BMC Public Health [JOURNAL]
Sun
200 papers
Early-onset cancer and modifiable risk: quantifying the combined impact of excess body weight and alcohol on breast and colorectal cancer in Italy (18-34 years).
Bolpagni F, Lanati S, Biino G … +7 more , Labrini L, Madini N, Vincenti A, Manuelli M, Sottotetti F, Locati LD, Cena H
BMC Public Health · 2026 Jul · PMID 42393603 · Full text
BACKGROUND: Rising rates of cancers diagnosed before the age of 50 have been reported worldwide, including in Italy. Among modifiable risk factors, excess body weight (overweight and obesity) and alcohol consumption inde...
BACKGROUND: Rising rates of cancers diagnosed before the age of 50 have been reported worldwide, including in Italy. Among modifiable risk factors, excess body weight (overweight and obesity) and alcohol consumption independently and synergistically increase the risk of breast and colorectal cancers, including early-onset disease. However, the population-level burden attributable to these exposures among adolescents and young adults (AYA) remains poorly quantified. METHODS: We combined a targeted overview of the literature with a quantitative Population Attributable Fraction (PAF) analysis to estimate the proportion of early-onset breast and colorectal cancers attributable to overweight/obesity, high-risk alcohol consumption, and their combined exposure in the Italian population aged 18-34 years. Sex- and age-specific prevalence data were derived from the national surveillance system "PASSI", while relative risks were obtained from meta-analyses and large cohort studies, prioritizing estimates from early-onset populations when available. PAFs were estimated using the Bruzzi et al. method, while combined PAFs were calculated assuming independence between exposures. Uncertainty was assessed through Monte Carlo simulations and sensitivity analyses on prevalence and relative risk assumptions. RESULTS: Among Italian young adults aged 18-34 years, overweight and obesity together accounted for a substantial proportion of early-onset colorectal cancer cases, while high-risk alcohol consumption showed the largest individual attributable fraction. The combined contribution of excess body weight and high-risk alcohol consumption reached 16.6% of early-onset colorectal cancer cases. For early-onset breast cancer in young women, high-risk alcohol consumption was associated with PAFs of 4.6%. Sensitivity analyses confirmed the robustness of the estimates and indicated that uncertainty in relative risk assumptions represented the main source of variability. CONCLUSIONS: Obesity and alcohol consumption contribute meaningfully to the burden of early-onset breast and colorectal cancers in Italy. Integrating weight management and alcohol risk assessment into clinical practice and public health strategies targeting young adults could prevent a measurable proportion of these cancers and help counteract the rising incidence of malignancies at young ages.
Accessibility and predictors of sexual and reproductive health services utilisation among adolescents and youth people with disabilities in Bono Region, Ghana: a cross-sectional survey.
Ojo L, Ginindza TG, Ansu-Mensah M … +1 more , Kuupiel D
BMC Public Health · 2026 Jul · PMID 42393602 · Full text
BACKGROUND: Despite global commitments to universal health coverage and the Sustainable Development Goals (SDGs), particularly SDGs 3, 4, 5, and 10 by 2030, adolescents and young people with disabilities (AYPWD), includi...
BACKGROUND: Despite global commitments to universal health coverage and the Sustainable Development Goals (SDGs), particularly SDGs 3, 4, 5, and 10 by 2030, adolescents and young people with disabilities (AYPWD), including those with long-term physical, sensory, speech, intellectual, or mental impairments, face persistent barriers to accessing sexual and reproductive health (SRH) services (including antenatal care, contraception, family planning) in low- and middle-income countries. Evidence from Ghana remains limited. This study assessed accessibility and predictors of SRH service utilisation among AYPWD aged 15-24 years in Ghana's Bono Region. METHODS: A community-based analytic cross-sectional survey was conducted among 440 AYPWD selected using multi-stage random sampling across urban and rural districts. Data were collected using structured questionnaires capturing sociodemographic characteristics, disability profiles, SRH service utilisation, and structural and perceived accessibility indicators. Descriptive statistics summarised patterns of service use, while logistic regression models identified predictors of SRH service access and perceived ease of access. Statistical significance was set at p < 0.05. RESULTS: Of the 440 respondents, most were female (62.0%), urban residents (80.7%), and aged 20-24 years (52.3%). Access to personal hygiene information was high (82.5%), whereas utilisation of contraceptive information (22.0%), sexually transmitted infection (STI) screening and treatment (32.0%), human immunodeficiency virus (HIV) testing (13.0%), safe abortion information (7.7%), and antenatal care (2.7%) was low. Females had significantly higher odds of accessing contraceptive information (AOR = 4.55; 95% CI: 2.43-8.50; p < 0.001) and menstrual health support (AOR = 13.42; 95% CI: 7.76-23.19; p < 0.001). Respondents with visual (OR = 0.15; 95% CI: 0.09-0.26; p < 0.001) and hearing disabilities (OR = 0.45; 95% CI: 0.25-0.81; p = 0.008) reported greater service-quality barriers, while visual disability was also associated with reduced perceived ease of access (OR = 0.50; 95% CI: 0.29-0.86; p = 0.013). CONCLUSION: SRH service utilisation among AYPWD in the Bono Region remains low and is shaped by gender, disability type, and structural and socioeconomic factors. Strengthening disability-inclusive infrastructure, communication support, gender-responsive programming, and targeted financing mechanisms is essential to improve equitable access and advance progress toward universal health coverage in Ghana.
Focusing on depressive symptoms in patients to mitigate the risk of pain: a nationwide, prospective cohort study.
Liu YW, Sun Y, Lei YL … +8 more , Di BR, Men XD, Zhu JZ, He KX, Wang JM, Peng L, Xiang L, Luo YH
BMC Public Health · 2026 Jul · PMID 42393600 · Full text
BACKGROUND: Depressive symptoms and pain frequently coexist and contribute substantially to individual and public health burdens. Although previous studies have demonstrated a bidirectional relationship between depressiv...
BACKGROUND: Depressive symptoms and pain frequently coexist and contribute substantially to individual and public health burdens. Although previous studies have demonstrated a bidirectional relationship between depressive symptoms and pain, several important knowledge gaps remain. Most investigations have focused on overall pain burden or specific pain conditions, limiting understanding of whether depressive symptoms are associated with the risk of pain across different anatomical sites. In addition, the dose-response relationship between depressive symptom severity and subsequent pain risk remains poorly characterized, particularly in nationally representative Chinese populations. METHODS: The China Health and Retirement Longitudinal Study (CHARLS), a national, multi-center, prospective cohort study initiated in 2011, enrolled 6,772 participants for the final analysis, based on specific inclusion and exclusion criteria. Depressive symptoms was defined as a Center for Epidemiologic Studies Short Depression (CESD) score ≥ 10. To investigate potential associations between depressive symptoms, CESD scores, and 15 distinct types of pain, Cox proportional hazards models were employed, with restricted cubic splines (RCS) applied to examine non-linear relationships. Lastly, subgroup analyses were performed to substantiate the reliability of the findings further. RESULTS: In the fully adjusted model, individuals with depressive symptoms exhibited a significantly higher risk of experiencing pain in specific body regions compared to their non-depressed counterparts. Furthermore, for every 1 standard deviation increase in CESD score, the risk of pain in certain body areas rose by 4%-7%. Moreover, CESD scores displayed a distinct S-shaped non-linear relationship with ten types of pain, including headache and shoulder ache. Additionally, in the majority of subgroups, both depressive symptoms and CESD scores were positively correlated with pain risk, aligning with the overall findings of the study. CONCLUSIONS: In the Chinese population, depressive symptoms and CESD scores represent significant potential risk factors for pain.
Effectiveness of an educational intervention in enhancing parents' knowledge, perception, and acceptability of human papillomavirus vaccine.
Abdulghani N, Faqih S, Alqurashi A … +1 more , Baljon K
BMC Public Health · 2026 Jul · PMID 42393589 · Full text
BACKGROUND: Cervical cancer is the fourth most common cancer among women worldwide, largely caused by the human papillomavirus (HPV). The HPV vaccine has been proven to effectively reduce HPV infection rates and cervical...
BACKGROUND: Cervical cancer is the fourth most common cancer among women worldwide, largely caused by the human papillomavirus (HPV). The HPV vaccine has been proven to effectively reduce HPV infection rates and cervical cancer risk, making vaccination a crucial preventive measure. OBJECTIVES: This study aims to evaluate the effectiveness of an educational intervention in improving parents' knowledge, perception, and acceptability of the HPV vaccine. METHODS: A pre-post research study was conducted in 2024 involving 140 parents in a specialized hospital in Makkah, Saudi Arabia. The intervention consisted of structured educational lectures, PowerPoint presentations, workshops, and parents' group discussions. Pre- and postintervention self-administered surveys were used to assess changes in knowledge, perception, and vaccine acceptability. RESULTS: The intervention resulted in a significant improvement in parents' knowledge regarding HPV and its associated risks. Parental understanding of HPV transmission and vaccine benefits improved greatly following the intervention, rising from 17% to 87%. The mean knowledge score significantly increased from 5.2 ± 2.1 to 9.9 ± 1.8 (P < 0.001), indicating a large effect size (Cohen's d = 0.58). Interestingly, parents with lower educational levels demonstrated the greatest improvement in knowledge scores compared with higher-educated parents (P = 0.039), suggesting that the intervention was particularly effective among this group. Additionally, the intervention positively influenced parental perception and acceptability of the HPV vaccine. CONCLUSIONS: The research provides valuable insights into the effectiveness of educational interventions in enhancing parental understanding and HPV vaccine acceptance. The findings contribute to the development of targeted interventions, explicitly challenge prevalent misconceptions about HPV infection, and suggest strategies to improve parental awareness and facilitate informed decision-making regarding HPV prevention and testing in collaboration with stakeholders and community leaders.
Maternal and child health challenges during and after flooding: a qualitative study in Makassar, Indonesia.
Goel R, Tarpenning MS, Ansar J … +8 more , Ansariadi A, Syahrani ZPA, Anggraeni N, Coombe KD, Weber W, Blythe E, Ansariadi A, Rosser JI
BMC Public Health · 2026 Jul · PMID 42387525 · Full text
BACKGROUND: Flooding is a recurrent and worsening public health threat in Indonesia, disproportionately affecting women and children in low-elevation urban areas. Pregnant and postpartum women in Indonesia experience uni...
BACKGROUND: Flooding is a recurrent and worsening public health threat in Indonesia, disproportionately affecting women and children in low-elevation urban areas. Pregnant and postpartum women in Indonesia experience unique physical and emotional burdens during floods, yet their lived experiences remain underexplored. Understanding how mothers adapt to recurrent flooding is critical for developing context-relevant interventions to improve maternal and child outcomes. This study aimed to explore (1) how recurrent flooding shapes the daily lived experiences and caregiving responsibilities of pregnant and postpartum women, (2) how flooding affects access to food, water, and healthcare, and (3) what community-informed interventions mothers identify as most impactful. METHODS: We conducted a qualitative descriptive study using in-depth interviews with 20 women who gave birth within the past three years and reported prior flood experience in the Tallo District of Makassar. They were randomly selected from a mother-child cohort based out of Hasanuddin University. Sample size was determined by data saturation. Interviews were transcribed and translated from Makassarese into English. They were then coded and analyzed thematically using MAXQDA. RESULTS: Flooding occurs annually, with severity differing between years. Mothers bore primary responsibility for lifting furniture, protecting children, and cleaning contaminated homes. Recurrent floods disrupted food preparation and reduced meal variety. Floodwater contaminated government-owned piped water and borehole well water. Toilets overflowed and bathing was often skipped to conserve clean water. Prenatal and routine health visits were frequently postponed until floodwaters receded; however, many mothers reported wading through deep water to attend scheduled appointments. The distress of these burdens was worsened by lost income from disrupted work. Mothers identified food distribution, drain maintenance, and improved housing infrastructure as the most impactful interventions. CONCLUSIONS: These findings provide translatable insights for flood-prone coastal urban communities. Educating households about water preparation and implementing timely food staple distribution through existing community networks can reduce illness and hunger during flooding. Supporting neighborhood-based drainage maintenance and subsidizing incremental home elevation with locally available materials can address the burdens placed on mothers during flooding.
Social and attitudinal predictors of tobacco use among Peruvian adolescents: a Structural Equation Modeling (SEM) of the Theory of Planned Behavior using Global Youth Tobacco Survey 2019.
Calle D, Cruz-Montero J, Durand-Gonzáles E … +2 more , Lora-Loza MG, Hualparuca-Olivera L
BMC Public Health · 2026 Jul · PMID 42387512 · Full text
BACKGROUND: The use of manufactured tobacco cigarettes and e-cigarettes continues to be an important determinant of adverse health outcomes during adolescence, especially in Latin America, despite existing prevention pol...
BACKGROUND: The use of manufactured tobacco cigarettes and e-cigarettes continues to be an important determinant of adverse health outcomes during adolescence, especially in Latin America, despite existing prevention policies. In Peru, there is a stabilization in cigarette consumption and a notable increase in the use of Electronic Nicotine Delivery Systems (ENDS), which requires new explanatory studies. Based on the Theory of Planned Behavior, the aim was to analyze how subjective norms and attitudes toward tobacco predict the intention and subsequent consumption of manufactured and e-cigarettes among Peruvian adolescents. METHODS: This was a cross-sectional study using secondary data from the Global Youth Tobacco Survey 2019 in Peru. The sample included 2593 school adolescents aged 13 to 15 from different regions of the country. Structural Equation Modeling was applied to evaluate a partial version of the Theory of Planned Behavior including the effects of exposure to tobacco consumption in environments close to adolescents such as the home, school, and other settings (descriptive subjective norms), as well as attitudes toward tobacco on the intention to use tobacco products, and the predictive effect of this intention on frequency of manufactured and e-cigarette consumption. Perceived Behavioral Control was not included in the model due to an insufficient number of indicators. RESULTS: Exposure to tobacco consumption at home and in adolescents' everyday environments was a significant predictor of the intention to use tobacco products, whereas exposure at school showed a weaker and not significant effect. Negative attitudes toward tobacco predicted lower intention, indicating a protective cognitive factor. Together, these variables explained 32% of the variance in the intention to consume tobacco. In turn, the intention to use tobacco products was significantly associated with both manufactured cigarette use and e-cigarette use, with a stronger predictive effect for manufactured cigarettes than for e-cigarettes, explaining 79% and 37% of their variance, respectively. CONCLUSIONS: Manufactured and e-cigarette consumption among Peruvian adolescents represents distinct behavioral outcomes that merit examination in relation to antecedents such as tobacco-related use intention, social norms, and attitudes. Preventive interventions should address both the family and public environment while also targeting adolescents' cognitive perceptions about tobacco, especially in a context of increasing e-cigarette use.
Reduction in suicides and suicide attempts following implementation of AI-based video surveillance in the Stockholm metro system: an intervention study.
Fredin-Knutzén J, Hadlaczky G, Andersson AL … +1 more , Sokolowski M
BMC Public Health · 2026 Jul · PMID 42387492 · Full text
BACKGROUND: Over 700,000 suicides occurring globally each year are a major public health issue. Railways and metros provide a lethal means of suicide, mainly occurring by persons under train (PUT) events. Restriction of...
BACKGROUND: Over 700,000 suicides occurring globally each year are a major public health issue. Railways and metros provide a lethal means of suicide, mainly occurring by persons under train (PUT) events. Restriction of means has been shown to be effective in reducing suicides and is increasingly being prioritized in railway settings, e.g., using physical barriers. Here, we instead investigated the changes in suicidal behavior on metro platforms following the implementation of an AI-based CCTV detection system. METHODS: We used longitudinal data about PUT due to suicidality in the Swedish metro system in Stockholm (2010-2025). A controlled interrupted time series (CITS) analysis, as well as uncontrolled analyses, were used to test if an AI-CCTV implementation in Q4 2021 (at 14 stations) was associated with decreased rates of PUT due to suicidality, compared to the other 86 stations as controls. We also evaluated secondary outcomes (e.g., suicide deaths and train-traffic cancellations). Sensitivity analyses assessed the robustness of the primary model. A separate exploratory analysis examined an extended post-period, which included multiple heterogeneous system-wide exposures. RESULTS: Rates of PUT due to suicidality were lower after AI-CCTV implementation, in analyses with (IRR = 0.27, p < 0.05) or without (IRR = 0.41, p < 0.05) controls. Secondary outcomes showed consistent point estimates, e.g. death by suicide after PUT (IRR = 0.3), safeguarded individuals (IRR = 0.8) and less cancelled train-kilometers in the metro system. The robustness of the changes in PUT and death by suicide outcomes were confirmed by Bayesian sensitivity analyses using weak priors. CONCLUSIONS: Implementation of AI-CCTV as described herein was associated with lower rates of PUT due to suicidality at metro stations, as well as changes in the same direction for e.g. deaths by suicide and less cancelled train-kilometers. This preliminary study of AI-CCTV in the metro system provides a specific example of how such an intervention may support suicide prevention in the metro system, at least in the short-term.
Improving healthy eating behaviour among in-school adolescents through collaborative instructional intervention: a theory-driven quasi-experimental study.
Ademiluyi DD, Adepoju OT, Oladosu GS … +9 more , Uthman-Akinhanmi YO, Akinsanya OB, Adewale IO, Asha OE, Olubiyi ED, Ojo-Adalumo AR, Adepoju AB, Ogunniyi AE, Oyewunmi BT
BMC Public Health · 2026 Jul · PMID 42387491 · Full text
BACKGROUND: Adolescence is a critical window for establishing dietary behaviours that shape long-term health outcomes. In Nigeria and other Sub-Saharan African countries, school-based nutrition education has been largely...
BACKGROUND: Adolescence is a critical window for establishing dietary behaviours that shape long-term health outcomes. In Nigeria and other Sub-Saharan African countries, school-based nutrition education has been largely ineffective when delivered through conventional didactic approaches. This study evaluated the effect of a Health Belief Model-guided collaborative learning intervention on diet quality, nutrition knowledge, and perceived dietary behaviour among in-school adolescents in Ogun State, Nigeria. METHODS: A quasi-experimental, pre-test-post-test control group design was used. Three hundred adolescents aged 13-19 years from two public secondary schools in Odeda Local Government Area were recruited, with 150 assigned to each group. The intervention group received eight weeks of structured nutrition education delivered through collaborative learning techniques, while the control group received the same content through conventional didactic instruction. Diet quality was assessed using the Global Diet Quality Questionnaire (DQQ), nutrition knowledge using a validated 20-item questionnaire, and perceived dietary behaviour using an HBM-based scale. Data were analysed using paired t-tests, independent t-tests, Difference-in-Differences analysis, and ANCOVA. RESULTS: The intervention group demonstrated statistically significant improvements in dietary diversity (DDS: 33.74%), NCD-Protect score (153.22%), and GDR score (39.86%), while the NCD-Risk score showed no significant change in either group (p = 0.967). Nutrition knowledge improved significantly in the intervention group (DiD = 7.94; p = 0.007), with no meaningful change in the control group. All six HBM constructs improved significantly in the intervention group, including self-efficacy (13.46%) and perceived severity (18.96%). ANCOVA confirmed that the intervention independently predicted improvements in both dietary diversity and nutrition knowledge after adjusting for baseline scores and sociodemographic covariates. CONCLUSIONS: The findings of this study suggest that collaborative learning-based nutrition education guided by the Health Belief Model was associated with meaningful improvements in diet quality, nutrition knowledge, and health beliefs among in-school adolescents. These findings support further evaluation of participatory and theory-driven instructional approaches within school-based nutrition programming in Nigeria and similar low-resource settings, ideally through cluster-randomised designs involving larger numbers of schools.
Challenges and countermeasures of the "Xinjiang Model" in tuberculosis prevention and control: a qualitative study based on health specialists' perspectives.
Zhang Y, Wei R, Wang S … +5 more , Wang X, Razbek J, Wen B, Wang J, Cao M
BMC Public Health · 2026 Jul · PMID 42387490 · Full text
BACKGROUND: Tuberculosis (TB) remains a significant public health threat, particularly in Xinjiang Uygur Autonomous Region of China, showing a high incidence. The "Xinjiang Model" is a TB service delivery system integrat...
BACKGROUND: Tuberculosis (TB) remains a significant public health threat, particularly in Xinjiang Uygur Autonomous Region of China, showing a high incidence. The "Xinjiang Model" is a TB service delivery system integrating universal chest X-ray screening, hospitalization for infectious patients, community-based follow-up for non-infectious cases, and nutritional support. Since 2018, Xinjiang has implemented the "Xinjiang model" for TB prevention and control to improve early screening and cure rates, but it continues to face challenges in long-term implementation. OBJECTIVE: This qualitative study aimed to explore the challenges encountered during the implementation of the "Xinjiang Model" and identify sustainability strategies to optimize and enhance TB prevention and control efforts. METHODS: Semi-structured interviews were conducted with 26 healthcare professionals from the Centers for Disease Control and Prevention across various Xinjiang prefectures, selected through purposive sampling. Data collection followed a tailored interview outline, and thematic analysis using Colaizzi's method was applied. RESULTS: Six significant challenges were identified: workforce fragility and insufficient incentives for TB providers; physical and psychological vulnerabilities affecting patients' treatment continuity; gaps in funding standards and policy alignment; limited public awareness and TB-related health literacy; capacity pressures affecting the quality and timeliness of universal health check-ups; and delays across referral pathways. Participants expressed confidence in the sustainability of the model and proposed strategies grouped into three domains: strengthening system inputs, including financial and policy support and provider compensation; improving patient-centered care, such as patient management, follow-up, and psychosocial or social support; and enhancing service delivery capacity by optimizing the TB workforce and improving the quality of universal health check-ups. CONCLUSION: This study revealed key operational barriers to sustaining the "Xinjiang Model" and underscores the need for strengthened financing, workforce incentives, and patient-centered support within ongoing health system reforms. These findings are essential for maintaining TB control efforts in Xinjiang, serve as a reference for similar regions in China, and offer contextual insights for comparable low- and middle-income countries seeking to implement integrated TB control strategies.
Enhancing collaborative relationships and mental health literacy to improve school behavioral health for middle school students: a randomized controlled trial.
Weist MD, Patterson B, McQuillin SD … +10 more , Fairchild AJ, Chehoski BE, Stevens RN, Haines C, Cox J, Chandler T, Hoover S, Reaves S, Lu Q, Obeid JS
BMC Public Health · 2026 Jul · PMID 42387471 · Full text
BACKGROUND: Escalating youth mental health challenges have challenged schools and providers to effectively support student well-being. School behavioral health (SBH) programs are evolving rapidly to meet this need, and t...
BACKGROUND: Escalating youth mental health challenges have challenged schools and providers to effectively support student well-being. School behavioral health (SBH) programs are evolving rapidly to meet this need, and this study pursued implementation of community-partner recommended enhancements to improve SBH programming and outcomes for students. METHODS: This study aimed to evaluate the effectiveness of stakeholder-recommended enhancements to SBH on increasing the number of students and families engaged in therapy; and to evaluate the impact of the intervention on social, emotional, behavioral and academic outcomes. This comparative effectiveness trial tested two approaches to effective SBH, both involving core evidence-based strategies, and one including four community partner-recommended enhancements: mental health literacy, family-school-clinician partnerships, therapeutic alliance, and cultural responsiveness and equity. RESULTS: The enhanced condition was associated with an increased use of telehealth services and improvements in behavioral functioning of students at a 6-month post assessment. Treatment effect heterogeneity analyses indicated a potential amplifying effect of stigma reduction on improvement in students' behavioral functioning. CONCLUSIONS: Emphasizing mental health literacy (MHL) and enhanced relationships (including collaboration with families, focus on therapeutic alliance, understanding cultural responsiveness and equity) shows promise for enhancing SBH programming to improve practice and points to a range of important future research directions grounded in implementation science. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT03901274. First submitted March 29, 2019.
Prevalence and severity of premenstrual tension syndrome and its impact on academic performance among female university students in Bangladesh: a cross-sectional study.
Lemon MMH, Ahmed S, Khatun MK … +1 more , Rana MS
BMC Public Health · 2026 Jul · PMID 42387460 · Full text
BACKGROUND: Premenstrual tension (PMT) syndrome is an important condition that affects women's psychological, physical, and behavioral well-being, as well as their academic performance. This study investigates the associ...
BACKGROUND: Premenstrual tension (PMT) syndrome is an important condition that affects women's psychological, physical, and behavioral well-being, as well as their academic performance. This study investigates the association between premenstrual tension (PMT) symptom severity and academic performance among female university students. METHODS: A cross-sectional study was conducted over an 8-month from January to August 2025 among 273 female students of Islamic University, Bangladesh. A reliable, self-administered, bilingual questionnaire was developed based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5) criteria to collect the primary data. It was used to assess the prevalence and severity of psychological, behavioral, and physical symptoms as well as their impact on academic performance. Data were analyzed using SPSS (version 25.0) and Python (Pandas, NumPy, SciPy, and Matplotlib). The Chi-square test was used to examine the association between PMT and academic outcomes. RESULTS: A total of 273 participants were selected from 976 eligible female students. The age of the participants ranged from 17 to ≥ 25 years, with a median age category of 23-24 years. The prevalence of premenstrual tension (PMT) symptoms was 65.2%, while 8.1% of participants met the criteria for premenstrual dysphoric disorder (PMDD). Severe mood swings (39.6%) and irritability (37.0%) were identified as the most frequently reported symptoms. A statistically significant association was observed between PMT and academic performance indicators, including difficulty concentrating in class (69.6%, p = 0.013), negative impact on examination performance (64.4%, p = 0.012), and difficulty participating in extracurricular activities (60.0%, p = 0.009). Overall, 54.9% of the female university students reported that their academic performance was negatively affected by premenstrual symptoms. CONCLUSION: Our study revealed a high prevalence of premenstrual tension (PMT) and premenstrual dysphoric disorder (PMDD) among female university students, with severe psychological symptoms such as mood swings and irritability negatively affecting concentration, examination performance, and participation in extracurricular activities. The findings underscore the importance of raising awareness, implementing targeted mental health support, and providing appropriate interventions to improve academic performance and overall well-being.
Association of musculoskeletal pain with incidence and recurrence of cardiovascular disease: a longitudinal cohort in China.
Chen Y, Sun S, Guo H … +5 more , Yan L, Peng C, Deng Y, Cai Y, Zhu M
BMC Public Health · 2026 Jul · PMID 42387455 · Full text
BACKGROUND: Globally, cardiovascular disease remains the leading cause of death and disability. Musculoskeletal pain, affecting nearly 30% of the global population, is increasingly recognized as a potential contributor t...
BACKGROUND: Globally, cardiovascular disease remains the leading cause of death and disability. Musculoskeletal pain, affecting nearly 30% of the global population, is increasingly recognized as a potential contributor to cardiovascular disease (CVD). However, its links to CVD persistence and recurrence in low- and middle-income regions remain unstudied. This study examines the association of musculoskeletal pain with both incident and recurrent CVD in a prospective cohort. METHODS: A prospective cohort analysis was performed using a nationally representative dataset of middle-aged and older population in China during 2011-2020. In the final analysis, 8,716 participants were evaluated for incident CVD, and 1,151 were examined for recurrent CVD events. The associations between musculoskeletal pain and both incident and recurrent CVD were examined using Cox proportional hazards regression and restricted cubic spline models. RESULTS: Participants with musculoskeletal pain showed a significantly higher CVD incidence rate than pain-free individuals throughout follow-up (3.45 vs. 2.43 per 100 person-years). Individuals with musculoskeletal pain had a 54% increased risk of recurrence (HR = 1.54, 95% CI: 1.28-1.85). Participants with multisite pain demonstrated progressively greater CVD risks, with significant trend for both incident and recurrent events (P trend < 0.001). All pain dynamics (generated, disappeared, intermittent, continuous) were significantly associated with both incident and recurrent CVD. CONCLUSIONS: Musculoskeletal pain is independently associated with both incident and recurrent CVD; prolonged pain duration and an increasing number of pain sites further amplify these risks.
Cross-border food reformulation: changes in nutrient content in Uruguay following the implementation of front-of-package policies in neighbouring countries.
Ares G, Alcaire F, Allegue G … +4 more , Antúnez L, Gitz E, Rincon Gallardo S, Natero V
BMC Public Health · 2026 Jul · PMID 42387448 · Full text
BACKGROUND: Food reformulation is frequently discussed as a potential strategy to address obesity and diet-related non-communicable diseases. However, evidence regarding its effectiveness and broader implications within...
BACKGROUND: Food reformulation is frequently discussed as a potential strategy to address obesity and diet-related non-communicable diseases. However, evidence regarding its effectiveness and broader implications within globalised food systems remains limited. This study examined changes in the nutrient content of packaged foods commercialised in Uruguay between 2021 and 2025, a period characterised by limited domestic regulatory action but during which front-of-package (FOP) warning label policies were implemented in Argentina and Brazil, Uruguay's main trading partners. METHODS: Nutrient information was obtained through systematic in-store data collection and compiled into an online database. Linear mixed-effects models were used to estimate changes in nutrient content, accounting for repeated product-level observations and testing interactions between year and country of origin. RESULTS: At the aggregate level, modest but statistically significant reductions were observed in total fat, saturated fat, and sodium, alongside a small increase in fibre content. However, significant interactions between year and country of origin revealed substantial heterogeneity in reformulation patterns. Products imported from Argentina showed the most pronounced reformulation, with significant reductions in total fat, saturated fat, and sodium, and increases in fibre content. In contrast, domestically produced products in Uruguay exhibited limited reformulation, with statistically significant changes observed only for saturated fat and of smaller magnitude. Products from Brazil and other countries showed minimal changes, with statistically significant increases limited to fibre content. Category-level analyses further indicated that reformulation effects were uneven across the packaged food supply. CONCLUSIONS: These findings are consistent with the possibility that the implementation of FOP warning labels in Argentina was associated with reformulation with spillover effects into the Uruguayan market. Differences in policy design, particularly the stringency of the underlying nutrient profile model, may help explain the divergent industry responses. The limited changes observed among domestic products in the period highlight the need for complementary policy instruments to promote more substantial reformulation.
Changes in household food purchases in Iran: income and urban-rural inequality.
Jafarvand E, kianiRad A, Pouraram H
BMC Public Health · 2026 Jul · PMID 42387445 · Full text
BACKGROUND: Regular monitoring of nutritional indicators serves as an early warning system for policymakers and is essential for the effective governance of food security. This study presents the first 18-year trend anal...
BACKGROUND: Regular monitoring of nutritional indicators serves as an early warning system for policymakers and is essential for the effective governance of food security. This study presents the first 18-year trend analysis of changes in Iranian household food purchases, with a specific focus on inequalities across income deciles and between urban and rural areas in Iran. METHODS: Data from the Statistical Center of Iran (2005-2022) were analyzed. Six major food groups, calories, and macronutrients derived from household purchases were examined. Linear regression, with year as a continuous predictor, was performed using SPSS (p < 0.05 considered significant). Data processing and figure generation were conducted using Microsoft Access 2016 and Excel 2016, respectively. RESULTS: Over the 18-year study period, per capita purchases of all major food groups declined in both urban and rural areas. Urban-rural disparities in household food purchases, as well as the associated estimated calorie and macronutrient quantities, narrowed. Furthermore, although higher-income households consistently purchased more of most food groups (except cereals) than lower-income households, these income-based inequalities also diminished over time. CONCLUSION: Although nutritional inequalities in Iran have decreased in recent years, the simultaneous decline in overall household food purchases calls for more rigorous research on the subject. Analyzing long-term trends in household food purchase-based nutritional indicators is a critical scientific and policy priority for evaluating programs and designing evidence-based policies.
Type 2 diabetes prevention programs at the community and municipal level: a scoping review of controlled intervention studies.
Michels D, Walter C, Grathwohl-Karl A … +4 more , Pfau J, Haumann H, Joos S, Fröhlich D
BMC Public Health · 2026 Jul · PMID 42387346 · Full text
BACKGROUND: Type 2 diabetes mellitus poses a major challenge to public health globally due to its rising prevalence and high proportion of patients who are undiagnosed, untreated and/or uncontrolled. Lifestyle interventi...
BACKGROUND: Type 2 diabetes mellitus poses a major challenge to public health globally due to its rising prevalence and high proportion of patients who are undiagnosed, untreated and/or uncontrolled. Lifestyle interventions targeting nutrition, physical activity, and further health-related behaviors such as weight and stress management can prevent the onset of type 2 diabetes mellitus or delay progression from prediabetes to manifest disease. Although lifestyle interventions are widely used in clinical trials and national programs, there is limited evidence on how such interventions are designed, adapted, and reported in community, municipal, and public health settings. METHODS: A scoping review was conducted using the Population Concept Context framework. Systematic searches were performed in PubMed, Web of Science Core Collection, CINAHL, and CENTRAL. The CDSR was used for citation tracking to identify relevant primary studies. Additional searches included grey literature, organizational websites, and an AI-assisted search (undermind.ai). Searches covered studies published in English or German between January 2014 and May 2025 and were conducted on 28 May 2025. Eligible studies examined lifestyle-based interventions targeting physical activity, nutrition, or broader behavioral change among healthy adults and adults at increased risk of developing type 2 diabetes, including individuals with prediabetes or metabolic syndrome, delivered in community, municipal, or public health settings. Inclusion was restricted to controlled study designs ((cluster-)randomized controlled trials, non-randomized controlled studies, or controlled clinical trials). Feasibility studies, pilot studies, uncontrolled implementation studies, and process evaluations were excluded. Pharmacological interventions were not considered. Data were charted and synthesized descriptively. RESULTS: Of 464 records identified, 26 studies were included. Interventions were largely adapted from established prevention programs and delivered through group-based education, with limited reporting of theoretical frameworks. Definitions and operationalization of "community-based" delivery varied across studies, and intervention duration and maintenance components were heterogeneous. The evidence base was dominated by studies conducted in high-income countries, with limited representation from lower-resource settings. CONCLUSIONS: This scoping review highlights the need for greater representation of studies from lower-resource settings and theoretically grounded and methodologically rigorous prevention approaches in the community setting. The potential of community-based initiatives offers valuable guidance for further development and scaling future diabetes prevention efforts. TRIAL REGISTRATION: Open Science Framework (osf.io/zafg5).
Evaluation of the quality and reliability of infertility information on Chinese social media platforms Bilibili and TikTok : a cross-sectional study.
Zhang J, He J, Wei Q … +1 more , Rao M
BMC Public Health · 2026 Jul · PMID 42387332 · Full text
BACKGROUND: Infertility has become a major global health issue, affecting approximately one in six couples worldwide; this problem is particularly pronounced in China. With the advent of the digital age, an increasing nu...
BACKGROUND: Infertility has become a major global health issue, affecting approximately one in six couples worldwide; this problem is particularly pronounced in China. With the advent of the digital age, an increasing number of people struggling with infertility are turning to social media platforms for health information. However, the quality and reliability of such video content remain unclear. Therefore, this study aims to assess the overall quality and reliability of infertility-related information on mainstream social media platforms in China. METHOD: This study used the Chinese term "Infertility" as a search term to retrieve the top 100 videos on Bilibili and TikTok. Video quality was assessed using the DISCERN tool and the Global Quality Scale (GQS), and statistical analysis was conducted to explore the relationships among various variables. RESULTS: This study ultimately included 163 videos in the analysis, comprising 72 videos from Bilibili and 91 from TikTok. The results showed that the average daily engagement metrics on Bilibili were significantly higher than those on TikTok (P < 0.05). The proportion of medical personnel on the TikTok platform was as high as 90.1%, significantly higher than the 27.8% on Bilibili (P < 0.001). Videos on the TikTok platform were more concentrated in the medium-quality category, while the Bilibili platform had a higher proportion of low-quality videos (GQS low quality: 41.7% vs. 21.1%, adjusted P = 0.024). Multivariate regression analysis showed that the DISCERN score was significantly positively correlated with the number of shares (β = 0.045, 95% CI: 0.002-0.088, P = 0.040). Both the number of likes and the number of comments were negatively correlated with video duration (β = -0.001, P = 0.040; β = -0.001, P = 0.022). CONCLUSION: The overall quality of videos on infertility-related topics on TikTok needs improvement. Bilibili has a significant gap in this content, suggesting that high-quality content creators-such as medical professionals-should not limit their science communication efforts to a single platform. Creators of science communication videos may consider adopting narrative techniques or focusing on specific topics for in-depth explanations to enhance the accessibility of their content.
The effect of boarding on students' noncognitive skills: evidence from rural education in Northwest China.
Tang B, Xiao S, Lin X … +4 more , Cheng Z, Qin Y, Shi Y, Chang F
BMC Public Health · 2026 Jun · PMID 42381010 · Full text
BACKGROUND: A significant proliferation of boarding schools and boarding students has been observed in rural areas of China due to the challenges associated with "school consolidation" policies and parental migration fro...
BACKGROUND: A significant proliferation of boarding schools and boarding students has been observed in rural areas of China due to the challenges associated with "school consolidation" policies and parental migration from rural to urban areas for employment purposes. Hence, boarding has emerged as a prominent characteristic within the present-day rural student community. However, there remains a lack of consensus regarding the impact of boarding on noncognitive development among rural students. This study investigates the impact of boarding on students' noncognitive development using a two-period panel dataset collected during the research conducted on rural elementary schools in 2019 and 2020. METHODS: Using a two-period panel dataset comprising 10,923 students from 195 rural elementary schools in 21 counties, we employ both the propensity score matching method and instrumental variable approach to establish a causal relationship between boarding arrangements and students' noncognitive development. RESULTS: This study finds that boarding has detrimental effects on students' noncognitive skills, negatively impacting certain aspects such as openness and grit, and affinity for schools. The study also reveals that the impact of boarding varies across different student subgroups, with girls, younger students, those from affluent families, and students with more educated mothers benefiting more from the boarding experience. The study also examines pathways through which boarding influences students' noncognitive development. CONCLUSIONS: This paper proposes the following policy recommendations: (1) At the familial level, parents should allocate additional time and effort towards nurturing their children's emotional well-being and academic performance. (2) Schools ought to incorporate curriculum training programs aimed at enhancing students' noncognitive skills, including self-care, resilience, and interpersonal abilities. (3) The government should ensure the cultivation of students' non-cognitive skills by implementing policies, allocating funds, as well as promoting and raising awareness about the significance of these skills.
Examining inclusive research practices to engage communities: a qualitative inquiry.
Chan SWC, Diaz K, Lin N … +6 more , Chakraborty T, Ali SH, Ðoàn LN, Kwon SC, Hade EM, Yi SS
BMC Public Health · 2026 Jun · PMID 42380985 · Full text
BACKGROUND: Efforts to improve representation of diverse communities in clinical research have progressed, yet suboptimal reach due to lack of language support, mistrust, and cultural misalignment, persist. While researc...
BACKGROUND: Efforts to improve representation of diverse communities in clinical research have progressed, yet suboptimal reach due to lack of language support, mistrust, and cultural misalignment, persist. While research often prioritizes generalizability or recruiting a specific community, a tailored approach is essential to recruit and retain diverse communities. This study aims to illustrate the depth and breadth of existing community-engaged research methods that have been used to increase recruitment and retention of diverse communities. METHODS: Semi-structured interviews were conducted to identify common themes and best practices of inclusive research with 48 principal investigators and their study staff who had successfully engaged with different diverse communities from research institutions in the United States. Data were analyzed using a rapid qualitative analysis approach and organized thematically. FINDINGS: Six key themes related to conducting community-engaged research emerged: research team as community health advocate, community-academic partnership characteristics, best practices for conducting research with diverse communities, incurred financial costs, sustainability of inclusive research efforts, and system-related challenges. Participants emphasized the role of research teams to uplift community voices, build authentic and collaborative partnerships, prioritize cultural practices of the community, and use data to inform policy. Best practices included providing incentives, offering bilingual materials and having bilingual staff, and using multi-pronged recruitment and retention strategies. Financial costs included both tangible costs such as transportation and honoraria, while intangible costs such as time and trust-building were also highlighted. Sustainability required early planning, capacity-building, and continuous fiscal support. Challenges included insufficient institutional support, burnout, and staff turnover, stressing the need for multi-level strategies and solutions integrated into the research environment to support inclusive research practices. CONCLUSIONS: A general research approach that tailors to specific communities' preferences and fosters collaborative partnerships will better enhance representation in research. However, the research environment requires attention to multi-level strategies to minimize challenges to conducting community-engaged research.
Associations of cumulative exposure and two-time-point clustering of the triglyceride-cholesterol-body weight index with incident cardiovascular disease in middle-aged and older Chinese adults: a nationwide cohort study.
Liu J, Fu Q, Zhang D … +8 more , Fu Y, Li S, Zhou L, Lyu Y, Wang P, Ao Q, Sun H, Liang N
BMC Public Health · 2026 Jun · PMID 42380976 · Full text
AIMS: The triglyceride-cholesterol-body weight index (TCBI) has been proposed as a biomarker of the prognosis of stroke. However, the relationship between cumulative exposure and dynamic trajectories of the TCBI (cuTCBI/...
AIMS: The triglyceride-cholesterol-body weight index (TCBI) has been proposed as a biomarker of the prognosis of stroke. However, the relationship between cumulative exposure and dynamic trajectories of the TCBI (cuTCBI/TCBI changes) and the risk of cardiovascular disease (CVD) remains unclear. The aim of this study is to examine the association between cuTCBI/TCBI changes and the risk of CVD. METHODS AND RESULTS: The participants were from the China Health and Retirement Longitudinal Study (CHARLS). Partitioning Around Medoids (PAM) algorithm, Cox regression model, restricted cubic spline (RCS), Kaplan-Meier analysis and subgroup analysis were employed to evaluate the association between cuTCBI/TCBI changes and CVD risk. In model 3, compared to Q1, the risk of CVD increased by 83% for Q4 (HR:1.83, 95%CI: 1.49,2.24) (P for trend < 0.001). RCS analysis revealed a significant nonlinear relationship between cuTCBI and CVD risk. The results of PAM clustering demonstrated that the participants in moderate increase cluster (HR:1.35, 95%CI: 1.17,1.56, P < 0.001) and persistently high level cluster (HR:1.49, 95%CI: 1.22,1.83, P < 0.001) demonstrated a significantly elevated risk of CVD compared with the stable low risk cluster, with a significant trend towards increased risk across clusters (P for trend < 0.001). In the gender-stratified analysis, significant associations were observed in males, whereas the female TCBI change clusters did not reach statistical significance in the fully adjusted model. CONCLUSION: Our research demonstrated a significant association between cuTCBI/TCBI changes and the increased risk of CVD. And the relationship between cuTCBI and CVD risk is nonlinear. The association between TCBI change clusters and outcomes may differ by gender, with statistical significance observed only in males. Our results indicated that regular monitoring of cuTCBI levels and maintaining relatively low levels may be crucial for CVD prevention.
Prevalence and trends of gestational diabetes in a large university hospital in Lebanon before and during the COVID-19 pandemic.
Yazbek N, Bou Absi M, Abi Tayeh G … +2 more , Gannagé-Yared MH, El Ghorayeb N
BMC Public Health · 2026 Jun · PMID 42380925 · Full text
BACKGROUND: The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide in parallel with obesity, maternal age, improved screening methods and wider screening coverage. The objective of our study was to...
BACKGROUND: The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide in parallel with obesity, maternal age, improved screening methods and wider screening coverage. The objective of our study was to determine the prevalence of GDM in Lebanon and to evaluate its risk factors before and during the COVID-19 pandemic. METHODS: Records of 2595 pregnant women who gave birth at the Hôtel-Dieu de France Hospital in Beirut, were collected retrospectively from 2018 to 2022. GDM was determined by documentation in the maternity fileward. A univariate analysis was performed to assess the factors affecting GDM. The χ² test, Fisher's exact test, independent samples T-test, and ANOVA were used for this purpose. RESULTS: The mean age was 32.03 years (± 4.75). The mean BMI at the beginning of pregnancy was 24.86 kg/m² (± 8.99), and the mean gestational weight gain (GWG) was 12.17 kg (± 5.06). The overall prevalence of GDM was 4.1%, increasing significantly from 2.9% to 6.4% between 2018 and 2022 (p value = 0.007). The peak in 2020 was temporally associated with the onset of the COVID-19 pandemic and the compounding socioeconomic crises. The risk factors associated with GDM included older age (p = 0.003) and obesity (p = 0.004). CONCLUSION: The increasing trend of GDM incidence emphasizes the importance of implementing evidence-based prevention, diagnostic, and treatment strategies.
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