Public Health [JOURNAL]
Sun
200 papers
Attitudes and beliefs regarding colorectal cancer screening among African American patients of community health centers in North-Central Florida and stakeholder perspectives: a qualitative study.
Luque JS, Dickey SL, Jackson DR … +10 more , Franklin OS, Vargas MA, Mohorne R, Kiros GE, Ali A, Robinson T, Duncan B, Freeman J, Howell-Murray J, Gwede CK
BMC Public Health · 2026 Jun · PMID 42374328 · Full text
BACKGROUND: Colorectal cancer (CRC) is one of the leading causes of cancer mortality in the US with African Americans continuing to experience CRC health disparities due to numerous factors. While colonoscopy remains the...
BACKGROUND: Colorectal cancer (CRC) is one of the leading causes of cancer mortality in the US with African Americans continuing to experience CRC health disparities due to numerous factors. While colonoscopy remains the most utilized test for CRC screening, stool-blood tests are cost-effective and offered by community health centers (CHC) serving un- and underinsured patients. Qualitative research has identified multilevel barriers to CRC screening and can potentially inform the development of tailored interventions to promote stool-based screening. METHODS: In this qualitative study, we explored the CHC context for delivering CRC screening services and patient education by interviewing six stakeholders of two north Florida CHCs and conducted six focus groups among African American patients of the two CHCs who had recently completed a CRC screening. CHC stakeholders were identified for interviews by their organizational roles delivering CRC screening services and focus group participants were recruited from our previous CRC screening behavioral clinical trial study group participant pool. RESULTS: CHC stakeholders assessed their organizations' delivery of CRC screening services, which included stool-based tests and colonoscopy referrals, and discussed trends in the screening rates achieved by their organizations. CHC stakeholders spoke about their patient education and outreach within the community and offered ideas about how community-based CRC screening education could be improved. CHCs highly valued the community-academic partnership, identifying numerous mutually beneficial aspects and embraced the ongoing partnership as a way to increase CRC screening adherence among their patients. The focus group discussions can be grouped into three main themes. The first theme is healthcare attitudes and relationships with providers. This theme covered perceptions of seeking healthcare and communication and trust with providers. The second theme is CRC knowledge and prevention. This theme covered patients' knowledge about CRC, what symptoms to monitor, knowing their family history of cancer, and the different screening tests. The third theme is technological and systematic issues in healthcare. These discussions focused on health insurance and accessing the patient portal. CONCLUSIONS: This study demonstrated the value of community-engaged qualitative research on CRC screening delivery and completion in partnership with CHC stakeholders.
Conflicted and healthy behavioural profiles in adolescents: a latent profile analysis of traditional sports attitude, physical activity attitude, and digital game addiction.
Özsaydi Ş, Uslu ÖS, Kabak B … +1 more , Erdoğan A
BMC Public Health · 2026 Jun · PMID 42374324 · Full text
PURPOSE: This study aimed to identify latent profiles of adolescents based on their traditional sports attitudes, digital game addiction levels, and physical activity attitudes using a person-centered approach. METHOD: A...
PURPOSE: This study aimed to identify latent profiles of adolescents based on their traditional sports attitudes, digital game addiction levels, and physical activity attitudes using a person-centered approach. METHOD: A total of 634 adolescents (female = 50.5%, n = 320; male = 49.5%, n = 314; mean age = 15.8 years; Grades 9-12) from state high schools in Antalya and Osmaniye provinces were assessed using the Traditional Sports Attitude Scale, the Digital Game Addiction Scale, and the Physical Activity Attitude Scale. Data were analysed via Latent Profile Analysis (LPA); between-profile differences were examined through ANOVA and post-hoc tests. RESULTS: LPA yielded three meaningful profiles (Entropy = 0.816). The Active-Healthy profile (n = 467, 73.7%) is characterised by high traditional sports attitude, low digital game addiction, and positive physical activity attitude. The Conflicted-Addicted profile (n = 101, 15.9%) exhibits an unexpected internal conflict pattern, carrying the highest digital game addiction in the sample (M = 3.31) despite high traditional sports attitude. The At-Risk profile (n = 66, 10.4%) displays the lowest values across all positive variables. Post-hoc analyses showed that traditional sports attitude failed to differentiate two profiles (|d| = 0.01 to 0.16; p = .314-0.994); whereas negative physical activity attitude was the strongest discriminating variable (η² = 0.621). CONCLUSION: A high traditional sports attitude cannot be considered universally protective against digital addiction risk. Intervention programs should directly target negative physical activity attitudes, beyond the dimension of cultural participation.
Dual-Model framework for CHIKV transmission modeling: ODE and Petri Net Analysis of the 2025 Foshan outbreak.
Liu H, Tian J, Li X … +6 more , Li Y, Li J, Yang Z, Deng X, Xu M, Hon C
BMC Public Health · 2026 Jun · PMID 42374320 · Full text
This study addresses the 2025 Chikungunya outbreak in Foshan City, Guangdong Province, China, by constructing a dual-model framework based on Ordinary Differential Equations (ODE) and Petri Nets (PN) for comparative anal...
This study addresses the 2025 Chikungunya outbreak in Foshan City, Guangdong Province, China, by constructing a dual-model framework based on Ordinary Differential Equations (ODE) and Petri Nets (PN) for comparative analysis of Chikungunya transmission dynamics and reproduction number estimation methods. The research employs SEICR (Susceptible-Exposed-Infectious-Chronic-Recovered) compartmental modeling to compare two formal representations under matched epidemiological assumptions, and evaluates the timing of epidemic control measures through a three-phase intervention fitting protocol. Model validation results show that both models achieve root mean square errors (RMSE) of 30.98 (ODE) and 31.05 (PN), mean absolute errors (MAE) of 15.57 and 15.78, and [Formula: see text] and 0.9498, respectively. Both models predict epidemic peaks at day 33 (406 cases), occurring 3 days earlier than the observed peak (432 cases), with a peak value error of 6.0%. Residual analysis reveals that negative residuals account for 71.4% (ODE) and 73.8% (PN) of the observation-window residuals, suggesting a structured overprediction pattern in descriptive diagnostics. Reproduction number analysis reveals that the initial transmission indicators are approximately 14.67 (ODE)/13.90 (PN), with effective values progressively decreasing through three intervention phases: 7.85/7.86 after Phase 1, 7.59/7.56 after Phase 2, and 0.059 in Phase 3, below the transmission threshold. An additional no-demography robustness check shows that removing demographic turnover changes total predicted cases by only 0.03%, suggesting that the remaining uncertainty lies mainly in omitted vector-side dynamics rather than in human-side demography. Sensitivity analysis indicates that the recovery rate (γ) is the most sensitive parameter affecting [Formula: see text] within this formulation, with a Sobol index of 0.9672, explaining 96.72% of total [Formula: see text] variation. This study provides a controlled comparison between ODE and Petri Net representations of the same epidemiological structure, offering a transparent comparative framework for outbreak fitting, intervention phase identification, and future extension toward explicit host-vector models.
Cost effectiveness and public health impact of PCV20 among adults in France.
Fiévez S, Menara M, Blanc E … +3 more , Bellier L, Sivignon M, Vietri J
BMC Public Health · 2026 Jun · PMID 42374313 · Full text
INTRODUCTION: Pneumococcal infections remain a significant public health concern in France, particularly among older adults at higher risk of developing severe forms. In 2023, the French health authorities updated vaccin...
INTRODUCTION: Pneumococcal infections remain a significant public health concern in France, particularly among older adults at higher risk of developing severe forms. In 2023, the French health authorities updated vaccination guidelines recommending a single-dose 20-valent pneumococcal conjugate vaccine (PCV20) for adults at increased risk due to underlying medical conditions and later extending it to all adults aged 65 years and over. The objective of this analysis is first to evaluate the cost-effectiveness and public health impact of PCV20 in replacing 13-valent pneumococcal conjugate vaccine → 23-valent pneumococcal unconjugated polysaccharide vaccine (PCV13 → PPV23) in the vaccination programme and secondly to assess the value of extending the recommendation to a broader population. METHODS: A deterministic Markov model was adapted to compare clinical and economic outcomes of adult pneumococcal vaccination strategies in France over a lifetime horizon. The economic inputs in this analysis were estimated in 2024 euros from a healthcare system perspective. Population parameters, epidemiological data and cost were derived from French databases and institutional reports. Utility and vaccine effectiveness inputs were obtained from the literature. RESULTS: Replacing PCV13 → PPV23 with PCV20 in at-risk adults reduced pneumococcal disease burden and was a dominant strategy, generating cost savings of €56,786 at the population level (€1.05 per patient) while improving health outcomes with an incremental gain of 0.00015 QALYs per patient. Expanding PCV20 to all individuals aged 65+ further reduced disease incidence and mortality over a lifetime horizon, averting 900 additional invasive pneumococcal diseases (IPD) cases (mainly bacteremia and meningitis), 11,600 pneumonia cases, and over 1,500 deaths. These additional health benefits were achieved at an incremental cost of €63,191 at population level (€0.81 per patient) corresponding to a gain of 0.00019 QALYs per patient. The incremental cost-effectiveness ratio was 4,308 €/QALY, indicating highly cost-effective strategy relative to commonly cited French vaccine HTA benchmarks. CONCLUSION: PCV20 is a cost-saving alternative to the PCV13 → PPV23 sequence for at-risk adults in France. Expanding recommendations to include all adults aged 65 years and over provides substantial public health gains and represents a highly cost-effective strategy.
Dynamic models of occupational fatigue: a systematic review for risk management advancement.
Wahyuni A, Russeng SS, Birawida AB … +3 more , Amqam H, Rahman MA, Bakri I
BMC Public Health · 2026 Jun · PMID 42374307 · Full text
BACKGROUND: Occupational fatigue is a major safety and health risk across work sectors. Because fatigue accumulates and fluctuates over time, effective fatigue management requires dynamic approaches that can anticipate r...
BACKGROUND: Occupational fatigue is a major safety and health risk across work sectors. Because fatigue accumulates and fluctuates over time, effective fatigue management requires dynamic approaches that can anticipate risk and inform preventive controls rather than rely on point-in-time assessment. Although dynamic fatigue modelling has expanded rapidly, evidence remains fragmented across modelling paradigms and sectors, limiting clarity on which approaches are most suitable for implementation. This systematic review synthesises recent evidence on dynamic models of occupational fatigue and evaluates their relevance for fatigue management and risk control. METHODS: Records published from 2019 to 2025 were identified from Scopus using DOI-indexed retrieval and screened with Watase Uake Tools to support article mining and Preferred Reporting Items for Systematic Reviews. Searches were complemented in PubMed, ProQuest, Wiley Online Library, and ScienceDirect. References were managed in Zotero, and screening, selection, and data extraction followed a structured process with manual searching and citation tracking. RESULTS: From 180 records, 12 peer-reviewed studies met the inclusion criteria. Four modelling approaches were identified: physiology-informed dynamic simulation, machine learning and deep learning for near real-time monitoring, probabilistic dynamic models such as Dynamic Bayesian Networks, and symptom-network or Bayesian graph approaches. Models were most useful for fatigue management when they integrated multimodal inputs and produced actionable outputs such as fatigue risk levels and intervention triggers, but implementation was limited by small samples and insufficient field validation. CONCLUSION: Future research should prioritize longitudinal workplace validation, harmonized benchmarking, and deployable hybrid models integrating physiological, psychosocial, and contextual determinants.
Youth Empowered Self-Care: a direct-to-participant intervention to promote mental well-being.
D'Agostino EM, Pulgaron ER, Neshteruk C … +13 more , Brown-Lowery C, Abbot-Grimes P, Fadika T, Ward M, Sato J, Cooper M, Hansen E, Enwright E, Nardi MI, Forde J, Hicks A, Li T, Hornik CP
BMC Public Health · 2026 Jun · PMID 42374306 · Full text
BACKGROUND: A crisis of youth mental health exists, disproportionately affecting minoritized and low-income youth. Park- and community-based recreation programs may promote mental well-being by offering accessible and af...
BACKGROUND: A crisis of youth mental health exists, disproportionately affecting minoritized and low-income youth. Park- and community-based recreation programs may promote mental well-being by offering accessible and affordable recreation in non-stigmatizing settings, with the potential to reduce mental health disparities. However, these programs are not currently being used at scale. Youth Empowered Self-Care (YES) is a mental well-being intervention intended to increase timely access to park- and community-based recreation programs among minoritized low-income youth. We evaluated YES for feasibility, acceptability, and change in participants' psychological, mental, and social well-being and anxiety. METHODS: This study was a single-arm prospective cohort pilot design. Youth aged 8-12 years were enrolled with two parks and recreation departments in Durham, North Carolina, and Miami, Florida, United States. Youth and caregivers were directed to the YES website, where they received information on mental health and resources, and park- and community-based programs. Data collected included website usage, program enrollment, and caregiver-reported youth psychological, mental, and social well-being and anxiety at baseline and at 3 months using the KIDSCREEN-27 and Screen for Child Anxiety Related Emotional Disorders (SCARED) measures to assess feasibility, acceptability, and change in psychological, mental, and social well-being and anxiety. Change from pre- to post-test scores and paired t-tests were used to determine change in mental well-being via the KIDSCREEN-27 and SCARED assessments. RESULTS: Participants (n = 247) included youth aged 8-12 years (36.4% Black;34.4% White; 11.7% Hispanic; 50.2% male; 39.7% >$50,000-$75,000 annual household income). The YES website had > 1,100 users, with ≥ 51.0% of website users enrolling in YES. Almost all (99.1%) participants indicated that YES connected them to a program, and that they subsequently completed their program (99.5%). Eighty-five percent and 31.3% of caregivers reported an increase on the youth psychological well-being and peer and social support subscales, respectively. Nearly half (46.5%) of caregivers reported a reduction in youth anxiety. CONCLUSIONS: This study suggests that YES may promote youth mental well-being. Pilot data also demonstrated YES feasibility and acceptability, and linkage to mental health education and treatment. The next steps for this research entail randomized prospective trials to assess YES efficacy. TRIAL REGISTRATION: NCT06255093 (www. CLINICALTRIALS: gov); registration date: February 12, 2024.
Classification of 24-h movement behaviour patterns among university students and their relationship with physical fitness: a latent profile analysis.
Song Y, Liu M, Cao L … +2 more , Liu Y, Xu C
BMC Public Health · 2026 Jun · PMID 42374302 · Full text
OBJECTIVE: University students' 24-h movement behaviours, including moderate-to-vigorous physical activity (MVPA), light-intensity physical activity (LIPA), sedentary behaviour (SB), and sleep (SLP), are interdependent a...
OBJECTIVE: University students' 24-h movement behaviours, including moderate-to-vigorous physical activity (MVPA), light-intensity physical activity (LIPA), sedentary behaviour (SB), and sleep (SLP), are interdependent and may jointly shape physical fitness. However, their combined relationship with physical fitness remains unclear, as most previous studies have focused on single behaviours or variable-centred associations and have rarely identified latent subgroups based on multidimensional behavioural patterns. Therefore, this study aimed to identify latent categories of 24-h movement behaviour patterns among university students using latent profile analysis (LPA), characterise these categories, and further examine their associations with physical fitness. METHODS: A total of 5,849 university students aged 18-23 years were recruited from 12 universities in Tianjin, China, including 2,267 males and 3,582 females. Time spent in MVPA, LIPA, SB, and SLP was assessed using the Chinese versions of the International Physical Activity Questionnaire and the Pittsburgh Sleep Quality Index. Physical fitness was evaluated according to the National Student Physical Fitness Standard (2014 Revised Edition), and total physical fitness score was used as the outcome variable. Latent profile analysis (LPA) was conducted separately by sex to identify 24-h movement behaviour patterns, and the BCH approach was used to compare differences in total physical fitness scores across latent classes. RESULTS: A four-class model was identified as the optimal solution for both sexes. Among males, the four profiles were low-activity / long-sleep (9.88%), higher light-intensity activity / low-sedentary (29.16%), low-activity / high-sedentary (52.89%), and high-activity / low-sedentary (8.07%). Among females, the four profiles were higher light-intensity activity / low-sedentary (13.51%), low-activity / long-sleep (12.98%), low-activity / high-sedentary / short-sleep (68.48%), and high-activity / low-sedentary (5.03%). Significant overall differences in total physical fitness scores were observed across latent classes in both males (χ² = 30.435, P < 0.001) and females (χ² = 26.215, P < 0.001). In both sexes, profiles characterised by lower sedentary behaviour and greater daily movement tended to show more favourable physical fitness scores, whereas low-activity and high-sedentary profiles showed poorer performance. CONCLUSION: University students showed clear heterogeneity in 24-h movement behaviour patterns, and these patterns were significantly associated with physical fitness. These findings support the development of sex-specific and profile-based intervention strategies to improve physical fitness among university students.
A systematic review of the determinants of vaccine hesitancy in the UK: Implications for future TB vaccine adoption.
Kennard A, Kılıç A, Alsugeir D … +2 more , Hamada Y, Rangaka MX
BMC Public Health · 2026 Jun · PMID 42374300 · Full text
BACKGROUND: Tuberculosis (TB) is a deadly yet vaccine-preventable disease mostly affecting adolescents and adults. Novel TB vaccines are now emerging, particularly for these populations; however, vaccine hesitancy, chara...
BACKGROUND: Tuberculosis (TB) is a deadly yet vaccine-preventable disease mostly affecting adolescents and adults. Novel TB vaccines are now emerging, particularly for these populations; however, vaccine hesitancy, characterised by delays, doubts or refusal to seek or accept vaccines, poses a challenge for sufficient adoption once these vaccines become available. Thus, this review systematically explored system- and individual-level determinants of vaccine hesitancy among adults in the UK, interpreting implications for the adoption of novel TB vaccines. METHODS: Five databases systematically searched for studies from 2020 - 2024 reporting qualitative outcomes on determinants of vaccine hesitancy among people living in the UK. Thematic analysis mapped extracted data onto a framework combining the Strategic Advisory Group of Experts (SAGE) model to explore system-level factors (e.g., vaccine-specific influences) and the Perceptions and Practicalities Approach (PaPA) to explore individual-level factors (e.g., perceptual influences) of vaccine hesitancy. The Mixed Methods Appraisal Tool was used to assess study quality. RESULTS: 29 qualitative and 21 mixed methods studies; 87.5% investigated hesitancy to COVID-19 vaccines. All SAGE themes were identified at the system level, most notably vaccine novelty, the media environment and health system experiences. At individual-level, all PaPA themes emerged, with vaccine-specific beliefs and knowledge most frequently identified. Overall, themes varied across the lifespan, with adolescents influenced mainly by media and social norms, and older adults by safety concerns and trust in health professionals. CONCLUSIONS: Vaccine hesitancy determinants interacted and were compounded in vulnerable subgroups, while post-pandemic disruptions to TB services may undermine adoption of novel TB vaccines. Addressing these challenges requires multi-level strategies centred on trusted, culturally sensitive communication. Delivery through routine, school and community-based programs aligns with evidence from high-incidence settings and highlights the need for coordinated action by policymakers and healthcare providers.
Baseline hypertension, adiposity, depressive symptoms, and incident stroke in middle-aged and older Chinese adults: a longitudinal analysis of CHARLS, 2011-2020.
Li W, Shao J, Zhu Y
BMC Public Health · 2026 Jun · PMID 42374299 · Full text
BACKGROUND: Stroke is a major cause of disability and death among middle-aged and older adults in China. Hypertension, adiposity, and depressive symptoms often coexist, but their associations with incident stroke are oft...
BACKGROUND: Stroke is a major cause of disability and death among middle-aged and older adults in China. Hypertension, adiposity, and depressive symptoms often coexist, but their associations with incident stroke are often examined separately. We assessed baseline cardiometabolic, adiposity-related, and psychosocial factors associated with first reported incident stroke in a longitudinal China Health and Retirement Longitudinal Study (CHARLS) cohort. METHODS: We used CHARLS data. Participants aged 45 years or older who were free of stroke at baseline and had at least one follow-up assessment were eligible. A person-period dataset was constructed to incorporate repeated follow-up intervals and the timing of first reported incident stroke. Person-period modified Poisson regression models with participant-level cluster-robust standard errors were used to estimate risk ratios (RRs) and 95% confidence intervals (CIs). RESULTS: Among 15,992 eligible participants, 1,246 first reported incident stroke events were identified during follow-up. The body mass index (BMI) and waist circumference complete-case models included 11,674 and 11,604 participants, with 949 and 941 incident stroke events, respectively. In the BMI model, hypertension (RR, 1.80; 95% CI, 1.56-2.07), diabetes (RR, 1.51; 95% CI, 1.21-1.88), heart problems (RR, 1.39; 95% CI, 1.17-1.64), BMI (RR per 1 kg/m², 1.05; 95% CI, 1.03-1.06), and 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) score (RR per 1 point, 1.03; 95% CI, 1.02-1.04) were associated with increased stroke risk. In the waist circumference model, waist circumference was also positively associated with incident stroke (RR per 1 cm, 1.02; 95% CI, 1.01-1.03). Sensitivity analyses yielded broadly consistent results. CONCLUSIONS: Hypertension, diabetes, heart problems, higher BMI, larger waist circumference, and higher CESD-10 score were associated with increased risk of first reported incident stroke among middle-aged and older Chinese adults. These observational findings suggest that vascular, adiposity-related, and psychosocial factors may help characterize stroke risk in this population, but they should be interpreted cautiously given anthropometric missingness, self-reported stroke ascertainment, and potential residual confounding.
Weight-loss practices and dietary quality in Chinese adolescents.
Yu Z, Feng D, Yu L … +9 more , Shen H, Yang X, Xu J, Pan Y, Guan Y, Xu C, Lu Y, Wang M, Qian J
BMC Public Health · 2026 Jun · PMID 42374295 · Full text
INTRODUCTION: This cross-sectional study aimed to investigate the associations between various weight-loss practices and unhealthy dietary patterns among Chinese adolescents. METHODS: We analyzed 17,483 students aged 6-1...
INTRODUCTION: This cross-sectional study aimed to investigate the associations between various weight-loss practices and unhealthy dietary patterns among Chinese adolescents. METHODS: We analyzed 17,483 students aged 6-19 years from The Zhejiang Childhood Behavior and Health Cohort, a school-based, multistage stratified cluster sample. Six weight-loss behaviors (laxatives, vomiting, non-prescribed diet pills, dieting/low-calorie foods, ≥ 24 h fasting, increased exercise) were assessed with yes/no items. Dietary quality was quantified with the 8-item Unhealthy Dietary Score (UDS-8; range 0-80, and categorized into low, moderate and high unhealthy dietary groups. Multivariable logistic regression estimated adjusted odds ratios (OR, 95% CI) for the association between each weight-loss method and dietary category. RESULTS: In the fully adjusted model, fasting ≥ 24 h conferred the highest risk of high unhealthy diet scores overall (OR = 4.65, 95% CI: 2.90-7.44), followed by vomiting (OR = 4.75, 95% CI: 2.25-10.00), diet pills (OR = 4.03, 95% CI: 1.90-8.56), and laxatives (OR = 2.65, 95% CI: 1.60-4.39), while increased exercise remained protective (OR = 0.83, 95% CI: 0.74-0.92). BMI-stratified analyses revealed that underweight adolescents showed the strongest associations for fasting (OR = 8.21) and vomiting (OR = 5.43); among those with overweight or obesity, fasting remained significant (OR = 3.32) and exercise showed the strongest protective effect (OR = 0.54); among normal-weight adolescents, dieting (OR = 1.59) and fasting (OR = 2.47) were significantly associated with high unhealthy diet, whereas exercise showed no significant association (OR = 1.03, 95% CI: 0.78-1.35). Notably, the associations between extreme weight-loss behaviors (e.g., vomiting, fasting ≥ 24 h) and unhealthy diet scores were more pronounced among underweight and obese adolescents, revealing important BMI-stratified heterogeneity. CONCLUSION: Extreme weight-control behaviors are strongly coupled with poor-quality diets among adolescents, with BMI-stratified heterogeneity, whereas increased exercise predicts healthier eating. School-based programs should prioritize the identification of extreme weight-loss behaviors and promote physical activity and balanced diets to prevent disordered eating.
Prevalence and associated factors of liver fibrosis and steatosis in Gansu, China: a community-based cross-sectional study.
Yang J, Ma X, Peng B … +9 more , Zhang M, Yang C, Yang Y, Ji J, Ren W, Zhang A, Yang X, Luo D, Wang L
BMC Public Health · 2026 Jun · PMID 42374294 · Full text
BACKGROUND: The epidemiology of chronic liver disease in China is undergoing a major transition, shifting from a predominance of viral hepatitis to metabolic-associated liver disease. However, population-based data from...
BACKGROUND: The epidemiology of chronic liver disease in China is undergoing a major transition, shifting from a predominance of viral hepatitis to metabolic-associated liver disease. However, population-based data from Northwest China remain limited. This study aimed to assess the prevalence and independent associated factors of liver fibrosis and steatosis in the general population of Gansu Province, China. METHODS: We conducted a community-based cross-sectional study across three regions in Gansu Province (Huining, Jingtai, and Jingyuan), enrolling 5,043 eligible participants between January and December 2025. All participants underwent anthropometric measurements, laboratory testing, and transient elastography (TE), and completed a structured questionnaire. Liver fibrosis and steatosis were assessed using the liver stiffness measurement (LSM) and ultrasound attenuation parameter (UAP), respectively. Fibrosis was staged as F0 (LSM < 7.3 kPa), F1 (7.3 ≤ LSM < 7.85), F2 (7.85 ≤ LSM < 10.0 kPa), and F3-4 (LSM ≥ 10.0 kPa). Steatosis grades S1 (mild), S2 (moderate), and S3 (severe) were defined using UAP cutoff values of 244, 269, and 296 dB/m, respectively. Independent associated factors were identified using multivariate logistic regression analysis. RESULTS: Among 5,043 participants (median age 46 years; 59.8% female), significant fibrosis (≥ F2) was observed in 5.18% (95% CI: 4.56-5.79), and advanced fibrosis or cirrhosis (F3-4) in 1.67% (95% CI: 1.31-2.02). The prevalence of liver steatosis (≥ S1) was 50.45% (95% CI: 49.07-51.85), including 26.87% with moderate-to-severe steatosis (≥ S2) and 7.16% with severe steatosis (S3). Multivariate analysis identified HBV infection (OR 3.19, 95% CI: 1.72-5.92), obesity (OR 5.14, 95% CI: 4.14-8.42), diabetes (OR 3.55, 95% CI: 2.02-6.25), elevated ALT (OR 3.86, 95% CI: 2.96-7.60), and decreased PLT (OR 6.45, 95% CI: 2.03-20.52) as independent factors cross-sectionally associated with advanced fibrosis. Severe steatosis was independently associated with obesity (OR 17.62, 95% CI: 13.50-23.01), diabetes (OR 1.73, 95% CI: 1.17-2.55), hypertension (OR 1.50, 95% CI: 1.14-1.96), dyslipidemia (OR 1.36, 95% CI: 1.04-1.78), decreased PLT (OR 4.16, 95% CI: 1.46-11.84), elevated ALT (OR 2.17, 95% CI: 1.46-3.22) and male sex (OR 1.70, 95% CI: 1.18-2.46). CONCLUSIONS: Hepatic steatosis was prevalent in this community population of Gansu Province, whereas clinically significant or advanced liver fibrosis remained relatively modest and was predominantly concentrated within high-risk metabolic and viral subgroups. These findings highlight the urgent need for integrated metabolic and viral screening strategies to enable early identification and prevention of progression to advanced liver disease in this high-risk population.
Prohibition isn't protection: Biosecurity without verification.
Syed MA, Lee ACK
Public Health · 2026 Jun · PMID 42373411 · Publisher ↗
The eradication of smallpox remains one of the most significant achievements in public health, symbolizing the power of international cooperation, scientific coordination, and collective responsibility. However, the cont...
The eradication of smallpox remains one of the most significant achievements in public health, symbolizing the power of international cooperation, scientific coordination, and collective responsibility. However, the continued retention of eradicated pathogens, particularly live variola virus, reflects a broader and unresolved challenge within global biosecurity governance. While debates surrounding smallpox have often been framed narrowly in terms of risk-benefit considerations specific to a single pathogen, they increasingly expose deeper structural limitations in the systems designed to prevent biological harm. International frameworks such as the Biological Weapons Convention (BWC) formally prohibit the development and stockpiling of biological agents for hostile purposes. Yet their effectiveness is constrained by incomplete universal participation, the absence of verification mechanisms, and limited capacity for enforcement. As a result, global biosecurity operates largely through normative commitments rather than enforceable accountability. In a world characterized by armed conflict, weakening multilateralism, and rapid advances in biotechnology, this reliance on trust-based governance is increasingly fragile. This editorial argues that the central issue is not simply whether eradicated pathogens such as variola virus, should be retained, but whether existing governance systems can manage biological risk in a credible and sustainable manner. If international norms cannot be effectively enforced, the assumption that prohibition equates to protection becomes increasingly untenable. Public health discourse must therefore move beyond pathogen-specific debates and engage more critically with the structural constraints of global biosecurity governance.
A novel maternal and newborn health composite indicator using national health surveys from low- and middle-income countries: Validation and association with infant mortality.
Arroyave L, Neves P, Wehrmeister FC … +2 more , Boerma T, Barros AJD
Public Health · 2026 Jun · PMID 42372678 · Publisher ↗
OBJECTIVES: To create a composite indicator to measure maternal and newborn health (MNH) interventions using national surveys from low- and middle-income countries (LMICs) and assess its relationship with neonatal and po...
OBJECTIVES: To create a composite indicator to measure maternal and newborn health (MNH) interventions using national surveys from low- and middle-income countries (LMICs) and assess its relationship with neonatal and post-neonatal mortality. STUDY DESIGN: Cross-sectional, multi-country study using nationally representative household survey data. METHODS: The Maternal and Newborn Health composite indicator (MNHci) was created based on three essential interventions: four or more antenatal care visits, institutional delivery, and postnatal care for the woman or baby within two days of delivery. One point was assigned per intervention received, ranging from zero to three. We analyzed national distributions and stratified results by wealth and residence. Spearman coefficients were used to assess the correlation between MNHci and neonatal and post-neonatal mortality. Multilevel Poisson regression using DHS data examined the relationship between MNHci and neonatal mortality. RESULTS: MNHci was estimated for 97 LMICs using data from 2010 to 2022. In 29 countries, over 80% of woman-baby dyads received all interventions; in 15 countries, more than 20% received none. Inequalities were evident: 83% of dyads in the wealthiest decile received all interventions compared to 44% in the poorest. Data from 80 countries showed a strong inverse correlation with neonatal (-0.64; 95% CI: -0.77, -0.50) and post-neonatal (-0.67; 95% CI: -0.81, -0.54) mortality. Adjusted Poisson regression indicated a 43% lower neonatal mortality incidence ratio (IR: 0.57; 95% CI: 0.38-0.83) for dyads receiving all interventions compared to none. CONCLUSIONS: The MNHci is a simple, standardized, and meaningful tool for tracking MNH coverage across LMICs, supporting efforts to reduce neonatal mortality and health inequalities.
Exponential cigarette-pack-year index (ECPYI).
Poorolajal J
Public Health · 2026 Jun · PMID 42372677 · Publisher ↗
OBJECTIVES: Traditional tobacco exposure metrics like the cigarette-pack-year (CPY) fail to capture the stronger, non-linear influence of smoking duration relative to intensity on lung cancer risk. To address this, the E...
OBJECTIVES: Traditional tobacco exposure metrics like the cigarette-pack-year (CPY) fail to capture the stronger, non-linear influence of smoking duration relative to intensity on lung cancer risk. To address this, the Exponential Cigarette-Pack-Year Index (ECPYI) was proposed, a novel metric that incorporates the square of cigarette consumption and the fourth power of smoking duration to better reflect their differential effects on risk. STUDY DESIGN: Methodological formulation and simulation-based comparative analysis. METHODS: ECPYI is calculated using the formula: ECPYI = ln (cigarettes × years), offering a biologically informed alternative to CPY. Comparative analyses illustrate how ECPYI distinguishes between patterns of exposure that CPY treats equivalently. RESULTS: Despite identical CPY values, ECPYI varied substantially across scenarios, reflecting the disproportionate risk posed by longer smoking duration. Graphical comparisons showed ECPYI increasing non-linearly with time, unlike CPY, which remained constant. CONCLUSIONS: ECPYI provides a more accurate and practical tool for assessing smoking-related lung cancer risk, aligning with epidemiological evidence. While simple to compute and useful in public health contexts, it currently omits key individual risk modifiers such as age at initiation and inhalation patterns.
Development and validation of the mental health self-care scale for the general adult population.
Mikhaylova O, Zhyrgalbek J, Yanis S … +8 more , Valyaeva D, Serebrennaya E, Fedotenkova E, Bogachev N, Bochanova E, Fomicheva E, Maksimova O, Rimma Z
Public Health · 2026 Jun · PMID 42372676 · Publisher ↗
OBJECTIVES: To develop and psychometrically validate the Mental Health Self-Care Scale (MHSCS) for assessing mental health self-care behaviours in the general adult population. STUDY DESIGN: Cross-sectional survey. METHO...
OBJECTIVES: To develop and psychometrically validate the Mental Health Self-Care Scale (MHSCS) for assessing mental health self-care behaviours in the general adult population. STUDY DESIGN: Cross-sectional survey. METHODS: A 62-item initial pool grounded in the updated Middle Range Theory of Self-Care was refined through expert review (n = 11) and cognitive interviewing (n = 24), then administered to 600 Russian adults recruited via an online panel. Exploratory and confirmatory factor analyses were conducted. Criterion-related validity was examined using correlations and adjusted linear and logistic regression models predicting depressive symptom severity and clinically significant depression (PHQ-8). RESULTS: Confirmatory factor analysis supported a six-factor structure (Basic Routines, Active Lifestyle, Existential, Self-Compassion, Health-Adaptive, Professional Engagement) comprising 45 items (CFI = 0.826, TLI = 0.815, RMSEA = 0.052, SRMR = 0.060). Subscale reliability was acceptable (McDonald's omega 0.737-0.883). Higher Existential, Active Lifestyle, Basic Routines, and Self-Compassion scores were associated with lower PHQ-8 scores, whereas Professional Engagement and Health-Adaptive scores were associated with higher PHQ-8 scores. Basic Routines and Self-Compassion were associated with lower odds of clinically significant depression, while Professional Engagement and Health-Adaptive behaviours were associated with higher odds. CONCLUSIONS: The MHSCS provides a multidimensional, theory-informed measure of mental health self-care behaviours in the general adult population. The findings support preliminary use in public health and research settings, with further refinement and cross-cultural validation warranted.
Managing Institutional Change Through Participatory Planning: Creating the College of Integrated Health Sciences at the University at Albany, State University of New York.
Appleton AA, Hardiman ER, Jurkowski JM … +2 more , Rizzo VM, Bell EM
Public Health Rep · 2026 Jun · PMID 42366803 · Full text
Many universities are navigating changes to strengthen their long-term sustainability. Although challenges and negative consequences of institutional change are often most visible, successful efforts can provide valuable...
Many universities are navigating changes to strengthen their long-term sustainability. Although challenges and negative consequences of institutional change are often most visible, successful efforts can provide valuable lessons. In 2024, the University at Albany launched the College of Integrated Health Sciences after a yearlong, participatory planning process. The new college integrates the university's long-standing public health programs and academic departments, 40-year partnership with the New York State Department of Health, 60-year-old School of Social Welfare, and newly developed nursing programs. A change consultant guided the planning process, and 3 working groups developed recommendations for the college's name, organizational structure, and vision, mission, and value statements. The planning process involved multiple strategies to identify student, faculty, and staff priorities and encourage active participation: 5 surveys (626 responses), 3 full-day retreats, 7 consultant-led listening sessions, and 41 working group meetings. Students, faculty, and staff (n = 168) voted on the final recommendations. Most participants reported satisfaction with the mission (75%), vision (79%), and value (85%) statements; 80% reported satisfaction (44%) or neutrality (36%) with the proposed organizational structure. Although the working groups presented 3 name options reflecting constituent priorities, voting did not reveal consensus. Deans of the public health and social work units ultimately recommended a name for the college using phrasing that resonated with the vision, mission, and value statements. The university provost and president adopted all recommendations. This case study demonstrates that effectively navigating change requires transparent, participatory planning and frequent 2-way communication, which will facilitate successful outcomes and establish a strong foundation for the institution's future.
Association of METS-IR with breast cancer risk: a large-scale retrospective cohort study of Korean women.
Park J, Lee JH, Kang SH … +4 more , Kim YH, Han B, Kim DH, Yoon J
BMC Public Health · 2026 Jun · PMID 42365356 · Full text
BACKGROUND: Insulin resistance has been linked to increased breast cancer risk through mechanisms involving metabolic dysfunction and chronic inflammation. This study aimed to investigate the association between the meta...
BACKGROUND: Insulin resistance has been linked to increased breast cancer risk through mechanisms involving metabolic dysfunction and chronic inflammation. This study aimed to investigate the association between the metabolic score for insulin resistance (METS-IR) and breast cancer incidence in a large cohort of Korean women. METHODS: We conducted a retrospective cohort analysis using data from 2,731,416 women aged ≥ 40 years, obtained from the 2009-2010 Korean National Health Screening Program. Participants had no prior history of breast cancer at baseline. METS-IR scores were calculated and stratified into quartiles. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for breast cancer incidence according to METS-IR quartiles. RESULTS: During 31,633,123 person-years of follow-up, 43,526 new breast cancer cases were identified. Women in the highest METS-IR quartile demonstrated a significantly increased breast cancer risk (HR: 1.07, 95% CI: 1.03-1.12) compared to those in the lowest quartile. This relationship exhibited a non-linear association, with the increased risk of breast cancer primarily driven by the highest quartile of metabolic dysfunction. CONCLUSIONS: Our findings validate METS-IR as a useful tool for breast cancer risk assessment among Korean women, highlighting the importance of insulin resistance as a modifiable metabolic risk factor. These results emphasize the need for targeted preventive interventions focusing on metabolic health to reduce breast cancer incidence.
Psychometric validation of a multidimensional health facility HIV stigma instrument among healthcare workers in Taiwan.
Lai HH, Liu SL, Wang CC … +3 more , Yen TF, Tsai CC, Hsu SH
BMC Public Health · 2026 Jun · PMID 42365318 · Full text
BACKGROUND: HIV-related stigma within healthcare settings remains a major barrier to HIV prevention, treatment engagement, and equitable care. Existing stigma instruments in Taiwan primarily assess individual-level attit...
BACKGROUND: HIV-related stigma within healthcare settings remains a major barrier to HIV prevention, treatment engagement, and equitable care. Existing stigma instruments in Taiwan primarily assess individual-level attitudes and do not adequately capture institutional or structural determinants of stigma. A multidimensional health facility-level stigma instrument is needed to support routine monitoring and stigma-reduction efforts. This study aimed to culturally adapt and psychometrically validate a Traditional Chinese version of the WHO/USAID Health Facility Staff HIV Stigma and Discrimination Questionnaire for use among healthcare workers in Taiwan. METHODS: A cross-sectional psychometric study was conducted using three independent samples. Content validity was evaluated by an expert panel. Item analysis was performed in a pretest sample (n = 157). The main validation sample (N = 619) was randomly divided into Subsample A (n = 310) for exploratory factor analysis and Subsample B (n = 309) for confirmatory factor analysis. Construct validity, convergent and discriminant validity, and reliability were evaluated. External convergent validity was examined using correlations with the Taiwanese version of the Health Care Provider HIV/AIDS Stigma Scale (TW-HPASS). RESULTS: Exploratory factor analysis identified a seven-factor structure consisting of Fear, Extra Infection Precautions, Observed Enacted Stigma, Secondary Stigma, Health Facility Policies and Work Environment, Attitudes toward PWH, and Willingness to Treat Key Populations, explaining 72.98% of total variance. Confirmatory factor analysis demonstrated acceptable model fit (CFI = 0.916, TLI = 0.902, RMSEA = 0.069). Composite reliability values ranged from 0.794 to 0.954, and average variance extracted supported convergent validity. Domains conceptually aligned with HPASS showed moderate-to-strong correlations (r = .362-0.691), whereas structural domains such as observed stigma and institutional policies demonstrated weak or negligible correlations, indicating that the instrument captures distinct facility-level dimensions of stigma beyond individual attitudes. CONCLUSIONS: The Traditional Chinese WHO/USAID Health Facility Staff HIV Stigma and Discrimination Questionnaire demonstrates strong psychometric properties and provides a multidimensional framework for assessing HIV-related stigma in Taiwanese healthcare settings. By capturing individual, interpersonal, and structural dimensions of stigma, the instrument may support facility-level monitoring, cross-institutional benchmarking, and the development of targeted stigma-reduction interventions.
Geospatial variations in the prevalence of children missing out of diphtheria-pertussis-tetanus vaccination in Nigeria: estimates from multiple household surveys.
Eshofonie F, Gayawan E
BMC Public Health · 2026 Jun · PMID 42365312 · Full text
BACKGROUND: Vaccination remains one of the most effective public health measures, yet many children in Nigeria continue to miss essential vaccines, leaving them exposed to preventable diseases. Understanding the geograph...
BACKGROUND: Vaccination remains one of the most effective public health measures, yet many children in Nigeria continue to miss essential vaccines, leaving them exposed to preventable diseases. Understanding the geographic and temporal patterns of missed vaccinations is important for designing targeted and equitable immunization strategies. This study investigates the geospatial variations in the prevalence of children who missed diphtheria-pertussis-tetanus vaccination in Nigeria. METHODS: Data were obtained from the Nigeria Demographic and Health Surveys conducted between 2003 and 2023/2024. Bayesian geostatistical models were fitted within the Integrated Nested Laplace Approximation (INLA) framework to estimate the prevalence of zero-dose and under-immunized children across states and survey periods. Exceedance probability maps were used to identify states with a high likelihood that the prevalence of zero-dose children exceeded ten percent. RESULTS: The results show clear geographic clustering, with persistently higher prevalence of missed vaccinations in the northern regions compared to the south. Dropout between consecutive DPT doses has decreased over time, indicating improved follow-through once children start vaccination; however, each successive dose still shows a higher prevalence of missed vaccinations than the preceding one. Exceedance probability maps further highlight states such as Kebbi, Sokoto, Zamfara, and parts of Niger, Kwara, Borno, Yobe, Taraba, and Kogi, where the likelihood of zero-dose prevalence surpassing 10% remains high. CONCLUSION: Despite improvements in childhood vaccination coverage, large geographic disparities persist, especially in northern states. The continued presence of states with a high probability of zero-dose prevalence suggests that national progress has not resulted in equitable gains. Strengthening local immunization systems, addressing regional barriers, and prioritizing targeted interventions are needed to ensure that all children benefit from routine vaccination services.
Associations between carbon monoxide exposure, physical activity, and outdoor play preferences among UK children: evidence from the millennium cohort study.
Kuroiwa M, Mak HW, Pikhartova J … +2 more , Tabche C, Shelton N
BMC Public Health · 2026 Jun · PMID 42365276 · Full text
BACKGROUND: Physical inactivity and air pollution are significant global health concerns, yet limited evidence examines how residential air pollution is associated with physical activity behaviours among children. Existi...
BACKGROUND: Physical inactivity and air pollution are significant global health concerns, yet limited evidence examines how residential air pollution is associated with physical activity behaviours among children. Existing research has mainly focused on adults, older adults, or self-reported activity outcomes. This study examined the association between residential carbon monoxide (CO) exposure, objectively measured physical activity, and children's reported preference for outdoor sports and games using data from the Millennium Cohort Study. METHODS: This study used a cross-sectional secondary analysis of Sweep 4 Millennium Cohort Study data. Physical activity was measured using accelerometer-derived total steps over one week. Residential CO exposure was derived from linked MEDIx air pollution deciles and categorised into relatively lower and higher exposure groups. Linear regression was used to examine the association between CO exposure and total steps. Logistic regression was used to examine the association between CO exposure and preference for outdoor sports and games. Models were adjusted for sex, ethnicity, and socio-economic position, with survey and non-response weights applied. RESULTS: The analytic sample included 6,281 children. In the adjusted linear regression model, children living in areas with higher CO exposure recorded, on average, 356.26 more steps than those living in areas with lower CO exposure. In the adjusted logistic regression model, higher CO exposure was associated with slightly higher odds of reporting a preference for outdoor sports and games. However, the adjusted step-count model explained only a small proportion of variation in total steps. CONCLUSION: Higher residential CO exposure was modestly associated with higher total steps and greater reported preference for outdoor sports and games. These findings should be interpreted cautiously because the study was cross-sectional, explanatory power was low, and residual confounding by neighbourhood, household, school travel, and built-environment factors is likely. Future studies should examine multiple pollutants alongside more detailed contextual and environmental measures.
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