BMC Public Health [JOURNAL]
Sun
200 papers
Attitudes and beliefs regarding colorectal cancer screening among African American patients of community health centers in North-Central Florida and stakeholder perspectives: a qualitative study.
Luque JS, Dickey SL, Jackson DR … +10 more , Franklin OS, Vargas MA, Mohorne R, Kiros GE, Ali A, Robinson T, Duncan B, Freeman J, Howell-Murray J, Gwede CK
BMC Public Health · 2026 Jun · PMID 42374328 · Full text
BACKGROUND: Colorectal cancer (CRC) is one of the leading causes of cancer mortality in the US with African Americans continuing to experience CRC health disparities due to numerous factors. While colonoscopy remains the...
BACKGROUND: Colorectal cancer (CRC) is one of the leading causes of cancer mortality in the US with African Americans continuing to experience CRC health disparities due to numerous factors. While colonoscopy remains the most utilized test for CRC screening, stool-blood tests are cost-effective and offered by community health centers (CHC) serving un- and underinsured patients. Qualitative research has identified multilevel barriers to CRC screening and can potentially inform the development of tailored interventions to promote stool-based screening. METHODS: In this qualitative study, we explored the CHC context for delivering CRC screening services and patient education by interviewing six stakeholders of two north Florida CHCs and conducted six focus groups among African American patients of the two CHCs who had recently completed a CRC screening. CHC stakeholders were identified for interviews by their organizational roles delivering CRC screening services and focus group participants were recruited from our previous CRC screening behavioral clinical trial study group participant pool. RESULTS: CHC stakeholders assessed their organizations' delivery of CRC screening services, which included stool-based tests and colonoscopy referrals, and discussed trends in the screening rates achieved by their organizations. CHC stakeholders spoke about their patient education and outreach within the community and offered ideas about how community-based CRC screening education could be improved. CHCs highly valued the community-academic partnership, identifying numerous mutually beneficial aspects and embraced the ongoing partnership as a way to increase CRC screening adherence among their patients. The focus group discussions can be grouped into three main themes. The first theme is healthcare attitudes and relationships with providers. This theme covered perceptions of seeking healthcare and communication and trust with providers. The second theme is CRC knowledge and prevention. This theme covered patients' knowledge about CRC, what symptoms to monitor, knowing their family history of cancer, and the different screening tests. The third theme is technological and systematic issues in healthcare. These discussions focused on health insurance and accessing the patient portal. CONCLUSIONS: This study demonstrated the value of community-engaged qualitative research on CRC screening delivery and completion in partnership with CHC stakeholders.
Conflicted and healthy behavioural profiles in adolescents: a latent profile analysis of traditional sports attitude, physical activity attitude, and digital game addiction.
Özsaydi Ş, Uslu ÖS, Kabak B … +1 more , Erdoğan A
BMC Public Health · 2026 Jun · PMID 42374324 · Full text
PURPOSE: This study aimed to identify latent profiles of adolescents based on their traditional sports attitudes, digital game addiction levels, and physical activity attitudes using a person-centered approach. METHOD: A...
PURPOSE: This study aimed to identify latent profiles of adolescents based on their traditional sports attitudes, digital game addiction levels, and physical activity attitudes using a person-centered approach. METHOD: A total of 634 adolescents (female = 50.5%, n = 320; male = 49.5%, n = 314; mean age = 15.8 years; Grades 9-12) from state high schools in Antalya and Osmaniye provinces were assessed using the Traditional Sports Attitude Scale, the Digital Game Addiction Scale, and the Physical Activity Attitude Scale. Data were analysed via Latent Profile Analysis (LPA); between-profile differences were examined through ANOVA and post-hoc tests. RESULTS: LPA yielded three meaningful profiles (Entropy = 0.816). The Active-Healthy profile (n = 467, 73.7%) is characterised by high traditional sports attitude, low digital game addiction, and positive physical activity attitude. The Conflicted-Addicted profile (n = 101, 15.9%) exhibits an unexpected internal conflict pattern, carrying the highest digital game addiction in the sample (M = 3.31) despite high traditional sports attitude. The At-Risk profile (n = 66, 10.4%) displays the lowest values across all positive variables. Post-hoc analyses showed that traditional sports attitude failed to differentiate two profiles (|d| = 0.01 to 0.16; p = .314-0.994); whereas negative physical activity attitude was the strongest discriminating variable (η² = 0.621). CONCLUSION: A high traditional sports attitude cannot be considered universally protective against digital addiction risk. Intervention programs should directly target negative physical activity attitudes, beyond the dimension of cultural participation.
Dual-Model framework for CHIKV transmission modeling: ODE and Petri Net Analysis of the 2025 Foshan outbreak.
Liu H, Tian J, Li X … +6 more , Li Y, Li J, Yang Z, Deng X, Xu M, Hon C
BMC Public Health · 2026 Jun · PMID 42374320 · Full text
This study addresses the 2025 Chikungunya outbreak in Foshan City, Guangdong Province, China, by constructing a dual-model framework based on Ordinary Differential Equations (ODE) and Petri Nets (PN) for comparative anal...
This study addresses the 2025 Chikungunya outbreak in Foshan City, Guangdong Province, China, by constructing a dual-model framework based on Ordinary Differential Equations (ODE) and Petri Nets (PN) for comparative analysis of Chikungunya transmission dynamics and reproduction number estimation methods. The research employs SEICR (Susceptible-Exposed-Infectious-Chronic-Recovered) compartmental modeling to compare two formal representations under matched epidemiological assumptions, and evaluates the timing of epidemic control measures through a three-phase intervention fitting protocol. Model validation results show that both models achieve root mean square errors (RMSE) of 30.98 (ODE) and 31.05 (PN), mean absolute errors (MAE) of 15.57 and 15.78, and [Formula: see text] and 0.9498, respectively. Both models predict epidemic peaks at day 33 (406 cases), occurring 3 days earlier than the observed peak (432 cases), with a peak value error of 6.0%. Residual analysis reveals that negative residuals account for 71.4% (ODE) and 73.8% (PN) of the observation-window residuals, suggesting a structured overprediction pattern in descriptive diagnostics. Reproduction number analysis reveals that the initial transmission indicators are approximately 14.67 (ODE)/13.90 (PN), with effective values progressively decreasing through three intervention phases: 7.85/7.86 after Phase 1, 7.59/7.56 after Phase 2, and 0.059 in Phase 3, below the transmission threshold. An additional no-demography robustness check shows that removing demographic turnover changes total predicted cases by only 0.03%, suggesting that the remaining uncertainty lies mainly in omitted vector-side dynamics rather than in human-side demography. Sensitivity analysis indicates that the recovery rate (γ) is the most sensitive parameter affecting [Formula: see text] within this formulation, with a Sobol index of 0.9672, explaining 96.72% of total [Formula: see text] variation. This study provides a controlled comparison between ODE and Petri Net representations of the same epidemiological structure, offering a transparent comparative framework for outbreak fitting, intervention phase identification, and future extension toward explicit host-vector models.
Cost effectiveness and public health impact of PCV20 among adults in France.
Fiévez S, Menara M, Blanc E … +3 more , Bellier L, Sivignon M, Vietri J
BMC Public Health · 2026 Jun · PMID 42374313 · Full text
INTRODUCTION: Pneumococcal infections remain a significant public health concern in France, particularly among older adults at higher risk of developing severe forms. In 2023, the French health authorities updated vaccin...
INTRODUCTION: Pneumococcal infections remain a significant public health concern in France, particularly among older adults at higher risk of developing severe forms. In 2023, the French health authorities updated vaccination guidelines recommending a single-dose 20-valent pneumococcal conjugate vaccine (PCV20) for adults at increased risk due to underlying medical conditions and later extending it to all adults aged 65 years and over. The objective of this analysis is first to evaluate the cost-effectiveness and public health impact of PCV20 in replacing 13-valent pneumococcal conjugate vaccine → 23-valent pneumococcal unconjugated polysaccharide vaccine (PCV13 → PPV23) in the vaccination programme and secondly to assess the value of extending the recommendation to a broader population. METHODS: A deterministic Markov model was adapted to compare clinical and economic outcomes of adult pneumococcal vaccination strategies in France over a lifetime horizon. The economic inputs in this analysis were estimated in 2024 euros from a healthcare system perspective. Population parameters, epidemiological data and cost were derived from French databases and institutional reports. Utility and vaccine effectiveness inputs were obtained from the literature. RESULTS: Replacing PCV13 → PPV23 with PCV20 in at-risk adults reduced pneumococcal disease burden and was a dominant strategy, generating cost savings of €56,786 at the population level (€1.05 per patient) while improving health outcomes with an incremental gain of 0.00015 QALYs per patient. Expanding PCV20 to all individuals aged 65+ further reduced disease incidence and mortality over a lifetime horizon, averting 900 additional invasive pneumococcal diseases (IPD) cases (mainly bacteremia and meningitis), 11,600 pneumonia cases, and over 1,500 deaths. These additional health benefits were achieved at an incremental cost of €63,191 at population level (€0.81 per patient) corresponding to a gain of 0.00019 QALYs per patient. The incremental cost-effectiveness ratio was 4,308 €/QALY, indicating highly cost-effective strategy relative to commonly cited French vaccine HTA benchmarks. CONCLUSION: PCV20 is a cost-saving alternative to the PCV13 → PPV23 sequence for at-risk adults in France. Expanding recommendations to include all adults aged 65 years and over provides substantial public health gains and represents a highly cost-effective strategy.
Dynamic models of occupational fatigue: a systematic review for risk management advancement.
Wahyuni A, Russeng SS, Birawida AB … +3 more , Amqam H, Rahman MA, Bakri I
BMC Public Health · 2026 Jun · PMID 42374307 · Full text
BACKGROUND: Occupational fatigue is a major safety and health risk across work sectors. Because fatigue accumulates and fluctuates over time, effective fatigue management requires dynamic approaches that can anticipate r...
BACKGROUND: Occupational fatigue is a major safety and health risk across work sectors. Because fatigue accumulates and fluctuates over time, effective fatigue management requires dynamic approaches that can anticipate risk and inform preventive controls rather than rely on point-in-time assessment. Although dynamic fatigue modelling has expanded rapidly, evidence remains fragmented across modelling paradigms and sectors, limiting clarity on which approaches are most suitable for implementation. This systematic review synthesises recent evidence on dynamic models of occupational fatigue and evaluates their relevance for fatigue management and risk control. METHODS: Records published from 2019 to 2025 were identified from Scopus using DOI-indexed retrieval and screened with Watase Uake Tools to support article mining and Preferred Reporting Items for Systematic Reviews. Searches were complemented in PubMed, ProQuest, Wiley Online Library, and ScienceDirect. References were managed in Zotero, and screening, selection, and data extraction followed a structured process with manual searching and citation tracking. RESULTS: From 180 records, 12 peer-reviewed studies met the inclusion criteria. Four modelling approaches were identified: physiology-informed dynamic simulation, machine learning and deep learning for near real-time monitoring, probabilistic dynamic models such as Dynamic Bayesian Networks, and symptom-network or Bayesian graph approaches. Models were most useful for fatigue management when they integrated multimodal inputs and produced actionable outputs such as fatigue risk levels and intervention triggers, but implementation was limited by small samples and insufficient field validation. CONCLUSION: Future research should prioritize longitudinal workplace validation, harmonized benchmarking, and deployable hybrid models integrating physiological, psychosocial, and contextual determinants.
Youth Empowered Self-Care: a direct-to-participant intervention to promote mental well-being.
D'Agostino EM, Pulgaron ER, Neshteruk C … +13 more , Brown-Lowery C, Abbot-Grimes P, Fadika T, Ward M, Sato J, Cooper M, Hansen E, Enwright E, Nardi MI, Forde J, Hicks A, Li T, Hornik CP
BMC Public Health · 2026 Jun · PMID 42374306 · Full text
BACKGROUND: A crisis of youth mental health exists, disproportionately affecting minoritized and low-income youth. Park- and community-based recreation programs may promote mental well-being by offering accessible and af...
BACKGROUND: A crisis of youth mental health exists, disproportionately affecting minoritized and low-income youth. Park- and community-based recreation programs may promote mental well-being by offering accessible and affordable recreation in non-stigmatizing settings, with the potential to reduce mental health disparities. However, these programs are not currently being used at scale. Youth Empowered Self-Care (YES) is a mental well-being intervention intended to increase timely access to park- and community-based recreation programs among minoritized low-income youth. We evaluated YES for feasibility, acceptability, and change in participants' psychological, mental, and social well-being and anxiety. METHODS: This study was a single-arm prospective cohort pilot design. Youth aged 8-12 years were enrolled with two parks and recreation departments in Durham, North Carolina, and Miami, Florida, United States. Youth and caregivers were directed to the YES website, where they received information on mental health and resources, and park- and community-based programs. Data collected included website usage, program enrollment, and caregiver-reported youth psychological, mental, and social well-being and anxiety at baseline and at 3 months using the KIDSCREEN-27 and Screen for Child Anxiety Related Emotional Disorders (SCARED) measures to assess feasibility, acceptability, and change in psychological, mental, and social well-being and anxiety. Change from pre- to post-test scores and paired t-tests were used to determine change in mental well-being via the KIDSCREEN-27 and SCARED assessments. RESULTS: Participants (n = 247) included youth aged 8-12 years (36.4% Black;34.4% White; 11.7% Hispanic; 50.2% male; 39.7% >$50,000-$75,000 annual household income). The YES website had > 1,100 users, with ≥ 51.0% of website users enrolling in YES. Almost all (99.1%) participants indicated that YES connected them to a program, and that they subsequently completed their program (99.5%). Eighty-five percent and 31.3% of caregivers reported an increase on the youth psychological well-being and peer and social support subscales, respectively. Nearly half (46.5%) of caregivers reported a reduction in youth anxiety. CONCLUSIONS: This study suggests that YES may promote youth mental well-being. Pilot data also demonstrated YES feasibility and acceptability, and linkage to mental health education and treatment. The next steps for this research entail randomized prospective trials to assess YES efficacy. TRIAL REGISTRATION: NCT06255093 (www. CLINICALTRIALS: gov); registration date: February 12, 2024.
Classification of 24-h movement behaviour patterns among university students and their relationship with physical fitness: a latent profile analysis.
Song Y, Liu M, Cao L … +2 more , Liu Y, Xu C
BMC Public Health · 2026 Jun · PMID 42374302 · Full text
OBJECTIVE: University students' 24-h movement behaviours, including moderate-to-vigorous physical activity (MVPA), light-intensity physical activity (LIPA), sedentary behaviour (SB), and sleep (SLP), are interdependent a...
OBJECTIVE: University students' 24-h movement behaviours, including moderate-to-vigorous physical activity (MVPA), light-intensity physical activity (LIPA), sedentary behaviour (SB), and sleep (SLP), are interdependent and may jointly shape physical fitness. However, their combined relationship with physical fitness remains unclear, as most previous studies have focused on single behaviours or variable-centred associations and have rarely identified latent subgroups based on multidimensional behavioural patterns. Therefore, this study aimed to identify latent categories of 24-h movement behaviour patterns among university students using latent profile analysis (LPA), characterise these categories, and further examine their associations with physical fitness. METHODS: A total of 5,849 university students aged 18-23 years were recruited from 12 universities in Tianjin, China, including 2,267 males and 3,582 females. Time spent in MVPA, LIPA, SB, and SLP was assessed using the Chinese versions of the International Physical Activity Questionnaire and the Pittsburgh Sleep Quality Index. Physical fitness was evaluated according to the National Student Physical Fitness Standard (2014 Revised Edition), and total physical fitness score was used as the outcome variable. Latent profile analysis (LPA) was conducted separately by sex to identify 24-h movement behaviour patterns, and the BCH approach was used to compare differences in total physical fitness scores across latent classes. RESULTS: A four-class model was identified as the optimal solution for both sexes. Among males, the four profiles were low-activity / long-sleep (9.88%), higher light-intensity activity / low-sedentary (29.16%), low-activity / high-sedentary (52.89%), and high-activity / low-sedentary (8.07%). Among females, the four profiles were higher light-intensity activity / low-sedentary (13.51%), low-activity / long-sleep (12.98%), low-activity / high-sedentary / short-sleep (68.48%), and high-activity / low-sedentary (5.03%). Significant overall differences in total physical fitness scores were observed across latent classes in both males (χ² = 30.435, P < 0.001) and females (χ² = 26.215, P < 0.001). In both sexes, profiles characterised by lower sedentary behaviour and greater daily movement tended to show more favourable physical fitness scores, whereas low-activity and high-sedentary profiles showed poorer performance. CONCLUSION: University students showed clear heterogeneity in 24-h movement behaviour patterns, and these patterns were significantly associated with physical fitness. These findings support the development of sex-specific and profile-based intervention strategies to improve physical fitness among university students.
A systematic review of the determinants of vaccine hesitancy in the UK: Implications for future TB vaccine adoption.
Kennard A, Kılıç A, Alsugeir D … +2 more , Hamada Y, Rangaka MX
BMC Public Health · 2026 Jun · PMID 42374300 · Full text
BACKGROUND: Tuberculosis (TB) is a deadly yet vaccine-preventable disease mostly affecting adolescents and adults. Novel TB vaccines are now emerging, particularly for these populations; however, vaccine hesitancy, chara...
BACKGROUND: Tuberculosis (TB) is a deadly yet vaccine-preventable disease mostly affecting adolescents and adults. Novel TB vaccines are now emerging, particularly for these populations; however, vaccine hesitancy, characterised by delays, doubts or refusal to seek or accept vaccines, poses a challenge for sufficient adoption once these vaccines become available. Thus, this review systematically explored system- and individual-level determinants of vaccine hesitancy among adults in the UK, interpreting implications for the adoption of novel TB vaccines. METHODS: Five databases systematically searched for studies from 2020 - 2024 reporting qualitative outcomes on determinants of vaccine hesitancy among people living in the UK. Thematic analysis mapped extracted data onto a framework combining the Strategic Advisory Group of Experts (SAGE) model to explore system-level factors (e.g., vaccine-specific influences) and the Perceptions and Practicalities Approach (PaPA) to explore individual-level factors (e.g., perceptual influences) of vaccine hesitancy. The Mixed Methods Appraisal Tool was used to assess study quality. RESULTS: 29 qualitative and 21 mixed methods studies; 87.5% investigated hesitancy to COVID-19 vaccines. All SAGE themes were identified at the system level, most notably vaccine novelty, the media environment and health system experiences. At individual-level, all PaPA themes emerged, with vaccine-specific beliefs and knowledge most frequently identified. Overall, themes varied across the lifespan, with adolescents influenced mainly by media and social norms, and older adults by safety concerns and trust in health professionals. CONCLUSIONS: Vaccine hesitancy determinants interacted and were compounded in vulnerable subgroups, while post-pandemic disruptions to TB services may undermine adoption of novel TB vaccines. Addressing these challenges requires multi-level strategies centred on trusted, culturally sensitive communication. Delivery through routine, school and community-based programs aligns with evidence from high-incidence settings and highlights the need for coordinated action by policymakers and healthcare providers.
Baseline hypertension, adiposity, depressive symptoms, and incident stroke in middle-aged and older Chinese adults: a longitudinal analysis of CHARLS, 2011-2020.
Li W, Shao J, Zhu Y
BMC Public Health · 2026 Jun · PMID 42374299 · Full text
BACKGROUND: Stroke is a major cause of disability and death among middle-aged and older adults in China. Hypertension, adiposity, and depressive symptoms often coexist, but their associations with incident stroke are oft...
BACKGROUND: Stroke is a major cause of disability and death among middle-aged and older adults in China. Hypertension, adiposity, and depressive symptoms often coexist, but their associations with incident stroke are often examined separately. We assessed baseline cardiometabolic, adiposity-related, and psychosocial factors associated with first reported incident stroke in a longitudinal China Health and Retirement Longitudinal Study (CHARLS) cohort. METHODS: We used CHARLS data. Participants aged 45 years or older who were free of stroke at baseline and had at least one follow-up assessment were eligible. A person-period dataset was constructed to incorporate repeated follow-up intervals and the timing of first reported incident stroke. Person-period modified Poisson regression models with participant-level cluster-robust standard errors were used to estimate risk ratios (RRs) and 95% confidence intervals (CIs). RESULTS: Among 15,992 eligible participants, 1,246 first reported incident stroke events were identified during follow-up. The body mass index (BMI) and waist circumference complete-case models included 11,674 and 11,604 participants, with 949 and 941 incident stroke events, respectively. In the BMI model, hypertension (RR, 1.80; 95% CI, 1.56-2.07), diabetes (RR, 1.51; 95% CI, 1.21-1.88), heart problems (RR, 1.39; 95% CI, 1.17-1.64), BMI (RR per 1 kg/m², 1.05; 95% CI, 1.03-1.06), and 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) score (RR per 1 point, 1.03; 95% CI, 1.02-1.04) were associated with increased stroke risk. In the waist circumference model, waist circumference was also positively associated with incident stroke (RR per 1 cm, 1.02; 95% CI, 1.01-1.03). Sensitivity analyses yielded broadly consistent results. CONCLUSIONS: Hypertension, diabetes, heart problems, higher BMI, larger waist circumference, and higher CESD-10 score were associated with increased risk of first reported incident stroke among middle-aged and older Chinese adults. These observational findings suggest that vascular, adiposity-related, and psychosocial factors may help characterize stroke risk in this population, but they should be interpreted cautiously given anthropometric missingness, self-reported stroke ascertainment, and potential residual confounding.
Weight-loss practices and dietary quality in Chinese adolescents.
Yu Z, Feng D, Yu L … +9 more , Shen H, Yang X, Xu J, Pan Y, Guan Y, Xu C, Lu Y, Wang M, Qian J
BMC Public Health · 2026 Jun · PMID 42374295 · Full text
INTRODUCTION: This cross-sectional study aimed to investigate the associations between various weight-loss practices and unhealthy dietary patterns among Chinese adolescents. METHODS: We analyzed 17,483 students aged 6-1...
INTRODUCTION: This cross-sectional study aimed to investigate the associations between various weight-loss practices and unhealthy dietary patterns among Chinese adolescents. METHODS: We analyzed 17,483 students aged 6-19 years from The Zhejiang Childhood Behavior and Health Cohort, a school-based, multistage stratified cluster sample. Six weight-loss behaviors (laxatives, vomiting, non-prescribed diet pills, dieting/low-calorie foods, ≥ 24 h fasting, increased exercise) were assessed with yes/no items. Dietary quality was quantified with the 8-item Unhealthy Dietary Score (UDS-8; range 0-80, and categorized into low, moderate and high unhealthy dietary groups. Multivariable logistic regression estimated adjusted odds ratios (OR, 95% CI) for the association between each weight-loss method and dietary category. RESULTS: In the fully adjusted model, fasting ≥ 24 h conferred the highest risk of high unhealthy diet scores overall (OR = 4.65, 95% CI: 2.90-7.44), followed by vomiting (OR = 4.75, 95% CI: 2.25-10.00), diet pills (OR = 4.03, 95% CI: 1.90-8.56), and laxatives (OR = 2.65, 95% CI: 1.60-4.39), while increased exercise remained protective (OR = 0.83, 95% CI: 0.74-0.92). BMI-stratified analyses revealed that underweight adolescents showed the strongest associations for fasting (OR = 8.21) and vomiting (OR = 5.43); among those with overweight or obesity, fasting remained significant (OR = 3.32) and exercise showed the strongest protective effect (OR = 0.54); among normal-weight adolescents, dieting (OR = 1.59) and fasting (OR = 2.47) were significantly associated with high unhealthy diet, whereas exercise showed no significant association (OR = 1.03, 95% CI: 0.78-1.35). Notably, the associations between extreme weight-loss behaviors (e.g., vomiting, fasting ≥ 24 h) and unhealthy diet scores were more pronounced among underweight and obese adolescents, revealing important BMI-stratified heterogeneity. CONCLUSION: Extreme weight-control behaviors are strongly coupled with poor-quality diets among adolescents, with BMI-stratified heterogeneity, whereas increased exercise predicts healthier eating. School-based programs should prioritize the identification of extreme weight-loss behaviors and promote physical activity and balanced diets to prevent disordered eating.
Prevalence and associated factors of liver fibrosis and steatosis in Gansu, China: a community-based cross-sectional study.
Yang J, Ma X, Peng B … +9 more , Zhang M, Yang C, Yang Y, Ji J, Ren W, Zhang A, Yang X, Luo D, Wang L
BMC Public Health · 2026 Jun · PMID 42374294 · Full text
BACKGROUND: The epidemiology of chronic liver disease in China is undergoing a major transition, shifting from a predominance of viral hepatitis to metabolic-associated liver disease. However, population-based data from...
BACKGROUND: The epidemiology of chronic liver disease in China is undergoing a major transition, shifting from a predominance of viral hepatitis to metabolic-associated liver disease. However, population-based data from Northwest China remain limited. This study aimed to assess the prevalence and independent associated factors of liver fibrosis and steatosis in the general population of Gansu Province, China. METHODS: We conducted a community-based cross-sectional study across three regions in Gansu Province (Huining, Jingtai, and Jingyuan), enrolling 5,043 eligible participants between January and December 2025. All participants underwent anthropometric measurements, laboratory testing, and transient elastography (TE), and completed a structured questionnaire. Liver fibrosis and steatosis were assessed using the liver stiffness measurement (LSM) and ultrasound attenuation parameter (UAP), respectively. Fibrosis was staged as F0 (LSM < 7.3 kPa), F1 (7.3 ≤ LSM < 7.85), F2 (7.85 ≤ LSM < 10.0 kPa), and F3-4 (LSM ≥ 10.0 kPa). Steatosis grades S1 (mild), S2 (moderate), and S3 (severe) were defined using UAP cutoff values of 244, 269, and 296 dB/m, respectively. Independent associated factors were identified using multivariate logistic regression analysis. RESULTS: Among 5,043 participants (median age 46 years; 59.8% female), significant fibrosis (≥ F2) was observed in 5.18% (95% CI: 4.56-5.79), and advanced fibrosis or cirrhosis (F3-4) in 1.67% (95% CI: 1.31-2.02). The prevalence of liver steatosis (≥ S1) was 50.45% (95% CI: 49.07-51.85), including 26.87% with moderate-to-severe steatosis (≥ S2) and 7.16% with severe steatosis (S3). Multivariate analysis identified HBV infection (OR 3.19, 95% CI: 1.72-5.92), obesity (OR 5.14, 95% CI: 4.14-8.42), diabetes (OR 3.55, 95% CI: 2.02-6.25), elevated ALT (OR 3.86, 95% CI: 2.96-7.60), and decreased PLT (OR 6.45, 95% CI: 2.03-20.52) as independent factors cross-sectionally associated with advanced fibrosis. Severe steatosis was independently associated with obesity (OR 17.62, 95% CI: 13.50-23.01), diabetes (OR 1.73, 95% CI: 1.17-2.55), hypertension (OR 1.50, 95% CI: 1.14-1.96), dyslipidemia (OR 1.36, 95% CI: 1.04-1.78), decreased PLT (OR 4.16, 95% CI: 1.46-11.84), elevated ALT (OR 2.17, 95% CI: 1.46-3.22) and male sex (OR 1.70, 95% CI: 1.18-2.46). CONCLUSIONS: Hepatic steatosis was prevalent in this community population of Gansu Province, whereas clinically significant or advanced liver fibrosis remained relatively modest and was predominantly concentrated within high-risk metabolic and viral subgroups. These findings highlight the urgent need for integrated metabolic and viral screening strategies to enable early identification and prevention of progression to advanced liver disease in this high-risk population.
Association of METS-IR with breast cancer risk: a large-scale retrospective cohort study of Korean women.
Park J, Lee JH, Kang SH … +4 more , Kim YH, Han B, Kim DH, Yoon J
BMC Public Health · 2026 Jun · PMID 42365356 · Full text
BACKGROUND: Insulin resistance has been linked to increased breast cancer risk through mechanisms involving metabolic dysfunction and chronic inflammation. This study aimed to investigate the association between the meta...
BACKGROUND: Insulin resistance has been linked to increased breast cancer risk through mechanisms involving metabolic dysfunction and chronic inflammation. This study aimed to investigate the association between the metabolic score for insulin resistance (METS-IR) and breast cancer incidence in a large cohort of Korean women. METHODS: We conducted a retrospective cohort analysis using data from 2,731,416 women aged ≥ 40 years, obtained from the 2009-2010 Korean National Health Screening Program. Participants had no prior history of breast cancer at baseline. METS-IR scores were calculated and stratified into quartiles. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for breast cancer incidence according to METS-IR quartiles. RESULTS: During 31,633,123 person-years of follow-up, 43,526 new breast cancer cases were identified. Women in the highest METS-IR quartile demonstrated a significantly increased breast cancer risk (HR: 1.07, 95% CI: 1.03-1.12) compared to those in the lowest quartile. This relationship exhibited a non-linear association, with the increased risk of breast cancer primarily driven by the highest quartile of metabolic dysfunction. CONCLUSIONS: Our findings validate METS-IR as a useful tool for breast cancer risk assessment among Korean women, highlighting the importance of insulin resistance as a modifiable metabolic risk factor. These results emphasize the need for targeted preventive interventions focusing on metabolic health to reduce breast cancer incidence.
Psychometric validation of a multidimensional health facility HIV stigma instrument among healthcare workers in Taiwan.
Lai HH, Liu SL, Wang CC … +3 more , Yen TF, Tsai CC, Hsu SH
BMC Public Health · 2026 Jun · PMID 42365318 · Full text
BACKGROUND: HIV-related stigma within healthcare settings remains a major barrier to HIV prevention, treatment engagement, and equitable care. Existing stigma instruments in Taiwan primarily assess individual-level attit...
BACKGROUND: HIV-related stigma within healthcare settings remains a major barrier to HIV prevention, treatment engagement, and equitable care. Existing stigma instruments in Taiwan primarily assess individual-level attitudes and do not adequately capture institutional or structural determinants of stigma. A multidimensional health facility-level stigma instrument is needed to support routine monitoring and stigma-reduction efforts. This study aimed to culturally adapt and psychometrically validate a Traditional Chinese version of the WHO/USAID Health Facility Staff HIV Stigma and Discrimination Questionnaire for use among healthcare workers in Taiwan. METHODS: A cross-sectional psychometric study was conducted using three independent samples. Content validity was evaluated by an expert panel. Item analysis was performed in a pretest sample (n = 157). The main validation sample (N = 619) was randomly divided into Subsample A (n = 310) for exploratory factor analysis and Subsample B (n = 309) for confirmatory factor analysis. Construct validity, convergent and discriminant validity, and reliability were evaluated. External convergent validity was examined using correlations with the Taiwanese version of the Health Care Provider HIV/AIDS Stigma Scale (TW-HPASS). RESULTS: Exploratory factor analysis identified a seven-factor structure consisting of Fear, Extra Infection Precautions, Observed Enacted Stigma, Secondary Stigma, Health Facility Policies and Work Environment, Attitudes toward PWH, and Willingness to Treat Key Populations, explaining 72.98% of total variance. Confirmatory factor analysis demonstrated acceptable model fit (CFI = 0.916, TLI = 0.902, RMSEA = 0.069). Composite reliability values ranged from 0.794 to 0.954, and average variance extracted supported convergent validity. Domains conceptually aligned with HPASS showed moderate-to-strong correlations (r = .362-0.691), whereas structural domains such as observed stigma and institutional policies demonstrated weak or negligible correlations, indicating that the instrument captures distinct facility-level dimensions of stigma beyond individual attitudes. CONCLUSIONS: The Traditional Chinese WHO/USAID Health Facility Staff HIV Stigma and Discrimination Questionnaire demonstrates strong psychometric properties and provides a multidimensional framework for assessing HIV-related stigma in Taiwanese healthcare settings. By capturing individual, interpersonal, and structural dimensions of stigma, the instrument may support facility-level monitoring, cross-institutional benchmarking, and the development of targeted stigma-reduction interventions.
Geospatial variations in the prevalence of children missing out of diphtheria-pertussis-tetanus vaccination in Nigeria: estimates from multiple household surveys.
Eshofonie F, Gayawan E
BMC Public Health · 2026 Jun · PMID 42365312 · Full text
BACKGROUND: Vaccination remains one of the most effective public health measures, yet many children in Nigeria continue to miss essential vaccines, leaving them exposed to preventable diseases. Understanding the geograph...
BACKGROUND: Vaccination remains one of the most effective public health measures, yet many children in Nigeria continue to miss essential vaccines, leaving them exposed to preventable diseases. Understanding the geographic and temporal patterns of missed vaccinations is important for designing targeted and equitable immunization strategies. This study investigates the geospatial variations in the prevalence of children who missed diphtheria-pertussis-tetanus vaccination in Nigeria. METHODS: Data were obtained from the Nigeria Demographic and Health Surveys conducted between 2003 and 2023/2024. Bayesian geostatistical models were fitted within the Integrated Nested Laplace Approximation (INLA) framework to estimate the prevalence of zero-dose and under-immunized children across states and survey periods. Exceedance probability maps were used to identify states with a high likelihood that the prevalence of zero-dose children exceeded ten percent. RESULTS: The results show clear geographic clustering, with persistently higher prevalence of missed vaccinations in the northern regions compared to the south. Dropout between consecutive DPT doses has decreased over time, indicating improved follow-through once children start vaccination; however, each successive dose still shows a higher prevalence of missed vaccinations than the preceding one. Exceedance probability maps further highlight states such as Kebbi, Sokoto, Zamfara, and parts of Niger, Kwara, Borno, Yobe, Taraba, and Kogi, where the likelihood of zero-dose prevalence surpassing 10% remains high. CONCLUSION: Despite improvements in childhood vaccination coverage, large geographic disparities persist, especially in northern states. The continued presence of states with a high probability of zero-dose prevalence suggests that national progress has not resulted in equitable gains. Strengthening local immunization systems, addressing regional barriers, and prioritizing targeted interventions are needed to ensure that all children benefit from routine vaccination services.
Associations between carbon monoxide exposure, physical activity, and outdoor play preferences among UK children: evidence from the millennium cohort study.
Kuroiwa M, Mak HW, Pikhartova J … +2 more , Tabche C, Shelton N
BMC Public Health · 2026 Jun · PMID 42365276 · Full text
BACKGROUND: Physical inactivity and air pollution are significant global health concerns, yet limited evidence examines how residential air pollution is associated with physical activity behaviours among children. Existi...
BACKGROUND: Physical inactivity and air pollution are significant global health concerns, yet limited evidence examines how residential air pollution is associated with physical activity behaviours among children. Existing research has mainly focused on adults, older adults, or self-reported activity outcomes. This study examined the association between residential carbon monoxide (CO) exposure, objectively measured physical activity, and children's reported preference for outdoor sports and games using data from the Millennium Cohort Study. METHODS: This study used a cross-sectional secondary analysis of Sweep 4 Millennium Cohort Study data. Physical activity was measured using accelerometer-derived total steps over one week. Residential CO exposure was derived from linked MEDIx air pollution deciles and categorised into relatively lower and higher exposure groups. Linear regression was used to examine the association between CO exposure and total steps. Logistic regression was used to examine the association between CO exposure and preference for outdoor sports and games. Models were adjusted for sex, ethnicity, and socio-economic position, with survey and non-response weights applied. RESULTS: The analytic sample included 6,281 children. In the adjusted linear regression model, children living in areas with higher CO exposure recorded, on average, 356.26 more steps than those living in areas with lower CO exposure. In the adjusted logistic regression model, higher CO exposure was associated with slightly higher odds of reporting a preference for outdoor sports and games. However, the adjusted step-count model explained only a small proportion of variation in total steps. CONCLUSION: Higher residential CO exposure was modestly associated with higher total steps and greater reported preference for outdoor sports and games. These findings should be interpreted cautiously because the study was cross-sectional, explanatory power was low, and residual confounding by neighbourhood, household, school travel, and built-environment factors is likely. Future studies should examine multiple pollutants alongside more detailed contextual and environmental measures.
Independent and joint associations of social participation and depressive symptoms with incident stroke risk in older adults: a prospective cohort study based on CHARLS and ELSA.
Ma L, Ma Y, Huang Z … +7 more , Wang L, Ma K, Lin Z, Li J, He L, Ren C, Zhang X
BMC Public Health · 2026 Jun · PMID 42363161 · Full text
BACKGROUND: Stroke remains a leading cause of death and disability among older adults. Depressive symptoms and low social participation have been linked to stroke risk via behavioral and biological pathways. This study e...
BACKGROUND: Stroke remains a leading cause of death and disability among older adults. Depressive symptoms and low social participation have been linked to stroke risk via behavioral and biological pathways. This study examined the independent and joint associations of social participation (SP) and depressive symptoms (DS) with incident stroke in two nationally representative cohorts. METHODS: Data were derived from two nationally representative cohorts: the China Health and Retirement Longitudinal Study (CHARLS; 2011-2018) and the English Longitudinal Study of Ageing (ELSA; 2012-2019). SP and DS were assessed at baseline and categorized into four phenotypic subgroups (SP+/DS-, SP-/DS-, SP+/DS+, SP-/DS+). Cox proportional hazards models were fitted within each cohort with sequential covariate adjustment. To address missing data, sensitivity analyses were performed using the multiple imputation method (MICE). RESULTS: In CHARLS (n = 10,555; mean age 58.3 years), DS + was associated with elevated stroke risk (Model 3 h = 1.40, 95% CI 1.18-1.65, p < 0.001), whereas SP- showed no significant association (HR = 1.14, 95% CI 0.96-1.34, p = 0.13). Compared with the SP+/DS- reference phenotype, the SP-/DS+ joint phenotype was associated with an increased stroke risk (HR = 1.56, 95% CI 1.27-1.93, p < 0.001). In ELSA (n = 5,321; mean age 65.1 years), SP - was not associated with stroke risk (HR = 1.05, 95% CI 0.74-1.51, p = 0.78), and DS+ exhibited a similar but non-significant association (HR = 1.54, 95% CI 0.95-2.51, p = 0.08); the SP-/DS + was associated with elevated stroke risk (HR = 1.87, 95% CI 1.04-3.37, p = 0.04). CONCLUSIONS: Depressive symptoms were associated with incident stroke, whereas low social participation alone showed no consistent association with incident stroke. Notably, the joint phenotype SP-/DS+ identified a subgroup with the highest incident stroke risk, although such associations exhibited some heterogeneity between cohorts.
HBV breakthrough infection in individuals born to mothers with HBV infection: a systematic review and meta-analysis.
Pan Y, Jia Z, Zhang Y … +2 more , Wu Y, Jiang J
BMC Public Health · 2026 Jun · PMID 42363157 · Full text
BACKGROUND: Despite effective immunoprophylaxis, hepatitis B vaccine breakthrough infection (VBI) can still occur among individuals born to mothers with HBV infection. This study synthesized evidence on the incidence of...
BACKGROUND: Despite effective immunoprophylaxis, hepatitis B vaccine breakthrough infection (VBI) can still occur among individuals born to mothers with HBV infection. This study synthesized evidence on the incidence of post-vaccination HBV infection in this high-risk population. METHODS: A systematic literature search was conducted in PubMed, Embase, Scopus, China National Knowledge Infrastructure and Wanfang Chinese databases for articles evaluating VBI in individuals born to mothers with HBV infection. The VBI was characterized by seroconversion to HBsAg and/or anti-HBc positivity at or after 2 years of age, following initial post-immunoprophylaxis HBsAg negativity. The incidence of VBI was pooled after quality assessment. The review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD420251058273). RESULTS: Among 40 included studies, 37 provided HBsAg data (4,776 individuals; 24,434 person-years) and 29 reported anti-HBc (6,190 individuals; 16,663 person-years). The pooled cumulative incidence of HBsAg positivity was 0.24% (95% CI: 0.01-0.66%) and the incidence rate was 2.19 per 1,000 person-years (95% CI: 1.01-4.74). Anti-HBc positivity was higher, with a pooled cumulative positivity of 4.57% (95% CI: 2.18-7.66%) and an incidence rate of 19.69 (95% CI: 6.05-64.01) per 1,000 person-years. Subgroup analyses showed comparable HBsAg positivity between children born to mothers who were HBeAg-positive and HBeAg-negative (0.38% vs. 0.34%), while anti-HBc positivity differed markedly (6.81% vs. 0.64%). Consistently lower infection rates were observed among children who received booster immunization (HBsAg: 0.00% vs. 0.34%; anti-HBc: 0.37% vs. 3.88%), higher vaccine doses (10 µg vs. 5 µg: HBsAg 0.32% vs. 0.84%; anti-HBc 3.84% vs. 11.12%), or yeast-derived recombinant vaccines (HBsAg: 0.16% vs. 0.95%; anti-HBc: 4.50% vs. 7.95%), whereas anti-HBc positivity was higher among children older than 5 years than among those aged ≤ 5 years (9.61% vs. 2.38%). CONCLUSIONS: HBsAg positivity after successful neonatal immunoprophylaxis was rare, but the higher anti-HBc positivity suggests cumulative HBV exposure in this population, particularly among children born to HBeAg-positive mothers. Sustaining long-term protection through optimized vaccine strategies, such as timely boosters or higher postnatal dose regimens, may further reduce VBI risk in high-risk population and warrants further evaluation.
Trends in methylphenidate dispensing and regional inequalities among children and adolescents in France around the 2021 prescription reform: a repeated cross-sectional ecological analysis of national data (2014-2024).
Guez E, Van der Waerden J, Cohen D … +1 more , Benarous X
BMC Public Health · 2026 Jun · PMID 42363137 · Full text
BACKGROUND: In 2021, France broadened methylphenidate prescribing conditions by allowing treatment initiation outside hospital-based specialist settings in children and adolescents. This regulatory change occurred during...
BACKGROUND: In 2021, France broadened methylphenidate prescribing conditions by allowing treatment initiation outside hospital-based specialist settings in children and adolescents. This regulatory change occurred during the COVID-19 period and alongside broader changes in attention-deficit/hyperactivity disorder (ADHD) recognition and care organization, making its specific effect difficult to disentangle from concurrent contextual factors. We therefore examined national trends in methylphenidate dispensing and regional inequalities in France over 2014-2024, interpreting the reform and pandemic period as contextual factors rather than isolated causal exposures. METHODS: We conducted a repeated cross-sectional ecological study using annual region-level aggregated data from OPENMEDIC and INSEE for individuals aged 0-19 years in France from 2014 to 2024. OPENMEDIC records dispensed boxes rather than treatment initiations or treated individuals. Pre- and post-periods were defined as 2014-2019 and 2022-2024; 2020-2021 were treated as transition years. The primary outcome was annual methylphenidate dispensations per 1,000 inhabitants. Secondary outcomes included methylphenidate as a proportion of all psychotropic dispensations and regional inequality indices. All analyses were interpreted descriptively. RESULTS: Methylphenidate dispensations per 1,000 inhabitants aged 0-19 years increased across all 13 French regions in 2022-2024 compared with 2014-2019. Nationally, dispensations rose from 0.058 per 1,000 in 2014 to 0.189 per 1,000 in 2024, corresponding to a 3.3-fold increase. In descriptive national and panel analyses, post-2022 slopes were steeper than pre-period slopes, whereas immediate level-change estimates were imprecise. The national proportion of methylphenidate among all psychotropic dispensations increased from 6.30% in 2014-2019 to 9.09% in 2022-2024. Regional inequality metrics showed no clear convergence. CONCLUSIONS: In this nationwide ecological study based on annually aggregated data, methylphenidate dispensing more than tripled in France between 2014 and 2024, with steeper post-2022 trends, while regional disparities remained observable and showed no clear convergence. Because the 2021 prescription reform coincided with the COVID-19 period and other changes in ADHD care, these findings should be interpreted as descriptive population-level trends rather than evidence of a specific reform effect.
HPV vaccine awareness, perceptions, uptake, and school-based information channels during Nigeria's national rollout: a cross-sectional study among adolescent girls in rural Oyo State.
Adewole IE, Akinsolu FT, Abodunrin OR … +9 more , Lukwa AT, Ola OM, Adelaja GM, Olagunju MT, Chukwuemeka AN, Ezechi LO, Raji DO, Aduroja PE, Ezechi OC
BMC Public Health · 2026 Jun · PMID 42363132 · Full text
BACKGROUND: Nigeria introduced the human papillomavirus (HPV) vaccine into its national routine immunisation programme in October 2023, using a phased delivery strategy that included school- and community-based platforms...
BACKGROUND: Nigeria introduced the human papillomavirus (HPV) vaccine into its national routine immunisation programme in October 2023, using a phased delivery strategy that included school- and community-based platforms. Evidence remains limited on how adolescent girls in rural communities understand HPV vaccination during active rollout. This study assessed awareness, knowledge, perceptions, self-reported HPV vaccine uptake, and willingness to receive the vaccine among adolescent girls in rural Oyo State during the Phase-2 national rollout. METHODS: We conducted a school-based cross-sectional survey among 441 in-school adolescent girls recruited from 12 public and private secondary schools across three rural local government areas of Oyo State between 26 May and 19 June 2024. Structured questionnaires measured knowledge of cervical cancer, HPV, and HPV vaccination, as well as perceptions, beliefs, and self-reported vaccination status. Multivariable binary logistic regression was used to identify factors associated with HPV vaccine uptake and willingness to be vaccinated. RESULTS: Awareness of cervical cancer (26.1%), HPV (28.8%), and HPV vaccination (29.0%) was low. Schools were the most frequently reported source of information on cervical cancer and HPV among those who had heard of them. Forty-one participants (9.3%) self-reported having received the HPV vaccine. In adjusted analysis, favourable vaccine perception was strongly associated with self-reported uptake (AOR = 11.00; 95% CI: 3.53-34.25; p < 0.001), although this estimate should be interpreted cautiously because the vaccinated subgroup was small. Among unvaccinated participants, lack of information (49.3%), low perceived risk (20.3%), and concerns about side effects (16.0%) were the most frequently reported reasons for non-vaccination. Definite willingness to be vaccinated was associated with favourable vaccine perception (AOR = 6.24; 95% CI: 3.16-12.33; p < 0.001). CONCLUSIONS: During Nigeria's HPV vaccine rollout, self-reported uptake among adolescent girls in rural Oyo State was low and was associated more consistently with favourable vaccine perceptions than with knowledge measures alone. The findings suggest the potential value of strengthening school-based communication, providing adolescent-appropriate information, and considering parent/guardian engagement as part of rural HPV vaccination implementation. Because the study was cross-sectional and vaccination status was primarily self-reported, findings should be interpreted as associations rather than causal effects.
Evaluating the acceptability of a portable handwashing intervention (the Spatap) in three Fijian communities, a mixed-methods study.
Hosking R, Richardson A, Gray D … +3 more , Hales S, Batikawai S, Lal A
BMC Public Health · 2026 Jun · PMID 42363092 · Full text
BACKGROUND: Water, sanitation, and hygiene (WASH) interventions in resource-constrained communities can improve health outcomes, but uptake and sustainability are influenced by acceptability. We evaluated the acceptabili...
BACKGROUND: Water, sanitation, and hygiene (WASH) interventions in resource-constrained communities can improve health outcomes, but uptake and sustainability are influenced by acceptability. We evaluated the acceptability of the Spatap, a portable silicone tap attached to a bottle, as a household handwashing intervention in Fijian communities. METHODS: We distributed Spataps in three communities and conducted a survey two to seven days later, assessing sociodemographic factors, WASH access, and Spatap acceptability (n = 207). We applied a novel quantitative approach, calculating a total acceptability score from seven Likert-scale questions aligned with the component constructs of the Theoretical Framework of Acceptability (with a maximum score of 35) and asked open-ended questions about barriers and enablers to Spatap use. We analysed scores and used multiple linear models to examine predictors. Five months later, we conducted three focus group discussions (FGD) (n = 22) to supplement the survey data and performed thematic analysis using NVivo (ver 12). RESULTS: Spatap acceptability scores ranged from 18 to 35 (median 29), indicating high overall acceptability. Burden and opportunity cost scored lower than other component constructs. Sociodemographic factors were not meaningfully associated with acceptability scores. Few barriers were reported: ease of use, water saving, and convenience were key enablers. FGDs largely supported the survey findings and additionally highlighted ease of use for children and perceived illness reduction as contributors to acceptability. Time spent refilling bottles was burdensome in some larger households, the cost of larger bottles was prohibitive for some, and minor leakage issues were reported. CONCLUSIONS: The Spatap was broadly acceptable in the study communities, particularly where its portability, ease of use, and water-saving potential addressed locally important needs. These findings suggest the Spatap may have value as a household WASH intervention in resource-constrained settings, though its appropriateness relative to lower-cost alternatives should be considered. Future implementations should assess the cost-effectiveness and availability of suitable bottles, provide local language and pictorial instructions, and consider targeted engagement with children. The acceptability score method showed potential as a rapid evaluation tool but requires refinement before reapplication.
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