 using the key search terms ‘international students’, ‘tertiary education’, ‘mental health and wellbeing’, and ‘COVID’. A total of 38 studies were included in this review. They revealed six factors across learning and psychosocial experiences. Predisposing factors for maladjustments included the students being younger and possessing poor English proficiency. Precipitating factors were related to online teaching/learning, and lack of accessibility and or insufficient learning and living resources. Perpetuating factors pertained to living arrangements. The protective factor identified was institutional support. This review highlighted that multifaceted factors were associated with international students’ experiences and mental health and wellbeing. In-depth understanding of risk and protective factors can help policymakers to prepare for unprecedented challenges and reduce disruptions to international students’ education and mental health when studying abroad.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010039

Authors: Yuan Tian Jenny Basran Wade McDonald Nathaniel D. Osgood

We engaged with health sector stakeholders and public health professionals within the health system through a participatory modeling approach to support policy-making in the early COVID-19 pandemic in Saskatchewan, Canada. The objective was to use simulation modeling to guide the implementation of public health measures and short-term hospital capacity planning to mitigate the disease burden from March to June 2020. We developed a hybrid simulation model combining System Dynamics (SD), discrete-event simulation (DES), and agent-based modeling (ABM). SD models the population-level transmission of COVID-19, ABM simulates individual-level disease progression and contact tracing intervention, and DES captures COVID-19-related hospital patient flow. We examined the impact of mixed mitigation strategies—physical distancing, testing, conventional and digital contact tracing—on COVID-19 transmission and hospital capacity for a worst-case scenario. Modeling results showed that enhanced contact tracing with mass testing in the early pandemic could significantly reduce transmission, mortality, and the peak census of hospital beds and intensive care beds. Using a participatory modeling approach, we not only directly informed policy-making on contact tracing interventions and hospital surge capacity planning for COVID-19 but also helped validate the effectiveness of the interventions adopted by the provincial government. We conclude with a discussion on lessons learned and the novelty of our hybrid approach.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010038

Authors: João Victor Rosa de Freitas Bráulio Evangelista de Lima Rizia Rocha-Silva Vinnycius Nunes de Oliveira Thalles Guillarducci Costa Mila Alves Matos Rodrigues Rodrigo Luiz Vancini Marília Santos Andrade Gustavo de Conti Teixeira Costa Lorenzo Laporta Ricardo Borges Viana Claudio Andre Barbosa de Lira

Introduction: Beach tennis has become a popular sport, but research on its mental health benefits is scarce. To the best of our knowledge, no studies have examined the effects of beach tennis on anxiety symptoms. Objectives: To assess the effect of a single session of beach tennis, in both singles and doubles modes, on anxiety symptoms. Methods: Twenty-two recreational players (11 women, age: 35.00 [13.50] years) were evaluated. Each participant underwent three intervention sessions in random order: one-on-one match (singles), two-on-two match (doubles), and a control session (non-exercise). State anxiety and affective responses were measured before and after each intervention. Results: For men, no significant interaction between time and session was found (p = 0.646). In women, there was a significant interaction between time and session (p = 0.002). Anxiety symptoms significantly decreased from pre- to post-singles condition (p = 0.007) and from pre- to post-doubles condition (p = 0.010). A significant difference was observed between the post-singles and post-control conditions (p = 0.002). Conclusion: Beach tennis demonstrated an anxiolytic effect in women, with significant reductions in anxiety symptoms following both singles and doubles sessions. However, no such effects were observed in men. These findings suggest that beach tennis could be a viable intervention for managing anxiety symptoms in women. The study was registered in the Brazilian Clinical Trials Registry (registration code: U1111-1293-7949).

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010036

Authors: Julie L. Nagoshi Craig Nagoshi Farzana Akter Vijayan K. Pillai

The present questionnaire study explores the relationship between intimate partner violence (IPV), coping strategies, and psychological maladjustment for both female and male college students, as well as considering the effects of perpetrated IPV. College students are at risk for experiencing and perpetrating IPV, and coping skills may act as important risk and protective factors. In total, 333 (247 women, 86 men) undergraduate college students completed an online survey for research participation credit. Perpetrated intimate partner verbal aggression and experienced and perpetrated relationship violence were significantly correlated with somatization and depression, while for women, perpetrated verbal aggression was significantly correlated with somatization, depression, anxiety, and eating disorder symptoms. Experienced verbal aggression was significantly correlated with depression for women, while perpetrated verbal aggression was significantly correlated with anxiety for men. Path analyses with bootstrapped mediation tests found that, for men, the relationships between experienced violence and somatization and depression were significantly mediated by avoidant coping, while for women, the relationships between perpetrated verbal aggression and somatization, depression, anxiety, and eating disorder symptoms were significantly mediated by avoidant coping. Findings suggest that, particularly for women, the use of avoidant coping behaviors may exacerbate cycles of victimization by and perpetration of IPV that, in turn, lead to greater psychological distress. The present findings suggest that interventions to reduce IPV should put greater emphasis on the teaching of adaptive coping skills in couple relationships to help reduce the impulse to perpetrate violence, on top of coping skills to deal with experienced violence.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010034

Authors: Benni Beltramo Soumya Kolluru Lisa Slager Lindsey Wall Kai Ostwald Drona Rasali

In response to emerging challenges that intersect humans, animals, and environments, there is growing international exigent need to adopt ‘One Health’ approaches. While One Health efforts are emerging in British Columbia in Canada, there are still challenges to overcome in the adoption of a One Health approach in policymaking. We conducted a comparative analysis of One Health policies in Asia, specifically, Singapore, Hong Kong, Bangladesh, and Thailand, which have well-established and sophisticated One Health approaches, to determine good practices in the implementation of One Health that could be considered for adoption in British Columbia. We conducted a literature review and scan of public-facing One Health websites, strategic action plans, and health databases, complemented by 13 semi-structured interviews with researchers, educators, service providers, human and animal health experts, and policymakers in our chosen Asian jurisdictions and British Columbia. While there was diversity in the One Health approaches taken by four jurisdictions, three key characteristics were present in policymaking processes in all of them: a national One Health strategic action plan, inter-ministerial coordination, and flexibility in the working relationships of public servants. One Health presents an opportunity for British Columbia to take a novel approach to public health policymaking, the one that is more holistic and effective at addressing shared health challenges.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010035

Authors: Andrea Ribeiro Rodrigo Soares Luis Barbosa Ana Silva Raquel Ferreira Sara Terroso Ana Claudia Andriolli Ligia Torres Silva Carlos A. Ribeiro

Health professionals have slowly integrated the environment and green areas into their prescriptions to connect patients with nature and outdoor activities. The World Health Organization recommends that everyone reside within 300 m of green regions to improve well-being and physical and mental health. The study aimed to explore the effects of urban and rural green areas on multiple physiological and functional variables, as well as evaluate the perception of individuals regarding the ease of use of these same spaces. Participants walked twice a week for six weeks, covering 1.6 km. Heart rate (HR), blood pressure (BP), oxygen saturation (SpO2), physical capacity analysis (IPAQ), risk of falls (Morse Fall Scale), Mini Mental State Examination, physical performance test (PPT), and perception of accessibility (Pedestrian Accessibility Perception Scale for adults over 65 years old) were evaluated/administered. Variables such as noise, temperature, and air quality were also measured during the outdoor activities. Twenty-four individuals divided into two groups participated in the study: group 1 (urban route) and group 2 (rural route). We found impacts on body weight (p = 0.021), SpO2 (p = 0.033), and Mini Mental State Examination (p = 0.041) scores in group 1 and SpO2 and PPT scores in group 2. This study highlights the importance of incorporating green infrastructure in urban planning to support healthy aging and improve accessibility for older adults, and shows that outdoor activities provide various health benefits (physical, mental, and social well-being) and that walking in urban and rural environments seems to impact the health of elderly individuals positively and should be considered in physical therapy by health professionals.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010033

Authors: Frano Giakoni-Ramírez Josivaldo de Souza-Lima Catalina Muñoz-Strale Nicolás Hasche-Zunino Constanza Sepúlveda-Barría Andrés Godoy-Cumillaf

(1) Background: Aging is associated with a progressive decline in physical capacity, which is further exacerbated by conditions such as arthritis and chronic joint pain. This study aimed to compare the effects of aquatic and land-based exercise on the functional fitness of older adult women. (2) Methods: Sixty older women (mean age 66.9 ± 3.8 years) participated in this study, divided into two groups: aquatic exercise and land-based exercise. Both groups completed functional fitness tests, including flexibility (Back Scratch and Chair Sit-and-Reach Tests), lower body strength (Chair Stand Test), and dynamic balance (8-Foot Up-and-Go Test). Statistical analyses compared group performance. (3) Results: Improvements in flexibility were observed in the aquatic group, with trends toward significance for the Back Scratch Test (−0.2 ± 1.0 cm vs. −2.0 ± 0.0 cm, p = 0.08) and the Chair Sit-and-Reach Test (2.87 ± 2.0 cm vs. 0.27 ± 1.0 cm, p = 0.07). No statistically significant differences were observed between the groups in measures of lower body strength (Chair Stand Test: 19.1 ± 4.47 reps vs. 18.97 ± 3.77 reps, p = 0.9) or dynamic balance (8-Foot Up-and-Go Test: 6.28 ± 6.2 s vs. 6.03 ± 5.83 s, p = 0.07). (4) Conclusions: Aquatic exercise showed greater improvements in flexibility, particularly in the upper and lower body, although these differences did not reach statistical significance. Both training modalities were equally effective in maintaining lower body strength and dynamic balance in older adult women. These findings support the inclusion of tailored exercise programs in aging populations to address specific functional needs.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010032

Authors: Abiola A. Adeniyi Swathi Ramachandran Cecilia Marie Jevitt

Research demonstrates associations between oral health and specific mental health conditions in the general population, yet these relationships remain understudied during pregnancy, despite pregnancy’s profound effects on both oral and psychological well-being. Our rapid review examines current evidence on associations between oral health conditions and psychological states (anxiety, depression, and stress) during pregnancy, aiming to inform and strengthen integrated prenatal care strategies. Following PRISMA-RR guidelines, we conducted a systematic search on OVID Medline, CINAHL, and PsycINFO (January 2000–November 2024) for studies examining relationships between oral health conditions (periodontal disease, dental caries) and psychological status during pregnancy and up to one year postpartum. Systematic screening of 1201 records yielded 22 eligible studies (13 cross-sectional studies, 3 longitudinal cohort studies, 3 comparative studies, 2 prospective studies, and 1 case–control study). Analysis confirmed significant associations between oral health and psychological well-being during pregnancy through three pathways: psychological (dental anxiety directly limits oral healthcare utilization), behavioral (maternal depression reduces oral health self-efficacy), and physiological (elevated stress biomarkers correlate with periodontal disease, and periodontal therapy is associated with reduced salivary cortisol). These interactions extend intergenerationally, with maternal psychological distress showing significant associations with children’s caries risk. Evidence suggests interactions between oral health conditions and psychological states during pregnancy, warranting integrated care approaches. We recommend: (1) implementing combined oral–mental health screening in prenatal care, (2) developing interventions targeting both domains, and (3) establishing care pathways that address these interconnections. This integrated approach could improve both maternal and child health outcomes.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010031

Authors: Anna-Lena Hansson Per Johnsson Sophia Eberhard Anna Ehnvall Sara Lindström Margda Waern Åsa Westrin

Suicide among children and young adults is a leading cause of mortality, highlighting the importance of the development of life-saving interventions. This study is part of the nationwide study Retrospective investigation of health care utilization of individuals who died by suicide in Sweden in 2015, Lund University, Sweden. The aim was to gain a better understanding of verbal suicidal communication and suicidal behaviour in children and young adults who die by suicide, to analyse gender and age differences, and to discuss the findings in relation to the prevailing psychological theories of suicidality. The study sample consisted of medical records from final health care consultations of 114 individuals up to 25 years, who died by suicide in Sweden a single year. Suicidal plans were documented in 13 percent of children and young adults. Females were more likely to have a notation of suicidal communication than males. Twenty-seven percent had made previous suicide attempts. Approximately 90 percent of the study cohort had contact with health care settings within 24 months prior to suicide. Questioning about suicidal plans appears to be an insufficient tool to assess suicidality in children and young adults. Clinical implications regarding alternative assessment methods and preventive measures are discussed.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010030

Authors: Natalia Stanulewicz-Buckley Edward Cartwright

This study examines the relative effectiveness of the UK government’s public health messages used during the first wave of the COVID-19 pandemic. We focus on the use of a loss versus gain frame. We look at the effect of framing on behavioural inclination to follow COVID-19 guidance, as well as affective mechanisms and individual characteristic moderators that might explain said willingness. We ran two studies with a voluntary sample of the UK adult population (total n = 300). Across both studies, we only find a significant impact of message framing on the level of negative affect triggered, with the loss frame triggering a higher negative affect. Instead, attitude to public health communication had a direct and indirect effect on behavioural inclination. Our results suggest that threat minimisation and satisfaction with authorities handling a health crisis might be key to consider when developing effective public health communications.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010029

Authors: Katherine A. Graves Lindsey G. Mirielli Cannon Ousley Chad A. Rose

The initial phase in any initiative aimed at preventing bullying involves evaluating the present prevalence to pinpoint students who might be more susceptible to involvement in the bullying dynamic. Assessment serves as a guide for shaping future decisions regarding intervention. The purpose of this study was to identify and evaluate current assessment tools to determine the extent to which the bullying dynamic is currently measured. The results indicated that assessment tools measured verbal bullying/victimization most frequently, followed by relational and physical. Also, items measured repetition and intent about 50% of the time, while they measured power imbalance less frequently (i.e., 25%). The importance of matching an appropriate assessment to a school’s needs is emphasized. Implications for both researchers and practitioners are discussed.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010028

Authors: Bong Nguyen Barbara Lohse Lynda H. Powell Kevin S. Masters Jannette Berkley-Patton Betty M. Drees

This study assessed the association of food security with potential cardio-metabolic risk factors among persons with metabolic syndrome (MetS). Data were derived from the baseline data of a randomized controlled lifestyle intervention trial for individuals with MetS. Household food security, fruit and vegetable intake, perceived food environment, and perceived stress were collected using validated questionnaires. Cardio-metabolic measures assessed with standardized procedures included body mass index, waist circumference, blood pressure, glucose, HbA1c, and lipids. Regression models adjusted for demographics, medication use, and perceived stress were performed. Of a total of 664 participants (median age 56), the majority were female, non-Hispanic White, college-educated, and employed. Food insecurity affected 23% (n = 152), with 5% (n = 31) experiencing very low food security. Food-insecure individuals had significantly higher stress (p < 0.001), lacked healthy food access (p < 0.001), were and less likely to consume ≥2 servings of vegetables/day (p = 0.003). HbA1c was the only cardio-metabolic measure significantly associated with food security (p = 0.007). The link between food insecurity and elevated HbA1c levels highlights the importance of addressing food insecurity and stress to improve metabolic health outcomes in the MetS population.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010027

Authors: Rodrigo Sanches Peres Pedro Afonso Cortez

(1) Background: Validated instruments to measure mental health variables related to sanitary crises can provide data for prevention or intervention plans. The objectives of this study were: (1) to evidence the psychometric factorial internal structure of the Battery for Assessing Mental Health–Pandemic Version (BASM-P) in the sample; (2) to investigate the psychosocial impact of the COVID-19 pandemic in Brazilian post-peak period among individuals with and without pre-existing psychiatric conditions using the BASM-P; and (3) to analyze relationships between the mental health variables measured by the BASM-P in both groups. (2) Methods: This is an internet-based quantitative, cross-sectional study with a non-probabilistic convenience sample. The participants (n = 209) were divided into a non-psychiatric group (n = 168) and a psychiatric group (n = 41). The instruments were the BASM-P and a sociodemographic questionnaire. Data were collected throughout the second semester of 2022 and analyzed with JASP software. (3) Results: The BASM-P demonstrated robust psychometric factorial internal structure. Significant differences were observed between the two groups across all variables. In the non-psychiatric group, obsessive thoughts presented strong connections to fear, distress, and grief from job loss. (4) Conclusions: This study highlights the central role of obsessive thoughts in shaping the psychosocial impact of the COVID-19 pandemic in the Brazilian post-peak period.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010026

Authors: Mona Pathak Sophie Mitra Jahnavi Pinnamraju Patricia A. Findley R. Constance Wiener Hao Wang Bo Zhou Chan Shen Usha Sambamoorthi

Inflation generates stress, which may lead to high rates of anxiety and depression. Given the recent surge and subsequent decline in the inflation rate in the United States, the prevalence of stress due to inflation may vary, as well as its relationship with anxiety and depression. Therefore, we investigated the prevalence of stress due to inflation and its association with anxiety and depression over time among working-age adults in the United States. We conducted a repeated cross-sectional analysis using Household Pulse Survey (HPS) data for the following weeks: Week 50 (5–17 October 2022) and Week 57 (26 April–8 May 2023). The HPS includes questions about individuals’ stress levels due to price increases in the past two months. We used logistic regressions to examine the association of stress (moderate or high stress versus little or no stress) due to inflation with depression and anxiety among working-age adults controlling for several factors, including demographic factors and social determinants of health. From October 2022 to April–May 2023, the prevalence of stress due to inflation affected more than three quarters of the population (77.7% and 78.7%, respectively). In logistic regressions, we found a significant positive association of stress due to inflation with depression (adjusted odds ratio (AOR) [95% CI] = 2.22 [1.92, 2.57]) and anxiety (AOR [95% CI] = 2.50 [2.18, 2.86]). Despite a decline in the prevalence of both depression and anxiety by three percentage points over the study period, the associations between stress, due to inflation on the one hand, and anxiety and depression, on the other, persisted over time. Stress due to inflation affects more than three-quarters of Americans, and is significantly associated with depression and anxiety. Stress due to inflation is a significant and persistent public health issue.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010024

Authors: Silvana Giannini Stefano Amatori Mario Vetrano Michela Battistelli Annalisa Belli Giorgia Simona Musicco Marco Bruno Luigi Rocchi Davide Sisti Fabrizio Perroni

The use of dietary supplements is widespread in sports and fitness, with many products containing multiple ingredients. Among supplements often consumed to support musculotendinous health, collagen hydrolysate (CH) has gained popularity for its potential in improving joint comfort and function. This single-blind quasi-experimental study investigated the effects of a three-month oral supplementation with a specific CH-based product, Chondrovita FIT® (Bone Srl, Rome, Italy), on tendon structure in elite Italian skaters. Eighteen male and female elite skaters (mean age: 21 ± 3 years) participated, receiving daily pre-workout (4500 mg CH) and post-workout (2500 mg CH) doses. Tendon structure in the patellar and peroneal tendons was assessed using ultrasound imaging at baseline and post-supplementation. Results showed a significant increase in tendon thickness in both the patellar and peroneal tendons after supplementation, although no changes were observed in the tendon cross-sectional area. These findings suggest that Chondrovita FIT® supplementation may induce beneficial structural changes in tendons, potentially supporting tendon health and performance in high-load sports. However, further research is needed to confirm long-term effects and functional outcomes.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010025

Authors: Sarah A. Stotz Luciana E. Hebert Lisa Scarton Kelli Begay Kelly Gonzales Heather Garrow Melanie Charley Melanie Aspaas Denise Charron-Prochownik Spero M. Manson

AI/AN communities are disproportionately impacted by food insecurity and gestational diabetes mellitus (GDM). Decreasing the risk of GDM can interrupt the intergenerational cycle of diabetes in AI/AN families, and can decrease diabetes-related health disparities. The goal of this study was to explore ways of supporting holistic health and reducing the risk of GDM among young American Indian and Alaska Native (AI/AN) females prior to pregnancy. Semi-structured interviews were conducted with adult AI/AN women (>18 years) who had GDM or who have young female relatives (e.g., daughters) (n = 41), AI/AN females between 12 and 24 years (n = 18), and key experts in food/nutrition and health within AI/AN communities (n = 32). Three themes emerged: (1) guidance on how to support young females’ holistic wellness; (2) evidence that generations of colonial violence, including forced removal, forced poverty, and the imposition of a Western-based food system, causes deeper, systemic fracturing of traditional cultural food knowledge and practices; and the fact that (3) opportunities for improved adolescent female health are rooted in AI/AN values and how AI/AN people resist the impacts of anti-Indigenous racism through family-based, community-led, and holistic health. These themes suggest alternative understandings about the relationships between food insecurity and holistic pre-pregnancy health and can guide our next steps in decreasing health disparities in these communities.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010023

Authors: Eleonora Gambaro Carla Maria Gramaglia Davide Cenci Daniela Ferrante Francesco Gavelli Mattia Bellan Patrizia Zeppegno

Patients intoxicated with alcohol or other substances are often assessed and assisted in the context of the Emergency Department (ED) by emergency physicians, who usually require a psychiatric assessment. This study aims to analyse the characteristics of a sample of patients receiving a psychiatric consultation in the ED setting of the Maggiore della Carità University Hospital in Novara, Italy, in the period from 1 January 2021 to 31 December 2023, to find out whether and how patients screening positive for alcohol/drugs differ from those screening negative. Socio-demographic and clinical history information and clinical data related to the ED psychiatric consultations were extracted from the PsNet database, a collection of data extracted from the application that serves as the electronic medical record for patients accessing the ED. Statistical analyses were performed using SAS 9.4 and STATA version 17 software. Chi-square/Fisher tests, t-tests, and both univariate and multivariate logistic models were employed. Most of the findings regarding socio-demographic characteristics, symptoms observed during the 1362 psychiatric consultations, and treatments received by a total of 922 patients in the ED were consistent with the literature on this topic. However, some results only partially aligned with previous studies, particularly concerning the higher frequency of anxiety and psychotic symptoms, as well as cognitive impairments, observed in consultations for patients who tested negative for alcohol or substances. Interpreting these findings is complex and raises important questions, which may be addressed more effectively by expanding the sample size (extending the research to other EDs) and analysing its characteristics in greater detail. In this regard, improving diagnostic methods for detecting substance use through laboratory tests would also be beneficial.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010022

Authors: Kaho Yamasaki Hiromitsu Miyata

The present pilot study examined effectiveness of a 2-week footbathing intervention on physiological, endocrine, and psychological status in healthy Japanese university students. A total of 51 participants were randomly assigned to a footbathing or normal bathing group. Participants in both groups provided daily free descriptions of their physical and mental states during the intervention period. Participants also underwent measurements of autonomic nervous system activities and salivary cortisol, and completed questionnaires in the pre- and post-intervention periods, as well as in the follow-up period. Neither the footbathing group nor the normal bathing group showed significant changes in deep body temperature, blood pressure, or salivary cortisol through the intervention period. Significant increases in dispositional mindfulness and interoceptive awareness, and significant decrease in trait anxiety were observed regardless of the groups. Nevertheless, an awareness of changes in bodily sensations and mood by footbathing mentioned in the participants’ free descriptions was significantly associated with increased deep body temperature, dispositional mindfulness, interoceptive awareness, and subjective well-being from the pre- to post-intervention periods. These results suggest that the period of intervention and sample size might have been insufficient to induce significant changes in baseline psychophysiological status, but that awareness of changes in psychophysiological states may potentially be involved in the mechanism of footbathing.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010021

Authors: Bernard Austin Kigunda Muriithi

For people experiencing homelessness (PEH), the provision of affordable housing has been recognized as the most crucial intervention for improving housing stability and facilitating substance abuse treatment. However, evidence indicates that providing housing does not significantly improve substance abuse, mental health, or physical health outcomes. Optimal participation in essential daily activities has been shown to improve health outcomes and support independent living, but there is limited research that identifies activity performance priorities among PEH living in transitional housing. The present study investigates activity performance priorities using the focus group methodology. Management and staff from a transitional housing facility participated in a focus group discussion (90 min) and a follow-up (member checking) session (75 min), to deliberate on this topic. Emerging priorities for activity performance include activities of daily living [personal hygiene]; instrumental activities of daily living [house maintenance, meal preparation, and transportation]; health management [mental health, physical health, medical appointments]; social participation [building healthy relationships]; work [seeking and/or maintaining]; sleep; and leisure [recreational] activities. Community members and other stakeholders can support PEH in transitional housing by facilitating participation in these activities, and researchers should evaluate the effects of specific activity-focused interventions on health.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010020

Authors: Edmar Mendes Paulo Farinatti Alynne Andaki André Pereira dos Santos Jéssica Cordeiro Susana Vale Andreia Pizarro Maria Paula Santos Jorge Mota

This study examined the associations between age, adiposity, physical activity, sedentary behavior, and elevated blood pressure (BP) in 2901 Portuguese children and adolescents aged 2–18. BP, body mass index (BMI), waist-to-height ratio (WHtR), physical activity, and sedentary behavior were measured. Elevated BP was defined as a BP above the 90th percentile for age, sex, and height. Multivariable analyses assessed the prevalence ratios (PR) of elevated BP across age groups, BMI, WHtR, physical activity, and sedentary behavior. Results showed that older age, especially among middle schoolers, was associated with a 1.8 times higher risk of elevated BP than preschoolers. Participants with a higher BMI (overweight/obese) and a WHtR ≥ 0.50 had a 1.49- and 1.4-times higher risk of elevated BP, respectively. Those who did not meet the recommended 60 min of moderate-to-vigorous physical activity (MVPA) per day showed a 1.63 times higher risk of elevated BP, whereas the association between sedentary behavior and BP was not significant after adjustment. These findings highlight age, higher BMI, central obesity, and insufficient physical activity as key factors associated with elevated BP, underscoring the need for early monitoring and intervention to prevent hypertension in this population.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010019

Authors: Manoel Rios David B. Pyne Ricardo J. Fernandes

We have examined the impact of CrossFit® workout sessions on physical fitness, comparing the obtained outcomes with the recommendations of the American College of Sports Medicine. In addition, we provide suggestions to improve training monitoring, as well as practical applications for researchers, coaches and practitioners. CrossFit® imposes high cardiorespiratory and metabolic demands, promoting improvements in circulatory capacity, oxidative metabolism and muscular endurance. Sustained elevations in heart rate contribute to cardiovascular conditioning, while a post-exercise hypotensive effect may help to reduce cardiovascular risks. Structured CrossFit® programs have led to improvements in maximal strength and muscular endurance, with substantial increases in squat performance observed in both untrained and recreationally active individuals. In addition, CrossFit® improves mental health through its motivating community. However, the high metabolic demands, increased creatine kinase levels and reduced performance in the countermovement jump reveal that muscle damage and neuromuscular fatigue can persist for up to 48 h. Balancing these intense sessions with adequate recovery is crucial, as improper management may lead to overtraining and compromise fitness gains. Future research should explore long-term cardiovascular adaptations, differences in gains and recovery between males and females and the application of real-time biomarker and artificial intelligence technologies to improve the training efficiency and safety. Machine learning algorithms could further personalize feedback, adapting to each individual’s biomechanics and physiological responses over time.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010018

Authors: Pooja Belur Patrick Sherry Ivan Rodriguez Chetan Kurkure Shashank V. Joshi

This review aims to systematically evaluate existing literature on reducing suicides along railroads, with specific focus on effectiveness, limitations, and research gaps in the current evidence base. Database searches were conducted in PubMed, PsycInfo, Scopus, Embase, and CINAHL covering studies published until 30 November 2024. After screening 623 studies and their references, 51 studies were included; 26 empirically assessed rail-related prevention interventions and 25 provided relevant qualitative insights. Physical barriers like removal of grade crossings, addition of fencing, and platform screen doors (PSDs) showed significant promise. Full-height PSDs eliminated all suicides and half-height PSDs significantly reduced suicide incidence. Fencing was found to be effective but raised concerns about feasibility and must be part of a comprehensive approach to mitigate potential displacement. Safe media reporting was linked to decreased suicides and a reduced risk of contagion, and CCTV monitoring and suicide pits also showed potential but had limited research. Other strategies showed mixed evidence and required additional evaluation. Some studies, particularly on physical barriers, showed possible displacement effects to other stations, highlighting the need for studies larger in geographic and temporal scope. Our findings support certain prevention interventions, but generalizability is limited by scope of research and methodological concerns. Overall, our findings highlight the need for broader, long-term studies to confirm efficacy and establish comprehensive, scalable approaches for policy implementation.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010017

Authors: Jay N. Meegoda William H. Pennock Christina Brenckman Ashish D. Borgaonkar

The production of plastics and associated products, including microplastics (MPs), has been surging over the past several decades and now poses a grave environmental threat. This is because when not appropriately recycled, incinerated, or disposed of in fully contained landfills, plastic waste manifests as a potent pollutant, with vast amounts finding their way into oceans annually, adversely impacting marine life and ecosystems. Additionally, research also confirms there are direct impacts from MPs on water, air, and soil, impacting ecosystem and human health. This study investigated all aspects of plastics and microplastics such as their generation and consumption, their presence in oceans, and their ultimate fate. Next, a comprehensive literature search was performed to identify impacts MPs have on watercourses and soils and eventually on the ocean, taking into consideration the coupled impacts of metals and emerging contaminants adsorbed onto MPs. Then, a model to estimate the number of MPs in oceans and then using toxicity of MPs to humans and aquatic life to estimate when oceans would become toxic to humanity is described. Utilizing the model, it is possible to estimate the year when MPs in the ocean could potentially become broadly toxic, for both humanity and marine life, under different emissions scenarios. The estimates conclude that with the current MP discharge growth, oceans would become toxic to humanity between 2398 and 2456, for MP discharge growth only until 2020, it could be reached between 2408 and 2472, and for emissions ending in 2020, oceans would not become toxic to the humanity. Finally, remediation strategies are described to prevent oceans from becoming toxic to humanity by focusing on various action items such as education and awareness, reducing the utilization of single-use plastic, and conventional and innovative strategies that can be used for the treatment of stormwater and wastewater.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010016

Authors: Neal J. Wilson Ryan Allenbrand Elizabeth Friedman Kevin Kennedy Amy Roberts Stephen Simon

Pediatric lead poisoning remains a persistent public health problem. Children in the US spend the preponderance of their time at home; thus, housing is an important social determinant of health. Improving health outcomes derived from housing-based sources involves differentiating the risks posed by the existing housing stock. In this paper, we developed a parcel-level lead risk index (LRI) based on external housing conditions and the year of home construction. The purpose of this study was to introduce a housing-based lead risk index (LRI), developed using retrospective data, to estimate parcel-by-parcel variation in housing-based lead risk. We described how the LRI is constructed, relate it to the likelihood of a pediatric occupant’s blood lead level (BLL) > 3.5 µg/dL using Lasso regression (n = 6589), visualized this relationship graphically, and mapped the outcome. We found that mapping the LRI provided more information at a more precise geographic level than was possible using other public health surveillance methods.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010015

Authors: Songhee Lee Hyung-Ui Baik Juyong Lee Yunjae Shin

This study investigates the effects of social norms on substance use severity mediated by health beliefs among people who use cannabis, narcotics, and psychotropic substances in Republic of Korea. A survey was administered to 109 people who use cannabis and narcotics and 191 people who use psychotropic substances between May and July 2024. Path analysis was conducted. The findings indicated that the effects of social norms on health beliefs and the impact of health beliefs on substance use severity were statistically significant among people who use psychotropic substances, whereas no such significance was observed among people who use cannabis and narcotics. We recommend implementing early intervention treatment and social rehabilitation programs tailored to the specific needs and severity of substance use in people who use psychotropic substances, cannabis, and narcotics in Republic of Korea. Additionally, the establishment of online platforms to disseminate information on harm reduction, prevention, treatment, and rehabilitation based on substance type is advocated.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010014

Authors: Thomas Volderauer Margit Raich Antje Bierwisch Harald Stummer Oliver Som

Current work environments, driven by globalization, demographic changes, and digitalization, demand substantial adaptation, which leads to decreased employee well-being. While occupational psychology research has identified supportive mechanisms, it often lacks a deepened understanding of how interventions function. This study aims to analyze the impacts of VUCA contexts and leadership behavior on job crafting, focusing on white-collar workers. Our objective is to identify workplace configurations that safeguard employee health in dynamic settings. Utilizing the JD-R model augmented by job crafting as a theoretical framework, we conducted qualitative comparative case studies using the GABEK® methodology to analyze and systematize data. This approach captures complex organizational interrelationships through sentence analysis, transforming subjective meanings into a comprehensive network and providing deeper insights into organizational dynamics. Research findings reveal that evolving work demands, notably from digital transformations, impact knowledge management, communication, and employee well-being. IT discrepancies and communication deficits intensify work complexity, underscoring the need for enhanced management frameworks. Proactive and adaptive leadership, along with job crafting, is crucial for protecting health and enhancing performance in fast-paced digital environments. These strategies promote structured decision-making and efficient knowledge management, fostering a resource-oriented culture that enhances employee well-being and overall effectiveness.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010013

Authors: Marina Schulz Kari Bø Marte Charlotte Dobbertin Gram

While moderate exercise supports regular menstrual cycle (MC) function, many female athletes experience MC symptoms that negatively influence their training and performance. Hereby, knowledge and communication about this topic are important to promote an athlete’s health and wellbeing. Hence, this study aimed to assess the knowledge and communication surrounding the MC among Norwegian rhythmic gymnasts, ballerinas, and dancers. In total, 116 rhythmic gymnasts, ballerinas, and dancers aged ≥ 16 years training ≥ 3 days per week completed an electronic questionnaire. Of these, 63% (n = 73) reported a lack of knowledge about the MC’s influence on physical fitness and performance, and 39% (n = 45) rated their coaches’ or pedagogues’ knowledge as low. With only 32% of participants discussing the MC with their coaches/pedagogues, communication was found to be limited. Seventy-three percent felt uncomfortable during training or competition due to their attire and recommended darker colors and more options in size and layering. The study highlights a significant gap in knowledge and communication about the MC among female athletes and coaches/pedagogues in aesthetic sports. It also recommends improving athletes’ choice of attire for greater comfort and confidence.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010012

Authors: Joanne Crawford Tara Lundy Chiarina Crawford Jane Moore Nicole Viscek Nyarayi Kapisavanhu

Social inclusion is a common goal for equitable access to resources for living, is important to health and wellbeing, and is supported by most Western or developed nations. Despite this, immigrant and refugee women continue to be excluded from social, cultural, economic, civic, and political participation during and after settlement. Most research exploring the context of social exclusion has reinforced that some groups experience greater exclusion than others in any given population, for example, immigrant women. The purpose of this study was to gain insights by exploring the experiences of social inclusion and exclusion and recommendations from the perspectives of immigrant and refugee women, as well as community service workers in the Niagara Region, Canada. Utilizing qualitative descriptive inquiry underpinned by intersectionality theory along with thematic analysis, we interviewed 10 immigrant and refugee women and 14 community service workers. Five themes were generated: (1) gendered nature of exclusion; (2) levels of exclusion; (3) paving a path for self; (4) formal inclusionary processes; and (5) informal inclusionary processes. The findings will be used to guide community action and may be transferable to community organizations that serve immigrant and refugee women in similar community contexts, with the aim of enhancing collaborations to advance health equity and inclusion.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010011

Authors: Alicia Carbone Carmela Pestell Thom Nevill Vincent Mancini

Improving parental self-efficacy has been linked with reductions in child mental health difficulties; however, underlying mechanisms remain unclear, especially for fathers. This study investigated whether father self-efficacy influences child mental health difficulties indirectly through parenting style and parent-facilitated regulation of children’s negative emotions. A community sample of American fathers (N = 350, M = 39.45 years old) completed self-reports on father self-efficacy, parenting styles, parent-facilitated emotion regulation, and their children’s mental health difficulties (aged 4–12). Path analysis was used to test a cross-sectional, parallel–sequential indirect effect model. Father self-efficacy had a significant indirect effect on child mental health difficulties via three significant pathways of permissive parenting, authoritative parenting–acceptance of child’s negative emotions, and authoritarian parenting–avoidance of child’s negative emotions. Our model explained a moderate amount of variance in child mental health difficulties. The findings support promoting father self-efficacy through parenting interventions and highlight parenting beliefs as important for clinicians providing child mental health care.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010010

Authors: Naohide Shinohara Jose Juan Felipe Ángeles García Miguel Magaña Reyes Becki Gatica Jiménez Roberto Basaldud Cruz Beatriz Cardenas Gonzalez Shinji Wakamatsu

Concerns regarding the health risks associated with employe exposure to volatile chemicals during gasoline refueling necessitates rigorous investigation and effective countermeasures. This study aims to evaluate the efficacy of vapor recovery systems in mitigating exposure risks during gasoline refueling. Employee exposure to volatile organic compounds, aldehydes, carbon monoxide, and fine particulate matter (PM2.5) was assessed at gasoline stations with and without vapor recovery systems. Three stations each from the State of Mexico and Mexico City, equipped with gasoline vapor recovery systems, were compared with three stations in Guadalajara lacking such systems. The exposure concentrations (mean ± standard deviation) to benzene in Guadalajara, the State of Mexico, and Mexico City were 45 ± 29, 24 ± 20, and 18 ± 15 μg/m3, respectively, which were significantly higher than the background atmospheric concentrations at 1.6 ± 0.56, 0.72 ± 0.083, and 0.65 ± 0.14 μg/m3, respectively. Similarly, the exposure concentrations of toluene, ethylbenzene, and xylenes at gasoline stations were significantly higher than the background atmospheric concentrations. However, the exposure concentrations of formaldehyde and PM2.5 were similar to the background atmospheric concentrations. The excess cancer risks due to benzene exposure were estimated at 1.2–4.2 × 10−5, 0.63–2.2 × 10−5, and 0.46–1.6 × 10−5 (mean) and 0.42–1.5 × 10−4, 0.29–1.0 × 10−4, and 2.4–8.6 × 10−5 (maximum) in Guadalajara, the State of Mexico, and Mexico City, respectively. The risk to employees in gasoline stations was reduced by 47–61% in service stations with gasoline vapor recovery systems.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010009

Authors: Bernard Austin Kigunda Muriithi Jennifer Muriithi

In its broadest meaning, salutogenesis denotes an orientation toward the origins and assets for positive health, as opposed to the origins and risk factors associated with disease (i.e., pathogenesis). While salutogenesis continues to inspire health promotion, it has been noted that qualitative studies can further its understanding and broaden its use in research, clinical practice, and policies. The present study is based on an analysis of structured and unstructured recorded interviews with six refugee musicians. Applying interpretive phenomenological analysis, we comparatively explored the factors contributing to persistence in music between participants. Five factors were found: (a) long-term participation and identity as musicians; (b) desirable effects of music performance; (c) competence, talent, and social recognition; (d) management of social and cultural differences; and (e) locally organized refugee events. The links between music performance and salutogenesis include the following: (1) the inclusion of salutogenic orientation (in addition to pathogenic orientation) toward health; (2) that music invigorated generalized resistance resources so that their expression was augmented, steady, and enduring; and (3) that a high sense of coherence (SOC) was demonstrated. Future studies are needed to reveal whether other activities can take similar roles in developing SOC, and experimental studies are needed before health policy recommendations regarding activities can be made for people that need improved SOC.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010008

Authors: Michelle F. Wright

The primary objective of this short-term longitudinal study was to investigate how age groups affect the relationships between cyberbullying victimization, bystanding, and depression among a convenience sample of students across different educational levels; there was a total of 234 elementary school students (fourth and fifth graders), 363 middle school students (sixth to eighth graders), and 341 high school students (ninth to twelfth graders) from the United States who completed self-reported questionnaires on cyberbullying, depression, and peer attachment during 2020. Additionally, this study examined whether peer attachment acted as a moderator in these relationships. The results revealed that strong peer attachment significantly moderated the connections between cyberbullying involvement and depression, as measured six months later, with particularly pronounced effects among middle school students. In contrast, weaker peer attachment intensified the positive correlations between cyberbullying victimization, bystanding, and subsequent depression. These findings highlight the crucial role of cultivating strong peer relationships, especially during pivotal developmental phases such as middle school. Implementing programs that promote positive peer interactions and supportive networks can be effective at alleviating the psychological effects of cyberbullying.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010007

Authors: María Rocío Pérez-Mesa Yair Alexander Porras-Contreras Rosa Nidia Tuay-Sigua

Living beings as open systems depend on climate and weather to survive. However, changes in the Earth’s climatology, which have become more frequent since the industrial period, have affected different territories of the planet, limiting access to ecosystem services and causing imbalances in health and well-being. The first purpose of this study is to conduct a literature review on academic production regarding climate change and its impact on health, in the context of education, using international academic production condensed in the Web of Science (WOS) database over the last 10 years as a reference. The second purpose focuses on identifying the environmental attitudes of science teachers in initial training regarding aspects related to climate change. The study results show three categories emerging from the literature review: Climate Change and Health, Nature and Risks, and Environment and Energy. For the analysis of environmental attitudes, a survey was conducted with 51 pre-service teachers, consisting of 59 items distributed in five categories: (a) environment, (b) climate change, (c) health, (d) education, and (e) lifestyle. Although the results reveal a positive attitude towards all analyzed categories, it is important to advance effective mitigation and adaptation strategies from the teacher training processes themselves.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010006

Authors: Jabulani Mathebula Olufunke Alaba

Under-five child poverty and income inequality are complex socio-economic phenomena that significantly impact the well-being of children worldwide. While there is a growing body of literature addressing child poverty in South Africa, our understanding of settlement discrepancies and factors influencing multidimensional under-five child poverty and income in the country remains limited. This study assesses under-five-specific multidimensional poverty and the determinates of child poverty and inequality in the lowest geographical areas in South Africa. Alkire-Foster’s methodology was applied to construct and estimate the multidimensional poverty index for under-five children across settlement areas. The selected indicators were designed to reflect the unique deprivations and challenges faced by children in this age group. The results showed that there is a significant number of children who are deprived in indicators such as access to ECD (43%), hunger (20%), and education and employment at 69% and 65%, respectively. These are some key variables that require policy interventions to improve the development outcomes of children. The logistic regression results showed that 14 out of the 34 predictors were significant. Inequality was significant and positive at 1%. The findings suggest that more work still needs to be undertaken to improve the living conditions of children, especially in the former homelands, to achieve the goals set in the National Development Plan and Sustainable Development Goals. In the past, non-whites were assigned a homeland according to their ethnicity or a place where national or ethnic identity has formed.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010005

Authors: Mengmeng He Yasuhiro Yamanaka Kazuya Takamatsu

The percentage of older drivers is increasing worldwide. Older adults are driving for their daily lives, including drivers who should not drive, “must-watch drivers”, for health conditions, etc. The “Public Survey of Long-Term Care Prevention and Needs in Spheres of Daily Life (Needs Survey)”, including the “Kihon Checklist (KCL)”, is a triennial nationwide survey conducted by welfare administrations in Japan. The objective of this study was to demonstrate that the Needs Survey can capture situations (e.g., driving avoidance) of older drivers obtained by previous studies, many of which are one-time surveys. As for our methods, we administered a survey with a format of questions used in previous studies combined with KCL to all older adults in Tsurui Village, a rural community in Japan, obtained 393 responses, around half of them, and conducted a logistic regression analysis to estimate whether they were driving or not and a multiple regression analysis for the frequency of driving avoidance. The former analysis showed that KCL could detect must-watch drivers with relatively deteriorated health among not-so-old adults, adding to another one with relatively not-so-bad health among much older adults, and the latter analysis showed that the KCL scores could be an alternative to the self-rating of driving ability used in previous studies. In conclusion, KCL in the Needs Survey is recommended to be a valuable survey for regularly assessing the driving conditions of older drivers nationwide.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010002

Authors: Talitha Crowley Lwandile Tokwe Leonie Weyers Rukshana Francis Charné Petinger

Adolescents with long-term health conditions may benefit from digital health interventions (DHIs) to support self-management. The study aimed to map the current research on DHIs for adolescents with long-term conditions in South Africa, focusing on the types of interventions, targeted chronic conditions, and reported outcomes. The scoping review was conducted following the Joanna Briggs Institute (JBI) guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. Searches were conducted in electronic databases such as EBSCOHost (CINAHL, MEDLINE, Academic Search Ultimate, and APA PSycArticles), Wiley Online Library, and PubMed for articles published between 2014 and 2024. Studies that (1) involved adolescents with a long-term health condition (aged 15–24) residing in South Africa, (2) reported on the use of digital health technology, and (3) provided empirical evidence were included. Nine studies were included in the analysis, focusing primarily on HIV, depression/anxiety, and diabetes. Most interventions utilized WhatsApp, SMS, or social media to provide peer or healthcare worker support. Process outcomes like acceptability and feasibility dominated, with limited data on effectiveness. DHIs show potential for supporting adolescent health but cover a limited number of long-term health conditions and face barriers to effective implementation. Affordable, context-specific solutions co-designed with adolescents are crucial to enhance engagement and ensure scalability in the South African context. Registration: The protocol was registered on Open Science Framework.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010004

Authors: Davide J. Testa João P. Vale Leonidas G. Ioannou Petros C. Dinas Tiago S. Mayor Kristine H. Onarheim Zahra R. Babar Sally Hargreaves Andreas D. Flouris

Background: Migrant construction workers involved in building infrastructure for mega-sporting events face elevated risks of illness and death. However, specific health outcomes for these workers have not been systematically reviewed, limiting opportunities to identify and address their challenges. Methods: This study systematically reviewed health outcomes among migrant construction workers involved in mega-sporting events. Results: 89 eligible studies involving 23,307 workers were identified. Of these, only 11 directly addressed specific health outcomes, including heat stress, occupational fatalities, and sexually transmitted infections. Notably, increased heat exposure during peak construction phases and the proximity of deadlines for mega-sporting events were correlated with elevated rates of occupational fatalities. Other key adverse factors impacting migrant construction workers’ health included an observed correlation between the timing of mega-sporting events and increased occupational fatalities, the involvement of labor recruiters, and shifting health and safety responsibilities among stakeholders (e.g., host states, event organizers, contractors, and recruitment agencies). Positive outcomes were observed when workers voluntarily engaged in non-mandatory safety activities, such as safety training programs and awareness meetings. Conclusions: There is a critical need for longitudinal and comparative studies to comprehensively examine the health of migrant workers throughout all stages of their journey, from pre-migration to return. This review underscores the urgency of prioritizing evidence-based policies that address unique health risks in this population, including mitigation of heat stress and enforcement of occupational safety standards, particularly amid construction spikes preceding mega-sporting events. Recommendations: Future research should prioritize understanding the unique health challenges faced by migrant workers to inform policy making, develop effective interventions, and implement best practices to improve their health and well-being.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010003

Authors: Ibone Olza Oscar Quintela Araceli García-Martínez

Obstetric violence during pregnancy and childbirth is unfortunately a major problem throughout the world. Neuroleptanalgesia is a classic form of analgesia which consists in administering analgesics and neuroleptics, such as haloperidol, simultaneously. Haloperidol is still occasionally used during childbirth and, in most cases, without informed consent in Spain. It is used with the excuse of being an antiemetic, but the reality is that it is a form of obstetric violence called chemical submission. The combination of haloperidol with opioids leads to a potentiation of the sedative effects of both drugs, which may lead to multiplied risks for both mother and baby. At present, the use of haloperidol during childbirth is a practice exclusive to Spain. In fact, the association El Parto es Nuestro (Birth Is Ours) launched an awareness campaign in February 2021 aimed at eradicating the use of haloperidol during childbirth without informed consent. The present essay aims to bring awareness about the ongoing practice of using haloperidol. It is of great importance to eradicate this practice that is so harmful to mothers and their babies, as well as educate health personnel regarding this situation.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph22010001

Authors: Fariba Kolahdooz Se Lim Jang Sarah Deck David Ilkiw Gertrude Omoro Arja Rautio Sami Pirkola Helle Moeller Gary Ferguson Birgitta Evengård Lianne Mantla-Look Debbie DeLancey André Corriveau Stephanie Irlbacher-Fox Adrian Wagg Cindy Roache Katherine Rittenbach Henry J. Conter Ryan Falk Sangita Sharma

Social determinants of health (SDHs) and the impact of colonization can make Canadian Arctic Indigenous communities susceptible to infectious diseases, including the coronavirus disease 2019 (COVID-19). This scoping review followed the PRISMA guidelines for scoping reviews and studied what is known about selected pandemics (COVID-19, tuberculosis, and H1N1 influenza) and SDHs (healthcare accessibility, food insecurity, mental health, cultural continuity, housing, community infrastructure, and socioeconomic status (SES)) for Canadian Arctic Indigenous communities. Original studies published in English and French up to October 2024 were located in databases (PubMed, Medline, and CINAHL), AlterNative: An International Journal of Indigenous Peoples, and through reference tracking. We included 118 studies: 6 relating to COVID-19, 5 to influenza, 5 to TB, 27 to food insecurity, 26 to healthcare access, 22 to mental health, 9 to SES, 8 to housing, 7 to cultural continuity, and 3 to community infrastructure. SDHs affecting Indigenous individuals include food insecurity, limited healthcare access, mental health challenges, low SES, suboptimal housing, and limited cultural continuity. These findings are relevant to other Arctic regions. It is crucial to understand how SDHs impact the health of Arctic communities and to utilize this information to inform policy and practice decisions for pandemic prevention, management, and treatment. Many SDHs pose challenges for preventing and managing infectious diseases.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121714

Authors: David W. Maidment Katie Clarkson Emma V. Shiel Karina Nielsen Jo Yarker Fehmidah Munir

The objective of this study was to synthesise evidence assessing the effectiveness of workplace-based interventions that promote self-management of multiple long-term conditions or disabilities, e.g., type I and II diabetes, asthma, musculoskeletal injury/disorder, cancer, and mental ill-health. A prospectively registered rapid systematic review was conducted. Both academic and grey literature databases were searched for papers published within the last 10 years, reflecting the most contemporary legislation and policy. The outcomes included work productivity, work engagement, self-management, work ability, quality of life, psychological wellbeing, workplace fatigue, job satisfaction, work-based attendance, work self-efficacy, and condition-specific health status. Five randomised controlled trials were included, and all assessed a chronic disease self-management programme consisting of six weekly facilitator-led group sessions. Due to the small number of studies and the variability in outcome measures employed, meta-analyses were not feasible. However, a narrative synthesis indicated that work engagement, self-management and wellbeing improved in the intervention compared to the control groups. All of the other outcomes showed mixed results. The findings highlight the need to develop less resource-intensive workplace-based self-management interventions that cater to both workers and employer stakeholders, to examine intervention implementation processes as well as effectiveness, and to draw on a common set of outcome measures to enable comparative analysis to better inform public health policy and practice.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121713

Authors: Jeeraporn Tippila Naw Lah Say Wah Kurnia Ardiansyah Akbar Narumol Bhummaphan Pokkate Wongsasuluk Kraiwuth Kallawicha

Breast cancer is the most prevalent malignancy among women. Certain air pollutants have carcinogenic and estrogenic properties that can contribute to breast cancer development. This systematic review aimed to investigate the association between air pollution and breast cancer based on epidemiological evidence. This systematic review included articles published between 2013 and 2022 from Scopus and PubMed databases, focusing on cohort and nested case-control studies examining the association between outdoor air pollution and breast cancer. A total of 25 articles were included. A total of eight outdoor pollutants were analyzed, with seven showing a significant association with breast cancer risk. Specifically, the strong association between benzo[a]pyrene and breast cancer risk was reported. Furthermore, all four studies on nitrogen oxides (NOx), fifteen out of eighteen (83.33%) on particulate matter less than 2.5 µm (PM2.5), nine out of thirteen studies (69.23%) on nitrogen dioxide (NO2), and three out of seven studies (42.86%) on particulate matter less than 10 µm PM10 showed an association with breast cancer risk (hazard ratio [HR]: 1.05–1.56; odds ratio [OR]: 1.03–1.86). In contrast, only one out of three studies (33.33%) on O3 (HR: 0.76–1.03) and all studies on cadmium (OR: 0.88–0.97) suggested a negative association with breast cancer risk. None of the studies on black carbon found an association with breast cancer risk. It is important to note the methodological limitations of this review, including potential publication bias due to the inclusion of only English-language articles and a regional focus on developed countries, which may limit the generalizability of findings. This study suggests that exposure to outdoor air pollutants is linked to an increased risk of breast cancer. Further research is needed to establish a causal relationship and the mechanisms by which environmental pollutants may trigger carcinogenic effects and contribute to breast cancer development through epigenetic pathways.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121712

Authors: Lina Echeverri Flavio Salio Richard Parker Pryanka Relan Oleg Storozhenko Ives Hubloue Luca Ragazzoni

Background: On 16 January 2021 (EB148/18 Session), the World Health Organization (WHO) and Member States emphasized the importance of expanding the WHO Emergency Medical Teams (EMT) Initiative, investing in a global health workforce and multidisciplinary teams capable of being rapidly deployed, equipped, and fully trained to respond to all-hazard emergencies effectively. This resulted in the need to define a comprehensive framework. To achieve this, the EMT Initiative proposes the application of the four components of Surge Capacity, known as the 4“S” (Staff, Systems, Supplies, and Structure/Space), to build global capacities and capabilities, ensuring rapid mobilization and efficient coordination of national and international medical teams for readiness and response, complying with crisis standards of care defined in an ethical and evidence-based manner. Methods: A mixed-qualitative research approach was used, incorporating expert consensus through focus group discussions (FGDs), between 2021 and July 2022. This facilitated a detailed process analysis for the application of the surge capacity components to build global capacities and capabilities. This research highlighted the similarities between surge capacity and capacity building from an initial desk review and unified these concepts within the EMT Initiative. A standardized formal pathway was developed to enhance local, regional, and global capacities for emergency readiness and response. Results: The results showed that the framework successfully integrated the essential components of surge capacity and capacity building, making it adaptable to various settings. Conclusions: This framework provides a unified and replicable approach for readiness and response for all-hazards emergencies.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121711

Authors: Rola Muhammed Shadid Reeta Alsaeed

Owing to the vital role played by dentists in patient education and due to the growing popularity of e-cigarette use among the younger population, this cross-sectional study aimed to assess the use, knowledge, beliefs, and attitudes toward e-cigarettes among dental students. A cross-sectional questionnaire was given between March and June of 2024 to undergraduate dental students in the Faculty of Dentistry at the Arab American University in Palestine. A 32-item questionnaire with five sections, namely demographics, smoking habits, knowledge, beliefs and attitude, and education about e-cigarettes was sent to all appropriate participants (N = 1050). The response rate was 31% (N = 325). About 11.7% of the respondents were current e-cigarette smokers. The two most commonly cited reasons for initial use of e-cigarettes were curiosity (52.8%) and a desire to quit conventional smoking (27.8%). The average knowledge score was 6.63 (3.08) out of 12, demonstrating a generally inadequate level of knowledge about e-cigarettes. Conventional cigarette smokers were more knowledgeable about e-cigarettes than non-smokers (OR = 1.928; 95% CI: 1.061–3.505; p-value = 0.031). The majority of students (92%) considered the level of education they received in the dental school about e-cigarettes as inadequate, and more than half (53.2%) received information from social media. In conclusion, the prevalence of e-cigarette use among Palestinian dental students is relatively high compared with that reported for other dental students worldwide. Since the students showed a generally inadequate level of knowledge about e-cigarettes, this study casts doubt on the competency of Palestinian dental students to offer cessation counseling, highlighting the necessity to revise the dental curricula to foster positive knowledge and belief conducive to ideal behaviors.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121710

Authors: Uchita Vaid

An increasing body of literature has investigated the implications of housing quality on health, confirming the negative consequences of poor housing quality on physical and mental health. Despite this increased focus on the salutogenic impacts of housing, the relationship between housing quality and cognitive health remains understudied. This study examined how the housing quality in urban informal settlements, where living conditions are often substandard, affects women’s cognitive functioning, with a specific focus on executive function (EF) skills. EF is a decision-making system that enables us to make decisions using working memory and attentional control. This study addressed two key questions: (1) Is housing quality associated with EF skills? (2) Does perceived housing stress experienced by women mediate the housing–EF relationship? A standardized observer-based tool assessed housing quality, psychometric instruments measured EF skills, and a 12-item questionnaire evaluated perceived housing stress. Results indicated that better housing quality is positively associated with higher EF skills, with housing stress acting as a mediating factor in this relationship. These findings have important implications for both health and housing policies. Investments in improving housing conditions can yield cognitive health benefits for women, and addressing stress-inducing housing factors could further enhance cognitive outcomes.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121709

Authors: Yasumasa Oka Michio Wachi Noriyuki Kida

Industrial physical therapy (IPT) interventions by physical therapists can enhance labor productivity. However, in Japan, there is a scarcity of case studies involving corporate visits, questionnaire-based data, and insights into corporate demands. Addressing this gap is vital for improving presenteeism related to chronic pain and increasing employees’ health literacy, thereby advancing corporate health management. This case study evaluates the effectiveness of a workshop aimed at preventing and reducing chronic pain among employees in the Development Department of Company A, an information technology (IT) firm. The research employed pre- and post-survey questionnaires, workshop interventions, and meetings with corporate management to assess the current state of musculoskeletal chronic pain and productivity losses and to verify the intervention’s effectiveness. Approximately 50 participants attended the workshop in person, while around 30 participated online, totaling 80 attendees. A total of 56 (51 men and 5 women) individuals responded to the pre-workshop questionnaire, and 28 responded to the post-workshop questionnaire. The age distribution of the 56 pre-survey respondents was as follows: 9 in their twenties, 13 in their thirties, 22 in their forties, and 12 aged 50 and older. Preliminary survey results showed that 55.4% of participants experienced chronic pain in at least one body part. The average presenteeism value was 82.8% (standard deviation = 16.8). It was also found that literacy regarding appropriate pain management strategies was low. An independent t-test comparing literacy scores based on the presence or absence of pain showed no significant differences (p = 0.34). Additionally, a one-way ANOVA conducted to examine differences across four age groups revealed no significant differences (F = 0.934, p = 0.431). Results from the post-workshop questionnaires indicated that more than 70% of the employees experienced an increase in understanding and satisfaction, with positive feedback on the improvement of knowledge about chronic pain mechanisms and posture. However, there were also requests for more interactive communication and a desire to learn more about specific care methods, suggesting the need to provide interventions tailored to appropriate stages of preventive medicine.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121708

Authors: Nicola Magnavita Igor Meraglia Giacomo Viti Martina Gasbarri

Workplace violence (WV) is a ubiquitous, yet under-reported and under-studied phenomenon. Prevention measures may be ineffective because risk assessment is often based on unvalidated algorithms. After monitoring the risk of WV in a healthcare company for over 20 years, this paper presents the results collected in 2023 and details of the methodology used. Monitoring WV in health surveillance can involve three actions: (1) asking all the workers who attend periodic medical examinations in the workplace whether they have suffered physical aggression, threats, or harassment in the previous year; (2) investigating WV at the end of workplace inspections by setting up participatory ergonomics groups (PEGs) to suggest solutions; (3) investigating the characteristics and consequences of WV through anonymous online questionnaires. In 2023, 6.9% of the healthcare workers (HCWs) reported having experienced one or more physical attacks during the previous year; 12.7% reported having been threatened, and 12.9% reported other types of violent, harassing behavior. The HCWs observed an increase in violence after the pandemic years and, in the PEGs, suggested using different preventive measures in different health departments. The online survey provided further information on the characteristics of WV and its consequences. The risk of WV can be effectively characterized and measured through health surveillance.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121707

Authors: Mbuso Sibazo Takshita Sookan-Kassie

Type 2 diabetes mellitus (T2DM) has become a global epidemic, where increasing urbanization encourages sedentary lifestyles. Persistent physical inactivity can lead to T2DM and increase the risk of T2DM in the general population. Therefore, the aim of this study was to explore the knowledge, attitudes, and practices (KAP) regarding exercise amongst T2DM and non-diabetic (ND) staff at a tertiary institution in KwaZulu Natal South Africa. A total of 166 responses were received: a total of 16 responses (9.6%) were T2DM, and 150 responses (90.0%) were non-diabetic (ND). The demographics included 66.3% females and 33.7% males who consented to taking part, 62.7% were black, 18.7% were Indian, 12% were white, 5.4% were colored, and 1.2% were other. A cross-sectional descriptive survey design, utilizing a modified validated online knowledge, attitudes, and practice questionnaire, was used to collect data. Descriptive statistics were used for the analysis: inferential statistics; the ordinal (1–5) Likert scale; t-tests; and chi-square tests. The level of statistical significance was set at p ≤ 0.05. No significant differences were found between the T2DM and ND groups except in their attitude towards exercise, which showed three items with significant differences. The ND group agreed significantly more than the T2DM group that they looked forward to exercising (p = 0.002), and even without company, they exercised regularly (p = 0.042). The T2DM group agreed significantly more with the statement that they had asked their doctor if there was medicine available to make them better without doing any exercise (p = 0.002). The overall KAP results of the current study found that both participants diagnosed with T2DM and those in the ND group know about exercise and have a good attitude toward exercise. However, both groups still have poor practice regarding physical activity.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121706

Authors: Sarah Chambliss Natasha Quynh Nhu Bui La Frinere-Sandoval Corwin Zigler Elizabeth J. Mueller Roger D. Peng Emily M. Hall Elizabeth C. Matsui Catherine Cubbin

A growing literature within the field of air pollution exposure assessment addresses the issue of environmental justice. Leveraging the increasing availability of exposure datasets with broad spatial coverage and high spatial resolution, a number of works have assessed inequalities in exposure across racial/ethnic and other socioeconomic groupings. However, environmental justice research presents the additional need to evaluate exposure inequity—inequality that is systematic, unfair, and avoidable—which may be framed in several ways. We discuss these framings and describe inequality and inequity conclusions provided from several contrasting approaches drawn from recent work. We recommend that future work addressing environmental justice interventions include complementary “Exposure-driven” and “Socially weighted” metrics, taking an intersectional view of areas and social groups that are both disproportionately impacted by pollution and are impacted by additional health risks resulting from structural racism and consider implications for environmental justice beyond distributional equity.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121705

Authors: Rosa Angela Fabio Rossella Suriano

The use of smartphones is widespread among adolescents and can affect various cognitive processes. However, the effects of smartphone use on sensory processing, particularly among individuals with attention deficit hyperactivity disorder (ADHD), remain largely unknown. The present study investigated the relationship between smartphone use intensity and sensory processing in adolescents with typical development and those with ADHD. The sample included 184 adolescents aged 14 to 18 years (M = 16.56; SD = ±1.87), with 92 diagnosed with ADHD and 92 with typical development, matched for age, gender, and IQ. Participants completed a self-report questionnaire to measure smartphone use intensity, while sensory processing was assessed using the Adolescent Sensory Profile (ASP). The results revealed a significant association between the intensity of smartphone use and heightened sensory responses in adolescents with typical development. However, this relationship was not observed in participants with ADHD. These preliminary findings suggest that smartphone use may influence sensory processing differently depending on neurotypical development or the presence of ADHD, potentially contributing to the promotion or mitigation of sensory dysfunctions. Future studies are needed to further explore the mechanisms underlying these differences and to better understand the impact of digital technologies on sensory functioning.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121704

Authors: Julie Cerel Martina Fruhbauerova Alice Edwards Leah Murphy Elizabeth Salt Beck Whipple Patti M. Clark John Ackerman

Suicide rates have increased in the US over the last decades. Schools often deliver suicide prevention trainings and there is growing evidence that these trainings in schools are effective. The current study examined a new upstream approach, CODE RED in which trainees complete their own safety plan prior to a mental health emergency. Participants were adult school personnel (n = 201) who completed CODE RED trainings and were surveyed using three validated 4-item measures: acceptability of intervention measure (AIM), intervention appropriateness measure (IAM), and feasibility of intervention measure (FIM). Open-ended questions were analyzed using a thematic approach. Of 201 participants who completed the survey, acceptability (18.0), appropriateness (17.9) and feasibility (18.0) were high as assessed by standardized implementation measures (each out of 20). Open-ended responses further indicated a great deal of satisfaction with the training. As a first step in determining acceptability and feasibility, CODE RED was found to be highly acceptable to adult school employees who found it applicable, appealing as an intervention, and easy to use. Most staff are hopeful that it will be useful with youth as well. It will be important to determine how this activity is used by youth and if it can be used in mental health crises to decrease symptoms.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121703

Authors: Wasantha Rajapakshe Anjana Koushani Wickramasurendra Rajini Ranmini Amarasinghe Shynie Lourds Minoli Kohilawatta Arachchige Wijerathne Nikini Devindi Wijesinghe Naduni Madhavika

Many countries, including Sri Lanka, are taking steps to integrate sex education into their educational systems to combat child abuse. However, this effort is often met with skepticism in Asian nations, including Sri Lanka. This study takes a unique approach by applying the criteria of the health belief model to predict the quality of reproductive health (SRH) education in Sri Lanka, offering a fresh perspective on this issue. A positive philosophical framework and a deductive approach have been employed to provide justification for the underlying assumptions. A structured questionnaire was used as the survey methodology, which included questions about external cues to action, self-efficacy, perceived barriers, perceived susceptibility, and perceived severity. Data was collected from a total of 384 Sri Lankan non-state undergraduate students to test their perception of these factors and how they affect the perceived benefits of quality SRH education. The level of self-efficacy, perceived susceptibility, and perceived severity yielded a coefficient estimate that was statistically significant, thus influencing the perceived benefits of quality SRH education. These results, obtained through a multivariate regression analysis, underscore the importance of one’s role in implementing effective SRH education. Importantly, there is no evidence that external cues to action and perceived barriers predict the perceived benefits of quality SRH education. This underscores the gravity of the situation and the need for immediate action. The findings of this study have significant practical implications. They can be used to develop an effective SRH program that aims to prevent sexual abuse among adolescents. This study also demonstrates that the health belief model can serve as a useful conceptual framework for such intervention programs, providing tangible solutions to the issue of SRH education quality.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121702

Authors: Beatriz Cardoso Armani Rafaela Cristina Vieira e Souza Fernanda Penido Matozinhos Luana Caroline dos Santos

Objective: To assess the birth weight of newborns whose mothers gave birth during the COVID-19 pandemic. Methods: A cross-sectional study based on data collected from medical records and through postnatal interviews to assess maternal and neonatal health outcomes (n = 470) during the pandemic. All participants were assisted in three Brazilian public hospitals in 2020. Multinomial logistic regression was performed to assess factors associated with birth weight. Results: Low and insufficient birth weight reached 9.8% and 25.7% prevalence, respectively. COVID-19 symptoms were reported by 8% of participants. Low birth weight was more often observed in premature children (OR: 70.9; 95% CI: 16.4–305.8) delivered by cesarean sections (OR: 7.70; 95% CI: 2.33–25.4). Insufficient weight was more frequent in premature children (OR: 5.59; 95% CI: 1.53–20.4) and children whose mothers did not exercise during pregnancy (OR: 2.85; 95% CI: 1.38–5.89). Women presenting higher gestational weight gain had a lower chance of delivering babies with insufficient weight (OR: 0.94; 95% CI: 0.90–0.99). Conclusions: Inadequate birth weight was associated with prematurity, delivery type, lower gestational weight gain, and maternal physical inactivity during the pandemic. According to the results, it is necessary to have adequate prenatal care and promote a healthy lifestyle during pregnancy.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121701

Authors: Laura N. Cushley Matthew Mo Tunde Peto A. Jonathan Jackson

Background: The COVID-19 pandemic brought many challenges for all and especially for people with a visual impairment. As a result, many healthcare services had to close or be reduced, and new rules and regulations were implemented. These rules, regulations and testing procedures were challenging for many people with a visual impairment. Methods: Focus groups were conducted with sensory support workers at a regional sensory meeting in Northern Ireland. A set of semi-structured questions were asked about how services were conducted, the challenges faced by people with a visual impairment and any specific cases which showed its impact. Two researchers transcribed and analysed the focus group data. Results: The analysis resulted in four themes, namely “as a result”; healthcare; rules, regulation and testing; and mental and physical health. Some of the biggest issues mentioned were access to healthcare, COVID testing, online working, online schools, one-way systems, social distancing and the impact on mental and physical health. Conclusions: As expected, COVID-19 impacted people with a visual impairment. This study shows some of the barriers faced by people with a visual impairment, especially with regards to the rules and regulations. People with a visual impairment also found it difficult to access the necessary healthcare and support, or they were too fearful to seek it out. This paper provides an insight into the barriers faced by people with a visual impairment and how we may support them in the future.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121700

Authors: Monique Louise Cassimiro Inácio Luana Caroline dos Santos Olívia Souza Honório Rafaela Cristina Vieira e Souza Thales Philipe Rodrigues da Silva Milene Cristine Pessoa

The aim of the present study is to identify obesogenic environment profiles to find the obesogenic environment pattern for Belo Horizonte City. The current research followed the ecological approach and was substantiated by data from food shops, public sports venues, crime rates (homicides and robberies) and the rate of accidents with pedestrians. Descriptive analyses and principal component analysis (PCA) were conducted in Stata software, version 14.0. Georeferencing and map plotting were carried out in Qgis software, version 2.10. All neighborhoods in Belo Horizonte City (n = 486) were included in the study. The obesogenic pattern comprised the highest mean number of shops selling ultra-processed food, crime rates, and accidents with pedestrians. The generated latent variable was divided into tertiles, and the second and third tertiles represented the most obesogenic environments. Neighborhoods accounting for the highest obesogenic profile also recorded the largest number of shops selling all food types. Furthermore, neighborhoods in the third tertile recorded the highest mean income (BRL 2352.00) (p = 0.001) and the lowest Health Vulnerability Index (HVI = 54.2; p = 0.001). These findings point towards the need for developing actions, policies and programs to improve these environments, such as tax incentives to open healthy food retailers and public sports venues to promote healthier lifestyles and to prevent diseases in the middle and long term.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121699

Authors: Diane Felmlee Sara Francisco Melissa Hardy

Cyberbullying entails multiple, problematic consequences for its victims. However, little is known about the factors that influence the dispersion of these damaging messages. Drawing on theories of social interaction, we argue that perpetrators disseminate messages containing sexist and racist slurs that reinforce stereotypical, social norms to enhance their online visibility. We collected cross-sectional and longitudinal samples of tweets (N = 539,558 and 248,497, respectively) that included either gender or Asian slurs. We find that tweets containing gender or Asian slurs that were more negative in sentiment had a significantly higher number of retweets than more positive tweets, thereby heightening a user’s online presence and the reach of their content. Two historical events unfolded during our study—the onset of COVID-19 and the murder of George Floyd by a police officer. Tweet negativity increased following both events. Our findings demonstrate the capacity of aggressive tweets to generate wide-ranging networks, a process which is exacerbated further by public crises. Results suggest that the practice of sending such messages is strategic. Perpetrators likely engage in cyberbullying, consciously or not, to increase their online attention. Moreover, this strategy appears to be successful.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121698

Authors: Andreas G. Franke Peggy Schmidt Stefanie Neumann

The relationship between unemployment and mental disorders has been a significant subject of study since at least the Industrial Revolution. However, most data show associations of unemployment and isolated mental disorders, and this study field has been neglected in the last years. Therefore, this narrative review aims to provide an updated overview of the association between unemployment and mental health in general as well as the most prevalent mental disorders. A literature search was conducted using PubMed with the initial search terms “unemployment” and “mental health”. The identified disorders were then used as search terms for a more in-depth search. Two raters screened abstracts and identified the literature containing relevant information. As a main result, it could be demonstrated that regardless of age and sex, there is still a broad association between unemployment and mental well-being in general (e.g., quality of life measure for example by the General Health Questionnaire), suicide attempts, suicide rates, as well as specific psychiatric disorders (substance use disorder, schizophrenia, depression, bipolar disorders, compulsive/obsessive disorders, eating disorders, specific personality disorders, intelligence disorders/impairment, and ADHD). The most significant association was found for affective disorders (depression) and substance use disorders. The association in general was particularly evident for long-term unemployment and mental disorders. Returning to work reduced the prevalence rates of mental disorders significantly. The literature review confirms the results of much older and disease centered studies that unemployment and mental disorders are associated with each other. The main conclusion is that early medical detection and intervention among the mentally ill are as crucial as labor market policy interventions to prevent, avoid, and reduce unemployment.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121697

Authors: Rafael Pizarro-Mena Elena S. Rotarou Diego Chavarro-Carvajal Patrick Alexander Wachholz María Fernanda López Cristina Perdomo Delgado Solange Parra-Soto Isabel Barrientos-Calvo Felipe Retamal-Walter Gloria Riveros-Basoalto

In recent decades, Latin America and the Caribbean region have experienced accelerated aging. However, despite the significant progress of gerontology in the region, the number of geriatricians and professionals trained in the field is low; a notable gap in the training related to the assessment of older adults can also be observed. Therefore, in this literature review, we update the concept of Comprehensive Gerontological Assessment (CGA) for its application in the region. We compile the characteristics, validity, and reliability of CGA tools, and their usage in government documents across countries in the region. We also analyze the adaptations made to CGA during the COVID-19 pandemic, and discuss challenges related to CGA administration, academic training, research, innovation, and management. This study is particularly relevant as it proposes lines of action for decision-makers, academics, researchers, university students, and the general community, which will allow for more tailored interventions aimed at meeting the needs of older adults, their families, and caregivers. Such actions will positively impact functionality, autonomy, and quality of life, while promoting healthy, active, and successful aging in the region.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121696

Authors: Ahlam El Shikieri Zakaria Eltahir Abdulmannan Aman Mohamad Alhadramy

Background: Diet influences the symptoms of gastroesophageal reflux disease (GERD). Plant-based diets rich in vegetables, fruits, legumes, seeds, and nuts may reduce inflammation and improve gut health, while high-fat foods may worsen symptoms. Objective: We examined the association between plant-based and animal-based foods, selected demographic characteristics, and the likelihood of GERD in Al Madinah Al Munawarah, Saudi Arabia. Method: A cross-sectional study using the GerdQ tool assessed the GERD likelihood among 303 adults. Dietary diversity scores were used to assess the quality of their diet. quality. Results: The participants were predominantly women (68.6%) and had low education levels (88.4%). Cereals were the most consumed plant-based foods, while vitamin A-rich fruits and vegetables were the least consumed. There was significant variation in the consumption of legumes, nuts, seeds, and milk and milk products among the GERD groups. The participants with a 50% GERD likelihood had the highest consumption (34.5%), followed by the 89% likelihood group (21.4%) and the 79% likelihood group (14.5%). The lowest consumption of milk and milk products was among those with an 89% GERD likelihood who also consumed more organ meat. In addition, GERD likelihood was inversely associated with age (r = −0.153; p = 0.008). The likelihood of GERD was negatively correlated with the intake of legumes, nuts, and seeds (r = −0.163; p = 0.005). Furthermore, the intake of cereals and tubers (r = 0.114; p = 0.047) and legumes, nuts, and seeds (r = 0.231; p = 0.0001) increased significantly with education. Conclusion: GERD prevention programs should target women, those with a low education level, and individuals consuming fewer plant-based foods and more organ meats.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121693

Authors: Dweet Chhaya Merna Gress Amna Raja Wieslawa Kosinska Terry Gordon Judith Zelikoff Joseph B. Guttenplan

The objective of this study is to investigate the potential mutagenic effects of the exposure of mice to aerosols produced from the component liquids of an electronic nicotine delivery system (ENDS). The use of electronic cigarettes (e-cigs) and ENDSs has increased tremendously over the past two decades. From what we know to date, ENDSs contain much lower levels of known carcinogens than tobacco smoke. While conventional tobacco smoke is a well-established mutagen, little is known about the mutagenicity of ENDS aerosols. Here, we report the mutagenic effects of a 3-month whole body exposure of C57 lacI mice (BigBlueTM) to filtered air (AIR) or ENDS aerosols in several tissues. Aerosols were generated from a 50/50 vegetable glycerin (VG)/propylene glycol (PG) mixture with and without nicotine. The results revealed that in the lung, bladder urothelial tissue, and tongue, mutagenesis was significantly greater in the VG/PG/nicotine group than in the AIR group. In all organs except the bladder, mutagenesis in the VG/PG only group was similar to those exposed to AIR. In the bladder, mutagenesis in the VG/PG group was elevated compared to that in the AIR group. In the liver, mutagenesis was modestly elevated in the VG/PG/nicotine group, but the elevation failed to reach statistical significance. Overall, there were no consistent differences in mutagenesis between the sexes. The results of this study suggest that exposure to e-cig aerosols containing nicotine represents a risk factor for carcinogenesis in several organ systems, and exposure to VG/PG alone may be a risk factor for bladder cancer.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121695

Authors: André Cardoso Andreia Ribeiro Paula Carneiro Ana Colim

This review provides a comprehensive analysis of studies investigating the impact of occupational exoskeletons on work-related musculoskeletal disorder (WMSD) risk factors. The primary objective is to examine the methodologies used to assess the effectiveness of these devices across various occupational tasks. A systematic review was conducted following the PRISMA guidelines, covering studies published between 2014 and 2024. A total of 49 studies were included, identified through searches conducted in Scopus and Web of Science databases, with the search string launched in August 2024. The review identifies a growing body of research on passive and active exoskeletons, with a notable focus on laboratory-based evaluations. The results indicate that direct measurement and self-report methods are the preferred approaches in these domains. Ergonomic limitations and user discomfort remain concerns in some cases. The findings of this review may influence stakeholders by providing insights into the potential benefits of adopting exoskeletons and improving workplace ergonomics to reduce WMSD risks. Additionally, the identification of WMSD assessment methods will be valuable for validating the use of these technologies in the workplace. The review concludes with recommendations for future research, emphasizing the need for more real-world assessments and improved exoskeleton designs to enhance user comfort and efficacy.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121694

Authors: Claire J. Han Xia Ning Christin E. Burd Fode Tounkara Matthew F. Kalady Anne M. Noonan Diane Von Ah

Background: Gastrointestinal (GI) distress is prevalent and often persistent among cancer survivors, impacting their quality of life, nutrition, daily function, and mortality. GI health screening is crucial for preventing and managing this distress. However, accurate classification methods for GI health remain unexplored. We aimed to develop machine learning (ML) models to classify GI health status (better vs. worse) by incorporating biological aging and social determinants of health (SDOH) indicators in cancer survivors. Methods: We included 645 adult cancer survivors from the 1999–2002 NHANES survey. Using training and test datasets, we employed six ML models to classify GI health conditions (better vs. worse). These models incorporated leukocyte telomere length (TL), SDOH, and demographic/clinical data. Results: Among the ML models, the random forest (RF) performed the best, achieving a high area under the curve (AUC = 0.98) in the training dataset. The gradient boosting machine (GBM) demonstrated excellent classification performance with a high AUC (0.80) in the test dataset. TL, several socio-economic factors, cancer risk behaviors (including lifestyle choices), and inflammatory markers were associated with GI health. The most significant input features for better GI health in our ML models were longer TL and an annual household income above the poverty level, followed by routine physical activity, low white blood cell counts, and food security. Conclusions: Our findings provide valuable insights into classifying and identifying risk factors related to GI health, including biological aging and SDOH indicators. To enhance model predictability, further longitudinal studies and external clinical validations are necessary.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121692

Authors: Martin Lavoie David Risk Daniel Rainham

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.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121690

Authors: Ian Philips Labib Azzouz Alice de Séjournet Jillian Anable Frauke Behrendt Sally Cairns Noel Cass Mary Darking Clara Glachant Eva Heinen Nick Marks Theresa Nelson Christian Brand

Physical inactivity is a leading risk factor for non-communicable diseases. Climate change is now regarded as the biggest threat to global public health. Electric micromobility (e-micromobility, including e-bikes, e-cargo bikes, and e-scooters) has the potential to simultaneously increase people’s overall physical activity while decreasing greenhouse gas emissions where it substitutes for motorised transport. The ELEVATE study aims to understand the impacts of e-micromobility, including identifying the people, places, and circumstances where they will be most beneficial in terms of improving people’s health while also reducing mobility-related energy demand and carbon emissions. A complex mixed methods design collected detailed quantitative and qualitative data from multiple UK cities. First, nationally representative (n = 2000), city-wide (n = 400 for each of the three cities; total = 1200), and targeted study area surveys (n = 996) collected data on travel behaviour, levels of physical activity, vehicle ownership, and use, as well as attitudes towards e-micromobility. Then, to provide insights on an understudied type of e-micromobility, 49 households were recruited to take part in e-cargo bike one-month trials. Self-reported data from the participants were validated with objective data-using methods such as GPS trackers and smartwatches’ recordings of routes and activities. CO2 impacts of e-micromobility use were also calculated. Participant interviews provided detailed information on preferences, expectations, experiences, barriers, and enablers of e-micromobility.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121691

Authors: Margaret Quaid Syed Emdadul Haque Tariqul Islam Mohammad Hasan Shahriar Golam Sarwar Alauddin Ahmed Steven O’Connell Farzana Jasmine Muhammad G. Kibriya Habibul Ahsan Maria Argos

Residents of Bangladesh are exposed to numerous chemicals due to local industries, including dyeing mills, cotton mills, and the use of biomass in daily cooking. It is, therefore, important to characterize the exposome and work to identify risk factors of exposure. We used silicone wristband passive samplers to evaluate exposure to volatile and semi-volatile organic compounds in a sample of 40 children in the Araihazar upazila of Bangladesh. We used stepwise linear regression models to determine which demographic, exposure, diet, and socioeconomic factors best predict exposure to single chemicals and classes of chemicals. Male sex at birth was associated with a decrease in the number of chemicals detected above their median concentration (β = −2.42; 95%CI: −5.24, 0.399), as was ownership of a flush toilet (β = −3.26; 95%CI: −6.61, 0.097). Increased body mass index (β = 1.81; 95%CI: 0.587, 3.03), father’s smoking (β = 2.74; 95%CI: −0.0113, 5.49), and father’s employment in the garment industry (β = 3.14; 95%CI: 0.209, 6.07) were each associated with an increase in the average number of chemicals detected above their median concentration. The observed results motivate future evaluation with health outcomes of these exposures.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121688

Authors: Jessica Beattie Lara Fuller Marley J. Binder Laura Gray Vincent L. Versace Gary D. Rogers

(1) Background: Medical graduates who have undertaken longitudinal rural training have consistently been found to be more likely to become rural doctors and work in primary care settings. A limitation of such findings is the heterogeneous nature of rural medical education and contested views of what constitutes ‘rurality’, especially as it is often reported as a binary concept (rural compared to metropolitan). To address the identified gaps in workforce outcomes for rural medical training and to demonstrate accountability to the communities we serve, we investigated whether Longitudinal Integrated Clerkship (LIC) graduates are practicing in communities with similar rural classification to those where they trained. Within an LIC, students learn the curriculum in an integrated, simultaneous manner. (2) Material and Methods: A retrospective cohort study analysing variables associated with working in smaller rural communities. (3) Results: LIC graduates who undertook an additional year of rural training were five times more likely to work in communities of similar rurality to the program’s training footprint. (4) Conclusions: The duration of rural training alone did not lead to optimal rural workforce outcomes. However, graduates who had trained in a combination of rural settings, an LIC, and block rotation were the most likely to practice in communities of similar rurality to the clerkship’s training footprint. This highlights the impact of both the training duration and setting inclusive of an LIC on fostering positive rural workforce outcomes and the need to develop innovative solutions to expand these models of training in smaller rural communities.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121689

Authors: Idalia Yazmin Castañeda-Yslas Olivia Torres-Bugarín María Evarista Arellano-García Balam Ruiz-Ruiz Juan Carlos García-Ramos Yanis Toledano-Magaña Alexey Pestryakov Nina Bogdanchikova

Cancer treatments have harmful side effects, including genotoxic ones. Our previous research discovered that a specific silver nanoparticle (AgNPs) formulation could reduce the genotoxic effects of an alkylating agent, cyclophosphamide. This study aims to evaluate if this protective effect is observed against an antimetabolite anticancer agent, cytosine arabinoside (Ara-C). An erythrocyte micronucleus assay was conducted on BALB/c mice. A most significant effect was observed after the application scheme, including three doses of Ara-C and three subsequent doses of AgNPs, resulting in a 3.7 and 2.0-fold decrease in the frequency of micronucleated reticulocytes and accumulated erythrocytes, respectively. Current and previous studies reveal that AgNPs could be used as a genoprotector against the genotoxic damage produced by the currently used antineoplastic antimetabolites and alkylating agents. It was revealed that AgNPs could be considered a new class of promising synthetic antineoplastic genoprotectants along with the known class of derivatives from natural sources.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121687

Authors: Thonaeng Charity Molelekoa Abayomi Samuel Oyekale

Background: The relationship between malaria/other febrile infections and anaemia among under-5 children is a subject of significant policy relevance among African health policy makers. The international significance of addressing anaemia is prominently underscored in the third Sustainable Development Goal (SDG). This paper therefore analysed the effect of malaria/other febrile infections and other maternal and child’s demographic variables on the prevalence of anaemia in Niger. Methods: We utilized the under-5 children’s module of the Malaria Indicator Survey (MIS) for 2021, which was collected from women of reproductive age (15–49) in selected households. The data were analysed with heteroscedasticity-consistent ordered probit regression model. Results: The results showed that 73.73% of the children was anaemic, while malaria and other febrile infections were present in 14.00% and 33.87%, respectively. Anaemia was highest in the Tillaberi and Dosso regions, where 84.12% and 79.12% of the children were anaemic. The ordered probit regression revealed that anaemia was promoted by malaria, other febrile infections, being a male child, second of multiple birth, and birth order, while wealth index, age, urban residence, and access to newspaper and television reduced it. Conclusions: Anaemia remains a major public health problem among under-5 children in Niger. A comprehensive healthcare intervention to address the problem should consider regional, sectoral, and gender differences in the incidences, with drastic efforts towards prevention of malaria and other fever-inducing illnesses. In addition, interventions to promote households’ economic status, reduce maternal fertility, and facilitate preventive practices through nutrition enhancement and health-related media programs hold some promise.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121686

Authors: Regina Ding Linda Duxbury

Caregiving plays a crucial role in aging societies by supporting individuals with chronic illnesses, disabilities, or aging-related needs. The unpaid labour provided by caregivers diverts healthcare resources from the formal healthcare system; however, this incurs costs to the caregivers themselves in terms of declines in personal wellbeing. This study explores the relationship between caregiving and healthcare spending for two groups of caregivers: eldercare only and sandwiched. We found that physician visits were the most common resource used by caregivers, at a mean of 3.69 (SD = 4.01) visits over a 6-month period, excluding non-users of this service. This was followed by mental health services (M = 5.86, SD = 7.02), emergency room visits (M = 1.77, SD = 1.38), and hospital admissions (M = 3.61, SD = 8.53). There were no significant differences in healthcare utilization between eldercare and sandwiched caregivers. There were mixed results regarding characteristics associated with greater resource use; however, the hours of weekly caregiving were most consistently associated with greater healthcare utilization, indicating that healthcare use may increase with care burden.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121685

Authors: Andre A. N. Bovell Cebisile Ngcamphalala Dane Abbott Jabulani Ncayiyana Themba G. Ginindza

Cervical cancer remains a significant public health issue globally. In Antigua and Barbuda, cervical cancer is ranked among the top five most common cancers in terms of incidence and mortality among females. There is no evidence that the costs of diagnosing, treating, and managing this cancer have been studied before in Antigua and Barbuda. From the providers’ perspective, this study aimed to estimate costs associated with cervical cancer in Antigua and Barbuda. The prevalence-based cost-of-illness methodology was used to assess patient data abstracted from four study sites for the period 2017–2021, and to derive the annual prevalence. Top-down and bottom-up costing approaches were used to estimate direct medical costs. Costs were computed using the 2021 price level and converted to United States Dollars (USD). Total annual direct medical costs of cervical cancer were estimated at USD 0.24 million (ranging between USD 0.19 million and USD 0.30 million). Major cost drivers were treatment (USD 112,863.76), post-treatment side-effects care (USD 67,406.57), and the diagnostic process (USD 26,238.58). The overall direct medical unit costs for managing a case were estimated at USD 115,822.09. Our study reflects the current estimates for managing cervical cancer and provides evidence to complement cervical cancer prevention and cost containment measures in Antigua and Barbuda.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121682

Authors: Steffen Flessa

Background: The sector-wide approach (SWAp) is an instrument of cooperation between external development partners (EDPs) and the government of a country. Its main purpose is the coordination, alignment and harmonisation of activities between EDPs and between EDPs and the respective government by covering the entire sector with one major programme. Methods: The main objective of this paper is to analyse the performance of the SWAps in two countries and draw conclusions about the appropriateness of SWAps as financing instruments in the healthcare sector under certain conditions. This paper analyses the development and achievements of the SWAp in healthcare of Bangladesh and Nepal in order to gain insights into the development and relevance of SWAps in the healthcare sectors of low- and lower-middle-income countries in general. We scrutinised the respective documents and conducted qualitative interviews with key stakeholders of the country’s sectors. The design of the questionnaires and the analysis of the interviews were built utilising a framework model reflecting the DAC criteria of development cooperation and the principles of the Declarations of Paris and Accra. Findings: The SWAps in Nepal and Bangladesh began rather early and cover about 20 years of cooperation. The components and interventions of SWAps were quite relevant for the health of the population, and their implementation was effective and efficient. The cohesion between partners strongly improved. However, for both countries, the interview partners do not perceive SWAps as the future of healthcare financing. Conclusions: SWAps were an appropriate instrument of cooperation between the respective governments and EDPs for almost two decades. However, as the share of government budgets in the sector finance has strongly increased and the management capacity of the respective ministries has gone up, there will come a point in time where EDPs can focus more on financing and implementing innovations instead of standard care.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121684

Authors: Anita Padmanabhanunni Tyrone B. Pretorius

Cynicism has been associated with adverse mental and physical health outcomes. This study investigated the role of cynicism in relation to indices of mental health among South African first responders. Research has highlighted that first responders are at increased risk of adverse mental health outcomes owing to the nature of their work. The sample consisted of 429 participants who completed a brief demographic questionnaire and several research instruments: Turner Cynicism Scale, Chalder Fatigue Scale, Patient Health Questionnaire-9, and Generalized Anxiety Disorder Scale-7. Structural equation modeling was used to explore the relationship between cynicism and mental health indicators. It included a measurement model, which identified four latent variables—cynicism, fatigue, depression, and anxiety—and their respective indicators, and a structural model, which defined the relationships among these latent variables. Path analysis was used to explore the potential mediating role of fatigue in the relationship between cynicism and indices of mental health. The results demonstrated significant associations between cynicism and anxiety, depression, and fatigue. Fatigue also mediated the relationship between cynicism and indices of mental health. The results underscore the importance of recognizing and addressing cynicism as a critical factor in the mental health of individuals working in high-stress occupations.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121683

Authors: Isabella Delgado Miguel Angello Camacho Isabella Pugliese Hugo Juan Camilo Clavijo Mabel Moreno Beatriz Muñoz Ospina Jorge Orozco

Falls are a public health problem, impacting quality of life, independence, and health costs. Subjective memory complaints (SMCs) and mild cognitive impairment (MCI) increase with age and may coexist. The risk of falls coinciding with SMCs is less understood. This study explored the risk factors associated with falls in adults with SMCs or MCI. A case–control study in adults over 50 was conducted. All participants underwent a neuropsychological assessment and a Timed Up and Go (TUG) test for gait analysis. Logistic regression calculated OR and p values, adjusting for demographic, clinical, cognitive, and gait variables. There was a total of 64 patients (47.06%) and 72 controls (52.94%). Fallers were older (70.76 ± 7.31) and had hypertension (29.63%), a history of stumbling (13.97%), slow TUG test performance (19.12%), and an asymmetric arm swing (19.85%). Fallers had lower verbal fluency (p = 0.043) and impairment on the Rey–Osterrieth figure copy (p = 0.047). Highest risk factors included female sex (OR 3.55, p = 0.006), older age (OR= 1.08, p = 0.006), hypertension (OR 3.33, p = 0.005), and stumbles (OR 5.65, p = 0.002). This study reconsiders clinical fall risk assessments in older adults with SMCs. Visuo-constructional abilities and executive dysfunction should be followed over time. Female sex, hypertension, and stumbles are risk factors. Integrated cognitive and motor assessments are crucial for detecting and proposing interventions for fall prevention in this population.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121681

Authors: Mehdi Torbat Esfahani Ibukun Awolusi Yilmaz Hatipkarasulu

In hot and humid work environments, construction workers can experience heat stress and heat-related illnesses (HRIs). While several studies have investigated engineering and administrative control methods to prevent certain heat stress risk factors, a comprehensive understanding of all existing risk factors and their corresponding control strategies is still lacking. It is crucial to identify gaps in current control strategies and develop a safety management framework for effective heat stress control by implementing existing measures. In addition, the effectiveness of the most common control strategies must be rigorously evaluated to ensure their efficacy and to guide future research aimed at enhancing these strategies or developing more effective ones. This study employed a mixed literature review methodology to address this knowledge gap. A structured literature review investigated and synthesized heat stress risk factors and control methods to find the gaps in control options to address underestimated risk factors. Furthermore, a comprehensive systematic literature review, including trend analysis, scientometric analysis, and meta-analysis, determined research foci and evaluated the effectiveness of the heat stress control methods. The scientometric analysis identified 11 clusters, encompassing key research themes such as environmental risk factors (e.g., high-temperature environments, climate change), administrative controls (e.g., work–rest schedules, climate change risk assessment), and personal interventions (e.g., cooling vests and sleep-related strategies). These findings highlight that the most commonly studied control methods are cooling vests, work–rest schedules, and cooling interventions. According to these results and the availability of quantitative results, the meta-analysis evaluated nine datasets of reductions in core body temperature by using types of cooling vests and anti-heat-stress uniforms and established the significant effectiveness of this control strategy in mitigating heat stress with a medium effect size. Moreover, five potential research studies have been identified to address gaps in control strategies for certain underestimated risk factors, including leveraging sensor technologies, conducting control training, dynamic work–rest schedules, using cutting-edge PPE, and governmental initiatives. Insights gained from this study enhance decision making for resource allocation, selection of control options, and intervention prioritization within a heat-stress-control framework based on the safety management system. The findings also highlight the effectiveness of cooling vests and areas that need to be developed, and evaluate potential heat-stress-control methods in construction.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121680

Authors: Hellen de Carvalho Lima Joubert Vitor de Souto Barbosa Adson Aragão de Araújo Santos Rafael Limeira Cavalcanti Adirlene Pontes de Oliveira Tenório Matheus Rodrigues Lopes Thais Sousa Rodrigues Guedes Achilles de Souza Andrade Geronimo José Bouzas Sanchis Rodrigo Pegado Johnnatas Mikael Lopes Marcello Barbosa Otoni Gonçalves Guedes

Chronic kidney disease (CKD) can impair activities of daily living (ADL), reducing quality of life. The influence of biopsychosocial factors on ADL limitations among CKD patients remains unclear. This study aims to investigate associations between these factors and ADL limitations among CKD patients in the Brazilian population. We analyzed data from 839 individuals diagnosed with CKD obtained from the National Health Survey. The outcome was the presence or absence of limitations in ADL caused by CKD. Biopsychosocial factors included clinical and health status, self-perceived behavior, contextual social support, lifestyle, and household characteristics. Cox regression was employed to adjust interactions between these factors, with the prevalence ratio used as a measure of effect (α ≤ 5%). From the analyzed sample, 373 CKD patients (40.7%; 95% CI: 35.4–46.1%) reported experiencing limitations in ADL. These limitations were associated with individual and contextual factors, including lack of private health insurance, residing in a rural area, poorer self-perceived health, presence of depressive symptoms, physical/mental disabilities, use of medications, and undergoing hemodialysis. Limitations in ADL among individuals with CKD are associated with biopsychosocial factors in the Brazilian population, emphasizing the necessity for public policies that support enhanced therapeutic management and address behavioral health.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121679

Authors: Ricky Finzi-Dottan Hila Abadi

Based on the literature indicating that emotional abuse erodes children’s secure attachment bonds, this study aimed to examine a mediation model positing that insecure attachment (anxious and/or avoidant styles) would mediate the association between childhood emotional abuse and rejection sensitivity (rejection and acceptance expectancies), which, in turn, will be associated with a fear of intimacy. One hundred and eighty members of the Israeli public aged 21–30 who were in relationships participated in the study. The results showed that avoidant and anxious attachment mediated the relationship between childhood emotional abuse and a fear of intimacy, acceptance expectancy mediated the relationship between avoidant and anxious attachment and a fear of intimacy, anxious attachment mediated the relationship between childhood emotional abuse and both rejection and acceptance expectancies, and avoidant attachment mediated the relationship between childhood emotional abuse and acceptance expectancy. These results indicated the salient role of insecure attachment styles and their associations with rejection sensitivity in forming intimate relationships due to having experienced childhood emotional abuse. Intervention promoting “earned security” was recommended.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121678

Authors: Eloise A. B. Price Mohammad Hamiduzzaman Vanette McLennan Christopher Williams Victoria Flood

This retrospective, descriptive study, conducted in 2024, analysed Virtual Care Survey (2020–2022) data of patients’ self-reported reflections on use and experiences to investigate relationships between demographics, the number of chronic conditions, and virtual care use among older rural patients (≥65 years with at least one chronic condition) living in New South Wales, and their satisfaction with virtual care. Associations between categorical variables were assessed using chi-squared tests, and Kruskal–Wallis tests were used for continuous variables. Qualitative feedback was analysed thematically. The study included 264 patients (median age 74 years; 51.1% women). Most virtual care appointments (65.3%) were for consultations, check-ups, or review of test results. Over one-third (38.3%) of the patients had multimorbidity and were 1.8 times more likely to have five or more virtual care appointments compared to the patients with one chronic condition. The oldest age group (≥80 years) preferred telephone over online mediums (Skype or Zoom) (p < 0.05). Patient satisfaction was high (65.8%), with 60.9% finding virtual care comparable to in-person consultations. Technological issues correlated with more negative experiences (p < 0.05). Key themes were enhanced accessibility and convenience, quality and safety of virtual care, and recommendations for equitable access. Despite positive responses, addressing technological complexities is important for optimising virtual care models for older rural Australians with chronic conditions.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121677

Authors: Barbara Gordon Jenifer Reader Benjamin G. Larsen Kelsey Cooper

The 2022 White House National Strategy on Hunger, Nutrition, and Health outlined goals for ending hunger in the US. Actions fell into five areas, called pillars; the goal of Pillar 5 was to enhance nutrition and food security research. This study leveraged participatory research theory and the National Strategy for developing a statewide, evidence-informed food security research agenda. A mixed-methods study employing the Community Engagement in Research Continuum (CEnR) was implemented. Engagement strategies included collecting baseline data via a statewide survey and encouraging participants of a statewide Summit to participate in a collective prioritization process. Surveys were emailed to a purposive sample of 1575 contacts; 31 registered for the in-person session. A total of 197 records were included in the survey analysis; all 31 registrants attended the in-person session. The research agenda was to include two objectives for implementation over the next two years. Academic and nonacademic stakeholders interacted as peers during the prioritization exercise. The first research objective was to conduct food assistance usage gap analyses; the second was to investigate barriers to collaboration among Idaho’s food security programs. The CEnR proved efficacious for producing a stakeholder-generated research agenda. Leveraging a national framework helped facilitate asset-based, actionable strategies within a proposed timeline.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121676

Authors: Wenping Hu Tanya Telfair LeBlanc Perri Zeitz Ruckart Quanza Shavonne Brooks-Griffin Paul Allwood

The objective of this study is to evaluate the impact of low blood lead levels (BLLs) on the red blood cell folate concentrations in U.S. children aged 2–17 years. All data were obtained from the National Health and Nutrition Examination Survey (NHANES) over six consecutive cycles from 2007–2008 to 2017–2018. A total of 12,739 children with BLLs lower than 10 µg/dL (geometric mean: 0.66 µg/dL) were included in the dataset. BLLs were categorized into three tertiles (tertile 1: <0.55 µg/dL; tertile 2: 0.55–0.95 µg/dL; and tertile 3: ≥0.95 µg/dL). The multivariate linear regression model analysis indicates a negative relationship between BLLs and red blood cell folate concentrations. After adjusting for potential confounding factors, red blood cell folate concentrations were lower in children in the BLL tertile 2 (β-coefficient = −0.0450; 95% CI: −0.0676, −0.0224) and BLL tertile 3 groups (β-coefficient = −0.0775; 95% CI: −0.1032, −0.0517) compared to children in the BLL tertile 1 group. When stratified by age, gender, and race/Hispanic origin, the subgroup analysis consistently revealed a negative relationship between BLLs and red blood cell folate concentrations, with red blood cell folate concentrations being lower (p < 0.05) in children in the BLL tertile 3 group compared to children in the tertile 1 group. Further investigation is needed to explore the mechanism underlying the potential relationship between BLLs and red blood cell folate concentrations and determine whether folate plays an active role beneficial for preventing the harmful effects of lead on children.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121675

Authors: Caglar Soylu Emre Serdar Atalay Duygu Turker Tezel Yildirim Sahan Necmiye Un Yildirim

Non-specific low back pain (NSLBP) is a common musculoskeletal issue that can limit function and reduce the patient’s quality of life. Enhancing spinal stabilizer muscle activity through targeted exercises may help improve spinal alignment and alleviate NSLBP symptoms. This study aimed to investigate whether incorporating the abdominal drawing-in maneuver (ADIM) into selected low back exercises influences the electromyographic (EMG) activity of key spinal extensor muscles. Forty participants with NSLBP (n = 29 female and n = 11 male; mean age = 21.42 ± 1.07 years; BMI = 20.65 ± 2.08 kg/m2; 80% right-side dominant) performed three exercises, prone trunk extension, superman, and unstable superman, with and without the ADIM. The EMG amplitudes of the iliocostalis lumborum pars lumborum (ICL), iliocostalis lumborum pars thoracis (ICT), and longissimus thoracis (LT) were measured. A cross-sectional observational study design was employed. Significant main effects were observed for both exercise types and the ADIM on the EMG amplitudes of the ICL, ICT, and LT (ICL: F1,14 = 82.69–114.23, p < 0.001, η2 ≥ 0.88; ICT: F1,14 = 100.69–117.13, p < 0.001, η2 ≥ 0.90; LT: F1,14 = 62.69–74.88, p < 0.001, η2 ≥ 0.81). Under ADIM conditions, the ICL activity decreased significantly (right ICL mean difference: 14.06–20.02; left ICL: 13.06–21.32; p < 0.001), while the ICT and LT activity increased (ICT mean difference: 6.45–8.89; LT: 9.37–12.13; p < 0.001). These changes were most pronounced during the unstable superman exercise (p < 0.01). Integrating the ADIM into specific low back exercises can differentially modulate spinal extensor muscle activity. In particular, the unstable superman exercise demonstrated the greatest changes in the EMG amplitudes. These findings support the inclusion of the ADIM in exercise programs aimed at improving spinal stability and may have implications for NSLBP management. Future research should examine the effects of the ADIM in populations with varying experience levels to enhance its generalizability and refine the clinical recommendations.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121674

Authors: Osayande Agbonlahor Delvon T. Mattingly Maggie K. Richardson Joy L. Hart Alison C. McLeish Kandi L. Walker

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.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121673

Authors: Shannon L. Stewart Abigail Withers Jeffrey W. Poss

Amongst school-aged children and youth, bullying is a significant problem warranting further investigation. The current study sought to investigate the influence of the COVID-19 pandemic waves and school closures on the bullying experiences of 22,012 children aged 4–18-years-old who were referred and assessed at mental health agencies in Ontario, Canada. Individual, familial, and mental health variables related to bullying experiences were also investigated. Data were collected from January 2017 to February 2022. The pre-pandemic period of study included January to June 2017, September 2018/2019 to June 2019/2020. The pandemic period was divided into categories of remote learning (17 March 2020 to 30 June 2020, 8 January 2021 to 16 February 2021, 12 April 2021 to 30 June 2021) and in-person learning (remaining pandemic dates). The summer holidays pre-pandemic were in July–August 2017, 2018, 2019 and during the pandemic they were in July–August 2020 and 2021. Logistic regressions were conducted to analyze data. Findings related to COVID-19 showed bullying rates to be lower during the pandemic when compared to pre-pandemic levels (bullied others during pandemic in school: OR = 0.44, CI = 0.34–0.57; victim of bullying during pandemic in school: OR = 0.41, CI = 0.33–0.5). Furthermore, bullying rates were lower during the pandemic periods when schools were closed for in-person learning (bullied others during pandemic remote: OR = 0.62, CI = 0.45–0.85; victim of bullying during pandemic remote: OR = 0.24, CI = 0.17–0.34). Children who lived in lower income areas, experienced home life challenges, exhibited mental health difficulties, or had behavioural concerns were more likely to be involved in bullying experiences. Finally, classroom type and school program impacted the child’s likelihood of bullying others or being bullied. These findings further our understanding of the impact of school closures on children’s mental health and behaviour during the pandemic. Public health and policy implications such as bullying prevention, supervision, and conflict management are discussed.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121671

Authors: Jennifer Louise Ferguson

Currently, women make up only 5% of the prison population, with 3604 women in prison in the UK compared to 74,981 men. Risky drinking is highly prevalent in both the male and female prison population, however, significantly more females drink in a risky way prior to prison (24% compared to 18% of men). In addition to risky drinking, those entering the criminal justice system (CJS), particularly women, are more likely to suffer from inequalities in society. Such inequalities can be linked to the pains of imprisonment for women. The overall research methods discussed in this paper are qualitative interviews. The interviews were designed after two systematic reviews exploring: the gendered pains of imprisonment and the feasibility and acceptability of women and alcohol brief interventions (ABI) were conducted. Interviews were conducted in an open prison setting, with both female residents and relevant staff and stakeholders. To date there is a dearth of evidence in relation to delivering ABI’s in prison, specifically with women. This research explored the feasibility and acceptability of delivering ABI to women in prison and found that when delivering ABI’s in a prison setting, by underpinning the research with criminological theory, could help women capitalise on the “teachable moment” necessary to induce behaviour change. The findings of the interviews found the intervention was both feasible and acceptable and identified five themes highlighting the women’s journey through prison chronologically to enable a more holistic ABI to be developed in future.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121672

Authors: Virginia A. Moreno Doris Lucero Nachalie Rodriguez-Cruz Qun Le Mary L. Greaney Ana Cristina Lindsay

Gestational weight gain (GWG) is critical for maternal and neonatal health, but excessive GWG can lead to complications such as gestational diabetes, hypertension, and increased obesity risk later in life. Minoritized and immigrant women often face higher risks of excessive GWG. This cross-sectional study assessed Central American women’s beliefs and concerns about GWG, the receipt of advice from healthcare providers, and sources of information for healthy weight management during pregnancy. A cross-sectional survey was conducted with 93 pregnant women from El Salvador (31.2%), Guatemala (46.2%), and Honduras (22.6%). Most participants were married (91.4%), and 91.2% had household incomes below $40,000. Self-reported pre-pregnancy weight status varied significantly (p = 0.03), with more Guatemalans self-reporting as overweight (34.9%) compared to Salvadorans (10.3%) and Hondurans (19.1%). Beliefs about GWG varied significantly; 72.1% of Guatemalan women accepted “eating for two”, while only 31.0% of Salvadorans did (p = 0.002). More Honduran women (90.5%) received weight gain recommendations from healthcare providers than Salvadorans (62.1%) and Guatemalans (60.5%) (p = 0.04). The Internet and family were common information sources on weight management, highlighting the need for culturally tailored health education. This study underscores critical differences in beliefs and access to prenatal care among pregnant Central American immigrant women, emphasizing the importance of culturally competent health education to support healthy pregnancy outcomes.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121670

Authors: Mary Fox Ann Joseph Neha Parimi Haley Huh

Asthma is the most common pediatric chronic disease, affecting about 5 million U.S. children. Controlling asthma requires intervention at the individual, household, and community levels. State asthma programs offer activities to support asthma control. We profiled U.S. state asthma programs through a website survey (24 CDC-funded, 10 non-CDC-funded) and then interviewed program managers about their information needs to identify ways to support their work. While CDC-funded and non-CDC-funded programs report similar goals and activities, their levels of engagement differed. Most programs rely on federal agencies or national associations for education materials. Concerns about materials were the lack of accessibility due to readability (reading level above sixth grade) and the lack of translations for culturally and linguistically diverse populations. In addition to priority needs around accessibility of materials, programs requested research to enhance their work and to support asthma management for young adults and incarcerated individuals.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121669

Authors: Kamila Dvořáková Laura García Valladares Bethany Butzer Calvin Lange Mark Greenberg

Background: Research has shown that 20% of Czech teachers suffer with burnout symptoms and 65% are at risk of burning out, which suggests that it is essential to continue addressing the issue of stress in Czech teachers. The main objective of this study was to evaluate a self-compassion and mindfulness-based professional development program for primary school teachers in the Czech Republic. Methods: Five schools were recruited, two as intervention schools (n of teachers = 47) and three as controls (n of teachers = 57). Teachers completed questionnaires at three time points: pre-test in September 2018, post-test in November 2018, and a follow-up in April 2019. Results: The results at post-test indicated that teachers in the intervention group scored significantly higher (p < 0.05) in self-efficacy and self-compassion, and significantly lower in depression, anxiety and emotional exhaustion, compared to the controls. The intervention teachers were marginally lower (p < 0.10) in perceived stress and marginally higher in subjective well-being, compared to the controls. At follow-up, teachers’ subjective well-being in the control group significantly worsened compared to the baseline. However, the intervention group did not show significant changes over time, which suggests a “protective effect” on the intervention group against worsening during the school year. Conclusions: The study suggests that providing teachers with self-compassion and mindfulness practices can lead to beneficial effects on several outcome variables. Further studies need to investigate if these benefits can be sustained and if they affect teachers’ physical health, their relationships with students, and the students’ outcomes.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121668

Authors: Mizuki Saito Yoshihiro Shimazaki Toshiya Nonoyama Yoshinori Inamoto

In 2020, the coronavirus disease 2019 (COVID-19) pandemic began worldwide. We examined the association between dental visit status and the incidence of COVID-19 and hospitalisation for it among older people based on medical claims data to help reduce COVID-19 severity. The study included 170,232 people who were 75–85 years old in fiscal 2019, with fiscal 2020 and 2021 serving as the follow-up period to ascertain the status of COVID-19. Using medical claims data, we investigated four types of dental visit (no visit, only periodontal treatment, periodontal and other treatment, and only other treatment) during fiscal 2019 and the incidence of COVID-19 and hospitalisation for COVID-19 during the follow-up period. Logistic regression analyses were performed with the incidence of COVID-19 and hospitalisation for COVID-19 as the dependent variables. Of the participants, 3206 (1.9%) developed COVID-19, of whom, 559 (17.4%) were hospitalised. There was not a significant association between the incidence of COVID-19 and type of dental visit. Participants with dental visits for periodontal treatment during the baseline year had a significantly lower odds ratio (OR) for hospitalisation due to COVID-19 compared to those without dental visits (OR: 0.71, 95% confidence interval: 0.58–0.78). The results suggest that dental visits for periodontal treatment including maintenance are important not only for maintaining oral health but also for preventing severe COVID-19.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21121667

Authors: Anne-Marie Hill Trish Starling Wei Xin Chiara Naseri Dan Xu Geraldine O’Brien Christopher Etherton-Beer Leon Flicker Max Bulsara Meg E. Morris Sharmila Vaz

The rising prevalence of chronic diseases could be mitigated by expanding community programs. This study aimed to evaluate the feasibility of delivering a community wellness program for older adults living with chronic disease. A two-group randomized controlled study, with blinded assessments, enrolling adults (≥50 years) with chronic disease, was conducted at a Western Australian community hub. Participants randomly allocated to the intervention participated in exercise groups and a wellness activity twice a week. Both the intervention and control groups received a Fitbit™ and workbook. The primary outcomes were recruitment, retention, acceptability, and suitability. The secondary outcomes measured at baseline and 12 weeks included physical function and physical activity (step count). There were 126 older adults approached, of whom 22 (17.5%) were recruited. Eighteen participants (mean age = 70.8 ± 8.1, n = 8 intervention, n = 10 control) completed 12 weeks. Two intervention participants (25% adherence) completed over 70% of sessions and eight participants (44.4% retention) accepted an ongoing 3-month program. Health problems (30.2%) were barriers to both recruitment and adherence. There were no significant between-group differences in physical function. Physical activity was significantly higher in the intervention group compared to the control group (p = 0.01). Tailored programs with ongoing support may be required to improve the health of older adults living with chronic disease.