BMC Public Health [JOURNAL]
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200 papers
Parental perspectives on physical inactivity and unhealthy diet as linked Non-Communicable Disease (NCD) risk factors among adolescents in Coastal Karnataka, India: a qualitative study.
Amin R, Kulkarni MM, Nagri SK … +14 more , Munoli RN, J V, Hebbar S, Srivastav P, Bommasamudram T, Vardhan RV, K B S, K S NP, K AP, Rao RS, Shetty P, Chaitra, Nayak L, Vaishali K
BMC Public Health · 2026 Jun · PMID 42324456 · Full text
BACKGROUND: Unhealthy dietary practices and physical inactivity during adolescence are key contributors to the future burden of non-communicable diseases (NCDs). Although parental influence on adolescents' lifestyle beha...
BACKGROUND: Unhealthy dietary practices and physical inactivity during adolescence are key contributors to the future burden of non-communicable diseases (NCDs). Although parental influence on adolescents' lifestyle behaviours is well recognized, evidence from low- and middle-income countries (LMICs), particularly within context-specific settings, remains limited. This study aimed to explore parents' perspectives on physical inactivity and unhealthy dietary practices as inter-related risk factors for NCDs among adolescents in Coastal Karnataka, India. METHODS: This qualitative study employed semi-structured interviews with 16 parents (10 mothers and 6 fathers) of adolescents aged 11-17 years in Coastal Karnataka, India. Participants were purposively recruited to ensure variation across school types and socio-economic backgrounds. Interviews were audio-recorded, transcribed verbatim, and analysed using a hybrid inductive-deductive thematic approach informed by the Capability-Opportunity-Motivation Behaviour (COM-B) model, Social Cognitive Theory, and the Theory of Planned Behaviour. RESULTS: Six interrelated themes were identified: (1) sustained awareness of healthy behaviours with a persistent awareness-practice gap; (2) the home environment as a space of negotiation rather than control; (3) normalization of intermittent unhealthy dietary practices and episodic physical inactivity; (4) academic demands as key barriers to healthy lifestyles; (5) schools as conditional but time-limited protective environments; and (6) gendered and culturally embedded influences on physical activity. Despite high levels of awareness, parents reported increasing difficulty in sustaining healthy behaviours due to academic pressures, adolescents' autonomy, and environmental constraints. CONCLUSIONS: Parental recognition of the importance of healthy behaviours is constrained by structural, academic, and socio-cultural factors that limit sustained adoption. Interventions targeting adolescent NCD prevention in LMIC settings should adopt multi-level strategies that integrate family support, school-based initiatives, and context-specific considerations such as academic pressures and cultural practices. TRIAL REGISTRATION: Clinical Trials Registry of India (CTRI/2025/05/087338), dated: 14/05/2025.
Assessment of cancer awareness levels among health sciences students.
Kocaoğlu BA, Güçlüel YÖ
BMC Public Health · 2026 Jun · PMID 42324452 · Full text
BACKGROUND: Cancer is a major global health problem; therefore, increasing awareness among health sciences students is important for early diagnosis and preventive behaviors. This study aimed to determine the cancer awar...
BACKGROUND: Cancer is a major global health problem; therefore, increasing awareness among health sciences students is important for early diagnosis and preventive behaviors. This study aimed to determine the cancer awareness levels of students studying at the Faculty of Health Sciences. METHODS: This quantitative and descriptive study included 233 students from the Faculty of Health Sciences. Data were collected using a questionnaire containing the participants' descriptive characteristics and the Cancer Awareness Scale. Descriptive statistics, independent samples t-tests, one-way ANOVA, and multiple linear regression analyses were used. RESULTS: The students' mean total score on the Cancer Awareness Scale was 45.51 ± 8.42, indicating a moderate level of overall awareness. Among the sub-dimensions, the lowest score was found in the "early warning signs of cancer" dimension, while awareness of risk factors and screening programs was also limited. Female students had significantly higher awareness levels than male students (p < 0.05). Students who exercised regularly, paid attention to healthy nutrition, and received cancer-related information from health professionals or coursework had significantly higher awareness scores (p < 0.05). No significant differences were found according to age, family history of cancer, alcohol consumption, or perceived health status (p > 0.05). In multivariate analysis, female gender (β = 0.268, p < 0.001), studying in the physiotherapy department (β = 0.188, p = 0.008), and regular exercise (β = 0.171, p = 0.013) remained independent predictors of higher cancer awareness. CONCLUSIONS: Overall, students' cancer awareness was found to be at a moderate level; however, this awareness was not homogeneous across subdimensions, and there were notable deficiencies particularly in knowledge regarding early warning signs and age-related cancer risk. These findings indicate that although cancer awareness is present among students, it does not yet reach a sufficient level of depth. Therefore, it is recommended to strengthen practical training activities in health sciences curricula aimed at improving cancer awareness, and to place greater emphasis on screening programs and recognizing early warning signs.
Uric acid influences the relationship between unsafe neighborhood and digestive diseases among middle-aged or older adults: a longitudinal cohort study from the China Health and Retirement Longitudinal Study (CHARLS).
Du J, Yang S, Qu C … +5 more , Cai L, Yuan X, Zhang J, Li X, Shen T
BMC Public Health · 2026 Jun · PMID 42324449 · Full text
BACKGROUND: Adverse childhood experiences (ACEs) are related to an increased risk of gastrointestinal disorders. However, whether uric acid (UA) affects the development of digestive diseases and its role in the link betw...
BACKGROUND: Adverse childhood experiences (ACEs) are related to an increased risk of gastrointestinal disorders. However, whether uric acid (UA) affects the development of digestive diseases and its role in the link between ACEs and digestive diseases have not been fully studied. METHODS: All data for this longitudinal cohort study came from the China Health and Retirement Longitudinal Study (CHARLS). Cox proportional hazards regression model was applied to assess the relationship between ACEs or UA and digestive diseases and the mediating effect of UA between ACEs and digestive diseases. Lastly, subgroup analyses were performed by demographic characteristics and health status grouping. RESULTS: The study included 3666 volunteers, of whom 617 had digestive disorders. Using Cox proportional hazards regression model, we analyzed the association between ACE and digestive diseases, and found that household mental illness, and living in an unsafe neighborhood were all obviously associated with disease incidence. Studies have also demonstrated an association between UA and digestive disorders. In the mediation analysis, we found that unsafe neighborhood had a negative indirect effect on digestive system diseases through UA, and this mediating effect was shown to have comparable results in the subgroup analyses. CONCLUSIONS: We found evidence that ACEs and UA levels are associated with the development of digestive diseases, and that UA levels influence the relationship between one of the ACEs, namely unsafe neighborhood and digestive disease. Further research should address the underlying mechanisms and interventions to prevent childhood adversities and their devastating effects on health.
Employer-provided workplace health promotion activities in Poland: evidence from a nationwide cross-sectional survey of full-time employees.
Olearczyk A, Sękowski K, Jankowski M … +2 more , Gujski M, Grudziąż-Sękowska J
BMC Public Health · 2026 Jun · PMID 42324447 · Full text
BACKGROUND: Workplace health promotion (WHP) is voluntary activity of employers aimed at improving health and well-being of employees. This study aimed to assess the employees' perceptions of employer-provided WHP activi...
BACKGROUND: Workplace health promotion (WHP) is voluntary activity of employers aimed at improving health and well-being of employees. This study aimed to assess the employees' perceptions of employer-provided WHP activities in Poland as well as to identify factors associated with reported WHP provision and the use of WHP activities among full-time employees aged 18-60 years. METHODS: This questionnaire-based cross-sectional survey was carried out in December 2025 among 1030 full-time employees aged 18-60 years in Poland using the computer-assisted web interview (CAWI) methodology. Quota sampling was used, with gender, age, and place of residence included into stratification model. RESULTS: Among the respondents, 49.8% worked in private Polish company, 26.6% worked in companies with more than 500 employees. Most of the respondents rated their job satisfaction as rather satisfied (61.2%), 64.2% had non-manual work, and 58.5% worked on fixed daytime hours. Among the respondents (n = 1030), 42.2% declared that their employer offers WHP - 20.1% regularly and 22.1% occasionally. Half of respondents, often (40.7%) or very often (9.9%) used WHP activities available in their workplace. Lack of time was the most common (34.5%) barrier in the use of WHP activities. Job satisfaction was the only socio-demographic variable that differentiated (p < 0.001) uptake of employer-provided WHP activities. Age 18-54 (p < 0.05), living in cities over 500,000 residents (aOR: 1.58; 95%CI: 1.02-2.45; p = 0.04), working in private foreign-owned company (aOR: 2.56; 95%CI:1.72-3.79; p < 0.001), working in company with more than 500 employees (aOR: 2.74; 95%CI: 1.59-4.73; p < 0.001), being rather satisfied (aOR: 3.90; 95%CI: 1.94-7.72; p < 0.001) or very satisfied (aOR: 5.66; 95%CI: 2.65-12.11; p < 0.001) from the current job; manager, director level or executive position (p < 0.05), as well as shift work including night shifts (aOR: 1.90; 95%CI: 1.16-3.11; p = 0.01) or flexible working hours (aOR: 1.95; 95%CI:1.30-2.94; p = 0.001) were significantly associated with higher odds of reporting access to WHP activities. CONCLUSIONS: This study provides an overview of WHP activities in Poland. Less than half of full-time employees in Poland reported access to employer-provided WHP, with significant differences by sociodemographic and job-related factors.
Association of primary caregiver anxiety and caregiving role with early development of preschool children: a population‑based study.
Guo J, Wen J, Yang G … +5 more , Xian R, Zhang Y, Shi Z, Zhao Y, Zhao Y
BMC Public Health · 2026 Jun · PMID 42323679 · Full text
BACKGROUND: Home caregiving environments are critical to early childhood development (ECD), but evidence on the primary caregiver factors in this link is limited. This study examines associations between primary caregive...
BACKGROUND: Home caregiving environments are critical to early childhood development (ECD), but evidence on the primary caregiver factors in this link is limited. This study examines associations between primary caregiver anxiety, primary caregiver role, and ECD outcomes. METHODS: This population-based survey was conducted in January 2024 across all 38 districts of Chongqing, China, using a stratified cluster sampling strategy. The Generalized Anxiety Disorder Questionnaire (GAD-7) and the Chinese Early Human Capacity Index (CHeHCI) were used to assess primary caregivers' anxiety and ECD levels, respectively. The primary caregiver role in the family was self-reported. RESULTS: In fully adjusted regression models (model 4), primary caregivers' anxiety was independently associated with child development delay, with an OR of 1.89 (95% CI: 1.75-2.05). Additionally, fathers' and grandparents' nurturing were positively associated with child development delay, with ORs of 1.24 (95% CI: 1.05-1.46) and 1.12 (95% CI: 1.01-1.25), respectively. Furthermore, the interaction between only-child status and screen time with anxiety concerning ECD is significant. Similarly, the interaction between only-child status and the primary caregiver role concerning ECD is significant. CONCLUSIONS: Primary caregiver anxiety and paternal or grandparental nurturing are significantly associated with delayed ECD, with only-child status and screen time further interacting with these factors. These findings highlight the need for family‑centered interventions targeting primary caregiver mental health.
Investigating the effect of hemodialysis on family dynamics: a qualitative study.
Çeli̇k D, Erkayiran O
BMC Public Health · 2026 Jun · PMID 42323627 · Full text
OBJECTIVE: This study sought to conduct a qualitative analysis of the changes caused by hemodialysis in families and their effects on family dynamics. METHOD: A qualitative research design was employed. From May to July...
OBJECTIVE: This study sought to conduct a qualitative analysis of the changes caused by hemodialysis in families and their effects on family dynamics. METHOD: A qualitative research design was employed. From May to July 2025, face-to-face semi-structured interviews were conducted with 15 patients receiving hemodialysis treatment at a hospital in the Central Anatolian region of Türkiye to collect data. Purposeful sampling was used. A thematic analysis was conducted that used a hybrid analytic framework, comprising deductive codes taken from the family systems literature, combined with inductive codes from the field. RESULTS: Six main themes were identified. These were: T1, intra-family solidarity and closeness; T2, redistribution of roles and caregiving burden; T3, fatigue-rest cycle; T4, dialysis-centered routine; T5, threshold between emotional continuity and practical/material support; T6, faith- and submission-based acceptance, long-term adaptation, and "normalization." These themes suggested increased household coordination, yet also pointed to the need for reorganizing timing and logistical routines. The T3 theme was more dominant among new hemodialysis patients, while T6 was more prominent among long-term hemodialysis patients. CONCLUSION: Through the formation of solidarity, redistribution of roles, and management of time around dialysis, hemodialysis restructures family functioning. The discourse of faith and acceptance helps to regulate emotions. The results emphasize the need for family-centered planning and the integration of periods of rest in everyday life, and for strengthening arrangements for transportation and logistics.
Determination of the frequency and predictors of prelacteal feeding practices of mothers in Eastern Turkey.
Kurt Can E, Can V, Bulduk M … +3 more , Ayşin N, Karasungur R, Dilbilir Y
BMC Public Health · 2026 Jun · PMID 42323622 · Full text
BACKGROUND: Prelacteal feeding, which deprives newborns of colostrum, remains a major public health concern, particularly in low- and middle-income countries. This study aimed to determine the prevalence and predictors o...
BACKGROUND: Prelacteal feeding, which deprives newborns of colostrum, remains a major public health concern, particularly in low- and middle-income countries. This study aimed to determine the prevalence and predictors of prelacteal feeding among mothers in eastern Turkey. METHODS: A cross-sectional study was conducted between January and August 2023, including 335 mothers with infants aged 0-24 months. Participants were recruited from volunteer mothers who met the inclusion criteria and attended the paediatrics and gynaecology clinics of a university hospital during the data collection period. Data were collected through face-to-face interviews conducted by the researchers using the Prelacteal Feeding Practices and Associated Factors Questionnaire (PFP-AFQ). RESULTS: Prevalence of prelacteal feeding was 17.9%. Common prelacteal substances administered include formula (51.7%), sugar water (28.3%), cow's milk (3.3%), and plain water (16.7%). Maternal education level, place of residence, employment status, family type, household income level, receipt of regular antenatal care, birth weight, breastfeeding education status, time of first breastfeeding after birth, knowledge regarding the importance and harms of colostrum, and the practice of administering colostrum immediately after birth were found to be significantly associated with prelacteal feeding (p<0.05). Furthermore, according to the multiple logistic regression analysis, income level, breastfeeding education, time of first breastfeeding after birth, knowledge regarding the importance and harms of colostrum, and the practice of administering colostrum immediately after birth were identified as significant predictors of prelacteal feeding (p<.05). CONCLUSIONS: In conclusion, prelacteal feeding remains a preventable but persistent practice influenced by maternal education, antenatal care, breastfeeding knowledge, and early initiation of breastfeeding. Integrating targeted educational interventions into prenatal and postnatal care may help reduce the prevalence of prelacteal feeding and improve breastfeeding outcomes.
Epidemiological analysis of infectious disease in border port areas of Heilongjiang Province, 2014-2023.
Wei ST, Dong YZ, Shu YT … +8 more , He JQ, Gao SR, Zhan Y, Wang YF, Chen X, Wang SN, Zhang LJ, Bao MJ
BMC Public Health · 2026 Jun · PMID 42323603 · Full text
BACKGROUND: Heilongjiang Province shares a 2,981-km border with the Russian Federation and runs the largest land-port network in China. The sheer volume and diversity of cross-border movement at these ports complicates i...
BACKGROUND: Heilongjiang Province shares a 2,981-km border with the Russian Federation and runs the largest land-port network in China. The sheer volume and diversity of cross-border movement at these ports complicates infectious disease surveillance and control. Although some individual ports and pathogens have been examined separately, a province-wide integrated analysis spanning all 18 border port municipalities has been absent. This study aimed to characterise the notifiable-disease burden across those municipalities and to identify the diseases warranting priority attention. METHODS: Individual case records of notifiable infectious diseases reported between 1 January 2014 and 31 December 2023 were retrieved from China's National Infectious Disease Reporting Information Management System. We computed constituent ratios, crude incidence rates, and disease rankings. Joinpoint regression yielded annual percent change (APC) and average annual percent change (AAPC) estimates. Seasonality was characterised by the direct average seasonal index method. Between-group differences were evaluated with χ² or Fisher's exact tests. A two-tailed P < 0.05 was the threshold for statistical significance, and population denominators came from the Heilongjiang Provincial Statistical Yearbook. RESULTS: Over the decade, 64,865 statutorily notifiable cases (out of 70,244 total reported cases) were recorded, corresponding to a mean annual incidence of 220.30 per 100,000. Respiratory diseases (37.99%) and bloodborne and sexually transmitted diseases (33.68%) jointly accounted for 71.67% of the burden. The five leading diseases were pulmonary tuberculosis (23.56%), hepatitis B (15.81%), influenza (9.85%), syphilis (9.35%), and hand, foot and mouth disease (6.48%). Overall incidence was statistically stable across the period (AAPC 1.85%, 95% CI - 0.18% to 3.93%; P > 0.05), though respiratory diseases trended upward (AAPC 6.61%, P < 0.05) while enteric and zoonotic and vector-borne diseases declined significantly (P < 0.05). Monthly incidence peaked in March (seasonal index 131%) and December (128%). Males outnumbered females (male-to-female ratio 1.51:1; rising to 3.01:1 for zoonotic and vector-borne diseases). The 15-59-year age group contributed 57.54% of cases. Farmers (31.86%), homemakers and the unemployed (23.17%), and students (10.52%) were the principal occupational groups affected. The highest cumulative incidence was observed in Mishan, Suifenhe, Mohe, Muling, and Tongjiang. CONCLUSIONS: Respiratory infections should receive heightened prevention efforts in the winter-spring season, whereas bloodborne and sexually transmitted infections call for sustained, risk-focused measures throughout the year. Working-age adults-farmers and homemakers in particular-represent the primary target population. Mishan and Suifenhe warrant reinforced surveillance, and a strengthened China-Russia cross-border joint-prevention mechanism is needed.
Comorbidities, health-related quality of life and its associated factors among people living with HIV/AIDS in Gandaki Province of Nepal.
Paudel S, Baral S, Yadav RK … +6 more , Baral YN, Yadav DK, Poudel S, Khadka KB, Nagila A, Adhikari B
BMC Public Health · 2026 Jun · PMID 42323573 · Full text
BACKGROUND: HIV/AIDS remains a public health concern globally. Comorbidities add to the disease burden among people living with HIV (PLHIV) and may be associated with poorer health-related quality of life. This study aim...
BACKGROUND: HIV/AIDS remains a public health concern globally. Comorbidities add to the disease burden among people living with HIV (PLHIV) and may be associated with poorer health-related quality of life. This study aimed to assess the prevalence of comorbidities, health-related quality of life (HRQoL), and associated factors among people living with HIV in Gandaki Province, Nepal. METHODS: A cross-sectional study was conducted at the antiretroviral therapy (ART) centre of Western Regional Hospital, Pokhara. PLHIV registered at the ART centre were selected using simple random sampling. A multivariable logistic regression model was used to explore factors associated with HRQoL. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. RESULTS: A total of 337 PLHIV participated in the study. The mean overall HRQoL score was 6.25 ± 1.87, and 52.2% of participants reported poor quality of life. At least one comorbidity was present in 28.2% of participants. The most frequently reported comorbidities were hypertension (36.8%), diabetes (33.7%), tuberculosis (14.9%), hepatitis B (10.6%), and hepatitis C (4.3%). PLHIV with comorbidities had higher odds of poor HRQoL compared with those without comorbidities (AOR = 1.65; 95% CI: 0.98-2.78). Factors associated with comorbidities included marital status, family structure, education, occupation, current alcohol consumption, having a migrant worker spouse, CD4 count, transportation costs, perceived behaviour of healthcare workers, and HRQoL across all except the physical domain. CONCLUSIONS: Comorbidities were common among people living with HIV. The findings suggest a high prevalence of poor quality of life among PLHIV, with comorbidities potentially associated with poorer HRQoL. These findings underscore the need for integrated interventions that address both health and social factors, including community engagement strategies.
Social determinants of older adult suicide: an ecological study using data of Japanese secondary medical areas.
Kudo S, Kodama T, Sasaki Y
BMC Public Health · 2026 Jun · PMID 42323564 · Full text
BACKGROUND: Suicide prevention among older adults is a major public health concern in Japan, where the population is rapidly ageing. In 2020, approximately 40% of all suicide deaths occurred among people aged 60 years an...
BACKGROUND: Suicide prevention among older adults is a major public health concern in Japan, where the population is rapidly ageing. In 2020, approximately 40% of all suicide deaths occurred among people aged 60 years and older. Previous suicide prevention efforts have focused primarily on early detection and management of depression, while the social determinants of suicide among older adults remain underexplored. This study examined the associations between social indicators, aggregated lifestyle-related data derived from health checkups, and suicide rates among older adults to inform policy development. METHODS: Using publicly available data, we examined the associations between the standardised mortality ratio (SMR) for suicide and socioeconomic factors, lifestyle, and lifestyle-related diseases among adults aged 60 years and older across secondary medical areas, which represent practical administrative units for implementing public health policies. Nonparametric correlation and multiple regression analyses were conducted. RESULTS: Multiple regression analysis showed positive associations between suicide SMR and hypertension, smoking, daily alcohol consumption, older adult single-person households, and employment rate of older adults among men. The analysis showed negative associations with the number of psychotherapists and psychiatrists and income per taxpayer among women. CONCLUSIONS: Suicide risk among older adults demonstrates distinct gender-specific determinants. Preventive strategies should integrate health-related behaviours, socioeconomic factors, and mental health resource availability, and should be adapted to local contexts to effectively mitigate suicide risk, while acknowledging the limitations inherent in the ecological study design.
Imaginative play for inclusion: evaluating the young dragons tabletop role-playing intervention in UK schools.
El-Osta A, Li Y, Altalib S … +7 more , Alaa A, Linsley R, Newman S, Steyn E, Harper G, Coulter D, Minton CJ
BMC Public Health · 2026 Jun · PMID 42323561 · Full text
BACKGROUND: School exclusion in England disproportionately affects pupils with social, emotional, and mental health needs. Tabletop roleplaying games (TTRPGs) may strengthen social emotional learning but are rarely evalu...
BACKGROUND: School exclusion in England disproportionately affects pupils with social, emotional, and mental health needs. Tabletop roleplaying games (TTRPGs) may strengthen social emotional learning but are rarely evaluated in UK state schools. Young Dragons, a Dungeons & Dragons based programme, was developed to support emotional regulation, teamwork, and engagement among pupils at risk of exclusion in two London boroughs. METHODS: A convergent mixed methods realist evaluation was delivered across ten schools. Pupils aged 9-16 attended weekly one-hour sessions for 6-8 weeks in small, consistent groups. Pre/post pupil surveys captured wellbeing, self-concept, peer relations, school belonging, and loneliness; matched pair change (n = 22) used Wilcoxon signed rank tests. Semi-structured interviews with school staff and facilitators and observation of multiagency meetings explored implementation and perceived impact. Findings were integrated using joint displays and context-mechanism-outcome (CMO) mapping. RESULTS: No statistically significant within person change was detected across matched items (all p > 0.10). Distributions showed heterogeneous trajectories: many pupils reported better mood, anger regulation, and confidence, while a minority shifted toward greater disengagement or loneliness. Exploratory analysis of routine school records (n = 30) showed a significant reduction in mean suspensions from 0.7 pre-intervention to 0.0 post-intervention (p = 0.022) and a modest, non-significant increase in mean attendance from 90.6% to 92.7% (p = 0.069). Qualitative accounts described strong engagement, psychological safety, and visible gains in self-management, turn taking, and teamwork, with positive spillover into classroom behaviour when groups were stable and facilitation was consistent. Delivery challenges included timetable pressures, space constraints, and stigma around targeted provision. Integration identified skilled facilitation, small-group safety, and structured reflection as key mechanisms enabling co-regulation, perspective taking, and belonging. CONCLUSION: Young Dragons was feasible and acceptable in high need school settings. Benefits were mechanism-consistent for many participants but contingent on context and facilitator quality. These pilot data justify a larger, controlled evaluation to test causal pathways and longer-term outcomes for inclusion and emotional wellbeing.
Snapshots of food security status in Western Sydney post-COVID-19 lockdown: a cross-sectional study.
Mekanna AN, Kalu KA, Li L
BMC Public Health · 2026 Jun · PMID 42321776 · Full text
OBJECTIVES: The COVID-19 lockdown had significant effects on daily life, particularly food security among Australian adults. This study examined the longer-term impact of lockdown measures on food security in Western Syd...
OBJECTIVES: The COVID-19 lockdown had significant effects on daily life, particularly food security among Australian adults. This study examined the longer-term impact of lockdown measures on food security in Western Sydney, a region more socio-economically challenged within the Sydney area. METHODS: A total of 548 adults were recruited via convenience sampling at least 6 months post-lockdown (May-August 2022 and January-February 2023). Of these, 523 completed the validated six-item USDA Household Food Security Survey Module and were included in the quantitative analysis. Fifty-four participants took part in 12 focus group discussions (FGDs), including some participants who did not complete the survey. FGDs explored food security perceptions based on its four pillars, both during and after lockdown. Inductive thematic analysis was conducted manually in Excel and verified in NVivo (version 14.23.0). RESULTS: The mean age of survey participants (n = 523) was 25.1 ± 9.7 years, and 63% were women. Among participants with available birthplace data (n = 521), 267 were Australian-born and 254 were overseas-born; birthplace information was missing for two participants. Only 6% reported improved food security post-lockdown. Using the USDA tool, females were significantly more likely than males to report meal size reductions post-lockdown (p = 0.0001)> FGDs revealed that food availability, access, utilisation and stability were affected by rising food prices, fear of virus contamination and shifts in shopping habits during and after lockdown. CONCLUSION: While the measured food insecurity prevalence was low based on the survey findings, the qualitative findings indicated that some participants continued to experience disruptions or vulnerabilities related to food security at least 6 to 15 months post-lockdown. These findings highlight the need for both crisis-responsive and recovery-oriented food security policies, with particular attention to supporting adult women who appear disproportionately affected.
Sexual health literacy and risky sexual behaviour among female university students in Tanzania: a social-ecological analysis of levels, differences, and determinants.
Makwinya NM, Lupeja TL
BMC Public Health · 2026 Jun · PMID 42321757 · Full text
INTRODUCTION AND PURPOSE: Unintended pregnancy (UIP) remains a persistent public health concern among young women in sub-Saharan Africa, including Tanzania. This study examined Sexual Health Literacy for Pregnancy Preven...
INTRODUCTION AND PURPOSE: Unintended pregnancy (UIP) remains a persistent public health concern among young women in sub-Saharan Africa, including Tanzania. This study examined Sexual Health Literacy for Pregnancy Prevention (SHLPP) and engagement in Sexual Behaviours potentially leading to UIP (referred to in this study as Risky Sexual Behaviours [RSB]) among female university students using a Social Ecological Model (SEM). Specifically, it assessed (i) levels of SHLPP and RSB, (ii) differences across individual, interpersonal, and contextual factors, and (iii) the predictive effects of these factors on SHLPP and RSB, including the influence of SHLPP on RSB. METHOD: A cross-sectional study was conducted involving 255 female university students at Sokoine University of Agriculture, Tanzania. Data were collected using a structured questionnaire and analysed using descriptive statistics, factorial ANOVA, and hierarchical multiple regression. FINDINGS: Most participants (75.6%) exhibited low-to-moderate SHLPP, while 63.7% reported moderate-to-high RSB. Upbringing environment significantly influenced both RSB (F(1,165) = 17.817, p < .001, η = .097) and SHLPP (F(1,218) = 4.124, p < .05, η = .019), with urban students reporting higher levels of both. Year of study showed a small, albeit significant effect on RSB (F(2,165) = 3.246, p < .05, η = .038) only. Parental education and accommodation type did not have significant independent effects on SHLPP and RSB. However, they exerted significant interaction effects between: (i) parental education and upbringing environment, and between parental education and accommodation type on RSB and (ii) upbringing environment and accommodation on SHLPP. Parent-daughter communication emerged as the strongest predictor of both SHLPP (β = .318, p < .001) and RSB (β = .402, p < .001). Notably, SHLPP did not significantly predict RSB (β = .088, p = .221), indicating a disconnect between knowledge and behavior. CONCLUSION AND IMPLICATIONS: Sexual behaviour among FUS is more strongly shaped by interpersonal and contextual factors than by individual knowledge alone. These findings underscore universities' need to enhance parent-child communication, deliver targeted sexual health education, and consider student backgrounds when allocating housing.
Beyond the clinic gate: barriers to childhood immunization access and strategies for improvement at a rural Zimbabwean clinic.
Shava E, Chiwungwe F, Chitura M
BMC Public Health · 2026 Jun · PMID 42321741 · Full text
BACKGROUND: Childhood immunization through the Expanded Programme on Immunization (EPI) remains central to reducing vaccine-preventable disease morbidity and mortality in sub-Saharan Africa. Zimbabwe's national EPI cover...
BACKGROUND: Childhood immunization through the Expanded Programme on Immunization (EPI) remains central to reducing vaccine-preventable disease morbidity and mortality in sub-Saharan Africa. Zimbabwe's national EPI coverage for pentavalent 3 stood at 83% in 2023, below the 90% global target. Nyaure Clinic in Goromonzi District, Mashonaland East Province, recorded coverage of 65%, 62%, and 67% for pentavalent 3 in 2021, 2022, and 2023 respectively. This study investigated factors affecting access to EPI services at Nyaure Clinic and identified strategies to improve coverage. METHODS: A quantitative cross-sectional survey design was used. The study population comprised 261 caregivers, 10 community health workers (CHWs), and 3 nurses in the Nyaure catchment area. A stratified random sample of 61 participants was selected using the Raosoft sample size calculator at a 90% confidence level. Data were collected in October 2024 using structured, self-administered questionnaires. Descriptive analysis was performed using Microsoft Excel and results are presented in tables and figures. RESULTS: Of 61 respondents, 93.4% were female. Among caregivers (n = 55), 96.4% reported receiving information about EPI, with 70.9% citing health facility workers as the primary source. Vaccines were reported as unavailable 14.5% of the time. Distance was reported as a barrier by 29.1% of caregivers and all 6 health workers. Religious and cultural beliefs, particularly among Apostolic sects, were reported as contributing to vaccine hesitancy. Poverty and political interference were not perceived as barriers. The leading strategies proposed by caregivers were outreach programmes (92.7%), health education (70.9%), and door-to-door vaccination (58.2%). The six health workers also endorsed building more clinics and recruiting more CHWs; support for legislation against vaccine hesitancy was expressed only by this small subgroup. CONCLUSIONS: Distance, religious and cultural beliefs, and intermittent vaccine shortages were the barriers most commonly reported by caregivers and health workers at Nyaure Clinic. Intensified outreach programmes, health education, and door-to-door vaccination were the strategies most frequently proposed by respondents. These reported barriers and preferred strategies may inform the work of EPI programme managers and district health teams in rural Zimbabwe, though the descriptive, single-site design means findings should be interpreted with caution.
Degree of urbanization and the prevalence of hypertension and diabetes mellitus in South Korea (Insight from Gyeonggi Province): A cross-sectional analysis with temporal trends, 2008-2023.
Choi SS, Jung J, Kim JH … +7 more , Jung SY, Yoo KD, Moon D, Lee SN, Jang WY, Jung JH, Her SH
BMC Public Health · 2026 Jun · PMID 42321737 · Full text
BACKGROUND: Despite South Korea's achievement of Universal Health Coverage (UHC), regional health inequities persist as a significant public health challenge. Traditional urban-rural classifications often fail to capture...
BACKGROUND: Despite South Korea's achievement of Universal Health Coverage (UHC), regional health inequities persist as a significant public health challenge. Traditional urban-rural classifications often fail to capture the nuanced spatial dynamics of modern settlement patterns. This study aimed to evaluate the prevalence of hypertension (HTN) and diabetes mellitus (DM) across the urbanization gradient-Cities, Urbanized, and Rural areas-using the UN-recommended Degree of Urbanization (DegUrba) classification. METHODS: We analyzed survey-weighted data from the Korean Community Health Survey (KCHS), restricting cross-sectional analyses to adults aged ≥ 18 years residing in Gyeonggi-do in 2020 (n = 41,983), classified into three DegUrba categories (Urban, Urbanized, Rural) using 1-km² population grids. Baseline characteristics were compared using survey-weighted linear regression and the Rao-Scott chi-square test. Three survey-weighted logistic regression models were constructed, with the fully adjusted model (Model 3: age, sex, education, marital status, smoking, and alcohol consumption) as the primary model. A sensitivity analysis excluded municipalities whose DegUrba classification changed during the preceding 10-year period. Age-standardized prevalence estimates from 2008 to 2023 were calculated by direct standardization to the 2020 study population, and temporal trends were assessed using general linear models. RESULTS: In 2020, the weighted prevalence of hypertension and diabetes mellitus was highest in Rural areas (29.4% and 13.4%) and similar between Urban (19.4% and 8.3%) and Urbanized (20.1% and 8.6%) areas (overall P < 0.001 for both). In the fully adjusted Model 3 with Urban as reference, the rural disadvantage was attenuated and only borderline significant (HTN: OR 1.09, 95% CI 0.99-1.21, P = 0.077; DM: OR 1.11, 95% CI 0.97-1.27, P = 0.143), whereas with Urbanized as reference the association was statistically significant for hypertension (OR 1.14, 95% CI 1.02-1.28, P = 0.026). The Urban-Urbanized comparison was not significant across all models. The sensitivity analysis restricted to municipalities with stable DegUrba classification yielded stronger and more consistent rural effects (HTN Model 3 vs. Urbanized: OR 1.16, P = 0.014; DM: OR 1.18, P = 0.049). From 2008 to 2023, age-standardized prevalence increased significantly for both conditions (year P = 0.002 for HTN, P < 0.001 for DM); Urban and Urbanized prevalences remained statistically indistinguishable (P > 0.999), whereas Rural prevalence was higher than both (all P < 0.005). CONCLUSION: The cross-sectional urban-urbanized similarity and persistently higher rural prevalence - particularly in geographically stable rural municipalities - indicate that the conventional urban-rural binary still captures most of the cardiometabolic disparity, but that compositional differences (age, education, marital status) account for a substantial portion of the raw rural penalty. Under universal health coverage, residual rural disadvantage in cardiometabolic disease remains a public-health priority, especially as the rural-urban gap continues to widen over time.
Self-reported functional and mobility limitations in mid-life: a systematic review of prevalence and association with chronic health conditions.
Hayek R, Springer S, Brown RT
BMC Public Health · 2026 Jun · PMID 42321735 · Full text
BACKGROUND: Middle age is increasingly recognized as a critical period for the emergence of functional and mobility limitations. However, no prior systematic review has synthesized prevalence or incidence data specifical...
BACKGROUND: Middle age is increasingly recognized as a critical period for the emergence of functional and mobility limitations. However, no prior systematic review has synthesized prevalence or incidence data specifically for this age group. This review aimed to summarize epidemiological evidence on self-reported functional and mobility limitations among middle-aged adults and to examine their associations with chronic conditions. METHODS: This systematic review was registered in PROSPERO (CRD420251038883) and conducted in accordance with PRISMA 2020 guidelines. A search of PubMed, Scopus, Embase, and Web of Science was performed for studies published between 2000 and 2025. Eligible studies included population-based samples of midlife-related adults reporting prevalence or incidence of functional and/or mobility limitations. When data were available, associations between these limitations and chronic conditions were also examined. Methodological quality was assessed using the Joanna Briggs Institute checklist, and risk of bias was evaluated using the tool developed by Hoy et al. Evidence certainty was assessed using GRADE. Due to conceptual and methodological heterogeneity, a meta-analysis was not performed and findings were synthesized narratively. RESULTS: Twenty-six population-based studies comprising over 500,000 participants from over 30 countries worldwide met the inclusion criteria. Reported prevalence of functional and mobility limitations varied widely by domain, instrument, and task. Across many studies, estimates fell within the range of 15% to 25%, while mobility limitation exceeded 40% in some settings. In studies assessing both domains, mobility limitations were generally reported more frequently than functional limitations. Chronic conditions were associated with functional and mobility limitations, particularly musculoskeletal pain and arthritis (Population-Attributable Risk [PAR]: 15.0%-38.3%), and multimorbidity (PAR: 12.0%-56.5%). In contrast, lower PAR estimates were reported for hypertension (3%). Most evidence was derived from cross-sectional studies, with heterogeneous age ranges and assessment tools, limiting comparability and causal inference. CONCLUSIONS: Functional and mobility limitations emerge during midlife worldwide and are associated with chronic conditions. The findings should be interpreted cautiously, given methodological variation across studies, including differences in measurement instruments, midlife age-group definitions, and outcome assessment, requiring standardization. Nevertheless, these findings may support earlier detection of functional and mobility changes and inform future prevention-oriented research and strategies. TRIAL REGISTRATION: PROSPERO (CRD420251038883).
Uneven integration of health in China's territorial spatial planning 2035.
Zhang Y, Cheng J, Duan L
BMC Public Health · 2026 Jun · PMID 42321731 · Full text
BACKGROUND: Spatial planning plays a pivotal role in shaping the health and well-being of urban populations. Since 2016, most Chinese cities have incorporated health-related elements into their Territorial Spatial Planni...
BACKGROUND: Spatial planning plays a pivotal role in shaping the health and well-being of urban populations. Since 2016, most Chinese cities have incorporated health-related elements into their Territorial Spatial Planning (TSP) 2035 Schemes as part of national healthy city initiatives. It is essential to examine how health is represented in these statutory planning documents and whether the level of attention varies across cities. METHODS: We developed an analytical framework for healthy city planning by synthesizing international scholarly literature and governmental policy documents. Using this framework, the TSP 2035 Schemes of 36 major Chinese cities were examined through a mixed-method design combining thematic dimension analysis, keyword network analysis, and disparity measures. RESULTS: All 36 cities have placed healthy city development on their planning schemes, focusing primarily on eight dimensions: (1) green and open space, (2) climate change and disaster response, (3) physical education (PE) facilities and public services, (4) environmental pollution prevention and control, (5) medical and health services, (6) elderly dimension, (7) health equity, and (8) healthy travel. Of these dimensions, green and open space along with climate change and disaster response receive the most emphasis. Notable healthy city keywords include 'park', 'green space', 'healthcare', 'livability', 'sports', 'resilience', 'pollution control', 'disaster prevention', 'walking', and 'jogging'. Cross-city comparisons reveal substantial disparities: cities with higher administrative status generally articulated more extensive and more diverse health-related planning content, whereas many lower-tier cities pay relatively little attention to equity-sensitive dimensions. CONCLUSIONS: Health has become a visible component of statutory planning discourse in China, but its integration remains selective and uneven across cities. The results suggest that China's healthy city development has reached an intermediate stage of "health promotion and education", and in terms of health-spatial planning integration, China has moved beyond a narrow environmental health orientation, yet important gaps remain in equity-sensitive and people-centered dimensions. Recommendations include strengthening legislation to support healthy city planning, improving the openness and transparency of TSP 2035 Schemes, and more differentiated policy support across cities.
Interventions involving community health workers and their effect on cervical cancer screening uptake in sub-Saharan Africa: a systematic review.
Lemoupa Makajio SH, Murtas M, Kenfack B … +4 more , Vassilakos P, Schmidt NC, Petignat P, Wisniak A
BMC Public Health · 2026 Jun · PMID 42321728 · Full text
BACKGROUND: Sub-Saharan Africa (SSA) has the highest incidence and mortality rates of cervical cancer (CC), largely due to limited screening coverage. Community health workers (CHWs) are lay health providers who strength...
BACKGROUND: Sub-Saharan Africa (SSA) has the highest incidence and mortality rates of cervical cancer (CC), largely due to limited screening coverage. Community health workers (CHWs) are lay health providers who strengthen healthcare delivery; however, their influence on cervical cancer screening (CCS) uptake remains insufficiently explored. This systematic review evaluates the impact of CHW-involved interventions on CCS uptake in SSA. METHODS: A systematic search of MEDLINE, EMBASE, and Cochrane databases was conducted in June 2023 and updated in May 2025. Studies were included if they: (1) were conducted in SSA among females eligible for CCS and published between January 2003 and May 2025; (2) compared CHW-based interventions with standard or non-CHW approaches; and (3) reported CCS uptake, linkage to triage and/or treatment after primary screening or attendance to follow-up visits. Only studies using a controlled design were included. A descriptive analysis was performed. PROSPERO registration: CRD42024495220. RESULTS: Six studies met the inclusion criteria. Despite methodological limitations, all studies involved CHWs in health education and counseling. CHWs conducted home visits to recruit participants for CCS, rescheduled follow-up appointments, facilitated access to care, and provided childcare during screening attendance. Interventions involving CHWs significantly increased CCS uptake in three of the five studies assessing it as the primary outcome and improved follow-up attendance in the single study examining this indicator. CONCLUSION: The effectiveness of CHW-based interventions varies by type and context but shows potential to enhance CCS uptake in SSA.
"We were locked in with our trauma" - a mixed-methods study of health pathways among intimate partner violence (IPV) survivors during COVID-19 lockdowns in Ontario.
Idriss-Wheeler D, El-Khatib Z, Hancock L … +3 more , Ham M, Bainbridge S, Deonandan R
BMC Public Health · 2026 Jun · PMID 42321726 · Full text
BACKGROUND: The COVID-19 pandemic disproportionately affected certain populations, with intimate partner violence (IPV) survivors facing heightened risks of adverse health outcomes. This study examined whether women who...
BACKGROUND: The COVID-19 pandemic disproportionately affected certain populations, with intimate partner violence (IPV) survivors facing heightened risks of adverse health outcomes. This study examined whether women who experienced IPV during Ontario's COVID-19 lockdowns were more likely to report negative behavioural, psychological, and physiological health outcomes compared to women who did not experience IPV . METHODS: Using a convergent mixed-methods design, a cross-sectional survey of Ontario residents and semi-structured interviews with key stakeholders were conducted. The final sample comprised 653 survey respondents who identified as women, 23% of whom reported experiencing IPV during COVID-19 lockdowns (n = 150). A total of 24 interviews were conducted, including 14 IPV survivors and 10 violence against women (VAW) service providers. RESULTS: Quantitative findings revealed that IPV survivors had significantly higher odds of adverse behavioural outcomes, including increased alcohol (43.3% vs. 21.9%, RRR = 3.39, p < 0.001), tobacco (15.3% vs. 8.8%, RRR = 2.16, p = 0.014), cannabis (23.8% vs. 10.4%, RRR = 3.49, p < 0.001), and illicit substance use (6.8% vs. 0.6%, RRR = 14.31, p < 0.001), as well as greater decreases in sleep quality (61.4% vs. 40.3%, RRR = 3.24, p < 0.001). They also exhibited more polarized help-seeking patterns: increased reliance on formal supports (34.7% vs. 12.9%, RRR = 4.75, p < 0.001) and higher likelihood of decreased informal support (29.5% vs. 17.3%, RRR = 2.53, p = 0.001). Logistic regression further supported that IPV survivors had over twice the odds of reporting poor mental health (aOR = 2.46, 95% CI: 1.27-4.75) and nearly twice the odds of poor physical health (aOR = 1.84, 95% CI: 1.00-3.36). Qualitative insights revealed that structural barriers, trauma, stigma, and loss of autonomy contributed to these adverse outcomes. CONCLUSIONS: These results underscore the bidirectional relationship between mental and physical health and the compounded vulnerabilities exacerbated by crisis conditions. Findings highlight the need to integrate IPV considerations into emergency preparedness and response planning to ensure continuity of care for IPV survivors. As public health emergencies and climate disasters become more frequent, inclusive responses must prioritize those most at risk, including IPV survivors.
Patient journeys mapping in health management for older patients with chronic obstructive pulmonary disease: a qualitative descriptive study.
Tan Y, Xu J, Liu J … +4 more , Hu X, Liu C, Zhang J, Zhao W
BMC Public Health · 2026 Jun · PMID 42321723 · Full text
BACKGROUND: Management of chronic obstructive pulmonary disease (COPD) in older adults remains suboptimal, often due to a fragmented, acute-care-focused approach that fails to address the comprehensive needs of patients...
BACKGROUND: Management of chronic obstructive pulmonary disease (COPD) in older adults remains suboptimal, often due to a fragmented, acute-care-focused approach that fails to address the comprehensive needs of patients across the care continuum. A thorough understanding of the patient journey is essential to identify systemic gaps and potential intervention points. AIM: This study aims to systematically map the complete cycle of the COPD patient journey in older adults, elucidating their multidimensional needs, challenges, and critical touchpoints throughout the stages of screening, diagnosis, inpatient care, and home-based rehabilitation. DESIGN: A qualitative descriptive study employing patient journey mapping. METHODS: A qualitative approach was used, involving in-depth, semi-structured interviews with a purposive sample of older COPD patients. Data collection continued until thematic saturation was achieved. Data were analysed using Braun and Clarke's thematic analysis technique. Patient journey mapping synthesized individual narratives into a consolidated visual representation, identifying key stages, touchpoints, and barriers within the patient experience. RESULTS: Analysis revealed themes organized across three dimensions: health management tasks, emotional experiences, and pain points. Key findings included challenges in early symptom recognition and diagnosis, ongoing burdens associated with symptom management, barriers to engaging in pulmonary rehabilitation, inadequate social and professional support, nutritional knowledge gaps, and pervasive concerns regarding physical activity. These themes contributed to a comprehensive patient journey map that highlighted the dynamic and interdependent needs throughout the various phases of COPD management. CONCLUSION: Patient journey mapping illustrates that the COPD care pathway constitutes a prolonged process, marked by critical vulnerabilities during diagnosis and care transitions. These findings highlight the necessity of transitioning from episodic care to continuous support frameworks that integrate digital health solutions, self-management education, and community-based services. IMPACT: This study offers empirical evidence to inform the development of targeted interventions and optimize resource allocation, ultimately aiming to improve self-management outcomes, reduce complications, and enhance the quality of life for older adults with COPD. REPORTING METHOD: This study adhered to the COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines to ensure methodological transparency and reproducibility.
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