BMC Public Health [JOURNAL]
Sun
200 papers
Unmet healthcare needs among adults with disabilities in South Korea: a nationally representative analysis using the behavioral model.
Seol EM, Nam SH
BMC Public Health · 2026 Jun · PMID 42363086 · Full text
BACKGROUND: Unmet healthcare needs are a critical indicator of health inequities. Despite near-universal health insurance coverage in South Korea, people with disabilities experience substantial barriers to healthcare ac...
BACKGROUND: Unmet healthcare needs are a critical indicator of health inequities. Despite near-universal health insurance coverage in South Korea, people with disabilities experience substantial barriers to healthcare access. This study identified factors associated with unmet healthcare needs among people with disabilities in South Korea. METHODS: This cross-sectional study used data from the 2023 Korea National Survey of People with Disabilities (KNSPD 2023), a nationally representative survey. The survey employed two-stage stratified cluster sampling, yielding an analytic sample of 6,772 adults with registered disabilities (weighted N = 2,630,374). Applying Andersen's Behavioral Model, complex-sample logistic regression examined predisposing, enabling, and vulnerability factors associated with unmet healthcare needs in the past 12 months. RESULTS: Overall, 17.3% of people with disabilities reported unmet healthcare needs. Transportation difficulties (36.5%) and financial cost (27.8%) accounted for nearly two-thirds of reported barriers. Among enabling factors, lack of health insurance emerged as the strongest predictor of unmet healthcare needs. Physical disability and poor self-rated health were also associated with substantially increased odds of unmet healthcare needs. Individuals with severe disabilities had lower odds of unmet healthcare needs than those with mild disabilities, suggesting potential gaps in support for people with less severe functional limitations. Women with physical disabilities showed particularly elevated odds of unmet healthcare needs. CONCLUSIONS: Despite universal insurance coverage, substantial unmet healthcare needs persist among people with disabilities in South Korea, driven primarily by transportation and financial barriers. Policy priorities should include expanding paratransit services, reducing out-of-pocket costs, targeting insurance enrollment assistance to the uninsured, addressing service gaps for mild disabilities, and implementing sex-specific interventions for women's compounded barriers. Healthcare access equity requires moving beyond coverage expansion to address structural accessibility barriers.
Prevalence of e-cigarette use and its association with knowledge and attitudes among palestinian medical students and physicians: a cross-sectional study.
Jabareen M, Humeedat M, Alhroub W … +10 more , Fasfoos A, AlBakri H, Shareef MG, Nairoukh DH, Maraqa RM, Said LN, Salameh A, Zatari M, Sham'a FKA, Qawasmeh AA
BMC Public Health · 2026 Jun · PMID 42351130 · Full text
BACKGROUND: Electronic cigarette (e-cigarette) use has increased globally, particularly among adolescents and young adults, despite growing evidence regarding potential health risks. Healthcare professionals play a criti...
BACKGROUND: Electronic cigarette (e-cigarette) use has increased globally, particularly among adolescents and young adults, despite growing evidence regarding potential health risks. Healthcare professionals play a critical role in tobacco control and smoking cessation; however, limited evidence exists regarding knowledge, attitudes, and practices (KAP) toward e-cigarettes among medical students and physicians in Palestine. METHODS: A cross-sectional study was conducted between November and December 2025 among medical students and physicians from major universities and teaching hospitals across the West Bank, Palestine. Data were collected using a structured, self-administered questionnaire adapted from a validated instrument. The questionnaire assessed sociodemographic characteristics, smoking-related behaviors, e-cigarette knowledge, attitudes, and use patterns. Multivariable logistic regression analyses were performed to identify factors independently associated with high knowledge levels, positive attitudes, and current e-cigarette use. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were reported. RESULTS: A total of 433 participants were included, with a mean age of 25.55 ± 7.69 years; 55.4% were female. Overall, 34.2% reported current use of at least one tobacco or nicotine product, and 11.8% were current e-cigarette users. Current e-cigarette use was substantially higher among males than females (20.7% vs. 4.6%, p < 0.001). High knowledge level was observed in 73.0% of participants, while 24.7% had positive attitudes toward e-cigarettes. Positive attitude was inversely associated with high knowledge level (aOR = 0.26, 95% CI: 0.16-0.44), while current e-cigarette use was associated with positive attitude (aOR = 4.32, 95% CI: 1.61-11.59). In the final parsimonious model, current e-cigarette use was independently associated with positive attitude toward e-cigarettes (aOR = 7.45, 95% CI: 3.66-15.18), having close friends who currently smoked (aOR = 3.63, 95% CI: 1.06-12.40), and spending more than five hours per day at college (aOR = 2.68, 95% CI: 1.02-6.99). Among current e-cigarette users, 51.0% also used at least one combustible tobacco product. Self-reported symptoms after switching from conventional cigarettes to e-cigarettes were described as exploratory findings based on a small subgroup. CONCLUSIONS: E-cigarette use is relatively common among medical students and physicians in Palestine and frequently coexists with other tobacco products. Although overall knowledge was generally high, important gaps remain, and positive attitudes toward e-cigarettes were strongly associated with current use. These findings highlight the need for enhanced education on emerging nicotine products within medical curricula, strengthened tobacco-control policies, and targeted interventions addressing social influences and misconceptions regarding e-cigarettes among current and future healthcare professionals.
Smartphone addiction as utility-reducing consumption: evidence from university students in Bangladesh.
Das AC
BMC Public Health · 2026 Jun · PMID 42351127 · Full text
BACKGROUND: The rapid increase in smartphone usage among university students has raised concerns about problematic use and its implications for mental well-being. While most existing studies adopt psychological perspecti...
BACKGROUND: The rapid increase in smartphone usage among university students has raised concerns about problematic use and its implications for mental well-being. While most existing studies adopt psychological perspectives, limited research interprets excessive smartphone use through an economic lens. Drawing on theories of rational addiction and time allocation, excessive smartphone use can be conceptualized as a form of utility-reducing consumption, where time spent on smartphones displaces welfare-enhancing activities such as physical activity and social interaction. This study aims to examine the determinants of smartphone addiction within a behavioral economic framework, focusing on its association with mental well-being and time-use-related behaviors among university students in Bangladesh. METHODS: A cross-sectional study was conducted among 500 university students in Bangladesh using a structured online questionnaire. Smartphone addiction risk was measured using the Smartphone Addiction Scale-Short Version (SAS-SV), while mental well-being and self-esteem were assessed using the WHO-5 and Rosenberg Self-Esteem Scale. Binary logistic regression models were estimated to identify factors associated with high-risk smartphone addiction. RESULTS: Approximately 54% of respondents were classified as high risk for smartphone addiction. Low mental well-being was significantly associated with higher odds of smartphone addiction (OR = 1.99, 95% CI: 1.14-4.79). CONCLUSION: The findings suggest that smartphone addiction can be interpreted as a utility-reducing behavior associated with diminished mental well-being within a time allocation framework. Behavioral factors appear more relevant than demographic characteristics in explaining problematic smartphone use. However, due to the cross-sectional design, causal relationships cannot be established.
Mapping risk communication practices in public health emergencies: a scoping review and comparison with Italian regional pandemic plans.
De Vita E, Arzilli G, Gesualdo F … +9 more , Casigliani V, Pasquale M, Cruschelli G, Tecchio F, Tosi F, Porretta AD, Romersi D, Buquicchio C, Rizzo C
BMC Public Health · 2026 Jun · PMID 42351103 · Full text
BACKGROUND: Effective risk communication is a cornerstone of public health emergency preparedness and response. The COVID-19 pandemic and other recent crises have highlighted both the centrality of communication in susta...
BACKGROUND: Effective risk communication is a cornerstone of public health emergency preparedness and response. The COVID-19 pandemic and other recent crises have highlighted both the centrality of communication in sustaining trust and compliance, and the persistent gap between theoretical frameworks and operational practice. METHODS: Within the framework of the CreSP project (Comunicare il Rischio nelle Emergenze per la Sanità Pubblica), we conducted a scoping review to map international evidence on risk communication in public health emergencies, comparing it with Italian regional pandemic preparedness plans. Following PRISMA-ScR guidelines, we searched PubMed, Scopus, and Web of Science (1 January 2019-16 May 2024). Peer-reviewed studies addressing health risk communication in emergencies were included. In parallel, 18 Italian regional pandemic plans were identified and analysed using a structured checklist derived from inductive thematic analyses. RESULTS: Of the 12,479 records identified, 173 studies were included. Most publications originated from high-income countries and focused on COVID-19 pandemic response. Mass communication strategies, especially via social media, predominated, while targeted and participatory approaches were less frequent. The emergency response phase was far more represented than the preparedness or post-emergency phases. Key principles such as timeliness, transparency, and trust were widely discussed across studies, whereas equity, citizen engagement, and infodemic management were less consistently operationalised. Analysis of Italian regional pandemic plans revealed substantial heterogeneity. Although communication was universally acknowledged as important, it was often framed as top-down information dissemination. Structured mechanisms for monitoring, evaluation, citizen participation, and infodemic management were inconsistently addressed. CONCLUSIONS: Although the concept of emergency risk communication is well-developed, its implementation varies across different levels of governance. The misalignment between scientific evidence and institutional frameworks-particularly regarding inclusivity, participatory models, and infodemic management-underscores the need for a more integrated and standardised national approach. Incorporating communication into preparedness infrastructures, supported by measurable indicators and workforce capacity building, is essential to strengthen resilience, equity, and public trust in the event of future emergencies.
Long-term mental health outcomes among healthcare workers following COVID-19 infection and frontline work: evidence of additive and non-additive patterns in Kazakhstan.
OAuthorNameova D, Tobzhanova K, Alibekova L … +7 more , Seitmanova A, Bilibayeva G, Ibraimzhanova Z, Kurmankhanova R, Shokay U, Alekesheva R, Suleimenova M
BMC Public Health · 2026 Jun · PMID 42351096 · Full text
BACKGROUND: Long-term mental health outcomes of COVID-19 related exposures among healthcare workers remain poorly characterized, particularly in Central Asia. METHODS: We conducted a cross-sectional comparative study bet...
BACKGROUND: Long-term mental health outcomes of COVID-19 related exposures among healthcare workers remain poorly characterized, particularly in Central Asia. METHODS: We conducted a cross-sectional comparative study between June and August 2025 among 2715 healthcare workers. Participants completed validated measures of BAT-33, GAD-7, PHQ-9, and EQ-5D-5 L with EQ-VAS. Main and interaction effects were examined by two-way ANСOVA and associations were decomposed into direct and indirect components using path analysis with bootstrap confidence intervals. RESULTS: COVID-19 infection was associated with higher burnout, while the COVID × Red Zone interaction was not significant, indicating an additive pattern. In contrast, significant interactions were observed for anxiety, depression, and quality of life, suggesting higher psychological symptoms among workers with dual exposure. Red Zone work showed a statistically significant but small association with burnout. In mediation analyses, anxiety and depression statistically accounted for 39.7% of the variance in burnout (R), suggesting these affective states are strongly associated associated with both pandemic-related exposures and burnout. CONCLUSIONS: Pandemic-related occupational and personal exposures remained statistically associated with mental health outcomes among healthcare workers 3-5 years after COVID-19, with burnout showing an additive pattern and anxiety and depression showing non-additive deviations. Within our sample, the dual-exposed subgroup showed approximately 2-fold higher prevalence of clinically significant symptoms of anxiety and depression than unexposed colleagues. These findings identify a subgroup that may warrant continued monitoring in future longitudinal research with objective exposure verification, before specific clinical or policy recommendations can be advanced. This is among the first large-scale studies examining post-pandemic psychological outcomes among healthcare workers in Central Asia.
Strengthening cancer prevention in european schools: a randomized controlled trial of digital interventions in adolescents: the SUNRISE program.
Barasoain M, Vélez-Del-Burgo A, Astigarraga I … +24 more , Haug S, Kiselev N, Koutra K, Kilintzis V, Krini M, Pampaka T, Hudders L, De Keyzer E, Serrano P, Pilotti C, Del Campo L, Nicoara D, Nicoara N, Molina-Barceló A, de Pablo Pardo T, Verduyn S, Cea G, Katsapi C, Segal LJ, Tsoupouroglou I, Guerra B, Triantafyllidis A, Arana-Arri E, SUNRISE Study Group
BMC Public Health · 2026 Jun · PMID 42351094 · Full text
BACKGROUND: Cancer remains a leading cause of mortality worldwide, with a substantial proportion of cases attributable to modifiable lifestyle-related risk factors that emerge during adolescence and often persist into ad...
BACKGROUND: Cancer remains a leading cause of mortality worldwide, with a substantial proportion of cases attributable to modifiable lifestyle-related risk factors that emerge during adolescence and often persist into adulthood. Despite the importance of this developmental period for habit formation, evidence on scalable, theory-driven, and sustainable school-based prevention interventions remains limited. The SUNRISE project addresses this gap by evaluating a co-created, digitally supported life-skills programme designed for routine school settings. METHODS: SUNRISE is a pragmatic, multinational, cluster randomised controlled trial conducted in approximately 80 primary and secondary schools across eight European countries (Greece, Switzerland, Slovenia, Spain, Cyprus, Italy, Belgium, and Romania), recruiting around 4,000 students. Classes are randomised at the class level (3:1) to either a six-month digitally enhanced life-skills intervention or standard education. The primary aim of the study is to evaluate the feasibility, implementation, and sustainability of the intervention in real-world school settings, with secondary exploratory assessment of behavioural outcomes. The intervention integrates multiple digital components, including a mobile-based life-skills coaching programme, a conversational assistant, educational and serious games, influencer-led media literacy content, moderated social interaction platforms, and teacher-led educational modules. Intervention design is guided by the Capability-Opportunity-Motivation Behaviour (COM-B) model and developed through systematic co-creation with students, educators, parents, public health experts, and policymakers within a School Living Lab framework. Feasibility, implementation, and sustainability are evaluated using the RE-AIM and PRISM frameworks. Secondary behavioural outcomes include substance use, dietary and physical activity behaviours, mental well-being, stress, social skills, critical thinking towards media and advertising, and critical coping with food-related information, assessed at baseline, 6 months, and 18 months. DISCUSSION: SUNRISE integrates behavioural science, participatory design, and digital innovation to address adolescent health behaviours in real-world educational contexts. By embedding implementation and sustainability evaluation alongside behavioural outcomes, the study aims to generate actionable evidence on how multi-component digital interventions can be adopted, adapted, and maintained across diverse school systems. Findings are expected to inform future large-scale, theory-driven, equitable, and sustainable cancer prevention strategies targeting adolescents across Europe. TRIAL REGISTRATION: NCT06931847 (registration date: 2025-04-09).
Behavioural determinants of testing behaviour during a hypothetical human-to-human avian influenza outbreak: an interview study.
van Hoorn RC, van Gestel LC, Harteveld-Griffioen D … +8 more , Petrignani MWF, Kersten C, Müskens M, Vols L, Borgdorff H, van der Meer IM, Adriaanse MA, van der Schoor AS
BMC Public Health · 2026 Jun · PMID 42351092 · Full text
BACKGROUND: Avian Influenza (AI) is a potential pandemic threat, specifically when human-to-human transmission occurs. In order to mitigate potential outbreaks amongst humans, testing is essential. l. It is necessary to...
BACKGROUND: Avian Influenza (AI) is a potential pandemic threat, specifically when human-to-human transmission occurs. In order to mitigate potential outbreaks amongst humans, testing is essential. l. It is necessary to identify determinants of testing behaviour for AI in an early phase, as current knowledge on testing behaviour is mostly derived from other infectious diseases such as COVID-19. Therefore, this interview study aims to identify a wide range of behavioural determinants of diagnostic testing during a hypothetical human-to-human transmissible AI outbreak. METHODS: Semi-structured in-depth interviews, based on the Theoretical Domains Framework, were carried out between May 2024 and February 2025. Participants were included through purposive and convenience sampling. During the interviews an animation was shown illustrating a hypothetical AI outbreak. Verbatim transcripts were thematically analysed. RESULTS: We included seventeen participants (median age 44, range 20-81; 71% women) with diverse backgrounds in terms of age, gender, educational level and country of birth. Results show that, in this hypothetical setting, having the choice to test increases acceptance of testing, whereas a decreased sense of autonomy discourages testing. Most themes included individual rather than population-level benefits as drivers of testing behaviour. These included protecting loved ones, one's own health and gaining psychological reassurance. External conditions such as being unable to go to work or an event would generally encourage testing behaviour. Lower trust in governmental authorities could hamper testing behaviour. Previous experiences from the COVID-19 pandemic shaped participants' answers about AI testing behaviour. CONCLUSION: Key considerations include balancing people's need for autonomy with the external measures imposed by employers or the government, rebuilding trust in institutions and acknowledging how prior experiences with testing may shape testing behaviour in future AI outbreaks. Further research is needed to determine how these findings can be translated into effective communication and how trust in authorities can be built.
Attributable fraction and number of cancer cases attributed to occupational carcinogens in Iran in 2019.
Naghibzadeh-Tahami A, Khosravi Y, Zamani AR … +1 more , Haghdoost AA
BMC Public Health · 2026 Jun · PMID 42351086 · Full text
BACKGROUND: Although occupational exposure to carcinogenic agents accounts for only a relatively small fraction of cancers, the estimated burden in Iran remains considerable due to widespread exposure in major industries...
BACKGROUND: Although occupational exposure to carcinogenic agents accounts for only a relatively small fraction of cancers, the estimated burden in Iran remains considerable due to widespread exposure in major industries and the scarcity of national data. This study aimed to estimate the proportion and number of cases of bladder, leukemia, lung, laryngeal, and liver cancers attributable to four major occupational carcinogens-silica, benzene, asbestos, and lead-in Iran in 2019. METHODS: An attributable fraction (AF)-based approach was used to estimate the burden of occupational cancers in Iran. AFs were calculated using odds ratios (ORs) associated with specific occupational exposures. Although AFs are traditionally calculated using relative risks (RRs), ORs were used because they are more commonly reported in occupational studies and can approximate RRs when outcomes are rare. For each exposure, ORs were selected from epidemiological sources, including industry- or population-based studies, meta-analyses, and reviews. The number of workers exposed to occupational carcinogens in 2019 was obtained from the national occupational exposure surveillance system. AFs were then applied to national cancer incidence data to estimate the attributable numbers (ANs) of cancers related to occupational exposures. Monte Carlo simulation was used to estimate uncertainty intervals (UIs) for both AFs and ANs. RESULTS: In 2019, 60 (95% UI: 46-77) cases of lung, bladder, liver, laryngeal, and leukemia cancers were attributable to historical lead exposure (AF = 34%). The total number of cancer cases attributable to historical silica exposure was estimated at 623 (95% UI: 365-881) (AF = 36%). Furthermore, 602 (95% UI: 334-887) cases of bladder, lung, liver, leukemia, and laryngeal cancers were attributable to occupational benzene exposure (AF = 23%). For asbestos, the AF was 42%, but the estimated attributable number was very small because of the limited number of exposed workers (AN = 0.41, 95% UI: 0.264-0.538). CONCLUSION: These findings suggest that occupational exposure to carcinogenic agents may contribute substantially to the burden of selected cancers in Iran. Although the estimates are exploratory and based on scenario-based modeling assumptions, they highlight the importance of preventive workplace interventions and improved occupational exposure surveillance systems.
Public health impact of nuisance biting blackfly (Simulium damnosum s.l.) along the Asejire dam in Southwest, Nigeria.
Azeez DI, Abdussalam FO, Adamani E … +8 more , Fasasi KA, Surakat OA, Kumbur J, Amanyi-Enegela J, Samuel O, Ademolu KO, Adeshina QO, Adeleke MA
BMC Public Health · 2026 Jun · PMID 42351083 · Full text
BACKGROUND: Black flies remain a global public health concern, particularly through their biting behaviour which is a crucial risk factor in disease transmission. The present study seeks to investigate the public health...
BACKGROUND: Black flies remain a global public health concern, particularly through their biting behaviour which is a crucial risk factor in disease transmission. The present study seeks to investigate the public health implications of the biting behaviour of Simulium damnosum s.l along the Asejire dam, bordering Oyo and Osun State, Nigeria. METHODS: Simulium damnosum s.l were collected using the standard human landing collection (HLC) between 0700 and 1800 across four study areas within first-line communities around the Asejire dam between December, 2024 and November, 2025. Collection was recorded hourly while the daily, monthly, and annual biting rate (ABR) were calculated using standard formulas. RESULT: A total of 9857 blackflies were collected with variations in abundance across the sites (P-value = 0.325). Osun had the higher flies collection 6685 (67.82%). The hourly catches varied in locations and bimodal biting peak was observed. Also, Simulium damnosum s.l abundance was high upstream of the dam than mid- and downstream. The monthly biting rate was more than 1000 bites/person/month in each of the study locations. The biting intensity (99,939.03) along the Oyo-Osun border is high, causing serious biting nuisance in the communities. CONCLUSION: The presence and persistence of black fly bites across the study communities along the border poses a great threat to disease transmission. Therefore, there is the need for an effective vector control measure targeted at preventing human-vector contact by the government of both states with a view to decimating fly abundance and reducing transmission risk.
Primary biliary cholangitis mortality in Europe: a temporal and spatial view across the period 2002-2022.
Ortega-Torres A, Sánchez-Díaz G, Villaverde-Hueso A … +2 more , Arias-Merino G, Alonso-Ferreira V
BMC Public Health · 2026 Jun · PMID 42351081 · Full text
BACKGROUND: Primary biliary cholangitis (PBC) is a rare autoimmune disease of multifactorial origin with an uneven incidence across countries. This study sought to identify temporal trends in PBC mortality and describe p...
BACKGROUND: Primary biliary cholangitis (PBC) is a rare autoimmune disease of multifactorial origin with an uneven incidence across countries. This study sought to identify temporal trends in PBC mortality and describe possible spatial patterns across Europe. METHODS: Data on PBC mortality (ICD-10 K74.3) and European populations by age group in 20 countries were sourced from the World Health Organization for the period 2002-2022. We calculated age-adjusted mortality rates (AAMR) for the period 2012-2022, both for individual countries and overall. Trends were assessed using Joinpoint regression analysis. To ascertain the geographical distribution, standardised mortality ratios (SMR) were calculated for the periods 2002-2011 and 2012-2022. RESULTS: A total of 12,934 PBC deaths (81.65% women) were recorded during the period 2002-2022. Mortality showed a downward trend in most countries except for Hungary, Türkiye, Romania and Poland. Lithuania registered the highest AAMR, at 3.47 per 1,000,000 population (95% CI 2.86-4.19), followed by Hungary and the United Kingdom (UK). During the period 2002-2011, the risk of death in northern countries was twice as high as expected (Finland, Lithuania and the UK with SMRs of 2.09 to 2.14). The differences between northern and southern Europe persisted during 2012-2022, albeit with some variations. CONCLUSIONS: PBC mortality is decreasing or remains stable in most European countries. Risk of death is higher in countries in the north and north-west. There is a need for further in-depth study of the causes of the geographical variability detected.
Neighborhood factors and the geography of type 2 diabetes in Malaysia: an ecological based geospatial modelling study.
Ganasegeran K, Manaf MRA, Safian N … +4 more , Waller LA, Mustapha FI, Maulud KNA, Rizal MFM
BMC Public Health · 2026 Jun · PMID 42351080 · Full text
BACKGROUND: Type 2 diabetes (T2D) often exhibits long-standing disparities across populations. Spatial regression models can identify associations between local rates and observed neighborhood factors to inform timely, l...
BACKGROUND: Type 2 diabetes (T2D) often exhibits long-standing disparities across populations. Spatial regression models can identify associations between local rates and observed neighborhood factors to inform timely, localized public health interventions. We identified area-level distributions of T2D rates across Malaysia and estimate associations between different neighborhood covariates and local T2D burden. METHODS: We obtained aggregated counts of national level T2D cases data by administrative-districts between 2016 and 2020 and computed district-wise crude rates to correlate with district-level neighborhood demographic, socio-economic, safety, physical activity and resources access, and urbanization process indicators from various national sources and census data. We applied a simultaneous spatial autoregressive (SAR) modeling strategy to account for spatial autocorrelation and estimate risk factors for district-level logged T2D crude rates in Malaysia. RESULTS: District-level logged T2D crude rates were associated with the proportion of households living below 50% of the median income (β = 0.009, p = 0.003) and below the national poverty line (β = -0.011, p = 0.001), income inequalities (β = -1.778, p = 0.015), CCTV coverage per 1000 population (β = 0.060, p = 0.049), and perceived access to recreational parks (β = 0.007, p = 0.001) and to bowling centers (β = -0.003, p = 0.009). CONCLUSION: Area-level district-wise logged T2D crude rate estimates were associated with neighborhood socio-economic vulnerabilities, neighborhood safety, and neighborhood perceived access to physical activity facilities, after accounting for residual spatial autocorrelation via a SAR model.
Earthquake preparedness in the context of Maslow's hierarchy of needs theory and the risk perception paradox: the role of socioeconomic inequalities in Türkiye.
Şahin AU, Yücel H, Kara B
BMC Public Health · 2026 Jun · PMID 42351079 · Full text
BACKGROUND: Earthquake preparedness in Türkiye is widely promoted through national awareness campaigns; however, household-level preparedness remains limited. Drawing on Maslow's hierarchy of needs and the Risk Perceptio...
BACKGROUND: Earthquake preparedness in Türkiye is widely promoted through national awareness campaigns; however, household-level preparedness remains limited. Drawing on Maslow's hierarchy of needs and the Risk Perception Paradox, this study examines how socioeconomic inequalities are associated with earthquake preparedness self-efficacy, preparedness behaviors, and perceived barriers and motivations at the household level. METHODS: The research universe was defined using the Türkiye Earthquake Hazard Map by identifying 325 districts located in high-hazard zones (≥ 0.4 g at DD-2 design value, 475-year return period). A 19-item structured questionnaire was developed and administered online between May and September 2025, yielding responses from 1,193 households across high-risk districts. Data were analyzed using descriptive statistics, cross-tabulations, and chi-square tests (p < 0.05). RESULTS: The findings indicate high earthquake salience: 80.9% of respondents reported prior earthquake experience and 93.1% perceived local earthquake risk. However, only 19.3% considered themselves sufficiently prepared, while 47.9% reported being partially prepared. Perceived constraints were substantial: 89.7% reported insufficient financial resources, 83.8% insufficient time, and 69.2% concerns about sustaining daily life. Preparedness self-efficacy was significantly associated with gender, age, and monthly household income. Training participation was also significantly associated with higher self-perceived preparedness, while homeownership was associated with greater knowledge of building earthquake resistance. CONCLUSIONS: Household earthquake preparedness in Türkiye appears to be constrained not only by awareness deficits but also by socioeconomic inequalities related to time, financial resources, and housing security. These findings suggest that awareness campaigns should be complemented by targeted education, financial support mechanisms, tenant-inclusive housing safety measures, and community-based preparedness practices.
Climate-related disease registry in Lebanon: a proposed roadmap.
Mrad M, Whaibeh E, Haddad J … +8 more , Saliba J, Hanna JA, Nader AA, Mina E, Jradi F, Amer R, Zgheib J, Tayeh GA
BMC Public Health · 2026 Jun · PMID 42351077 · Full text
BACKGROUND: Climate change poses urgent health risks in the Arab region, yet most countries lack integrated systems to monitor climate-sensitive health outcomes. Lebanon, facing extreme climatic variability, widespread a...
BACKGROUND: Climate change poses urgent health risks in the Arab region, yet most countries lack integrated systems to monitor climate-sensitive health outcomes. Lebanon, facing extreme climatic variability, widespread air pollution, and fragile health infrastructure, has no centralized mechanism to link environmental and health data. However, the capacity of existing surveillance systems to capture and integrate climate-sensitive health risks remains poorly understood. OBJECTIVE: This study aims to develop a national climate-related disease registry framework for Lebanon by synthesizing evidence from global and regional surveillance models and convening national stakeholders to identify priorities and implementation pathways for institutional integration within Lebanon's health and environmental systems. METHODS: A desk review was conducted to examine climate-sensitive health risks, structured around the WHO-UNFCCC's classification of climate-related health risks, and to analyze existing global registries and surveillance platforms. In parallel, a national multi-sectoral consultation was held with representatives from government, academia, healthcare providers, and international organizations. Outputs were thematically synthesized to propose a registry framework and phased roadmap. RESULTS: The desk review revealed that while climate-sensitive outcomes are partially captured across disease-specific systems, key domains, including non-communicable diseases, mental health, and extreme weather-related outcomes, remain structurally excluded from integrated monitoring. Stakeholders identified interoperability barriers rooted not only in technical limitations but also in governance structures, institutional mandates, and legislative constraints. Concomitantly, existing digital infrastructure and epidemiological platforms were recognized as potential anchors for phased integration. The proposed framework outlines short-, medium-, and long-term actions to establish an interoperable climate-health registry. CONCLUSIONS: These findings highlight both the structural gaps and institutional opportunities and provide a phased roadmap for advancing an integrated national climate-health registry. By aligning stakeholders around a unified framework, the study lays the groundwork for evidence-based adaptation strategies in Lebanon and other climate-vulnerable settings.
Community-level COVID-19 vaccination promotion capacity and its association with vaccination dose per capita in China: an entropy-weighted TOPSIS and multilevel analysis.
Zhao T, Xie T, Zhang X … +4 more , Xu Q, Huang N, Liu Y, Cui F
BMC Public Health · 2026 Jun · PMID 42351076 · Full text
OBJECTIVE: To develop an evaluation framework for community-level capacity to promote coronavirus disease 2019 (COVID-19) vaccination and to quantify vaccination promotion capacity across primary care communities in diff...
OBJECTIVE: To develop an evaluation framework for community-level capacity to promote coronavirus disease 2019 (COVID-19) vaccination and to quantify vaccination promotion capacity across primary care communities in different regions of China. We further examined the association between promotion capacity and COVID-19 vaccination dose per capita to inform optimization of primary immunization services in the post-pandemic era. METHODS: A multicenter cross-sectional study was conducted across 94 primary care communities from 10 provinces. Indicators of vaccination mobilization and service delivery from 2020 to 2022 were collected via questionnaire across four domains: health education, mass vaccination, incentives, and monitoring/reminders. External and internal covariates were collected simultaneously, including policy, ecological and socioeconomic environments. The entropy weight method and the technique for order preference by similarity to ideal solution were used to calculate a composite score index, and communities were categorized using the rank-sum ratio (RSR) method. After covariate selection via Lasso regression, multilevel mixed-effects linear regression models assessed associations between promotion capacity and dose per capita. RESULTS: Marked provincial differences were observed in overall vaccination promotion capacity. Provinces such as Anhui, Henan and Zhejiang had a higher proportion of high-capacity communities (25%), whereas provinces/municipalities such as Hubei, Guizhou, Shanghai, Guangxi, Shandong, Fujian and Xinjiang had a larger share of medium- and low-capacity communities. In multilevel mixed-effects linear regression models, the RSR ranking of overall vaccination promotion capacity was significantly and negatively associated with community COVID-19 vaccination dose per capita (exp[β] = 0.79, 95% CI: 0.69-0.92), indicating that communities with better (lower RSR ranking scores) capacity achieved higher dose per capita. RSR rankings of all four primary domains were negatively associated with vaccination dose per capita: health education capacity (exp[β] = 0.76, 95% CI: 0.65-0.88), mass vaccination capacity (exp[β] = 0.74, 95% CI: 0.63-0.87), vaccination incentive capacity (exp[β] = 0.77, 95% CI: 0.65-0.91), and monitoring/reminders (exp[β] = 0.93, 95% CI: 0.88-0.98). The number of policy documents issued by municipal-level authorities and studied by local staff, as well as the post-training assessment pass rate among vaccination staff, were consistently and positively associated with dose per capita in most models. CONCLUSION: In conclusion, the composite evaluation framework effectively captured regional differences in community vaccination promotion capacity. Higher overall capacity and better performance in all four domains were linked to higher COVID-19 vaccination dose per capita. Strengthening policy dissemination and implementation, enhancing the quality of training and assessment for vaccination staff may help build an efficient community-based vaccination promotion system, mitigate vaccine hesitancy, and increase vaccine coverage.
A silent epidemic? Poliomyelitis, disability burden, and social impact in Turkey (1942-1968).
Erkmen A, Tüzün N, Erkmen O
BMC Public Health · 2026 Jun · PMID 42351074 · Full text
BACKGROUND: Historical scholarship has largely framed poliomyelitis through narratives of biomedical progress and vaccination success, often marginalising its long-term clinical and social consequences in the pre-vaccina...
BACKGROUND: Historical scholarship has largely framed poliomyelitis through narratives of biomedical progress and vaccination success, often marginalising its long-term clinical and social consequences in the pre-vaccination era. This study examines the experience of poliomyelitis in Turkey between 1942 and 1968 by focusing on the discrepancy between official epidemiological indicators and the disease's actual societal burden. METHODS: Using a historical epidemiology approach, the study integrates multiple source types, including official health statistics, medical reports, contemporaneous clinical assessments, and national press coverage. These sources were analysed to assess trends in reported cases and deaths, patterns of underreporting, and the broader social and clinical consequences of poliomyelitis beyond conventional epidemiological measures. RESULTS: The analysis suggests that, despite relatively low reported case and mortality figures, poliomyelitis in Turkey generated a substantial cumulative burden through permanent disability, long-term care needs, and widespread social anxiety. A marked increase in reported cases in 1956 represents a non-linear trajectory characterised by persistence and periodic intensification rather than a single epidemic wave. Contemporary medical assessments consistently highlighted systematic underreporting, undermining the reliability of official statistics. Limited rehabilitation capacity, inadequate surveillance, and unequal access to healthcare shifted much of the long-term disease burden into the household sphere. CONCLUSION: Conceptualised as a 'silent but destructive' epidemic, poliomyelitis in Turkey can be interpreted as illustrating how low numerical visibility can coexist with substantial social impact. These findings underscore the importance of assessing epidemics beyond mortality- and incidence-based indicators, incorporating disability outcomes, care burdens, and structural inequalities into evaluations of public health impact.
A community-engaged public health research and outreach program for immigrant and racialized workers in meat processing during the COVID-19 pandemic.
Fabreau GE, Norrie E, Holdbrook L … +19 more , Antonio M, Essar MY, Youssef M, Sahilie A, Yemane M, Ramirez-Cerino E, Hassan N, Grewal R, Hussain Z, Altahsh D, Magwood O, Saad A, Santana M, Bharwani A, Nielssen I, Edwards ST, Spitzer D, Coakley A, Pottie K
BMC Public Health · 2026 Jun · PMID 42351072 · Full text
BACKGROUND: COVID-19 caused major outbreaks among immigrant and racialized workers in meat processing plants in North America, but trust barriers limited engagement with public health and research. This study investigate...
BACKGROUND: COVID-19 caused major outbreaks among immigrant and racialized workers in meat processing plants in North America, but trust barriers limited engagement with public health and research. This study investigates how community-based participatory research (CBPR) methods were employed to create a Community Scholar (CS) program to facilitate research and public health outreach among immigrant and racialized workers. METHODS: We conducted a qualitative case study of a CS program to describe its co-creation, failures, successes and experiences working across multiple Canadian meat processing plants affected by mass COVID-19 outbreaks. We hired six CSs from racialized ethnocultural minority groups, trained them in research ethics, public health protocols, survey tools, and vaccine operations, then embedded CSs within academic-public health teams. We used administrative document analysis to describe the project setting, training, and roles across research and vaccine operations between March 2020 and February 2022. CSs completed reflexivity activities using narrative analysis to summarize their experiences and impacts on themselves, immigrant and racialized workers, and their communities. Narrative analyses were triangulated with administrative, quantitative, and time-series data. FINDINGS: We summarize three study phases: (1) CS recruitment and training, (2) early engagement, and (3) outreach vaccination. Initial recruitment attempts lacked engagement, seemingly due to mistrust and fear of reprisals. Trust between workers and CSs appeared to increase over time as indicated by increased study engagement. CSs played key roles in nine onsite meat processing plant occupational and community outreach COVID-19 vaccine clinics. They also facilitated 191 surveys and 43 in-depth interviews across 11 meat processing plants in eight languages. CSs described their roles, successful outreach strategies, prerequisite skills and motivations. Key learnings included the skillset of empathetic listening, a greater understanding of meat processing plant workplaces and the role community presence plays in them, and how to empower workers through translating worker stories into advocacy. CS involvement appeared to increase trust, facilitate vaccine access through vaccine outreach clinics, and enable multilingual participation in research. INTERPRETATION: During public health crises, community-academic-healthcare partnerships can rapidly implement multicultural CBPR strategies to engage immigrant and racialized workers concurrently in research and public health outreach.
Factors influencing vaccination willingness in the context of the COVID-19 pandemic: data from the CoCo-Fakt study.
Derakhshani L, Feddern S, Grüne B … +7 more , Haberstock L, Kossow A, Niessen J, Rost S, Wiesmüller GA, Schmidt N, Joisten C
BMC Public Health · 2026 Jun · PMID 42351071 · Full text
BACKGROUND: During the COVID-19 pandemic, the population's willingness to be vaccinated was a decisive factor in containing infections. International studies have identified that health literacy and sociodemographic char...
BACKGROUND: During the COVID-19 pandemic, the population's willingness to be vaccinated was a decisive factor in containing infections. International studies have identified that health literacy and sociodemographic characteristics play a significant role in vaccination decisions. This study investigated possible factors influencing vaccination willingness in Germany. METHODS: Data were collected from the CoCo-Fakt study, which used an online questionnaire to survey infected cases and contact persons from the health authorities in Cologne and Augsburg county. Sociodemographic data and information on chronic diseases, vaccination status, willingness to be vaccinated, and subjectively perceived health literacy via a modified HLS19-Q47 questionnaire were collected. A total of 9,705 people was included in the analysis. Factors associated with vaccination willingness were assessed using chi-squared-tests and t-tests, followed by binary logistic regression with backward elimination to identify independent associations. RESULTS: Of those surveyed, 91.6% had already been vaccinated against COVID-19 or were willing to be vaccinated, while 8.4% had refused. A higher willingness to be vaccinated was found among older people (OR = 1.02), infected individuals (OR = 1.98), individuals with chronic diseases (OR = 1.32), individuals with higher socioeconomic status (OR = 1.26), and those with high health literacy (OR = 1.28). By contrast, individuals with a migration background (OR = 0.39) and those with moderate health literacy (OR = 0.76) showed greater reluctance to be vaccinated. CONCLUSION: The results underscore the importance of individual and social factors for vaccination acceptance. Particularly vulnerable groups included younger adults, individuals with a migration background, and those with moderate health literacy. This highlights the need to tailor future vaccination campaigns to target specific groups, possibly through low-threshold, multilingual information services and targeted health literacy promotion.
Prevalence and associated factors of anxiety and depression among hemodialysis patients in Sudan during armed conflict: a multicenter cross-sectional study.
Fadlelmoula YAD, Madani MAAMA, Hussein IAM … +7 more , Gasmalha MEA, Gasmelseed NMI, Hmidah AJA, Mohammed MAA, Mohamed TMA, Mohammed HMM, Ahmed SMM
BMC Public Health · 2026 Jun · PMID 42351068 · Full text
BACKGROUND: Patients with chronic kidney disease (CKD) receiving hemodialysis are at high risk of depression and anxiety, especially in conflict settings where healthcare access is disrupted. No large-scale study in Suda...
BACKGROUND: Patients with chronic kidney disease (CKD) receiving hemodialysis are at high risk of depression and anxiety, especially in conflict settings where healthcare access is disrupted. No large-scale study in Sudan has simultaneously assessed depression and anxiety during armed conflict. This study aims to estimate the prevalence of anxiety and depressive symptoms and assess their associations with sociodemographic characteristics, dialysis duration, and comorbidities among hemodialysis patients in Sudan during the ongoing armed conflict. METHODS: A multicenter, cross-sectional study was conducted across 13 dialysis units in nine Sudanese states between April and December 2025. A total of 811 adult patients (≥ 18 years) on maintenance hemodialysis were recruited via convenience sampling. Depression and anxiety were assessed using the validated Arabic versions of the PHQ-9 and GAD-7, respectively. Binary logistic regression identified factors associated with depression and anxiety. RESULTS: The prevalence of depressive symptoms was 40.3% (n = 327) and anxiety symptoms 28.6% (n = 232). Comorbid diabetes mellitus (Depression: OR = 2.66, 95% CI: 1.71-4.13; Anxiety: OR = 2.01, 95% CI: 1.28-3.14) and use of neurotoxic medications were associated with higher odds of both conditions. Longer dialysis duration (> 12 months) was associated with lower odds. Female sex and lower dialysis frequency (one session/week) were uniquely linked to higher odds of depression, while older age (≥ 74 years) was protective against anxiety. Geographic variation was observed, with higher odds in Gadarif state. CONCLUSION: Depression and anxiety are highly prevalent among hemodialysis patients in Sudan, exacerbated by ongoing conflict. Diabetes, neurotoxic medications, and regional disparities are key associated factors. Targeted mental health screening and support should be integrated into nephrology care, focusing on high-risk subgroups and conflict-affected regions.
Application of health belief model (HBM) in health sciences and medical researches: systematic review on African and Asian countries.
Tolera ST, Zerihun E, Hunduma G … +1 more , Letta S
BMC Public Health · 2026 Jun · PMID 42351066 · Full text
BACKGROUND: The Health Belief Model (HBM) is a widely used psychological framework for explaining and predicting individual's health related attitudes, belief, and behaviors. Although the model has been applied across va...
BACKGROUND: The Health Belief Model (HBM) is a widely used psychological framework for explaining and predicting individual's health related attitudes, belief, and behaviors. Although the model has been applied across various fields of health and medical sciences, the extent of its global use, particularly across African and Asian countries has not been well documented. OBJECTIVE: This systematic review aimed to assess the application of HBM in health sciences and medical research conducted between 2010 and 2025 in Africa and Asian countries. METHODS: The review followed the updated Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Searches were conducted using keywords "Health Belief Model" combined with Boolean operators (AND, OR) across major databases, including PubMed, CINAHL, Web of Science, Scopus, Cochrane Library and PsycINFO. Eligible studies included peer-reviewed research articles applying the HBM within African and Asian contexts. RESULT: From a total of 1,421 identified records, 77 studies met the inclusion criteria. Of these, 61% (n = 47) were conducted in Africa countries and 39% (n = 30) in Asian countries. Most studies (64.94%) employed cross-sectional quantitative design, while 12% used mixed-methods approaches. Random controlled trial account for 9.11% of studies, quasi-experimental design for 7%, and qualitative approaches (including focus groups and in-depth interviews) for 6%. Overall, 85.71% of the studies applied all core components of HBM. Fifteen studies examined COVID-19 vaccine acceptance, nine focused on HIV/AIDS testing, counseling and prevention, and eleven studies explored non-communicable diseases prevention. Additionally, six studies assessed women's adherence to breast cancer screening, and four studies examined cervical cancer screening behaviours using HBM. CONCLUSION: A current systematic review demonstrates that the HBM remain a valuable framework for understanding and influencing health behaviors across diverse settings. Its application in Africa and Asian research highlights its usefulness in guiding targeted interventions that address perceived susceptibility, severity, benefits, barriers, and cues to action, ultimately contributing to improved health outcomes.
Association between risk perception and lifestyle modification practices among patients with diabetes mellitus attending the chronic follow-up clinic at Mizan-Tepi University teaching hospital, Southwest Ethiopia, Ethiopia, 2023.
Zegeye M, SofiyaYimerMengesha, Hussen S
BMC Public Health · 2026 Jun · PMID 42351063 · Full text
BACKGROUND: The association between risk Perception of Diabetes mellitus complications and lifestyle modification is an important issue in diabetes prevention and control. Also, an individual's ability to practice lifest...
BACKGROUND: The association between risk Perception of Diabetes mellitus complications and lifestyle modification is an important issue in diabetes prevention and control. Also, an individual's ability to practice lifestyle change by adhering to medication, exercise, and dietary requirements has reduced complications and deaths. However, many of the studies on diabetes in this study area from our review have often concentrated on the epidemiological aspect of the condition, with little on the relation between risk perception and lifestyle modification practices. OBJECTIVES: To determine the association between the risk perception and lifestyle modification practice among Diagnosed Diabetes Mellitus patients in Mizan-Tepi Teaching Hospital. METHODS: An institution-based cross-sectional study was conducted. A total of 436 registered diabetic patients were included and studied during the period from April 1, 2023, to May 30, 2023. Data on participants were gathered using an interviewer-administered questionnaire. Descriptive Statistical analysis, such as mean, standard deviation, frequency, and percentage, was done. The relation between Risk perception and lifestyle modification was analyzed using Pearson's χ2 statistics (p-value < 0.05, 95%CI), and the effect size was measured by Phi to measure the strength of association. RESULT: The study revealed that only half of the participants were perceived as potentially at risk for DM complications by the patient, and 63% of the respondents who practiced good lifestyle modification had a significant positive relationship in that good risk perception regarding the DM and its complications (Pearson's χ2 = 80.07914, p-value 0.0001), with a moderate association (0.44Phi-coefficient). About 48.8% with 95% CI (44.2, 53.1) and 42.4% with 95% CI (38.2, 47.5) respondents have good lifestyle modification actions of the practice and good risk perceptions for DM, respectively. Similarly, 41.7% with 95% CI (36.6, 47.2) of the respondents thought that alcohol drinking could not increase the risk of DM and its complications. CONCLUSION AND RECOMMENDATION: Good risk perception and good lifestyle modification practices have a positive association with preventing complications. Creating awareness of the risk factors, perception, and related or potential complications among DM patients may help strengthen adherence to recommended lifestyle modification practices.
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