Public Health [JOURNAL]
Sun
200 papers
Age-dependent performance of obesity measures in screening for cardiometabolic risk over the lifespan.
Xue Y, Qi Q, Gao C … +3 more , Meng X, Liu W, Yan Y
Public Health · 2026 Jun · PMID 42364371 · Publisher ↗
OBJECTIVES: To evaluate age-specific associations of body mass index (BMI) and waist-to-height ratio (WHtR) with cardiometabolic risk and to explore potential age- and sex-specific screening thresholds. STUDY DESIGN: Thi...
OBJECTIVES: To evaluate age-specific associations of body mass index (BMI) and waist-to-height ratio (WHtR) with cardiometabolic risk and to explore potential age- and sex-specific screening thresholds. STUDY DESIGN: This cross-sectional study included 58,712 participants from the NHANES in the United States from 1999 to 2020. METHODS: Using data from 58,712 participants (aged 12-85 years) from NHANES 1999-2020, we analyzed age-stratified associations between obesity metrics (BMI, WHtR) and cardiometabolic risk (hypertension, dyslipidemia, diabetes). We used subsample population weights to produce estimates representative of the U.S. POPULATION: Covariates included demographics, lifestyle, socioeconomic factors, and medication use. Logistic regression, receiver operating characteristic (ROC) curves, and population attributable fraction were used. Exploratory age- and sex-specific screening thresholds were estimated using Youden's index. RESULTS: ROC analysis suggested that the discriminative performance of both BMI and WHtR for identifying prevalent cardiometabolic risk decreased with increasing age. The association between adiposity measures and prevalent cardiometabolic risk appeared to attenuate with age, as reflected by lower odds ratios and population attributable fractions. Nonlinear, J-shaped cross-sectional associations of BMI and WHtR with cardiometabolic risk were observed, particularly among older adults, in whom the risk appeared to plateau at higher adiposity levels. The screening performance of conventional obesity thresholds varied across age groups. The exploratory age- and sex-specific thresholds based on the maximum Youden index showed relatively balanced sensitivity and specificity, but require prospective validation. CONCLUSIONS: BMI and WHtR exhibited nonlinear associations with cardiometabolic risk. The strength of these associations and their discriminative performance appeared to decrease with age, suggesting that age- and sex-specific screening thresholds may warrant further investigation.
Independent and joint associations of social participation and depressive symptoms with incident stroke risk in older adults: a prospective cohort study based on CHARLS and ELSA.
Ma L, Ma Y, Huang Z … +7 more , Wang L, Ma K, Lin Z, Li J, He L, Ren C, Zhang X
BMC Public Health · 2026 Jun · PMID 42363161 · Full text
BACKGROUND: Stroke remains a leading cause of death and disability among older adults. Depressive symptoms and low social participation have been linked to stroke risk via behavioral and biological pathways. This study e...
BACKGROUND: Stroke remains a leading cause of death and disability among older adults. Depressive symptoms and low social participation have been linked to stroke risk via behavioral and biological pathways. This study examined the independent and joint associations of social participation (SP) and depressive symptoms (DS) with incident stroke in two nationally representative cohorts. METHODS: Data were derived from two nationally representative cohorts: the China Health and Retirement Longitudinal Study (CHARLS; 2011-2018) and the English Longitudinal Study of Ageing (ELSA; 2012-2019). SP and DS were assessed at baseline and categorized into four phenotypic subgroups (SP+/DS-, SP-/DS-, SP+/DS+, SP-/DS+). Cox proportional hazards models were fitted within each cohort with sequential covariate adjustment. To address missing data, sensitivity analyses were performed using the multiple imputation method (MICE). RESULTS: In CHARLS (n = 10,555; mean age 58.3 years), DS + was associated with elevated stroke risk (Model 3 h = 1.40, 95% CI 1.18-1.65, p < 0.001), whereas SP- showed no significant association (HR = 1.14, 95% CI 0.96-1.34, p = 0.13). Compared with the SP+/DS- reference phenotype, the SP-/DS+ joint phenotype was associated with an increased stroke risk (HR = 1.56, 95% CI 1.27-1.93, p < 0.001). In ELSA (n = 5,321; mean age 65.1 years), SP - was not associated with stroke risk (HR = 1.05, 95% CI 0.74-1.51, p = 0.78), and DS+ exhibited a similar but non-significant association (HR = 1.54, 95% CI 0.95-2.51, p = 0.08); the SP-/DS + was associated with elevated stroke risk (HR = 1.87, 95% CI 1.04-3.37, p = 0.04). CONCLUSIONS: Depressive symptoms were associated with incident stroke, whereas low social participation alone showed no consistent association with incident stroke. Notably, the joint phenotype SP-/DS+ identified a subgroup with the highest incident stroke risk, although such associations exhibited some heterogeneity between cohorts.
HBV breakthrough infection in individuals born to mothers with HBV infection: a systematic review and meta-analysis.
Pan Y, Jia Z, Zhang Y … +2 more , Wu Y, Jiang J
BMC Public Health · 2026 Jun · PMID 42363157 · Full text
BACKGROUND: Despite effective immunoprophylaxis, hepatitis B vaccine breakthrough infection (VBI) can still occur among individuals born to mothers with HBV infection. This study synthesized evidence on the incidence of...
BACKGROUND: Despite effective immunoprophylaxis, hepatitis B vaccine breakthrough infection (VBI) can still occur among individuals born to mothers with HBV infection. This study synthesized evidence on the incidence of post-vaccination HBV infection in this high-risk population. METHODS: A systematic literature search was conducted in PubMed, Embase, Scopus, China National Knowledge Infrastructure and Wanfang Chinese databases for articles evaluating VBI in individuals born to mothers with HBV infection. The VBI was characterized by seroconversion to HBsAg and/or anti-HBc positivity at or after 2 years of age, following initial post-immunoprophylaxis HBsAg negativity. The incidence of VBI was pooled after quality assessment. The review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD420251058273). RESULTS: Among 40 included studies, 37 provided HBsAg data (4,776 individuals; 24,434 person-years) and 29 reported anti-HBc (6,190 individuals; 16,663 person-years). The pooled cumulative incidence of HBsAg positivity was 0.24% (95% CI: 0.01-0.66%) and the incidence rate was 2.19 per 1,000 person-years (95% CI: 1.01-4.74). Anti-HBc positivity was higher, with a pooled cumulative positivity of 4.57% (95% CI: 2.18-7.66%) and an incidence rate of 19.69 (95% CI: 6.05-64.01) per 1,000 person-years. Subgroup analyses showed comparable HBsAg positivity between children born to mothers who were HBeAg-positive and HBeAg-negative (0.38% vs. 0.34%), while anti-HBc positivity differed markedly (6.81% vs. 0.64%). Consistently lower infection rates were observed among children who received booster immunization (HBsAg: 0.00% vs. 0.34%; anti-HBc: 0.37% vs. 3.88%), higher vaccine doses (10 µg vs. 5 µg: HBsAg 0.32% vs. 0.84%; anti-HBc 3.84% vs. 11.12%), or yeast-derived recombinant vaccines (HBsAg: 0.16% vs. 0.95%; anti-HBc: 4.50% vs. 7.95%), whereas anti-HBc positivity was higher among children older than 5 years than among those aged ≤ 5 years (9.61% vs. 2.38%). CONCLUSIONS: HBsAg positivity after successful neonatal immunoprophylaxis was rare, but the higher anti-HBc positivity suggests cumulative HBV exposure in this population, particularly among children born to HBeAg-positive mothers. Sustaining long-term protection through optimized vaccine strategies, such as timely boosters or higher postnatal dose regimens, may further reduce VBI risk in high-risk population and warrants further evaluation.
Trends in methylphenidate dispensing and regional inequalities among children and adolescents in France around the 2021 prescription reform: a repeated cross-sectional ecological analysis of national data (2014-2024).
Guez E, Van der Waerden J, Cohen D … +1 more , Benarous X
BMC Public Health · 2026 Jun · PMID 42363137 · Full text
BACKGROUND: In 2021, France broadened methylphenidate prescribing conditions by allowing treatment initiation outside hospital-based specialist settings in children and adolescents. This regulatory change occurred during...
BACKGROUND: In 2021, France broadened methylphenidate prescribing conditions by allowing treatment initiation outside hospital-based specialist settings in children and adolescents. This regulatory change occurred during the COVID-19 period and alongside broader changes in attention-deficit/hyperactivity disorder (ADHD) recognition and care organization, making its specific effect difficult to disentangle from concurrent contextual factors. We therefore examined national trends in methylphenidate dispensing and regional inequalities in France over 2014-2024, interpreting the reform and pandemic period as contextual factors rather than isolated causal exposures. METHODS: We conducted a repeated cross-sectional ecological study using annual region-level aggregated data from OPENMEDIC and INSEE for individuals aged 0-19 years in France from 2014 to 2024. OPENMEDIC records dispensed boxes rather than treatment initiations or treated individuals. Pre- and post-periods were defined as 2014-2019 and 2022-2024; 2020-2021 were treated as transition years. The primary outcome was annual methylphenidate dispensations per 1,000 inhabitants. Secondary outcomes included methylphenidate as a proportion of all psychotropic dispensations and regional inequality indices. All analyses were interpreted descriptively. RESULTS: Methylphenidate dispensations per 1,000 inhabitants aged 0-19 years increased across all 13 French regions in 2022-2024 compared with 2014-2019. Nationally, dispensations rose from 0.058 per 1,000 in 2014 to 0.189 per 1,000 in 2024, corresponding to a 3.3-fold increase. In descriptive national and panel analyses, post-2022 slopes were steeper than pre-period slopes, whereas immediate level-change estimates were imprecise. The national proportion of methylphenidate among all psychotropic dispensations increased from 6.30% in 2014-2019 to 9.09% in 2022-2024. Regional inequality metrics showed no clear convergence. CONCLUSIONS: In this nationwide ecological study based on annually aggregated data, methylphenidate dispensing more than tripled in France between 2014 and 2024, with steeper post-2022 trends, while regional disparities remained observable and showed no clear convergence. Because the 2021 prescription reform coincided with the COVID-19 period and other changes in ADHD care, these findings should be interpreted as descriptive population-level trends rather than evidence of a specific reform effect.
HPV vaccine awareness, perceptions, uptake, and school-based information channels during Nigeria's national rollout: a cross-sectional study among adolescent girls in rural Oyo State.
Adewole IE, Akinsolu FT, Abodunrin OR … +9 more , Lukwa AT, Ola OM, Adelaja GM, Olagunju MT, Chukwuemeka AN, Ezechi LO, Raji DO, Aduroja PE, Ezechi OC
BMC Public Health · 2026 Jun · PMID 42363132 · Full text
BACKGROUND: Nigeria introduced the human papillomavirus (HPV) vaccine into its national routine immunisation programme in October 2023, using a phased delivery strategy that included school- and community-based platforms...
BACKGROUND: Nigeria introduced the human papillomavirus (HPV) vaccine into its national routine immunisation programme in October 2023, using a phased delivery strategy that included school- and community-based platforms. Evidence remains limited on how adolescent girls in rural communities understand HPV vaccination during active rollout. This study assessed awareness, knowledge, perceptions, self-reported HPV vaccine uptake, and willingness to receive the vaccine among adolescent girls in rural Oyo State during the Phase-2 national rollout. METHODS: We conducted a school-based cross-sectional survey among 441 in-school adolescent girls recruited from 12 public and private secondary schools across three rural local government areas of Oyo State between 26 May and 19 June 2024. Structured questionnaires measured knowledge of cervical cancer, HPV, and HPV vaccination, as well as perceptions, beliefs, and self-reported vaccination status. Multivariable binary logistic regression was used to identify factors associated with HPV vaccine uptake and willingness to be vaccinated. RESULTS: Awareness of cervical cancer (26.1%), HPV (28.8%), and HPV vaccination (29.0%) was low. Schools were the most frequently reported source of information on cervical cancer and HPV among those who had heard of them. Forty-one participants (9.3%) self-reported having received the HPV vaccine. In adjusted analysis, favourable vaccine perception was strongly associated with self-reported uptake (AOR = 11.00; 95% CI: 3.53-34.25; p < 0.001), although this estimate should be interpreted cautiously because the vaccinated subgroup was small. Among unvaccinated participants, lack of information (49.3%), low perceived risk (20.3%), and concerns about side effects (16.0%) were the most frequently reported reasons for non-vaccination. Definite willingness to be vaccinated was associated with favourable vaccine perception (AOR = 6.24; 95% CI: 3.16-12.33; p < 0.001). CONCLUSIONS: During Nigeria's HPV vaccine rollout, self-reported uptake among adolescent girls in rural Oyo State was low and was associated more consistently with favourable vaccine perceptions than with knowledge measures alone. The findings suggest the potential value of strengthening school-based communication, providing adolescent-appropriate information, and considering parent/guardian engagement as part of rural HPV vaccination implementation. Because the study was cross-sectional and vaccination status was primarily self-reported, findings should be interpreted as associations rather than causal effects.
Evaluating the acceptability of a portable handwashing intervention (the Spatap) in three Fijian communities, a mixed-methods study.
Hosking R, Richardson A, Gray D … +3 more , Hales S, Batikawai S, Lal A
BMC Public Health · 2026 Jun · PMID 42363092 · Full text
BACKGROUND: Water, sanitation, and hygiene (WASH) interventions in resource-constrained communities can improve health outcomes, but uptake and sustainability are influenced by acceptability. We evaluated the acceptabili...
BACKGROUND: Water, sanitation, and hygiene (WASH) interventions in resource-constrained communities can improve health outcomes, but uptake and sustainability are influenced by acceptability. We evaluated the acceptability of the Spatap, a portable silicone tap attached to a bottle, as a household handwashing intervention in Fijian communities. METHODS: We distributed Spataps in three communities and conducted a survey two to seven days later, assessing sociodemographic factors, WASH access, and Spatap acceptability (n = 207). We applied a novel quantitative approach, calculating a total acceptability score from seven Likert-scale questions aligned with the component constructs of the Theoretical Framework of Acceptability (with a maximum score of 35) and asked open-ended questions about barriers and enablers to Spatap use. We analysed scores and used multiple linear models to examine predictors. Five months later, we conducted three focus group discussions (FGD) (n = 22) to supplement the survey data and performed thematic analysis using NVivo (ver 12). RESULTS: Spatap acceptability scores ranged from 18 to 35 (median 29), indicating high overall acceptability. Burden and opportunity cost scored lower than other component constructs. Sociodemographic factors were not meaningfully associated with acceptability scores. Few barriers were reported: ease of use, water saving, and convenience were key enablers. FGDs largely supported the survey findings and additionally highlighted ease of use for children and perceived illness reduction as contributors to acceptability. Time spent refilling bottles was burdensome in some larger households, the cost of larger bottles was prohibitive for some, and minor leakage issues were reported. CONCLUSIONS: The Spatap was broadly acceptable in the study communities, particularly where its portability, ease of use, and water-saving potential addressed locally important needs. These findings suggest the Spatap may have value as a household WASH intervention in resource-constrained settings, though its appropriateness relative to lower-cost alternatives should be considered. Future implementations should assess the cost-effectiveness and availability of suitable bottles, provide local language and pictorial instructions, and consider targeted engagement with children. The acceptability score method showed potential as a rapid evaluation tool but requires refinement before reapplication.
Unmet healthcare needs among adults with disabilities in South Korea: a nationally representative analysis using the behavioral model.
Seol EM, Nam SH
BMC Public Health · 2026 Jun · PMID 42363086 · Full text
BACKGROUND: Unmet healthcare needs are a critical indicator of health inequities. Despite near-universal health insurance coverage in South Korea, people with disabilities experience substantial barriers to healthcare ac...
BACKGROUND: Unmet healthcare needs are a critical indicator of health inequities. Despite near-universal health insurance coverage in South Korea, people with disabilities experience substantial barriers to healthcare access. This study identified factors associated with unmet healthcare needs among people with disabilities in South Korea. METHODS: This cross-sectional study used data from the 2023 Korea National Survey of People with Disabilities (KNSPD 2023), a nationally representative survey. The survey employed two-stage stratified cluster sampling, yielding an analytic sample of 6,772 adults with registered disabilities (weighted N = 2,630,374). Applying Andersen's Behavioral Model, complex-sample logistic regression examined predisposing, enabling, and vulnerability factors associated with unmet healthcare needs in the past 12 months. RESULTS: Overall, 17.3% of people with disabilities reported unmet healthcare needs. Transportation difficulties (36.5%) and financial cost (27.8%) accounted for nearly two-thirds of reported barriers. Among enabling factors, lack of health insurance emerged as the strongest predictor of unmet healthcare needs. Physical disability and poor self-rated health were also associated with substantially increased odds of unmet healthcare needs. Individuals with severe disabilities had lower odds of unmet healthcare needs than those with mild disabilities, suggesting potential gaps in support for people with less severe functional limitations. Women with physical disabilities showed particularly elevated odds of unmet healthcare needs. CONCLUSIONS: Despite universal insurance coverage, substantial unmet healthcare needs persist among people with disabilities in South Korea, driven primarily by transportation and financial barriers. Policy priorities should include expanding paratransit services, reducing out-of-pocket costs, targeting insurance enrollment assistance to the uninsured, addressing service gaps for mild disabilities, and implementing sex-specific interventions for women's compounded barriers. Healthcare access equity requires moving beyond coverage expansion to address structural accessibility barriers.
Prevalence of e-cigarette use and its association with knowledge and attitudes among palestinian medical students and physicians: a cross-sectional study.
Jabareen M, Humeedat M, Alhroub W … +10 more , Fasfoos A, AlBakri H, Shareef MG, Nairoukh DH, Maraqa RM, Said LN, Salameh A, Zatari M, Sham'a FKA, Qawasmeh AA
BMC Public Health · 2026 Jun · PMID 42351130 · Full text
BACKGROUND: Electronic cigarette (e-cigarette) use has increased globally, particularly among adolescents and young adults, despite growing evidence regarding potential health risks. Healthcare professionals play a criti...
BACKGROUND: Electronic cigarette (e-cigarette) use has increased globally, particularly among adolescents and young adults, despite growing evidence regarding potential health risks. Healthcare professionals play a critical role in tobacco control and smoking cessation; however, limited evidence exists regarding knowledge, attitudes, and practices (KAP) toward e-cigarettes among medical students and physicians in Palestine. METHODS: A cross-sectional study was conducted between November and December 2025 among medical students and physicians from major universities and teaching hospitals across the West Bank, Palestine. Data were collected using a structured, self-administered questionnaire adapted from a validated instrument. The questionnaire assessed sociodemographic characteristics, smoking-related behaviors, e-cigarette knowledge, attitudes, and use patterns. Multivariable logistic regression analyses were performed to identify factors independently associated with high knowledge levels, positive attitudes, and current e-cigarette use. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were reported. RESULTS: A total of 433 participants were included, with a mean age of 25.55 ± 7.69 years; 55.4% were female. Overall, 34.2% reported current use of at least one tobacco or nicotine product, and 11.8% were current e-cigarette users. Current e-cigarette use was substantially higher among males than females (20.7% vs. 4.6%, p < 0.001). High knowledge level was observed in 73.0% of participants, while 24.7% had positive attitudes toward e-cigarettes. Positive attitude was inversely associated with high knowledge level (aOR = 0.26, 95% CI: 0.16-0.44), while current e-cigarette use was associated with positive attitude (aOR = 4.32, 95% CI: 1.61-11.59). In the final parsimonious model, current e-cigarette use was independently associated with positive attitude toward e-cigarettes (aOR = 7.45, 95% CI: 3.66-15.18), having close friends who currently smoked (aOR = 3.63, 95% CI: 1.06-12.40), and spending more than five hours per day at college (aOR = 2.68, 95% CI: 1.02-6.99). Among current e-cigarette users, 51.0% also used at least one combustible tobacco product. Self-reported symptoms after switching from conventional cigarettes to e-cigarettes were described as exploratory findings based on a small subgroup. CONCLUSIONS: E-cigarette use is relatively common among medical students and physicians in Palestine and frequently coexists with other tobacco products. Although overall knowledge was generally high, important gaps remain, and positive attitudes toward e-cigarettes were strongly associated with current use. These findings highlight the need for enhanced education on emerging nicotine products within medical curricula, strengthened tobacco-control policies, and targeted interventions addressing social influences and misconceptions regarding e-cigarettes among current and future healthcare professionals.
Smartphone addiction as utility-reducing consumption: evidence from university students in Bangladesh.
Das AC
BMC Public Health · 2026 Jun · PMID 42351127 · Full text
BACKGROUND: The rapid increase in smartphone usage among university students has raised concerns about problematic use and its implications for mental well-being. While most existing studies adopt psychological perspecti...
BACKGROUND: The rapid increase in smartphone usage among university students has raised concerns about problematic use and its implications for mental well-being. While most existing studies adopt psychological perspectives, limited research interprets excessive smartphone use through an economic lens. Drawing on theories of rational addiction and time allocation, excessive smartphone use can be conceptualized as a form of utility-reducing consumption, where time spent on smartphones displaces welfare-enhancing activities such as physical activity and social interaction. This study aims to examine the determinants of smartphone addiction within a behavioral economic framework, focusing on its association with mental well-being and time-use-related behaviors among university students in Bangladesh. METHODS: A cross-sectional study was conducted among 500 university students in Bangladesh using a structured online questionnaire. Smartphone addiction risk was measured using the Smartphone Addiction Scale-Short Version (SAS-SV), while mental well-being and self-esteem were assessed using the WHO-5 and Rosenberg Self-Esteem Scale. Binary logistic regression models were estimated to identify factors associated with high-risk smartphone addiction. RESULTS: Approximately 54% of respondents were classified as high risk for smartphone addiction. Low mental well-being was significantly associated with higher odds of smartphone addiction (OR = 1.99, 95% CI: 1.14-4.79). CONCLUSION: The findings suggest that smartphone addiction can be interpreted as a utility-reducing behavior associated with diminished mental well-being within a time allocation framework. Behavioral factors appear more relevant than demographic characteristics in explaining problematic smartphone use. However, due to the cross-sectional design, causal relationships cannot be established.
Mapping risk communication practices in public health emergencies: a scoping review and comparison with Italian regional pandemic plans.
De Vita E, Arzilli G, Gesualdo F … +9 more , Casigliani V, Pasquale M, Cruschelli G, Tecchio F, Tosi F, Porretta AD, Romersi D, Buquicchio C, Rizzo C
BMC Public Health · 2026 Jun · PMID 42351103 · Full text
BACKGROUND: Effective risk communication is a cornerstone of public health emergency preparedness and response. The COVID-19 pandemic and other recent crises have highlighted both the centrality of communication in susta...
BACKGROUND: Effective risk communication is a cornerstone of public health emergency preparedness and response. The COVID-19 pandemic and other recent crises have highlighted both the centrality of communication in sustaining trust and compliance, and the persistent gap between theoretical frameworks and operational practice. METHODS: Within the framework of the CreSP project (Comunicare il Rischio nelle Emergenze per la Sanità Pubblica), we conducted a scoping review to map international evidence on risk communication in public health emergencies, comparing it with Italian regional pandemic preparedness plans. Following PRISMA-ScR guidelines, we searched PubMed, Scopus, and Web of Science (1 January 2019-16 May 2024). Peer-reviewed studies addressing health risk communication in emergencies were included. In parallel, 18 Italian regional pandemic plans were identified and analysed using a structured checklist derived from inductive thematic analyses. RESULTS: Of the 12,479 records identified, 173 studies were included. Most publications originated from high-income countries and focused on COVID-19 pandemic response. Mass communication strategies, especially via social media, predominated, while targeted and participatory approaches were less frequent. The emergency response phase was far more represented than the preparedness or post-emergency phases. Key principles such as timeliness, transparency, and trust were widely discussed across studies, whereas equity, citizen engagement, and infodemic management were less consistently operationalised. Analysis of Italian regional pandemic plans revealed substantial heterogeneity. Although communication was universally acknowledged as important, it was often framed as top-down information dissemination. Structured mechanisms for monitoring, evaluation, citizen participation, and infodemic management were inconsistently addressed. CONCLUSIONS: Although the concept of emergency risk communication is well-developed, its implementation varies across different levels of governance. The misalignment between scientific evidence and institutional frameworks-particularly regarding inclusivity, participatory models, and infodemic management-underscores the need for a more integrated and standardised national approach. Incorporating communication into preparedness infrastructures, supported by measurable indicators and workforce capacity building, is essential to strengthen resilience, equity, and public trust in the event of future emergencies.
Long-term mental health outcomes among healthcare workers following COVID-19 infection and frontline work: evidence of additive and non-additive patterns in Kazakhstan.
OAuthorNameova D, Tobzhanova K, Alibekova L … +7 more , Seitmanova A, Bilibayeva G, Ibraimzhanova Z, Kurmankhanova R, Shokay U, Alekesheva R, Suleimenova M
BMC Public Health · 2026 Jun · PMID 42351096 · Full text
BACKGROUND: Long-term mental health outcomes of COVID-19 related exposures among healthcare workers remain poorly characterized, particularly in Central Asia. METHODS: We conducted a cross-sectional comparative study bet...
BACKGROUND: Long-term mental health outcomes of COVID-19 related exposures among healthcare workers remain poorly characterized, particularly in Central Asia. METHODS: We conducted a cross-sectional comparative study between June and August 2025 among 2715 healthcare workers. Participants completed validated measures of BAT-33, GAD-7, PHQ-9, and EQ-5D-5 L with EQ-VAS. Main and interaction effects were examined by two-way ANСOVA and associations were decomposed into direct and indirect components using path analysis with bootstrap confidence intervals. RESULTS: COVID-19 infection was associated with higher burnout, while the COVID × Red Zone interaction was not significant, indicating an additive pattern. In contrast, significant interactions were observed for anxiety, depression, and quality of life, suggesting higher psychological symptoms among workers with dual exposure. Red Zone work showed a statistically significant but small association with burnout. In mediation analyses, anxiety and depression statistically accounted for 39.7% of the variance in burnout (R), suggesting these affective states are strongly associated associated with both pandemic-related exposures and burnout. CONCLUSIONS: Pandemic-related occupational and personal exposures remained statistically associated with mental health outcomes among healthcare workers 3-5 years after COVID-19, with burnout showing an additive pattern and anxiety and depression showing non-additive deviations. Within our sample, the dual-exposed subgroup showed approximately 2-fold higher prevalence of clinically significant symptoms of anxiety and depression than unexposed colleagues. These findings identify a subgroup that may warrant continued monitoring in future longitudinal research with objective exposure verification, before specific clinical or policy recommendations can be advanced. This is among the first large-scale studies examining post-pandemic psychological outcomes among healthcare workers in Central Asia.
Strengthening cancer prevention in european schools: a randomized controlled trial of digital interventions in adolescents: the SUNRISE program.
Barasoain M, Vélez-Del-Burgo A, Astigarraga I … +24 more , Haug S, Kiselev N, Koutra K, Kilintzis V, Krini M, Pampaka T, Hudders L, De Keyzer E, Serrano P, Pilotti C, Del Campo L, Nicoara D, Nicoara N, Molina-Barceló A, de Pablo Pardo T, Verduyn S, Cea G, Katsapi C, Segal LJ, Tsoupouroglou I, Guerra B, Triantafyllidis A, Arana-Arri E, SUNRISE Study Group
BMC Public Health · 2026 Jun · PMID 42351094 · Full text
BACKGROUND: Cancer remains a leading cause of mortality worldwide, with a substantial proportion of cases attributable to modifiable lifestyle-related risk factors that emerge during adolescence and often persist into ad...
BACKGROUND: Cancer remains a leading cause of mortality worldwide, with a substantial proportion of cases attributable to modifiable lifestyle-related risk factors that emerge during adolescence and often persist into adulthood. Despite the importance of this developmental period for habit formation, evidence on scalable, theory-driven, and sustainable school-based prevention interventions remains limited. The SUNRISE project addresses this gap by evaluating a co-created, digitally supported life-skills programme designed for routine school settings. METHODS: SUNRISE is a pragmatic, multinational, cluster randomised controlled trial conducted in approximately 80 primary and secondary schools across eight European countries (Greece, Switzerland, Slovenia, Spain, Cyprus, Italy, Belgium, and Romania), recruiting around 4,000 students. Classes are randomised at the class level (3:1) to either a six-month digitally enhanced life-skills intervention or standard education. The primary aim of the study is to evaluate the feasibility, implementation, and sustainability of the intervention in real-world school settings, with secondary exploratory assessment of behavioural outcomes. The intervention integrates multiple digital components, including a mobile-based life-skills coaching programme, a conversational assistant, educational and serious games, influencer-led media literacy content, moderated social interaction platforms, and teacher-led educational modules. Intervention design is guided by the Capability-Opportunity-Motivation Behaviour (COM-B) model and developed through systematic co-creation with students, educators, parents, public health experts, and policymakers within a School Living Lab framework. Feasibility, implementation, and sustainability are evaluated using the RE-AIM and PRISM frameworks. Secondary behavioural outcomes include substance use, dietary and physical activity behaviours, mental well-being, stress, social skills, critical thinking towards media and advertising, and critical coping with food-related information, assessed at baseline, 6 months, and 18 months. DISCUSSION: SUNRISE integrates behavioural science, participatory design, and digital innovation to address adolescent health behaviours in real-world educational contexts. By embedding implementation and sustainability evaluation alongside behavioural outcomes, the study aims to generate actionable evidence on how multi-component digital interventions can be adopted, adapted, and maintained across diverse school systems. Findings are expected to inform future large-scale, theory-driven, equitable, and sustainable cancer prevention strategies targeting adolescents across Europe. TRIAL REGISTRATION: NCT06931847 (registration date: 2025-04-09).
Behavioural determinants of testing behaviour during a hypothetical human-to-human avian influenza outbreak: an interview study.
van Hoorn RC, van Gestel LC, Harteveld-Griffioen D … +8 more , Petrignani MWF, Kersten C, Müskens M, Vols L, Borgdorff H, van der Meer IM, Adriaanse MA, van der Schoor AS
BMC Public Health · 2026 Jun · PMID 42351092 · Full text
BACKGROUND: Avian Influenza (AI) is a potential pandemic threat, specifically when human-to-human transmission occurs. In order to mitigate potential outbreaks amongst humans, testing is essential. l. It is necessary to...
BACKGROUND: Avian Influenza (AI) is a potential pandemic threat, specifically when human-to-human transmission occurs. In order to mitigate potential outbreaks amongst humans, testing is essential. l. It is necessary to identify determinants of testing behaviour for AI in an early phase, as current knowledge on testing behaviour is mostly derived from other infectious diseases such as COVID-19. Therefore, this interview study aims to identify a wide range of behavioural determinants of diagnostic testing during a hypothetical human-to-human transmissible AI outbreak. METHODS: Semi-structured in-depth interviews, based on the Theoretical Domains Framework, were carried out between May 2024 and February 2025. Participants were included through purposive and convenience sampling. During the interviews an animation was shown illustrating a hypothetical AI outbreak. Verbatim transcripts were thematically analysed. RESULTS: We included seventeen participants (median age 44, range 20-81; 71% women) with diverse backgrounds in terms of age, gender, educational level and country of birth. Results show that, in this hypothetical setting, having the choice to test increases acceptance of testing, whereas a decreased sense of autonomy discourages testing. Most themes included individual rather than population-level benefits as drivers of testing behaviour. These included protecting loved ones, one's own health and gaining psychological reassurance. External conditions such as being unable to go to work or an event would generally encourage testing behaviour. Lower trust in governmental authorities could hamper testing behaviour. Previous experiences from the COVID-19 pandemic shaped participants' answers about AI testing behaviour. CONCLUSION: Key considerations include balancing people's need for autonomy with the external measures imposed by employers or the government, rebuilding trust in institutions and acknowledging how prior experiences with testing may shape testing behaviour in future AI outbreaks. Further research is needed to determine how these findings can be translated into effective communication and how trust in authorities can be built.
Attributable fraction and number of cancer cases attributed to occupational carcinogens in Iran in 2019.
Naghibzadeh-Tahami A, Khosravi Y, Zamani AR … +1 more , Haghdoost AA
BMC Public Health · 2026 Jun · PMID 42351086 · Full text
BACKGROUND: Although occupational exposure to carcinogenic agents accounts for only a relatively small fraction of cancers, the estimated burden in Iran remains considerable due to widespread exposure in major industries...
BACKGROUND: Although occupational exposure to carcinogenic agents accounts for only a relatively small fraction of cancers, the estimated burden in Iran remains considerable due to widespread exposure in major industries and the scarcity of national data. This study aimed to estimate the proportion and number of cases of bladder, leukemia, lung, laryngeal, and liver cancers attributable to four major occupational carcinogens-silica, benzene, asbestos, and lead-in Iran in 2019. METHODS: An attributable fraction (AF)-based approach was used to estimate the burden of occupational cancers in Iran. AFs were calculated using odds ratios (ORs) associated with specific occupational exposures. Although AFs are traditionally calculated using relative risks (RRs), ORs were used because they are more commonly reported in occupational studies and can approximate RRs when outcomes are rare. For each exposure, ORs were selected from epidemiological sources, including industry- or population-based studies, meta-analyses, and reviews. The number of workers exposed to occupational carcinogens in 2019 was obtained from the national occupational exposure surveillance system. AFs were then applied to national cancer incidence data to estimate the attributable numbers (ANs) of cancers related to occupational exposures. Monte Carlo simulation was used to estimate uncertainty intervals (UIs) for both AFs and ANs. RESULTS: In 2019, 60 (95% UI: 46-77) cases of lung, bladder, liver, laryngeal, and leukemia cancers were attributable to historical lead exposure (AF = 34%). The total number of cancer cases attributable to historical silica exposure was estimated at 623 (95% UI: 365-881) (AF = 36%). Furthermore, 602 (95% UI: 334-887) cases of bladder, lung, liver, leukemia, and laryngeal cancers were attributable to occupational benzene exposure (AF = 23%). For asbestos, the AF was 42%, but the estimated attributable number was very small because of the limited number of exposed workers (AN = 0.41, 95% UI: 0.264-0.538). CONCLUSION: These findings suggest that occupational exposure to carcinogenic agents may contribute substantially to the burden of selected cancers in Iran. Although the estimates are exploratory and based on scenario-based modeling assumptions, they highlight the importance of preventive workplace interventions and improved occupational exposure surveillance systems.
Public health impact of nuisance biting blackfly (Simulium damnosum s.l.) along the Asejire dam in Southwest, Nigeria.
Azeez DI, Abdussalam FO, Adamani E … +8 more , Fasasi KA, Surakat OA, Kumbur J, Amanyi-Enegela J, Samuel O, Ademolu KO, Adeshina QO, Adeleke MA
BMC Public Health · 2026 Jun · PMID 42351083 · Full text
BACKGROUND: Black flies remain a global public health concern, particularly through their biting behaviour which is a crucial risk factor in disease transmission. The present study seeks to investigate the public health...
BACKGROUND: Black flies remain a global public health concern, particularly through their biting behaviour which is a crucial risk factor in disease transmission. The present study seeks to investigate the public health implications of the biting behaviour of Simulium damnosum s.l along the Asejire dam, bordering Oyo and Osun State, Nigeria. METHODS: Simulium damnosum s.l were collected using the standard human landing collection (HLC) between 0700 and 1800 across four study areas within first-line communities around the Asejire dam between December, 2024 and November, 2025. Collection was recorded hourly while the daily, monthly, and annual biting rate (ABR) were calculated using standard formulas. RESULT: A total of 9857 blackflies were collected with variations in abundance across the sites (P-value = 0.325). Osun had the higher flies collection 6685 (67.82%). The hourly catches varied in locations and bimodal biting peak was observed. Also, Simulium damnosum s.l abundance was high upstream of the dam than mid- and downstream. The monthly biting rate was more than 1000 bites/person/month in each of the study locations. The biting intensity (99,939.03) along the Oyo-Osun border is high, causing serious biting nuisance in the communities. CONCLUSION: The presence and persistence of black fly bites across the study communities along the border poses a great threat to disease transmission. Therefore, there is the need for an effective vector control measure targeted at preventing human-vector contact by the government of both states with a view to decimating fly abundance and reducing transmission risk.
Primary biliary cholangitis mortality in Europe: a temporal and spatial view across the period 2002-2022.
Ortega-Torres A, Sánchez-Díaz G, Villaverde-Hueso A … +2 more , Arias-Merino G, Alonso-Ferreira V
BMC Public Health · 2026 Jun · PMID 42351081 · Full text
BACKGROUND: Primary biliary cholangitis (PBC) is a rare autoimmune disease of multifactorial origin with an uneven incidence across countries. This study sought to identify temporal trends in PBC mortality and describe p...
BACKGROUND: Primary biliary cholangitis (PBC) is a rare autoimmune disease of multifactorial origin with an uneven incidence across countries. This study sought to identify temporal trends in PBC mortality and describe possible spatial patterns across Europe. METHODS: Data on PBC mortality (ICD-10 K74.3) and European populations by age group in 20 countries were sourced from the World Health Organization for the period 2002-2022. We calculated age-adjusted mortality rates (AAMR) for the period 2012-2022, both for individual countries and overall. Trends were assessed using Joinpoint regression analysis. To ascertain the geographical distribution, standardised mortality ratios (SMR) were calculated for the periods 2002-2011 and 2012-2022. RESULTS: A total of 12,934 PBC deaths (81.65% women) were recorded during the period 2002-2022. Mortality showed a downward trend in most countries except for Hungary, Türkiye, Romania and Poland. Lithuania registered the highest AAMR, at 3.47 per 1,000,000 population (95% CI 2.86-4.19), followed by Hungary and the United Kingdom (UK). During the period 2002-2011, the risk of death in northern countries was twice as high as expected (Finland, Lithuania and the UK with SMRs of 2.09 to 2.14). The differences between northern and southern Europe persisted during 2012-2022, albeit with some variations. CONCLUSIONS: PBC mortality is decreasing or remains stable in most European countries. Risk of death is higher in countries in the north and north-west. There is a need for further in-depth study of the causes of the geographical variability detected.
Neighborhood factors and the geography of type 2 diabetes in Malaysia: an ecological based geospatial modelling study.
Ganasegeran K, Manaf MRA, Safian N … +4 more , Waller LA, Mustapha FI, Maulud KNA, Rizal MFM
BMC Public Health · 2026 Jun · PMID 42351080 · Full text
BACKGROUND: Type 2 diabetes (T2D) often exhibits long-standing disparities across populations. Spatial regression models can identify associations between local rates and observed neighborhood factors to inform timely, l...
BACKGROUND: Type 2 diabetes (T2D) often exhibits long-standing disparities across populations. Spatial regression models can identify associations between local rates and observed neighborhood factors to inform timely, localized public health interventions. We identified area-level distributions of T2D rates across Malaysia and estimate associations between different neighborhood covariates and local T2D burden. METHODS: We obtained aggregated counts of national level T2D cases data by administrative-districts between 2016 and 2020 and computed district-wise crude rates to correlate with district-level neighborhood demographic, socio-economic, safety, physical activity and resources access, and urbanization process indicators from various national sources and census data. We applied a simultaneous spatial autoregressive (SAR) modeling strategy to account for spatial autocorrelation and estimate risk factors for district-level logged T2D crude rates in Malaysia. RESULTS: District-level logged T2D crude rates were associated with the proportion of households living below 50% of the median income (β = 0.009, p = 0.003) and below the national poverty line (β = -0.011, p = 0.001), income inequalities (β = -1.778, p = 0.015), CCTV coverage per 1000 population (β = 0.060, p = 0.049), and perceived access to recreational parks (β = 0.007, p = 0.001) and to bowling centers (β = -0.003, p = 0.009). CONCLUSION: Area-level district-wise logged T2D crude rate estimates were associated with neighborhood socio-economic vulnerabilities, neighborhood safety, and neighborhood perceived access to physical activity facilities, after accounting for residual spatial autocorrelation via a SAR model.
Earthquake preparedness in the context of Maslow's hierarchy of needs theory and the risk perception paradox: the role of socioeconomic inequalities in Türkiye.
Şahin AU, Yücel H, Kara B
BMC Public Health · 2026 Jun · PMID 42351079 · Full text
BACKGROUND: Earthquake preparedness in Türkiye is widely promoted through national awareness campaigns; however, household-level preparedness remains limited. Drawing on Maslow's hierarchy of needs and the Risk Perceptio...
BACKGROUND: Earthquake preparedness in Türkiye is widely promoted through national awareness campaigns; however, household-level preparedness remains limited. Drawing on Maslow's hierarchy of needs and the Risk Perception Paradox, this study examines how socioeconomic inequalities are associated with earthquake preparedness self-efficacy, preparedness behaviors, and perceived barriers and motivations at the household level. METHODS: The research universe was defined using the Türkiye Earthquake Hazard Map by identifying 325 districts located in high-hazard zones (≥ 0.4 g at DD-2 design value, 475-year return period). A 19-item structured questionnaire was developed and administered online between May and September 2025, yielding responses from 1,193 households across high-risk districts. Data were analyzed using descriptive statistics, cross-tabulations, and chi-square tests (p < 0.05). RESULTS: The findings indicate high earthquake salience: 80.9% of respondents reported prior earthquake experience and 93.1% perceived local earthquake risk. However, only 19.3% considered themselves sufficiently prepared, while 47.9% reported being partially prepared. Perceived constraints were substantial: 89.7% reported insufficient financial resources, 83.8% insufficient time, and 69.2% concerns about sustaining daily life. Preparedness self-efficacy was significantly associated with gender, age, and monthly household income. Training participation was also significantly associated with higher self-perceived preparedness, while homeownership was associated with greater knowledge of building earthquake resistance. CONCLUSIONS: Household earthquake preparedness in Türkiye appears to be constrained not only by awareness deficits but also by socioeconomic inequalities related to time, financial resources, and housing security. These findings suggest that awareness campaigns should be complemented by targeted education, financial support mechanisms, tenant-inclusive housing safety measures, and community-based preparedness practices.
Climate-related disease registry in Lebanon: a proposed roadmap.
Mrad M, Whaibeh E, Haddad J … +8 more , Saliba J, Hanna JA, Nader AA, Mina E, Jradi F, Amer R, Zgheib J, Tayeh GA
BMC Public Health · 2026 Jun · PMID 42351077 · Full text
BACKGROUND: Climate change poses urgent health risks in the Arab region, yet most countries lack integrated systems to monitor climate-sensitive health outcomes. Lebanon, facing extreme climatic variability, widespread a...
BACKGROUND: Climate change poses urgent health risks in the Arab region, yet most countries lack integrated systems to monitor climate-sensitive health outcomes. Lebanon, facing extreme climatic variability, widespread air pollution, and fragile health infrastructure, has no centralized mechanism to link environmental and health data. However, the capacity of existing surveillance systems to capture and integrate climate-sensitive health risks remains poorly understood. OBJECTIVE: This study aims to develop a national climate-related disease registry framework for Lebanon by synthesizing evidence from global and regional surveillance models and convening national stakeholders to identify priorities and implementation pathways for institutional integration within Lebanon's health and environmental systems. METHODS: A desk review was conducted to examine climate-sensitive health risks, structured around the WHO-UNFCCC's classification of climate-related health risks, and to analyze existing global registries and surveillance platforms. In parallel, a national multi-sectoral consultation was held with representatives from government, academia, healthcare providers, and international organizations. Outputs were thematically synthesized to propose a registry framework and phased roadmap. RESULTS: The desk review revealed that while climate-sensitive outcomes are partially captured across disease-specific systems, key domains, including non-communicable diseases, mental health, and extreme weather-related outcomes, remain structurally excluded from integrated monitoring. Stakeholders identified interoperability barriers rooted not only in technical limitations but also in governance structures, institutional mandates, and legislative constraints. Concomitantly, existing digital infrastructure and epidemiological platforms were recognized as potential anchors for phased integration. The proposed framework outlines short-, medium-, and long-term actions to establish an interoperable climate-health registry. CONCLUSIONS: These findings highlight both the structural gaps and institutional opportunities and provide a phased roadmap for advancing an integrated national climate-health registry. By aligning stakeholders around a unified framework, the study lays the groundwork for evidence-based adaptation strategies in Lebanon and other climate-vulnerable settings.
Community-level COVID-19 vaccination promotion capacity and its association with vaccination dose per capita in China: an entropy-weighted TOPSIS and multilevel analysis.
Zhao T, Xie T, Zhang X … +4 more , Xu Q, Huang N, Liu Y, Cui F
BMC Public Health · 2026 Jun · PMID 42351076 · Full text
OBJECTIVE: To develop an evaluation framework for community-level capacity to promote coronavirus disease 2019 (COVID-19) vaccination and to quantify vaccination promotion capacity across primary care communities in diff...
OBJECTIVE: To develop an evaluation framework for community-level capacity to promote coronavirus disease 2019 (COVID-19) vaccination and to quantify vaccination promotion capacity across primary care communities in different regions of China. We further examined the association between promotion capacity and COVID-19 vaccination dose per capita to inform optimization of primary immunization services in the post-pandemic era. METHODS: A multicenter cross-sectional study was conducted across 94 primary care communities from 10 provinces. Indicators of vaccination mobilization and service delivery from 2020 to 2022 were collected via questionnaire across four domains: health education, mass vaccination, incentives, and monitoring/reminders. External and internal covariates were collected simultaneously, including policy, ecological and socioeconomic environments. The entropy weight method and the technique for order preference by similarity to ideal solution were used to calculate a composite score index, and communities were categorized using the rank-sum ratio (RSR) method. After covariate selection via Lasso regression, multilevel mixed-effects linear regression models assessed associations between promotion capacity and dose per capita. RESULTS: Marked provincial differences were observed in overall vaccination promotion capacity. Provinces such as Anhui, Henan and Zhejiang had a higher proportion of high-capacity communities (25%), whereas provinces/municipalities such as Hubei, Guizhou, Shanghai, Guangxi, Shandong, Fujian and Xinjiang had a larger share of medium- and low-capacity communities. In multilevel mixed-effects linear regression models, the RSR ranking of overall vaccination promotion capacity was significantly and negatively associated with community COVID-19 vaccination dose per capita (exp[β] = 0.79, 95% CI: 0.69-0.92), indicating that communities with better (lower RSR ranking scores) capacity achieved higher dose per capita. RSR rankings of all four primary domains were negatively associated with vaccination dose per capita: health education capacity (exp[β] = 0.76, 95% CI: 0.65-0.88), mass vaccination capacity (exp[β] = 0.74, 95% CI: 0.63-0.87), vaccination incentive capacity (exp[β] = 0.77, 95% CI: 0.65-0.91), and monitoring/reminders (exp[β] = 0.93, 95% CI: 0.88-0.98). The number of policy documents issued by municipal-level authorities and studied by local staff, as well as the post-training assessment pass rate among vaccination staff, were consistently and positively associated with dose per capita in most models. CONCLUSION: In conclusion, the composite evaluation framework effectively captured regional differences in community vaccination promotion capacity. Higher overall capacity and better performance in all four domains were linked to higher COVID-19 vaccination dose per capita. Strengthening policy dissemination and implementation, enhancing the quality of training and assessment for vaccination staff may help build an efficient community-based vaccination promotion system, mitigate vaccine hesitancy, and increase vaccine coverage.
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