BMC Public Health [JOURNAL]
Sun
200 papers
Global suicide trends across major religions from 2000 to 2021.
Ito A, Mori H, Yano Y … +1 more , Naito T
BMC Public Health · 2026 Jul · PMID 42380917 · Full text
BACKGROUND: Suicide claims over 700,000 lives annually. Religious beliefs may influence suicide risk, yet large-scale, cross-national comparisons remain limited. METHODS: This retrospective, ecological study analyzed age...
BACKGROUND: Suicide claims over 700,000 lives annually. Religious beliefs may influence suicide risk, yet large-scale, cross-national comparisons remain limited. METHODS: This retrospective, ecological study analyzed age-standardized suicide rates of 185 countries over a 22-year period (2000-2021) using World Health Organization (WHO) mortality data. Countries were classified by dominant religion, including Buddhism, Christianity, Hinduism, Islam, and Others, per Pew Research Center data, and by income level (World Bank) and region (WHO). Suicide numbers were estimated by multiplying suicide rates and UN population data. Poisson regression models, controlling for income, region, and year, examined the association between religion and suicide rates. RESULTS: Islam showed the lowest suicide rates across total, male, and female populations. Poisson analysis confirmed significantly lower risk for Muslims (total population RR = 0·37, 95% CI: 0·33-0·42) than Buddhists as a base. Hindu populations, particularly females, exhibited the highest suicide rates (total population RR = 2·02, 95%CI:1·82-2·24), (female population RR = 4·74, 95%CI: 4·26-5·28). Christianity showed high male suicide rates descriptively, but adjusted risk decreased after accounting for region. (total population RR = 0·65, 95%CI: 0·57-0·75). CONCLUSIONS: Our findings indicate a statistical association between a country's dominant religion and its suicide rates. The lower rates observed in Islamic-majority countries might be related to factors such as religious prohibitions and community cohesion, while the high rates among females in Hindu-majority nations could be linked to specific socio-cultural pressures. Given the study's cross-sectional ecological design, these results merely highlight associations and cannot establish causality. Further research is necessary to elucidate the complex mechanisms underlying these observations.
Determinants of female genital mutilation among daughters in Ethiopia: a negative binomial regression approach.
Tsegaye TG, Azeze GA, Kena SS … +1 more , Negash BT
BMC Public Health · 2026 Jun · PMID 42380912 · Full text
BACKGROUND: Female genital mutilation is a major issue that has considerable effect on millions of girls in Africa, including Ethiopia. Despite the state initiatives to eliminate the practice by making it illegal, many m...
BACKGROUND: Female genital mutilation is a major issue that has considerable effect on millions of girls in Africa, including Ethiopia. Despite the state initiatives to eliminate the practice by making it illegal, many mothers continue think that it should be continued for their daughters. Therefore, we aimed determinants of the number undergoing female genital mutilation of daughters in Ethiopia. METHODS: Data for this study were obtained from the 2016 EDHS. The weighted sample included in this study was 3754 adolescent girls and young women aged 15-24 years. Descriptive data were summarized using descriptive statistics and tables. A negative binomial regression model was fitted. The strength of association was assessed using AIR with a 95% confidence interval (CI) and a p-value < 0.05 was reported. The deviance test was used to check the goodness of fit. RESULTS: Of the 3754 women, 1728 (46%) were aged from 25 to 34 years and 2503(66.7%) women were uneducated. Maternal age between 25 and 34 years (AIRR = 0.25, 95% CI: 0.16-0.37), as well as between 35 and 44 years (AIRR = 0.57, 95% CI: 0.44-0.739), living in urban areas (AIRR = 0.343, 95% CI: 0.222-0.532), having no employment (AIRR = 1.4, 95% CI: 1.1,1.6), not listening to the radio at all (AIRR = 2.68, 95% CI: 1.96-3.7) or listen to it less than once per weeks (AIRR = 2.39, 95% CI:2.391.68-3.38), and watching television less than once per week (AIRR = 2.1, 95% CI: 1.24-3.6), along with having one to five household members(AIRR = 0.64, 95% CI: 0.54,0.76), were significant predictors of daughter's FGM. CONCLUSION: In this study, factors that help protect a daughter from female genital mutilation include older maternal age, residing in urban areas, and having a smaller household size. Conversely, maternal unemployment and limited exposure to TV and radio are associated with a higher risk of female genital mutilation. Address these issue, efforts should be made to empower mothers through employment opportunities, and addressing the female genital concerns in targeted media campaigns is crucial.
Predicting abnormal birth weight and identifying associated factors using machine learning in the Hararghe Health and Demographic Surveillance System, Ethiopia.
Abdeta S, Diop O, Cygu S … +14 more , Drame A, Momanyi R, Endalamaw Dejene B, Tadele M, Sintayehu Y, Barasa M, Woldie M, Girma T, Tsegaye R, Kiragga A, Adnew B, Howe R, Dheresa M, Abdisa A
BMC Public Health · 2026 Jun · PMID 42380910 · Full text
BACKGROUND: Birth weight is a reliable indicator of intrauterine growth and an important predictor of neonatal survival, growth, and long-term development. Globally, approximately 15.5% of live births are low birth weigh...
BACKGROUND: Birth weight is a reliable indicator of intrauterine growth and an important predictor of neonatal survival, growth, and long-term development. Globally, approximately 15.5% of live births are low birth weight, and nearly 10% are macrosomic (high birth weight), with a substantial proportion of these cases occurring in sub-Saharan Africa. Birth weights outside the normal range of 2,500-4,000 g are considered abnormal and are associated with increased risks of neonatal and maternal complications. Ethiopia is similarly affected by the growing burden of abnormal birth weight. METHODS: A retrospective cross-sectional study design using secondary HDSS data collected from 2015 to 2022 was employed. This design was considered appropriate because the study aimed to develop machine learning models using routinely collected surveillance data to predict abnormal birth weight and identify associated factors, rather than to establish causal relationships. All singleton births were included, and those with missing birth weight data were excluded. Six machine learning algorithms identified from the literature were built and compared to identify the best-performing model for predicting abnormal birth weight. Prior observational studies and expert opinion were used to select the candidate features for all models. The synthetic minority oversampling technique (SMOTE) was used to manage the imbalance in the dataset. The dataset was split into training (80%, n = 9,242) and testing (20%, n = 2,311) subsets for model development and evaluation. Hyper-parametric tuning was performed using grid search combined with 10-fold cross-validation to optimize model performance and reduce over-fitting. Model performance was evaluated using the area under the receiver operating characteristic curve (AUROC), accuracy, precision, F1-score, and Kappa. Feature importance analysis was done using Shapley Additive explanation (SHAP) values. RESULTS: The Descriptive analysis of 11,553 singleton births showed that 10.78% of the newborns had high birth weight (HBW) and 9.28% had low birth weight (LBW). The eXtreme Gradient Boosting (XGBoost) model performed best by achieving an AUC of 0.835, an accuracy of 0.72, a precision of 0.67, an F1-score of 0.63, a recall of 0.54, and a kappa of 0.52 for abnormal birth weight prediction. The feature importance analysis showed that the top predictors for the low birth weight (LBW) include maternal educational status, age at first delivery, and antenatal care (ANC) visit, while high birth weight (HBW) was strongly predicted by antenatal care (ANC) visit, maternal literacy status, age at first delivery, and maternal education. CONCLUSION: Machine learning models showed moderate performance in predicting abnormal birth weight using HDSS surveillance data. Maternal educational characteristics, age at first delivery, and ANC utilization were identified as important predictive features. However, the findings should be interpreted cautiously because the model identified predictive associations rather than causal relationships. Further studies incorporating additional maternal clinical and nutritional variables, as well as external validation datasets, are recommended to improve predictive performance and generalizability.
Associations between physical activity and sociodemographic and migration-related correlates among adults with a history of migration in Germany: results of a nationwide cross-sectional survey.
Zhang H, Koschollek C, Hövener C … +2 more , Loss J, Manz K
BMC Public Health · 2026 Jun · PMID 42380899 · Full text
BACKGROUND: Promoting physical activity among the general population as well as among people with a history of migration is a crucial aspect of health promotion. However, we still lack a general understanding of physical...
BACKGROUND: Promoting physical activity among the general population as well as among people with a history of migration is a crucial aspect of health promotion. However, we still lack a general understanding of physical activity levels and their potential correlates among adults with a history of migration living in Germany. METHODS: The GEDA Fokus study, conducted by the Robert Koch Institute from 11/2021 to 05/2022, is a nationwide cross-sectional health interview survey of adults (18-79 years) with Croatian, Italian, Polish, Syrian or Turkish citizenship living throughout Germany (n = 6,038). The Aims of this study were (1) to assess the physical activity levels of adults with selected citizenships in Germany, specifically, adherence to World Health Organization (WHO) recommendations for aerobic activity and muscle strengthening, and in addition, cycling as a means of transport and (2) to identify sociodemographic, migration-related and psychosocial correlates of their physical activity behaviour. RESULTS: Approximately 70% of the participants reported not achieving the WHO recommendations for aerobic physical activity and 75% did not achieve the recommendation for muscle strengthening. The physical activity levels among the participants were associated with a number of sociodemographic, migration-related and psychosocial factors. Multivariable regression analyses showed that men compared to women, adults with higher educational levels, higher subjective social status, better German language proficiency and a higher level of social support were more likely to achieve the WHO recommendations for physical activity. In addition, men compared to women and adults with higher educational levels were more likely to cycle as a means of transport. CONCLUSIONS: Overall, the study found that physical activity levels among adults of Croatian, Italian, Polish, Syrian or Turkish citizenship living in Germany were low in comparison to the general population, and there were significant associations between their physical activity behaviour and a range of sociodemographic, migration-related and psychosocial factors. Further in-depth research is needed, both from a public health and health sociology perspective, to identify barriers to physical activity among people with a history of migration and to derive appropriate measures for intervention planning.
Systematic review of sexual violence against sex workers: implications for mental and sexual health.
Püffel M, Orbay İ, Salo I … +5 more , Berg H, Hasanagic L, Ruiz Burga E, Bernier T, Heinrichs N
BMC Public Health · 2026 Jun · PMID 42380886 · Full text
BACKGROUND: Sex workers worldwide experience different forms of violence and stigma that increase the risk of adverse health outcomes. It is assumed that a discriminatory, criminalizing context as well as intersectional...
BACKGROUND: Sex workers worldwide experience different forms of violence and stigma that increase the risk of adverse health outcomes. It is assumed that a discriminatory, criminalizing context as well as intersectional stigma increases the risk of sexual violence for sex workers. We aim to answer the following questions: (1) What types of sexual violence do sex workers experience and (2) how frequently do they encounter it? (3) To what extent are these types of sexual violence associated with mental and sexual health conditions? (4) Are these associations moderated by legislative models? METHODS: In a preregistered systematic review (PROSPERO: CRD42024503922), scientific databases, references from meta-analyses, and publications from sex work organizations were searched. A total k = 207 quantitative and qualitative studies (N = 157,991) published since 2013 were summarized meta-analytically and narratively. RESULTS: Sex workers experience sexual violence across various contexts, with quantitative records identifying rape as the most prevalent form. Qualitative findings document varied forms of sexual violence including non-penetrative acts, sexual harassment, technology-facilitated sexual violence, and sexual neglect. The lifetime prevalence of sexual violence is 26.3% (95% Confidence Interval [CI] 22.0-31.0). Mental health conditions (depressive, post-traumatic stress symptoms, and suicidality) were associated with sexual violence: OR [95% CI] = 1.85 [1.58-2.16], p < .001, as were alcohol and other recreational drugs: OR [95% CI] = 1.95 [1.59-2.38], p < .001. Both sexually transmitted infections, including HIV (OR [95% CI] = 1.36 [1.11-1.66], p = .003) and reproductive health related outcomes (OR [95% CI] = 1.76 [1.18-2.63], p = .013) were significantly associated with sexual violence. Potential moderation by legislative model could not be detected due to insufficient data. CONCLUSION: This systematic review suggests sexual violence against sex workers as a critical human rights issue. However, the generalisability of these findings is constrained by substantial statistical heterogeneity and limited representativeness within the current literature, which remains focused predominantly on cisgender women in in-person sex work. This calls for redefining sexual violence with input by sex workers and addressing structural inequities to aid in destigmatizing sex work and reducing social inequities.
Community-based abdominal ultrasound survey of cystic echinococcosis in Bhutan: prevalence and risk factors.
Wangchuk P, Hattendorf J, Zinsstag J
BMC Public Health · 2026 Jun · PMID 42380884 · Full text
BACKGROUND: Cystic echinococcosis (CE) is a neglected parasitic zoonosis, caused by larvae of the Echinococcus granulosus sensu lato (s.l.) complex. The parasitic transmission cycle is maintained between dog and livestoc...
BACKGROUND: Cystic echinococcosis (CE) is a neglected parasitic zoonosis, caused by larvae of the Echinococcus granulosus sensu lato (s.l.) complex. The parasitic transmission cycle is maintained between dog and livestock (ungulates), with humans involved as dead-end hosts. In Bhutan, CE is a recognized public health and veterinary problem; however, the true burden of CE in high-risk communities remains unknown. This study assessed the community-level prevalence, potential risk factors, and awareness of CE in Bumthang District to inform CE control strategies. METHODS: We conducted a cross-sectional, community-based abdominal ultrasound survey (April-July 2025) in four gewogs of Bumthang district using cluster sampling design. We invited all individuals aged ≥ 12 years from the selected villages. The WHO-IWGE ultrasound staging criteria were used to classify the cysts. RESULTS: Among the 3,058 participants with complete data (of 3,077 screened), the cluster-adjusted prevalence of confirmed CE (ultrasound-pathognomonic findings) was 2.58% (95% CI: 1.93-3.44). When cystic lesions (CL) were included, the estimate was 3.66% (95% CI: 2.92-4.59). The liver was the most commonly affected organ (93%), and cyst stages ranged from CE1 to CE5, indicating the presence of both active and inactive infections. Only intermittent dog contact ("sometimes") was independently associated with higher odds of prevalent CE (aOR 1.73, 95% CI 1.04-2.82). Other commonly hypothesized individual-level factors (sex, education, occupation and place of birth) were not independently associated with infection. All participants with CE and other clinically significant ultrasound findings received counselling, stage-appropriate management for CE cases, and appropriate referral and treatment within Bhutan's state-funded free healthcare system. CONCLUSION: CE is prevalent in Bumthang district. Currently, it remains under-recognized, under-reported and a huge detection gap exists between hospital-based passive detection and true community prevalence. The weak discrimination by individual-level risk factors and the pattern of modest village-level clustering are consistent with the environmentally mediated transmission hypothesis. These findings support the need of One Health control strategies including integrated surveillance rather than targeted approaches for high-risk groups.
Health literacy and vaccination attitudes among parents from different ethnic groups: a health belief model approach.
Deger VB, Butun A
BMC Public Health · 2026 Jun · PMID 42380835 · Full text
INTRODUCTION: Health literacy is a key determinant of health behaviours, including vaccination. Despite the proven benefits of immunization, vaccine hesitancy remains a global challenge, shaped by cultural, social, and i...
INTRODUCTION: Health literacy is a key determinant of health behaviours, including vaccination. Despite the proven benefits of immunization, vaccine hesitancy remains a global challenge, shaped by cultural, social, and individual factors. The aim of this study was to investigate the relationship between parents' health literacy and vaccine attitudes according to the health belief model among different ethnic groups. This study is expected to highlight the role of cultural differences in achieving public health objectives, while also contributing to improved health literacy and the development of more inclusive policies in child health and immunization. METHODS: This descriptive cross-sectional study was conducted with 908 parents (Turkish: 249; Kurdish: 217; Arab: 245; Assyrian: 197) living in Mardin, Turkey, between January and July 2025. Data were collected through face-to-face interviews using a sociodemographic form, the Public Attitude Towards Vaccination Scale-Health Belief Model, and the Turkey Health Literacy Scale-32. Data were analysed using descriptive statistics, chi-square tests, one-way ANOVA, and generalized linear model analyses. RESULTS: Health literacy and vaccination attitudes differed significantly according to ethnic group (p< .001). Arab parents had the lowest general health literacy scores and the most negative vaccination attitudes, including the highest perceived barriers to vaccination (24.04 ± 3.98). In contrast, Assyrian parents had the highest scores for sensitivity and severity, awareness of importance, belief in vaccine benefits, and health responsibility. Higher health literacy was positively associated with more favourable vaccination attitudes among Turkish, Kurdish, and Assyrian parents. However, among Arab parents, higher health literacy was associated with lower awareness of importance, lower belief in vaccine benefits, lower health responsibility, and greater perceived barriers. Significant interaction effects between ethnicity and health literacy were found for awareness of importance, belief in vaccine benefits, and health responsibility. CONCLUSION: Health literacy is an important factor influencing vaccination attitudes, but its effect varies according to ethnic background and cultural context. In some groups, higher health literacy supports more positive vaccination attitudes, whereas in others it may not lead to greater vaccine acceptance. Public health interventions should therefore use culturally sensitive and trust-based approaches to improve vaccination attitudes among diverse populations.
The association between parents' marital status, problematic internet use, and negative emotions among Chinese adolescents: a cross-lagged panel network analysis.
Fang T, Song J, Hu Z … +4 more , Jiang L, Zhuo F, Yang Y, Kong L
BMC Public Health · 2026 Jun · PMID 42380831 · Full text
BACKGROUND: Prior studies have established a link between problematic internet use (PIU) and negative emotional states, highlighting how familial factors are associated with this relationship. However, most existing stud...
BACKGROUND: Prior studies have established a link between problematic internet use (PIU) and negative emotional states, highlighting how familial factors are associated with this relationship. However, most existing studies have employed cross-sectional designs, with few utilizing cross-lagged panel network analysis to explore the dynamic symptom-level relationships among parental marital status, PIU, and negative emotions. This study aimed to investigate the dynamic network interactions among them in Chinese adolescents. METHODS: The sample comprised 10,394 adolescents who completed the Internet Addiction Test (IAT), the Children's Depression Inventory (CDI), and the Multidimensional Anxiety Scale for Children (MASC) twice over a six-month period. A total of four symptom networks and two cross-lagged panel networks were developed. RESULTS: The findings revealed that adolescents from divorced families exhibited significantly higher rates of PIU (PIU: T1 = 21.6%, T2 = 25.6%), depressive symptoms, and anxiety symptoms compared to their peers from non-divorced families (PIU: T1 = 15.3%, T2 = 16.5%). "Social anxiety" emerged as the key node of the networks across time. "Negative self-esteem" emerged as the most influential node in both the married and divorced family groups (married: OEI = 0.896; divorced: OEI = 0.888). It also functioned as a bridge symptom in the divorced group, whereas "anhedonia" served as the bridge symptom in the married group. CONCLUSIONS: This study underscores that PIU and negative emotions differ across parental marital status groups. Key and bridge symptoms may serve as priority targets for preventing and addressing PIU and negative emotions among Chinese adolescents.
Early exposure to aggressive and prosocial television content and children's social and behavioral development from ages 2 to 8.
Swit CS, Gath M, Gawn J … +3 more , Smith J, McLean MA, Wang Y
BMC Public Health · 2026 Jun · PMID 42380830 · Full text
BACKGROUND: Early childhood is a sensitive developmental period during which television exposure is widespread which may include portrayals of aggressive and prosocial behavior. Although prior research suggests modest as...
BACKGROUND: Early childhood is a sensitive developmental period during which television exposure is widespread which may include portrayals of aggressive and prosocial behavior. Although prior research suggests modest associations between media content and child behavior, most studies focus on screen time rather than content quality and typically examine aggressive and prosocial content in isolation. From a public health perspective, there is limited longitudinal evidence on how early exposure to aggressive and prosocial television content, and their co-occurrence, relates to children's social and behavioral development over time. METHODS: Data were drawn from the Growing Up in New Zealand longitudinal cohort. Children's exposure to aggressive and prosocial television content at age 2 was assessed using fine-grained content coding of children's most frequently watched television programmes. Children's conduct problems, peer relationship problems, and prosocial behavior were assessed at ages 2, 4.5, and 8 using the Strengths and Difficulties Questionnaire (N = 5,338). A series of latent growth curve models were estimated to examine associations between aggressive content exposure, prosocial content exposure, their interaction, and overall television viewing time, with children's initial levels and developmental trajectories of social and behavioral outcomes. RESULTS: Children's television exposure frequently included both aggressive and prosocial behaviors, highlighting the heterogeneity of content viewed by young children. Higher exposure to aggressive television content was associated with higher levels of conduct and peer relationship problems at age 2, though these associations were attenuated after accounting for overall television viewing time, which predicted a steeper decline in conduct problems across childhood. Exposure to prosocial television content, the co-occurrence of aggressive and prosocial content, and all interaction terms with overall television viewing time were not associated with any outcome at age 2 or over time. CONCLUSIONS: Overall, the findings suggest that early television content exposure is associated with behavioral differences early in development, though associations with developmental change across childhood did not contribute beyond the contribution of total television viewing time. From a public health perspective, these findings highlight the importance of considering television content quality alongside viewing quantity, recognizing that both are embedded within broader family and developmental contexts that warrant further investigation.
Pharmaceuticals and Personal Care Products (PPCPs) disposal practices in Tokha, Nepal: a health belief model study.
Bhandari G, Magar UG
BMC Public Health · 2026 Jun · PMID 42380815 · Full text
BACKGROUND: Unused and expired Pharmaceuticals and Personal Care Products (PPCPs) are emerging environmental contaminants that may pose serious risks to human health and the environment. In Nepal, household and pharmacy...
BACKGROUND: Unused and expired Pharmaceuticals and Personal Care Products (PPCPs) are emerging environmental contaminants that may pose serious risks to human health and the environment. In Nepal, household and pharmacy level waste disposal behaviors remain poorly documented. METHODS: A cross-sectional survey was conducted in Tokha municipality among 298 households and 53 pharmacy retailers. Structured questionnaires included data on: (i) demographic features, (ii) usage and storage patterns of PPCPs, and (iii) their disposal practices. This study was based on the Health Belief Model (HBM) constructs. Data were analyzed using descriptive statistics, chi-square tests, Spearman's correlation analysis, and partial least squares structural equation modeling (PLS-SEM). RESULTS: Unsafe storage and improper disposal practices being common among households and pharmacy retailers. About 41.6% of the households stored unused or expired pharmaceuticals, primarily analgesics and skincare products that accounted 63.1% and 77.5%, respectively. Expired PPCPs were mostly disposed of in household garbage containers (88.9%) or burned (12.8%), while only 4.7% were returned to pharmacies. Of the HBM constructs, self-efficacy was the strongest predictor of response to cues for safe disposal behaviors (β = 0.184). Of all pharmacy retailers, only 17% were aware of disposal regulations and facilities. Major challenges included the lack of take-back systems (37.8%) and limited disposal facilities (24.5%). The study highlighted significant challenges in the management of unused and expired PPCPs among households and pharmacy retailers in Tokha municipality. CONCLUSIONS: Households and pharmacy retailers reported unsatisfactory waste disposal practices. Community-based awareness drives and pharmaceutical waste management modules boost self-efficacy by giving people the knowledge and confidence to safely handle and manage unused and expired PPCPs. In a case there are accessible municipal collection systems, pharmacy- or municipal-level take-back points, and clear regulatory mechanisms in the country, it becomes easier for individuals to accelerate that confidence into safety practices to reduce environmental deterioration and protect public health in Nepal.
Beyond knowledge deficits: social visibility, family dynamics, and delayed initiation among people living with HIV in Southwestern China-a descriptive phenomenological study.
Zhou Y, He Q, He X … +4 more , Li M, Yang H, Suen LKP, Chen L
BMC Public Health · 2026 Jun · PMID 42380811 · Full text
BACKGROUND: Despite global recommendations for early antiretroviral therapy (ART) initiation and the well-established benefits of timely treatment, delayed ART initiation remains a concern in some settings. Previous stud...
BACKGROUND: Despite global recommendations for early antiretroviral therapy (ART) initiation and the well-established benefits of timely treatment, delayed ART initiation remains a concern in some settings. Previous studies have identified multiple barriers to ART initiation, including limited treatment knowledge, stigma, disclosure concerns, side-effect fears, and service-related barriers. Less is known, however, about how these factors become organized in everyday life into a sustained process of delay after diagnosis. This study explored how people living with HIV in southwestern China experienced delayed ART initiation, with attention to social visibility, family relationships, informal information, and changing perceptions of treatment urgency. METHODS: A descriptive phenomenological design was used. Semi-structured, in-depth interviews were conducted with 23 people living with HIV who had delayed ART initiation and were recruited from two HIV-designated hospitals in Yunnan Province, China. Interviews were audio-recorded, transcribed, and analyzed using Colaizzi's seven-step method. The analysis was primarily inductive, while an HIV-related stigma framework informed the research question, interview domains, and later interpretation. RESULTS: Four themes were identified. First, delayed ART initiation often began when treatment entry was experienced as a risk of being recognized, leading to concealment, stigma-related shame, and avoidance. Second, delay was sustained through family negotiation, informal information, symptom-free periods, concerns about side effects, and the normalization of waiting. Third, treatment initiation became more likely when family or significant-other support, continued healthcare-provider contact, symptoms, or complications changed participants' perceptions of risk. Fourth, cross-theme patterns showed that delayed ART initiation was experienced as unfolding from concealment and waiting toward treatment entry when support, symptoms, or changing perceptions of risk made continued delay less acceptable. The local context functioned primarily as a contextual condition shaping social visibility, mobility-related experience, informal information, and treatment urgency, rather than as a standalone mechanism. CONCLUSIONS: Delayed ART initiation in this study was not solely attributable to insufficient knowledge or poor treatment awareness. Participants described delay as an experience shaped by social visibility concerns, stigma-related shame, family negotiation, informal information, symptom experiences, and changing perceptions of risk. Efforts to promote timely ART initiation may need to address not only treatment knowledge, but also confidentiality concerns, stigma-sensitive support, family context, and the social conditions in which treatment decisions are made.
Hungry for equity in the Green Mountain State: food insecurity among college students in Vermont.
Bhurosy T, Danzy J, Scott L … +6 more , Abraham FO, Cromis M, Mbaya PY, Lyras S, Reilly N, Chung T
BMC Public Health · 2026 Jun · PMID 42380808 · Full text
BACKGROUND: There are limited data on food insecurity among college students from different marginalized backgrounds, both in Vermont and other predominantly White spaces, and what their institutions could do to improve...
BACKGROUND: There are limited data on food insecurity among college students from different marginalized backgrounds, both in Vermont and other predominantly White spaces, and what their institutions could do to improve food security and other basic needs. Thus, the aims of this study were to 1) examine food insecurity prevalence and its correlates among underrepresented college students, 2) assess their reasons for using campus food pantries and strategies for improving access to culturally appropriate foods on campus, and 3) determine their perspectives regarding how their institutions can address their basic needs. METHODS: Using a mixed methods cross-sectional research design, a convenience sample of full-time students or trainees ages 18 and older enrolled at four institutions of higher education in Vermont, United States, were recruited through flyers, course announcements, newsletters, listservs, and social media posts. An online survey provided estimates of food insecurity, on-campus food pantry use, and participant perspectives on institutional strategies to address basic needs through open-ended questions. Food insecurity was assessed by the 10-item United States Department of Agriculture food security survey module. Descriptive statistics assessed frequencies and percentages along with means and standard deviations. Binary logistic regression was conducted to estimate the odds of food insecurity. Inductive coding was used to analyze qualitative data and identify emergent themes. RESULTS: Around 40% of all participants experienced food insecurity in the past year, with higher odds observed in students aged ≥ 30, Pell Grant recipients, first-generation students, Black students, and those who used a food pantry. The most cited reason for using a campus food pantry was ease of getting to the pantry while lack of awareness was the most reported barrier. Over 50% of participants recommended gathering feedback from students about their preferences to improve access to culturally appropriate foods. Common themes from qualitative analyses included: food access support, safe and affordable housing access, mental health and healthcare access, financial aid access, reliable and affordable transportation access, non-financial academic support, and general support services. CONCLUSIONS: Institutions should prioritize food assistance programs targeting college students and incorporate mental health care, housing support, and financial aid for comprehensive safety nets.
Does the obesity paradox truly exist? A study on the relationship between different degrees of obesity and stroke incidence and mortality based on the UK Biobank.
Shi L, Zhai S, Shi J … +7 more , Zhang F, Zhang Z, Pan Z, Tian M, Zhang Z, Dong Z, Li Y
BMC Public Health · 2026 Jun · PMID 42380798 · Full text
BACKGROUND: Obesity has been associated with increased incidence and severity of various cardiovascular risk factors, as well as an elevated risk of stroke. However, the evidence of its effect on outcomes in stroke patie...
BACKGROUND: Obesity has been associated with increased incidence and severity of various cardiovascular risk factors, as well as an elevated risk of stroke. However, the evidence of its effect on outcomes in stroke patients has been equivocal. Previous studies have documented the obesity paradox in stroke, characterized by a negative correlation between BMI and stroke mortality. To address the limitations of relying solely on BMI in previous investigations, notably the documented obesity paradox linking BMI to stroke mortality, our study incorporates additional obesity metrics beyond BMI. We aimed to comprehensively evaluate the relationship between obesity and stroke outcomes, thereby providing a more holistic understanding of their association. METHODS: The present study included 502,128 participants from the UK Biobank database. Cox proportional hazard models were performed to determine the associations of indicators, including BMI, WC, WHR, WHtR and BFP with the incidence and mortality of stroke. RESULTS: Increased BMI was associated with elevated stroke incidence and mortality, with the lowest risk observed in the BMI range of 18-24 kg/m². Both lower BMI (17≤BMI<18.5 kg/m²) and higher BMI (BMI≥25 kg/m²) were linked to higher incidence and mortality of stroke. In contrast, other obesity-related indicators (WC, WHR, WHtR and BFP) exhibited more pronounced linear relationships with the incidence of stroke, all-cause mortality in the total population, stroke mortality in the total population and all-cause mortality in stroke patients. However, no significant differences were found in stroke-specific mortality among underweight, normal weight, overweight and obese groups in stroke patients across various obesity indicators, suggesting no obvious association between obesity and stroke-specific mortality in stroke patients under the current definitions and adjustments in this study. Notably, stroke severity, acute care, and complications were not available in the analysis, and residual confounding from these unmeasured factors cannot be ruled out. Furthermore, our analyses on the relationships between several obesity subtypes with different metabolic health statuses and stroke incidence and mortality revealed that, regardless of normal weight or not, individuals with metabolic abnormalities had significantly higher incidence and mortality of stroke compared to those with normal metabolism. This highlights the importance of metabolic status in the onset and prognosis of stroke. CONCLUSIONS: Our findings demonstrate that stroke-specific mortality in stroke patients was not associated with obesity severity when assessed using multiple obesity indicators including BMI, WC, WHR, WHtR and BFP. This is inconsistent with previous observations of the obesity paradox. Meanwhile, the observation that individuals with metabolic abnormalities exhibit significantly higher stroke incidence and mortality compared to those with normal metabolism further confirms the adverse impact of metabolic disturbances on stroke risk and prognosis, underscoring the pivotal role of metabolic health in stroke management.
Physical activity among active-duty US military servicemembers with overweight and obesity.
Yarish NM, Morse JL, Wooldridge JS … +2 more , Dooley EE, Afari N
BMC Public Health · 2026 Jun · PMID 42374412 · Full text
BACKGROUND: To examine physical activity (PA) among US military servicemembers (SM) with overweight and obesity (OW/OB) and if they meet Physical Activity Guidelines (PAG). To assess differences in PA by sex and associat...
BACKGROUND: To examine physical activity (PA) among US military servicemembers (SM) with overweight and obesity (OW/OB) and if they meet Physical Activity Guidelines (PAG). To assess differences in PA by sex and associations between PA and body composition. METHODS: PA duration and intensity were objectively collected via accelerometers and self-reported daily average via self-report International Physical Activity Questionnaire (IPAQ) among US active-duty SM (n=113, 58% female, Mean BMI = 33.3 ± 3.9 kg/m2). Sex, body mass index (BMI), and body fat % (BF% via circumference and an equation) were measured. Accelerometer PA and sedentary time were computed for IPAQ categories who met PAG. PA sex differences were assessed with t-tests and chi-square. Pearson correlations examined associations between PA, BMI, and BF%. RESULTS: Accelerometry showed SM engaged in a daily average of 93 minutes of moderate to vigorous PA (MVPA), 145.2 minutes of light, and 307 minutes of sedentary activity. The IPAQ showed SM engaged in 91 minutes of MVPA, 121.1 minutes of walking, and 423 minutes sitting. Males engaged in more accelerometer-derived MVPA (p = 0.04) than females. Accelerometry showed 100% of SM met the PAG while the IPAQ showed 90% met the PAG. The IPAQ and accelerometer MVPA metrics were correlated (r = 0.26; p < 0.01). Sedentary time was correlated with BMI (r = 0.25; p < 0.01). Sitting was correlated with BF % (r = -0.26; p = 0.02). CONCLUSIONS: Overall, SM with OW/OB meet PAG. PA levels among SM are related to sex, BMI, and BF%.
Post-disaster psychosocial and physical determinants of perceived chewing difficulty among fukushima residents: the Fukushima Health Management Survey.
Funakubo N, Ohira T, Sato S … +7 more , Nagao M, Hayashi F, Eguchi E, Maeda M, Miura I, Yabe H, Yasumura S
BMC Public Health · 2026 Jun · PMID 42374378 · Full text
BACKGROUND: Oral functions, including chewing and occlusal function, are associated with nutritional intake, cognitive function, muscle strength, and balance. Therefore, maintaining oral functions is crucial for extendin...
BACKGROUND: Oral functions, including chewing and occlusal function, are associated with nutritional intake, cognitive function, muscle strength, and balance. Therefore, maintaining oral functions is crucial for extending healthy life expectancy. This study aimed to identify factors associated with perceived chewing difficulty as a functional oral outcome and its worsening following the Great East Japan Earthquake, with a particular focus on disaster-related psychosocial factors. METHODS: This cross-sectional study investigated self-reported chewing difficulty, psychological factors (e.g., traumatic reactions and psychological distress), disaster-related experiences (e.g., evacuation and experiences related to the nuclear accident, job loss, loss of a close person), medical history, and lifestyle factors among 64,188 residents aged 16-101 years who experienced the earthquake on March 11, 2011. Multinomial logistic regression analyses were performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for each factor associated with prevalent and exacerbated chewing difficulty. RESULTS: The proportions of participants with prevalent and exacerbated chewing difficulty were 2.8% and 0.31%, respectively. Multivariate-adjusted ORs (95% CIs) for factors associated with exacerbated chewing difficulty were as follows: post-traumatic stress disorder symptoms, 3.23 (2.35-4.43); psychological distress, 3.71 (2.71-5.09); experience of the nuclear accident, 1.57 (1.14-2.17); job loss, 1.47 (1.08-2.02); history of mental illness, 2.94 (2.00-4.32); dyslipidemia, 1.47 (1.06-2.05); and current exercise habit, 0.60 (0.44-0.83). CONCLUSIONS: These findings suggest that previously underexplored post-disaster psychosocial factors, including PTSD symptoms, experience of the nuclear accident, and job loss, as well as physical factors such as a history of mental illness and dyslipidemia, are associated with perceived chewing difficulty. In contrast, regular exercise habits were negatively associated with perceived chewing difficulty and may have a preventive role.
Predicting high perceived stress in late adolescence: development and validation of a prognostic model.
Steen PB, Dalgaard VL, Andersen JH … +2 more , Willert MV, Biering K
BMC Public Health · 2026 Jun · PMID 42374368 · Full text
AIM: Stress levels have increased among adolescents, yet tools for identifying those at high risk remain limited. This study aimed to develop and internally validate a prognostic model estimating the probability of high...
AIM: Stress levels have increased among adolescents, yet tools for identifying those at high risk remain limited. This study aimed to develop and internally validate a prognostic model estimating the probability of high perceived stress in young adulthood using data collected at age 15. METHODS: Data were from the West Jutland Cohort Study including 2,108 Danish adolescents with complete information on the 4-item Perceived Stress Scale at ages 15 and 18. High stress at age 18 was defined as a total score of 9 or higher. Twenty-three candidate predictors were examined using Least Absolute Shrinkage and Selection Operator (LASSO) regression across 100 imputed datasets. Predictors selected in ≥ 80% of imputations were entered into a pooled logistic regression model. Model performance was evaluated using 10-fold cross-validation under multiple imputation. Discrimination was assessed with the area under the receiver operating characteristic (ROC) curve (AUC), and calibration with calibration-in-the-large (CITL) and slope. RESULTS: Three predictors at age 15 were retained: perceived stress, depressive symptoms, and self-esteem. The model showed good calibration (CITL = 0.003; slope = 1.008; expected-to-observed ratio = 0.998) and acceptable discrimination with an AUC = 0.72 (0.68;0.76). The Brier score was 0.081, indicating satisfactory overall predictive accuracy. The model showed high negative predictive values but modest positive predictive values. CONCLUSIONS: A simple model based on self-reported psychosocial measures in mid-adolescence predicted later high stress with good calibration and moderate discrimination. External validation is needed to assess generalisability and inform potential use as a low-burden decision-support tool in school health settings.
Perceived barriers to maternal healthcare utilization: insights from skilled birth attendants in six high-burden states of northern Nigeria.
Ebinim H, Akpiroroh E, Ajayi M … +12 more , Sabbath UO, Jibril J, Ehize P, Isiaka S, Kolawole D, Nto S, Unogu C, Rauf R, Atobatele S, Sampson S, Eugene E, Okagbue H
BMC Public Health · 2026 Jun · PMID 42374354 · Full text
BACKGROUND: Maternal mortality remains a major public health concern globally despite significant progress over the past two decades. Nigeria is among the countries with the highest maternal mortality rates. Within the c...
BACKGROUND: Maternal mortality remains a major public health concern globally despite significant progress over the past two decades. Nigeria is among the countries with the highest maternal mortality rates. Within the country, marked regional disparities persist, with northern Nigeria experiencing a significantly higher burden. These disparities are shaped by a complex interaction of sociocultural norms, household power relations, geographic constraints, and health system limitations that influence women's access to skilled birth attendance and facility-based delivery. The study explored skilled birth attendants' perceived barriers to the provision of maternal healthcare services that prevent pregnant women from seeking appropriate care in government-based facilities. METHODS: This study employed a qualitative research design to explore skilled birth attendants' perspectives on barriers preventing women from accessing maternal healthcare services. Twenty-four skilled birth attendants were purposively selected from primary healthcare facilities across six high-burden northern Nigerian states: Bauchi, Kaduna, Katsina, Kano, Jigawa, and Niger. Data were collected through in-depth interviews using a semi-structured and pretested interview guide. The Three Delay Model guided the study to examine factors affecting women's decisions to seek care, their ability to reach healthcare facilities, and their experiences receiving care within facilities. RESULTS: The findings revealed multiple barriers across the three phases of delay. At the household level, cultural expectations, generational beliefs, and patriarchal decision-making structures limited women's autonomy to seek skilled care. Mothers-in-law and husbands often influenced or determined childbirth decisions, sometimes discouraging facility delivery. Structural barriers also affected women's ability to reach health facilities, including long travel distances, poor road infrastructure, and limited transportation options. Even when women arrived at health facilities, systemic challenges such as shortages of skilled health workers, inadequate medical supplies, insufficient delivery beds, financial constraints, and weak referral systems contributed to delays in receiving appropriate care. CONCLUSION: In conclusion, maternal healthcare service utilization in northern Nigeria is shaped by interconnected sociocultural, economic, and health system factors that contribute to delays in seeking, reaching, and receiving care. Therefore, addressing maternal mortality in this context requires comprehensive strategies that strengthen health system capacity, improve transportation and referral systems, reduce financial barriers, and promote gender-equitable decision-making within households and communities. Such integrated efforts are essential for improving access to skilled birth attendance and advancing progress toward global maternal health targets.
Physical exercise and problematic smartphone use among adolescents in Western China: a multi-center cross-sectional study on the serial mediation of self-control and meaning in life.
He X, Liu M, Mo P … +2 more , Luo W, Luo J
BMC Public Health · 2026 Jun · PMID 42374353 · Full text
OBJECTIVE: Problematic smartphone use has become a prominent public health issue in the information era. Although research has shown that exercise is beneficial in alleviating problematic smartphone use among adolescents...
OBJECTIVE: Problematic smartphone use has become a prominent public health issue in the information era. Although research has shown that exercise is beneficial in alleviating problematic smartphone use among adolescents, the specific underlying mechanisms have not been fully elucidated. This study aims to explore the internal mechanisms between self-control and the meaning in life in adolescents' problematic smartphone use (PSU) through physical exercise. METHODS: A multi-center, large-sample cross-sectional study was conducted among students from 34 primary and secondary schools in western China. Assessments were conducted using the Physical Activity Rating Scale (PARS-3), the Brief Self-Control Scale (BSCS), Meaning in Life Questionnaire (MLQ), and the Smartphone Addiction Scale-Short Version (SAS-SV). Data were analyzed using the Mann-Whitney U test, correlation analysis, and mediation analysis based on structural equation modeling. RESULTS: A total of 8,245 participants were included. The rates of PSU in males and females were found to be 23.97% and 19.47%, respectively. After adjusting for relevant demographic covariates, structural equation modeling analysis indicated that exercise was negatively associated with PSU (β = -0.056, p < 0.001). Both self-control (β = -0.034, p < 0.001) and meaning in life (β = -0.019, p < 0.001) played potential partial mediating roles in the relationship between physical exercise and PSU. Furthermore, self-control and meaning in life served as potential partial chain mediators between physical exercise and adolescent PSU (β = -0.011, p < 0.001), accounting for 9.17% of the total association. CONCLUSION: Maintaining regular physical exercise can enhance adolescents' self-control ability and meaning in life thereby helping to prevent or alleviate PSU behaviors.
The burden and risk factors of NCDs in Zimbabwe: evidence from the Zimbabwe population based HIV impact assessment 2020 survey.
Mapingure MP, Dzinamarira T, Chingombe I … +6 more , Moyo E, Mpofu A, Mugurungi O, Herrera H, Madziva R, Musuka GN
BMC Public Health · 2026 Jun · PMID 42374351 · Full text
BACKGROUND: The burden of non-communicable diseases (NCDs) has emerged as a critical public health challenge in Zimbabwe, exacerbated by a complex interplay of socioeconomic factors, demographic shifts, and urbanization....
BACKGROUND: The burden of non-communicable diseases (NCDs) has emerged as a critical public health challenge in Zimbabwe, exacerbated by a complex interplay of socioeconomic factors, demographic shifts, and urbanization. This study leverages data from the Zimbabwe Population-Based HIV Impact Assessment (ZIMPHIA) 2020 survey to provide further insights and understanding of the prevalence and risk factors associated with NCDs in the country. METHODS: Utilizing a two-stage, stratified cluster sample design, we analyzed data from 19,535 participants. We conducted univariate and multivariate logistic regression analyses to evaluate the relationship between self-reported NCDs and demographic factors, including age, gender, urban versus rural residency, HIV status, and socioeconomic status. RESULTS: Findings revealed that approximately 14.3% of the population reported being diagnosed with at least one NCD, with hypertension and diabetes presenting prevalences of 10.8% and 2.2%, respectively. Age was a significant predictor of NCD burden, and we also noted disparities, particularly among women and individuals in higher wealth quintiles. CONCLUSION: Approximately one in seven Zimbabwean adults had been diagnosed with at least one non-communicable disease before 2020, with hypertension and diabetes the most common conditions. Older age increases NCD risk, and women and people in higher wealth quintiles carry a higher burden. These patterns suggest the need to keep prioritizing NCD prevention, screening, and management.
Knowledge, practices, perceived challenges, and factors associated with menstrual hygiene among adolescent school girls in southern Sri Lanka.
Dissanayaka DMYWK, Balapitiya WMPAF, Sundarapperuma SMTD … +1 more , Kariyawasam PN
BMC Public Health · 2026 Jun · PMID 42374340 · Full text
BACKGROUND: Menstrual hygiene is essential for adolescent girls, as it greatly affects their capacity to engage in academic and extracurricular activities. Adolescent girls often encounter various challenges in maintaini...
BACKGROUND: Menstrual hygiene is essential for adolescent girls, as it greatly affects their capacity to engage in academic and extracurricular activities. Adolescent girls often encounter various challenges in maintaining proper menstrual hygiene, making it essential to explore these challenges to design effective future interventions. Therefore, this study was conducted to assess the knowledge, practices, perceived challenges, and factors associated with menstrual hygiene among adolescent school girls in Galle Educational Zone in southern Sri Lanka. METHODS: This study employed a mixed-methods design, utilizing a sequential explanatory strategy, comprising a quantitative descriptive component followed by an exploratory descriptive qualitative component. The study was conducted with the participation of 389 girls in the Galle educational division using the multi-stage cluster sampling method in 2024. A validated, modified, self-administered questionnaire was used to collect data. Descriptive statistics, Chi-square test, independent sample t-test, one-way ANOVA, and multiple linear regression were used based on the type of variable. For the qualitative component, in-depth interviews were conducted with 15 purposively selected school girls. The interviews were transcribed verbatim, and the data were coded systematically to identify recurring patterns and themes. The ethical approval was obtained from the ethics review committee Faculty of Allied Health Sciences, University of Ruhuna. RESULTS: Among the participants, only 32.7% (n = 125) had satisfactory knowledge, and only 17.3% (n = 66) had a satisfactory level of practice on menstrual hygiene. Knowledge on menstruation was associated with menstrual hygiene practices (p = 0.015), information received from the media (p = 0.010), experience on menstruation (p = 0.025), mother's level of education (p < 0.001) and father's level of education (p < 0.001). Hygiene practices on menstruation were associated with the type of family (p = 0.023). In the qualitative component, under the perceived challenges, four sub-themes emerged: comfort and dignity, socio-cultural taboos, physical constraints, and insufficient resources. CONCLUSION: The participants' overall knowledge on menstruation and menstrual hygiene was inadequate. Key factors influencing menstrual hygiene included parents' level of education, family structure, and prior experience with menstruation.
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