BMC Public Health [JOURNAL]
Sun
200 papers
Fragile cooperation in high-casualty traffic incidents: a grounded theory study of inter-organizational emergency response in Iran.
Farzinnia B, Khorasani-Zavareh D, Shojafard J … +3 more , Mortazavi M, Delshad V, Khankeh H
BMC Public Health · 2026 Jun · PMID 42351062 · Full text
BACKGROUND: Road traffic injuries remain one of Iran's top four causes of death, posing a continuing public health and governance concern. Inter-organizational cooperation is frequently fragmented, particularly in mass-c...
BACKGROUND: Road traffic injuries remain one of Iran's top four causes of death, posing a continuing public health and governance concern. Inter-organizational cooperation is frequently fragmented, particularly in mass-casualty traffic incidents, despite the existence of numerous emergency response organisations. In addition to developing a grounded conceptual framework that explains patterns of coordination failure, this study aims to theorise and model inter-organizational cooperation in such occurrences in Iran. METHODS: From 2020 to 2024, this qualitative grounded theory study was carried out. Through semi-structured interviews and expert panel discussions, twenty-seven managers, experts, and emergency response professionals from EMS, police, fire departments, the Iranian Red Crescent Society, and academic institutions took part. The Corbin and Strauss constant comparative approach, which uses open, axial, and selective coding, was used to analyse the data. RESULTS: "Fragile Cooperation" emerged as the main category from the investigation. Adaptive and maladaptive tendencies alternated in interorganisational collaboration. Paternalistic leadership in chaotic conditions, advocacy and volunteer participation, personalised crisis encounters, increased interaction after significant incidents, and selfless risk-taking were examples of adaptive tactics. Vague responsibility boundaries, cooperation-averse communication structures, interorganisational bias and competitiveness, conflicts of interest, and disorganised event scene management were examples of maladaptive tactics. The main tactic for enhancing collaboration, according to participants, is the creation of a unified emergency response system with a single national emergency number and integrated dispatch structure. CONCLUSIONS: The interorganisational collaboration of Iranian emergency response systems is highly dependent on relational and contextual factors and is structurally fragile. Sustainable improvement requires institutional reforms, unified emergency dispatch procedures, integrated operating protocols, and interoperable communication technology.
Differential effects of primary and latent syphilis co-infection on immune reconstitution and virological failure in HIV-positive adults on ART.
Shi L, Liu X, Qiu T … +8 more , Ding Q, Chen L, Chen Y, Lu J, Hu H, Xu X, Yang D, Wu Z
BMC Public Health · 2026 Jun · PMID 42351061 · Full text
BACKGROUND: HIV and syphilis are sexually transmitted diseases (STDs) that share transmission routes and risks factors. Many countries face the dual challenge of HIV and syphilis epidemics. Co-infection can mutually acce...
BACKGROUND: HIV and syphilis are sexually transmitted diseases (STDs) that share transmission routes and risks factors. Many countries face the dual challenge of HIV and syphilis epidemics. Co-infection can mutually accelerate disease progression and increase transmission risk, posing a major challenge to global public health. METHODS: This retrospective study was based on a cohort of people living with HIV (PLWH). All PLWH diagnosed between 2016 and 2023 were included. The Chi-square test was used to compare demographic and clinical characteristics between groups. Factors associated with syphilis co-infection were assessed using multivariate logistic regression, with adjusted odds ratio (aOR) and 95% confidence interval (95%CI) estimated. Kaplan-Meier analysis was used to estimate the cumulative probability of immune reconstitution (IR) and virological failure (VF) in syphilis co-infection versus HIV mono-infected individuals. Multivariate Cox regression was used to evaluate adjusted hazard ratio (aHR) and 95% CI for factors associated with IR and VF. To reduce potential confounding, we used propensity score matching (PSM) to balance baseline covariates between the syphilis co-infection and HIV mono-infection groups. All statistical analyses were performed by SPSS 23.0 and R 4.3.3. RESULTS: Among 39,924 PLWH in Jiangsu Province (2016-2023), the prevalence of syphilis co-infection was 14.1% (5,645/39,924). Factors independently associated with higher odds of co-infection included age < 60 years, male sex, current HIV stage, single, Han ethnicity, history of STDs, and homosexual HIV transmission. In the IR analysis, 56.6% of PLWH achieved IR. After stratifying by syphilis stage, primary syphilis was associated with a higher probability of IR before matching (log rank P < 0.001), but this difference disappeared after PSM (log rank P = 0.99). Latent syphilis showed no significant association with IR. In the virological failure (VF) analysis, latent syphilis co-infection was associated with an increased risk of VF in Cox regression models both before (log rank P = 0.0011) and after PSM (log rank P = 0.0032). Primary syphilis had no significant effect on VF. Younger age at ART initiation, early HIV stage, higher baseline CD4 T cell count, and college or higher education were protective against VF and/or promoted IR. CONCLUSIONS: HIV/syphilis co-infection prevalence was high among PLWH in Jiangsu. Latent syphilis co-infection independently increases the risk of VF. Younger age at ART initiation, current HIV stage, and higher education protected against VF and/or promoted IR; male, migrant, and homosexual HIV transmission were risk factors for poorer IR. Integrated screening and management of syphilis are essential to optimizing HIV treatment outcomes.
Psychological distress, financial literacy, loneliness, and coping in relation to financial difficulties: a cross-sectional study in Sweden.
Willborg E, Larsson J, Berge J … +4 more , Lindström S, Håkansson A, Ahlström R, Levinsson H
BMC Public Health · 2026 Jun · PMID 42351056 · Full text
BACKGROUND: Many individuals experience recurring or anticipated difficulties in meeting essential financial obligations, such as paying bills. Financial difficulties are associated with a range of adverse outcomes and a...
BACKGROUND: Many individuals experience recurring or anticipated difficulties in meeting essential financial obligations, such as paying bills. Financial difficulties are associated with a range of adverse outcomes and are influenced not only by objective economic conditions but also by psychological factors, including psychological distress, loneliness, coping strategies, and financial literacy, which may shape how individuals perceive, manage, and respond to their financial situation. Against this background, it is important to further examine the economic and psychological factors associated with financial difficulties. METHOD: The present cross-sectional study examined whether financial literacy, psychological distress, loneliness, and coping were associated with financial difficulties, operationalised as recurring difficulties paying bills during the past 12 months and expected difficulties paying bills in the upcoming two months. Data was collected through an online questionnaire completed by 2,035 adults aged 18-96 during the autumn of 2024. Logistic regression analyses were conducted to identify variables independently associated with financial difficulties when considered simultaneously. RESULTS: The analyses showed that financial literacy, psychological distress, loneliness, and avoidant coping were independently associated with both outcomes. CONCLUSIONS: This study examines contemporaneous associations between economic and psychological variables and self-reported financial difficulties. The cross-sectional design precludes conclusions regarding causality. Further longitudinal research is needed to clarify the direction and nature of these relationships.
Efficacy of codesigned COVID-19 booster vaccine promotion materials for long-term care staff: a cluster-randomized trial.
Hsu C, Piccorelli AV, Green BB … +15 more , Arthur KC, Becker M, Berry B, Binion B, Derus A, Gachuiri M, Hansen K, Koné A, McCracken C, McDonald B, Nisotel L, Senturia K, Volney J, Wilson KB, Williamson BD
BMC Public Health · 2026 Jun · PMID 42351054 · Full text
BACKGROUND: Among health care workers, long-term care center (LTCC) staff are among the most hesitant to obtain COVID-19 vaccines and boosters. Our objective was to compare the effectiveness of enhanced usual care (EUC)...
BACKGROUND: Among health care workers, long-term care center (LTCC) staff are among the most hesitant to obtain COVID-19 vaccines and boosters. Our objective was to compare the effectiveness of enhanced usual care (EUC) to codesigned materials (Codesign) in increasing COVID-19 booster vaccination rates and willingness to promote the booster among long term care center (LTCC) staff. METHODS: We conducted a two-arm cluster-randomized trial in 40 LTCCs in Georgia (n = 21) and Washington (n = 19) from August 2021 to December 2023. EUC LTCCs distributed standard government COVID-19 booster promotion materials. LTCCs in the Codesign arm allowed staff to participate in virtual codesign teams. Over 10 weekly meetings, the teams developed tailored COVID-19 booster promotion materials. Materials were distributed to both arms in January 2023. Primary outcomes were LTCC-level COVID-19 booster vaccination and a Net Promoter Score (NPS) measuring booster promotion to coworkers. Secondary outcomes included staff-level vaccine hesitancy and confidence scores and booster promotion to friends and family. RESULTS: We did not detect a significant difference between the EUC and Codesign arms in COVID-19 booster rates or primary NPS measure. Similarly, secondary and exploratory outcomes were not significantly different between either arm. CONCLUSIONS: The null findings of this trial are consistent with the challenges of other clinical trials of COVID-19 vaccine-promotion interventions in improving COVID-19 vaccine uptake among LTCC staff. Lessons for future research include identifying better ways to: (1) engage leaders and staff, (2) design more effective targeting messages, and (3) develop ways to target and customize dissemination. TRIAL REGISTRATION: This study is registered at www. CLINICALTRIALS: gov. CLINICALTRIALS: gov #NCT05449418. Date of registration: 6/22/2022.
Can curriculum-integrated health education improve postgraduate student well-Being? One-group pretest-posttest design.
Maciel EDS, Pontes-Silva A, Quaresma FRP … +1 more , Nascimento LRD
BMC Public Health · 2026 Jun · PMID 42351053 · Full text
OBJECTIVE: To evaluate whether a curriculum-integrated educational intervention focused on psychosocial well-being is associated with changes in perceived stress and quality of life among postgraduate students. METHODS:...
OBJECTIVE: To evaluate whether a curriculum-integrated educational intervention focused on psychosocial well-being is associated with changes in perceived stress and quality of life among postgraduate students. METHODS: This pre-experimental study (one-group pretest-posttest design without a control group) was conducted over one academic semester. A total of 31 postgraduate students were enrolled. The intervention consisted of a curriculum-integrated course addressing mental health, self-care, and well-being strategies through structured weekly sessions. Outcomes included perceived stress (PSS-10), quality of life (WHOQOL-bref), self-compassion, and life satisfaction. Pre-post comparisons were performed using paired-sample t-tests, with 95% confidence intervals and effect sizes (Cohen's d). RESULTS: A total of 31 postgraduate students were enrolled and completed both baseline and post-intervention assessments, with no loss to follow-up. A statistically significant reduction in perceived stress was observed (mean difference: -3.63; 95% CI: -6.08 to - 1.18; p = 0.005; d = 0.59). Overall quality of life showed a statistically significant increase (mean difference: 0.15; 95% CI: 0.03 to 0.27; p = 0.010; d = 0.30). No statistically significant changes were observed for self-compassion, life satisfaction, or health satisfaction (p > 0.05). Domain-specific analyses of quality of life showed no significant changes in the environmental domain (p = 0.325), while other domains presented identical mean values at both time points, precluding inferential analysis. CONCLUSION: The curriculum-integrated educational intervention was associated with reduced perceived stress and improved overall quality of life among postgraduate students. Given the pre-experimental design and absence of a control group, causal inferences cannot be established. These findings suggest that curriculum-based strategies may represent a feasible approach to promote psychosocial well-being in postgraduate education.
Exploratory thresholds for ambient PM constituents in relation to blood pressure levels in Chinese children.
Wang J, Wang X, Huang S … +5 more , Dong B, Jiang Y, Tao M, Liu J, You C
BMC Public Health · 2026 Jun · PMID 42351052 · Full text
BACKGROUND: This study aimed to examine the associations of fine particulate matter (PM) constituents and their interactions with meteorological factors with blood pressure (BP) among Chinese school-aged children, to inf...
BACKGROUND: This study aimed to examine the associations of fine particulate matter (PM) constituents and their interactions with meteorological factors with blood pressure (BP) among Chinese school-aged children, to inform targeted protection strategies. METHODS: We analyzed 16,446 children from the Zhongshan Student Growth Cohort, with annual physical examinations conducted from 2006 to 2020 in Southeast China. Bayesian kernel machine regression (BKMR), weighted quantile sum (WQS), distributed lag non-linear models (DLNMs) and restricted cubic splines (RCS) were used to analyze the joint effects, exposure-response threshold, and effect modification by meteorological factors of PM constituents on BP. RESULTS: Overall, 20.2% were classified with high blood pressure (HBP). Each IQR increase in PM over lag0-14d was associated with a higher risk of HBP (RR = 1.97, 95%CI: 1.61-2.34) among overweight children. BKMR and WQS models consistently revealed joint effects of PM constituents on BP, with Black carbon (BC) as the dominant driver. RCS models established non-linear exposure-response relationships and suggested potential threshold concentrations for key components (BC: 1.98 µg/m³). Notably, both low temperature and low relative humidity (RH) significantly amplified the toxicity of PM constituents. CONCLUSIONS: PM constituents were adversely associated with BP in children, particularly for BC. These associations were modified by meteorological factors, with both low temperature and low RH exacerbating the adverse effects. These findings highlight the importance of considering meteorological factors in developing evidence-based air quality guidelines.
The association between living environmental factors and hearing loss in Chinese middle-aged and older adults: Results from a cross-sectional and longitudinal study hearing loss and living environment.
Huang W, Wang S, Liu Y … +6 more , Wang Y, Zheng L, Chen Y, Liu T, Liu J, Wang S
BMC Public Health · 2026 Jun · PMID 42351049 · Full text
BACKGROUND: Hearing loss (HL) substantially impairs quality of life and functional independence among middle-aged and older adults. Although individual environmental exposures have been associated with hearing health, th...
BACKGROUND: Hearing loss (HL) substantially impairs quality of life and functional independence among middle-aged and older adults. Although individual environmental exposures have been associated with hearing health, the relationship between overall living environment quality and HL remains insufficiently understood. This study aimed to examine the association between a composite living environment score and HL in a nationally representative sample of Chinese adults. METHODS: Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS). Cross-sectional analyses included 4,404 adults aged ≥ 45 years, and longitudinal analyses followed 3,603 participants without HL at baseline for up to 7 years. A composite living environment score (range: 0-6) was constructed based on ambient PM₂.₅ exposure, household fuel type, drinking water source, building type, and indoor temperature. Cross-sectional associations were assessed using logistic regression models, while longitudinal associations were assessed using Cox proportional hazards models. RESULTS: In cross-sectional analyses, higher living environment scores were inversely associated with prevalent HL (all P < 0.05). During longitudinal follow-up, 645 incident HL cases were identified. Each one-point increase in the living environment score was associated with a 5.7% lower risk of incident HL (fully adjusted hazard ratio [HR] = 0.943, 95% confidence interval [CI]: 0.889-0.999). Compared with participants in high-risk environments, those in low-risk environments showed a lower risk of HL (HR = 0.801, 95% CI: 0.638-1.005), with evidence of a dose-response relationship (P for trend = 0.038). Restricted cubic spline analyses indicated a linear association (P for nonlinearity > 0.05). CONCLUSION: Better overall living environment quality was associated with a lower risk of hearing loss among middle-aged and older adults, suggesting that improvements in living conditions may contribute to healthier auditory aging.
Development and pilot of a drug use and HIV stigma reduction training for Tajik migrants who work in Moscow: the SRI-AVLOD intervention.
Mackesy-Amiti ME, Levy JA, Williams LD … +1 more , Jonbekov J
BMC Public Health · 2026 Jun · PMID 42351039 · Full text
BACKGROUND: Tajik labor migrants who inject drugs while working in Moscow are subject to the negative effects of stigma within the diaspora community in Russia. They are also at risk of acquiring HIV, which further compo...
BACKGROUND: Tajik labor migrants who inject drugs while working in Moscow are subject to the negative effects of stigma within the diaspora community in Russia. They are also at risk of acquiring HIV, which further compounds their stigmatization. An intervention to reduce both drug-related and HIV-related stigma within the Tajik diaspora community is needed to prevent adverse social and health effects among its members who inject drugs. METHODS: We conducted a series of focus groups and interviews, from January to June 2024, with Tajik migrant workers (n = 65) and health workers (n = 18) who treat migrants in Moscow to inform the development of a four-session anti-discrimination training for Tajik community leaders. The training sessions are designed to educate leaders about substance use disorder and HIV and prepare them to act as change agents in reducing stigma toward both disorders within the Moscow Tajik diaspora community. In September 2025, we pilot tested the Stigma Reduction Intervention Approach Via Leaders of Diaspora (SRI-AVLOD) for cultural acceptability and feasibility with two groups of 8 traditional migrant community (avlod) leaders while residing in Tajikistan before returning to Moscow for work. Measures of drug use and HIV-related stigma were administered prior to the first and after the final training session. We collected participant feedback on the acceptability and feasibility of the intervention and conducted a brief follow-up interview post-training to assess participants' experience in delivering the anti-stigma messages to their community. RESULTS: Participant ratings and comments indicated high acceptability and satisfaction with the training. Ratings of acceptability, feasibility, appropriateness and usefulness were uniformly high. Measures of stigmatizing attitudes among the avlod leaders were reduced following the intervention. In follow-up interviews, participants reported favorable experiences in delivering the anti-stigma message to people in their community. CONCLUSION: The SRI-AVLOD intervention proved feasible and acceptable to Tajik community leaders and was judged to have considerable potential for effective diffusion within the migrant diaspora community.
Spatio-temporal dynamics, trend analysis, and incidence prediction of echinococcosis in Xinjiang, China (2005-2024).
Jiang L, Zhang L, Yang Y … +7 more , Tursunjiang K, Cao X, Maimaitiyiming Y, Shi G, Simayi A, Zhao J, Li L
BMC Public Health · 2026 Jun · PMID 42351036 · Full text
OBJECTIVE: Given the persistent transmission and marked spatial heterogeneity of echinococcosis in endemic settings, a comprehensive spatiotemporal assessment is warranted. This study aimed to characterize the spatiotemp...
OBJECTIVE: Given the persistent transmission and marked spatial heterogeneity of echinococcosis in endemic settings, a comprehensive spatiotemporal assessment is warranted. This study aimed to characterize the spatiotemporal epidemiology of echinococcosis in the Xinjiang Uygur Autonomous Region from 2005 to 2024, develop a time-series forecasting framework, and inform region-specific prevention and control strategies. METHODS: Spatiotemporal clustering analysis was conducted to delineate geographic heterogeneity and dynamic transmission patterns at the county level. An interrupted time series framework was employed to estimate changes in the level and slope associated with the implementation of the universal free health examination policy in September 2016. Subsequently, a seasonal autoregressive integrated moving average (SARIMA) model was fitted to characterize temporal autocorrelation structures and seasonal fluctuations and to produce short-term forecasts of incidence trends. RESULTS: From 2005 to 2024, a total of 23,813 echinococcosis cases were reported in Xinjiang, with an average annual incidence of 5.48 per 100,000 population. Incidence increased significantly from January 2005 to August 2016 (β = 0.0026 per 100,000 per month, P < 0.001), with an immediate increase observed in September 2016 (0.2265 per 100,000, P < 0.05), and then declined significantly through December 2024 (β = -0.0069 per 100,000 per month, P < 0.001). Spatial clustering was observed in the Ili and Altay regions. Incidence increased and then decreased across sex and age groups, with larger declines among males. Significant reductions were observed in the 15-44 and ≥ 45 year groups, but not in the 0-14 year group. The optimal first-stage model was SARIMA(1,1,0)(2,0,0)₁₂, and the second-stage model was SARIMA(0,1,1)(1,0,2)₁₂. The second-stage model produced a relative prediction error of - 14.06% and projected 1,040 cases in 2025. CONCLUSION: Echinococcosis incidence in Xinjiang demonstrated a temporal increase followed by a sustained decline, with pronounced spatial heterogeneity across regions. Despite inherent uncertainty, SARIMA-based projections offer evidence to strengthen early warning systems and guide region-specific control strategies.
Disease risk perception, health intervention intention and their influencing factors among prehypertensive and hypertensive populations: a cross-sectional study with 1050 participants.
Zhang J, Liu J, Xu J … +4 more , Tang F, Xu Y, Zeng Z, Wan J
BMC Public Health · 2026 Jun · PMID 42351033 · Full text
BACKGROUND: Prehypertension and hypertension are major modifiable cardiovascular risk factors that impose a substantial global public health burden. Disease risk perception and health beliefs are critical determinants of...
BACKGROUND: Prehypertension and hypertension are major modifiable cardiovascular risk factors that impose a substantial global public health burden. Disease risk perception and health beliefs are critical determinants of health behaviors, yet few studies have compared the heterogeneous patterns influencing intervention intention between prehypertensive and hypertensive individuals. OBJECTIVE: To compare differences in health cognition, health beliefs, lifestyle behaviors, and intervention intention between prehypertensive and hypertensive groups, and to explore heterogeneous predictors of intervention intention to inform targeted prevention strategies. METHODOLOGY: A cross-sectional study enrolled 1050 adults (525 prehypertensive, 525 hypertensive) via convenience sampling from community centers and hypertension clinics (January-December 2025). Questionnaires included demographic characteristics, lifestyle behaviors, Health Belief Model (HBM) scales, and intervention intention. Data were analyzed using SPSS 25.0 with t-tests, χ² tests, correlation analyses, and multivariate logistic regression. RESULTS: Hypertensive patients were older, had more comorbidities, higher perceived severity, better lifestyle behaviors, and stronger intervention willingness (all P < 0.001). Lifestyle behaviors were positively correlated with intervention intention (r = 0.533, P < 0.01). Universal predictors included family history of hypertension, lifestyle behaviors, perceived severity, and health motivation (all P < 0.05). Prehypertensive individuals were primarily predicted by lifestyle behaviors (OR = 1.533, P < 0.001) and health motivation (OR = 1.398, P = 0.001); hypertensive patients by self-efficacy (OR = 1.464, P < 0.001), perceived susceptibility (OR = 1.163, P = 0.029), and lifestyle (OR = 1.089, P = 0.012). The prehypertension model had the highest explanatory power (Nagelkerke R²=0.849). CONCLUSIONS: Significant differences exist in health cognition, health beliefs, and intervention willingness between groups. Lifestyle behaviors serve as universal predictors of intervention intention, whereas disease perception factors play a more critical role among hypertensive patients. Targeted strategies-lifestyle optimization for prehypertension and self-efficacy enhancement for hypertension-are needed to improve self-management and reduce cardiovascular risk.
Community gardening as a conduit for bolstering wellbeing, employment, education and volunteering in vulnerable communities: a feasibility study.
Tracey D, Gray T, Pigott F
BMC Public Health · 2026 Jun · PMID 42351023 · Full text
BACKGROUND: Growing evidence promotes community gardening as an effective community-based initiative to enhance the wellbeing of community members, including those considered vulnerable. Whilst this expanding evidence-ba...
BACKGROUND: Growing evidence promotes community gardening as an effective community-based initiative to enhance the wellbeing of community members, including those considered vulnerable. Whilst this expanding evidence-base is encouraging, little is known about the feasibility of community gardening thus limiting its scalability. METHODS: The current mixed-method study assesses the feasibility, acceptability and implementation of the Community Greening program delivered in vulnerable communities in New South Wales, Australia. Data was gathered from 33 survey participants, 39 interview participants, and case notes from seven sites. RESULTS: Findings demonstrate that participants have particular needs in wellbeing and employment outcomes, especially for those with reported disability. Attendance is variable with identified enablers and barriers. Satisfaction with the program is evident with suggestions for improvements. Finally, fidelity of implementation is strong, with an opportunity to increase community-led workshops, and enhance future implementation informed by the reported enablers and barriers. CONCLUSIONS: With the positive impact of community gardening now established, findings guide how we effectively resource and sustainably implement programs with the fidelity required to realise their potential. TRIAL REGISTRATION: N/A.
COVID-19-related disruptions and measles vaccination uptake among children attending urban health centers in Guelmim, Morocco: a cross-sectional study.
Asraoui A, Soulaymani A
BMC Public Health · 2026 Jun · PMID 42343352 · Full text
BACKGROUND: The COVID-19 pandemic disrupted routine immunization services and may have widened measles immunity gaps. Morocco has experienced a widespread measles outbreak since late 2023. This study assessed the associa...
BACKGROUND: The COVID-19 pandemic disrupted routine immunization services and may have widened measles immunity gaps. Morocco has experienced a widespread measles outbreak since late 2023. This study assessed the association between COVID-19-related disruptions and measles vaccination uptake among children in Guelmim, Morocco, and described additional informational and access barriers. METHODS: A descriptive cross-sectional study was conducted from March to May 2025 in three urban public health centers in Guelmim. Using an interviewer-administered questionnaire, data were collected from 350 mothers of children aged 0-59 months. Descriptive statistics and Pearson's chi-square tests were used to examine associations between child measles vaccination status and COVID-19-related, informational, and access-related factors. RESULTS: Only 44.29% of children were reported as vaccinated against measles. Lower uptake was significantly associated with delaying child vaccination during COVID-19 (27.27% vaccinated vs. 69.61% among those reporting no delay; p < 0.001), missing a measles dose during the pandemic (28.64% vs. 67.96%; p < 0.001), insufficient vaccine information (28.19% vs. 73.98%; p < 0.001), lack of trust in vaccines offered by the public health system (28.29% vs. 68.92%; p < 0.001), difficulty accessing vaccination services (35.88% vs. 69.32%; p < 0.001), and lack of information on post-pandemic vaccination dates (25.00% vs. 68.83%; p < 0.001). Receipt of a measles catch-up dose was strongly associated with vaccination uptake (82.79% among those receiving catch-up; p < 0.001). CONCLUSIONS: In this urban sample, measles vaccination uptake was low and was associated with both COVID-19-related service disruptions and broader informational, trust, and access barriers. Strengthening catch-up activities, service communication, and trust-building strategies may help close immunity gaps in similar settings.
A global scoping review of interventions to increase participation in screening programmes for breast, cervical and colorectal cancer between 2016 and 2025.
Kigongo E, Heaney C, McBride L … +2 more , Gliga G, Burns RM
BMC Public Health · 2026 Jun · PMID 42343351 · Full text
BACKGROUND: Implementation of timely and targeted health screening programmes is strongly aligned with the United Nations Sustainable Development Goals (SDGs) in promoting prevention, early detection, and timely interven...
BACKGROUND: Implementation of timely and targeted health screening programmes is strongly aligned with the United Nations Sustainable Development Goals (SDGs) in promoting prevention, early detection, and timely intervention across populations. However, participation in breast, cervical, and colorectal cancer screening remains suboptimal and inequitable, and is increasingly challenged. This review synthesised global evidence on implementation interventions aimed at increasing screening participation and reducing disparities, to identify gaps that must be addressed to achieve screening targets. METHODS: This scoping review was conducted and reported in accordance with PRISMA-ScR and the Joanna Briggs Institute methodological guidance. The Consolidated Framework for Implementation Research (CFIR) was used to extract and synthesise barriers and facilitators, while the RE-AIM framework for the performance of interventions. We used descriptive quantitative methods and a hybrid (deductive-inductive) thematic analysis to summarise and interpret the evidence. RESULTS: One hundred ten studies were included and identified ten intervention categories: educational, reminders, self-sampling, outreach, peer education and counselling, quality improvement, promotional messages, patient navigation and tracking, mass media, and multicomponent interventions. Barriers and facilitators to screening participation were assessed using the CFIR framework, while intervention performance was synthesised using RE-AIM components. Although most interventions demonstrated promising effectiveness, multicomponent interventions showed the greatest impact. However, most interventions were implemented in highly controlled settings, limiting their real-world applicability and scalability. CONCLUSION: Findings revealed important gaps in culturally responsiveness and real-world intervention approaches for cancer screening. Future research should prioritise pragmatic, culturally appropriate, and multiple component interventions, supported by sufficiently long follow-up periods to assess sustainability and real-world effectiveness.
Epidemiology and factors associated with Talaromyces marneffei detection in the mainland of China, 2022-2024: a cross-sectional study of hospitalized patients.
Lun X, Yuan J, Qiao W … +8 more , Wang M, Li P, Wang X, Jin R, Xu J, Chen C, Song R, Sun Y
BMC Public Health · 2026 Jun · PMID 42343343 · Full text
BACKGROUND: Epidemiological studies of Talaromyces marneffei (T. marneffei) infection are largely confined to HIV-positive populations and specific geographic regions, whereas its population-scale characteristics and env...
BACKGROUND: Epidemiological studies of Talaromyces marneffei (T. marneffei) infection are largely confined to HIV-positive populations and specific geographic regions, whereas its population-scale characteristics and environmental factors associated with infection in China are lacking. This study investigates spatiotemporal patterns, host susceptibility, and environmental correlates of T. marneffei detection in Chinese mainland. METHODS: Targeted next-generation sequencing (tNGS) data from patients hospitalized for acute respiratory tract infections (ARTIs) from 2022 to 2024 were used for epidemiological, spatiotemporal, and co-detection analyses. Geographical detector models with the q-statistic were employed to quantify the associations of meteorological, host distribution, and social factors on detection risk, where the q-statistic measures the proportion of spatial variance explained by each factor. RESULTS: Among 2,316 reported cases, we identified significant spatial clustering, with bimodal seasonal peaks in detection rate. Males and individuals aged 41-50 showed the highest susceptibility. Pneumocystis jirovecii was the predominant co-detected pathogen; 5 pathogens were positively and 16 were negatively correlated with T. marneffei. Univariate analysis using the q-statistic revealed that dew point temperature had the strongest explanatory power for T. marneffei detection at 48.55%. Bivariate interaction analysis demonstrated that paired factor combinations exhibited enhanced explanatory power for disease prevalence compared with single factors. Average air pressure, which alone explained only 1.4% of the spatial variance, showed markedly higher explanatory power when paired with other variables. CONCLUSIONS: This study revealed spatiotemporal heterogeneity, population susceptibility, and environmental factors associated with T. marneffei detection in Chinese mainland, which can guide disease monitoring and control through enhanced surveillance and tailored interventions in epidemic hotspots and among high-risk groups.
Fertility intentions among medical students in war-torn Ukraine: a cross-sectional survey.
Mogilevkina I, Olovsson M, Getsko O … +2 more , Marichereda V, Tyden T
BMC Public Health · 2026 Jun · PMID 42343333 · Full text
BACKGROUND: Ukraine's total fertility rate was 0.9 in 2022, among the lowest in Europe. Amid the ongoing full-scale invasion, understanding reproductive intentions is important for informing future pronatalist policies....
BACKGROUND: Ukraine's total fertility rate was 0.9 in 2022, among the lowest in Europe. Amid the ongoing full-scale invasion, understanding reproductive intentions is important for informing future pronatalist policies. This study assessed fertility intentions and attitudes toward parenthood, with a focus on sex differences, and subjective determinants of reproductive decision-making among undergraduate medical students in wartime Ukraine. METHODS: A cross-sectional, confidential, online survey was conducted among students at Odesa National Medical University in May 2024. The Swedish Fertility Awareness Questionnaire was used, supplemented with a question on contraceptive use. Data were analysed using descriptive statistics, univariable, multivariable and stepwise logistic regression. RESULTS: The mean age was 20 years among the participants: 655 women and 191 men. Overall, 75% intended to have children, with a preferred family size of two children. Women preferred to have their first child at a younger age than men (26.1 vs. 28.1 years; p < 0.001). No sex differences were observed in the perceived importance of having children. Oral and long-acting reversible contraceptive use was relatively low. Furthermore 62% of participants indicated that they would support a hypothetical pregnancy to birth, mainly for moral or religious reasons. Among those opting for abortion, the most commonly cited reasons were financial constraints and war-related concerns. In the case of infertility, more women than men were willing to consider IVF or adoption (p < 0.001). Key prerequisites for parenthood included adequate housing (93%) and financial stability (92%). Women were more likely to anticipate emotional benefits of parenthood (OR 1.66), whereas men were more likely to anticipate negative impacts on personal time (OR 1.91) and finances (OR 1.72). Intention to have children was associated with psychological readiness, emotional fulfilment, life priorities, and perceived housing adequacy (aOR 3.02), as a key independent predictor of overall readiness for parenthood. CONCLUSIONS: Despite the ongoing war, fertility intentions among medical students remain relatively optimistic, equally for women and men. As adequate housing was an important prerequisite for parenthood, post-war pronatalist policies may benefit from integrating housing support into broader family well-being strategies, while also addressing sexuality education and cultural influences on family formation and parenthood decisions.
Unintentional ingestion of recreational drugs among young children, 2000-2024.
Uskovich K, Hays HL, Badeti J … +4 more , Rine NI, Michaels NL, Ding K, Smith GA
BMC Public Health · 2026 Jun · PMID 42343328 · Full text
BACKGROUND: Previous studies of pediatric recreational drug exposures have often been limited in scope. Given the rapidly changing recreational drug supply and the related unintentional ingestion of these drugs by young...
BACKGROUND: Previous studies of pediatric recreational drug exposures have often been limited in scope. Given the rapidly changing recreational drug supply and the related unintentional ingestion of these drugs by young children, a comprehensive study that includes recent data about these exposures is needed. The objective of this study is to investigate the characteristics and trends of unintentional ingestions of recreational drugs by children < 6 years old. METHODS: Using a retrospective cohort study design, National Poison Data System data from 2000 to 2024 were analyzed. United States Census Bureau data were used to calculate population-based ingestion rates. Rate ratios (RRs) with 95% confidence intervals (CIs) were calculated to assess the magnitude of relationships between key characteristics and outcomes, such as highest level of health care received and medical outcome. RESULTS: There were 41,612 unintentional ingestions involving recreational drugs among children < 6 years old reported to United States poison centers from 2000 to 2024. Most were among children < 3 years old (57.6%), involved a single substance (95.9%), and occurred in a residence (96.4%). Although 50.6% of children experienced no or minor effects, 5.0% had a major effect and there were six deaths. Children < 3 years old were more likely to experience a major effect (RR: 1.54; 95% CI:1.39-1.71) or be admitted to a critical care unit (RR: 1.23; 95% CI: 1.16-1.30) than children 3-5 years old. Cannabinoids accounted for 84.7% of ingestions, followed by stimulants (8.4%), psychedelics (3.5%), opioids (2.8%), and dissociative agents (0.6%). Ingestions involving opioids (RR: 2.60; 95% CI: 2.36-2.86), stimulants (RR: 2.16; 95% CI: 2.01-2.31), and dissociative agents (RR: 1.59; 95% CI: 1.23-2.06) were more likely to be admitted to a critical care unit than the other substance categories combined. The recreational drug ingestion rate per 100,000 US children < 6 years old increased 3,307% from 1.05 in 2000 to 35.91 in 2024, with a rapid increase beginning in 2013, especially involving edible marijuana and psilocybin products. CONCLUSIONS: The recreational drug ingestion rate among children < 6 years old reported to United States poison centers increased substantially from 2000 to 2024. Additional efforts are needed to prevent these unintentional ingestions in this vulnerable population.
Study protocol for evaluating integrated urban development plans: impacts on health, social equity, and environmental sustainability in Germany.
Tönnies J, Krumreihn A, Stelzer F … +7 more , Senck E, Bongers-Römer S, Stalling I, Gröne K, Bammann K, Köckler H, Bolte G
BMC Public Health · 2026 Jun · PMID 42343327 · Full text
BACKGROUND: The urban environment plays a significant role in shaping residents' health, wellbeing, and opportunities for social participation. Urban development interventions have been shown to positively influence phys...
BACKGROUND: The urban environment plays a significant role in shaping residents' health, wellbeing, and opportunities for social participation. Urban development interventions have been shown to positively influence physical activity, mental health, quality of life, and self-reported health status. However, most previous studies have focused on single measures or specific environmental aspects. Integrated Urban Development Plans (IUDPs), by contrast, combine interventions from multiple domains, such as housing, infrastructure, green spaces, and social participation, to promote health equity and sustainable urban transformation. The SalusTransform project aims to evaluate IUDPs in three German cities regarding their implementation processes as well as their impacts on health, social equity, and ecological sustainability. METHODS: We will compare three IUDP intervention areas with three control areas in the respective cities using a mixed-methods design. Quantitative and qualitative data will be collected to assess both process and outcome quality of the IUDPs. Primary data collections include resident surveys and focus groups, qualitative interviews with stakeholders, as well as environmental and infrastructural assessments, including air-quality measurements, site visits, and observations related to active mobility and urban green spaces. Secondary data on population structure, aggregated health indicators, and local implementation processes will be provided by the municipalities. Analyses will follow a difference-in-differences approach to identify changes attributable to IUDP implementation while accounting for similar developments in the control areas. DISCUSSION: By building a comprehensive database that links health-related, social, and environmental indicators, SalusTransform will provide valuable evidence on the real-world effects of IUDPs. Findings will inform municipalities, policymakers, and practitioners about the effectiveness and transferability of IUDPs and contribute to the institutionalisation of their systematic evaluation. Close collaboration with local authorities will ensure continuous monitoring of changes and strengthen the practical relevance of the research. Targeted communication strategies will be implemented to engage population groups that are often underrepresented in research and urban planning processes. TRIAL REGISTRATION: This study was prospectively registered with the German Clinical Trials Register (DRKS00036042) on May 28th, 2025.
The effect of fall-prevention education on fall-related behaviors in older adults.
Çevik BE, Tok HH
BMC Public Health · 2026 Jun · PMID 42343326 · Full text
AIM: This study aimed to examine the effect of a structured fall-prevention education program on safe fall-related behaviors among older adults. METHOD: The study was conducted using a pretest-posttest parallel-group ran...
AIM: This study aimed to examine the effect of a structured fall-prevention education program on safe fall-related behaviors among older adults. METHOD: The study was conducted using a pretest-posttest parallel-group randomized controlled design. A total of 66 older adults who attended a family health center in the Central Anatolia region of Türkiye and were classified as high risk according to the Morse Fall Risk Scale were included. The intervention group received an education program consisting of two sessions delivered through interactive presentations and question-answer discussions, while the control group received an informational brochure only. Data were collected using the Personal Information Form, the Morse Fall Risk Scale, and the Fall Behaviors Scale for Older Adults. RESULTS: A statistically significant increase was observed in fall behavior scores in the intervention group between the pretest and posttest assessments. In contrast, no significant difference was found between pretest and posttest scores in the control group. Between-group comparisons revealed that posttest scores of the intervention group were significantly higher than those of the control group. CONCLUSION: The structured and interactive education program was found to be effective in improving safe fall-related behaviors among older adults. Passive information-based approaches were insufficient to produce behavioral change, whereas nursing-based educational interventions that promote active participation were more effective. TRIAL REGISTRATION: NCT07499895- 2026/03/30- Retrospectively registered.
Access to WASH facilities and health implications of period poverty among in-school girls in rural areas of Africa: a scoping review.
Alabi AJ, Fawole OI
BMC Public Health · 2026 Jun · PMID 42343318 · Full text
INTRODUCTION: Menstrual health is essential to adolescent well-being, yet many girls experience period poverty, an inadequate access to sanitary products, water, sanitation facilities, and menstrual education. This scopi...
INTRODUCTION: Menstrual health is essential to adolescent well-being, yet many girls experience period poverty, an inadequate access to sanitary products, water, sanitation facilities, and menstrual education. This scoping review synthesised existing evidence on access to menstrual products, commonly described barriers and reported associations between poor health and period poverty among in-school girls in rural areas of Africa. METHODS: This study was developed in accordance with the Joanna Briggs Institute recommendations and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. PubMed, Web of Science and Google Scholar were searched for literature published in English, between 2015 and 2025. The literature must meet the inclusion criterion of being conducted among in-school girls in rural communities in Africa. Extracted data were summarised in an Excel spreadsheet, and descriptive analyses were conducted. RESULTS: Twenty-one (21) relevant studies were identified, of which 14 were quantitative, four were qualitative, and three were mixed methods studies. The studies were conducted across six countries, with the largest proportion from Kenya (5/21; 23%). Many of the girls were between 10 and 19 years. Period poverty was common among in-school menstruating girls in rural areas of Africa, and it negatively influenced their physical, mental, social and sexual health. Period poverty was linked to body odour, body burns, headaches, fatigue, urogenital symptoms, experience of fear, discomfort, shame, and stress. It can also lead to vulnerability to sexual exploitation, disrupted schooling, poor academic performance and school dropout. CONCLUSIONS: Period poverty was widespread among in-school girls in rural Africa and linked to negative implications on their health. Integrated interventions that reduce girls' vulnerability to stigma and sexual exploitation, such as free or subsidised menstrual products, gender-responsive water, sanitation and hygiene facilities, and menstrual education for boys and girls, are urgently required.
Joint associations between maternal exposure to ambient air pollutants during pregnancy and low Apgar score in newborns: a birth cohort study in China.
Chen Z, Lin B, Ouyang Z … +11 more , Ni W, Jiang L, Wu B, Chen S, Lai L, Chen S, Zheng H, Zhu M, Jing Y, Yu X, Fan J
BMC Public Health · 2026 Jun · PMID 42343309 · Full text
BACKGROUND: Epidemiological evidence on the risk of low Apgar score in newborns associated with ambient air pollutants, their joint associations, and sensitive exposure windows is limited. This study aimed to investigate...
BACKGROUND: Epidemiological evidence on the risk of low Apgar score in newborns associated with ambient air pollutants, their joint associations, and sensitive exposure windows is limited. This study aimed to investigate the independent and joint associations between exposure to ambient air pollutants during different pregnancy trimesters and low Apgar score in newborns. METHODS: Twenty thousand eight hundred ninety-four pregnant women were included in the prospective birth cohort in Shenzhen. Concentrations of PM, PM, NO, O, SO, and CO were assessed based on residential addresses of participants. Generalized additive model (GAM) was used to assess the independent associations of air pollutants exposure with low Apgar score, and restricted cubic spline (RCS) model was used to analyze the dose-response trends. Quantile g-computation (Qgcomp) and weighted quantile sum (WQS) regression models were further used to investigate the joint associations and constituent contributions. RESULTS: Second-trimester exposure to PM, PM, and NO was associated with an increased risk of low 1-minute Apgar score (PM: OR = 1.64, 95% CI: 1.10, 2.44; PM: OR = 1.59, 95% CI: 1.01, 2.50; NO: OR = 1.48, 95% CI: 1.11, 1.98, per interquartile range increase). In the mixed-pollutant models, both Qgcomp and WQS models showed that each one-quartile increase in the air pollutant mixture was significantly associated with low 1-minute Apgar score (Qgcomp: OR = 1.48, 95% CI: 1.06, 2.07; WQS: OR = 1.15, 95% CI: 1.09, 1.21). PM and NO were the primary contributors to the risk (Qgcomp: 48.0%, 34.5%; WQS: 23.6%, 39.4%). CONCLUSIONS: Second-trimester exposure to air pollutants was associated with an increased risk of low 1-minute Apgar score, and PM and NO may be the key relative contributors. These findings support the need for further research and increased public health attention to air pollutant exposure during pregnancy to prevent adverse neonatal health outcomes. TRIAL REGISTRATION: Not applicable.
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