BMC Public Health [JOURNAL]
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200 papers
Effectiveness and gender-tailoring of suicide prevention interventions for men: a systematic review.
Shi L, Sutori S, Lögdberg U … +2 more , Carli V, Eliasson ET
BMC Public Health · 2026 Jun · PMID 42337495 · Full text
BACKGROUND: Men have 2-4 times higher suicide mortality than women and are less likely to seek help, with disparities linked to restrictive masculine norms and stigma. This review aimed to synthesize the effectiveness of...
BACKGROUND: Men have 2-4 times higher suicide mortality than women and are less likely to seek help, with disparities linked to restrictive masculine norms and stigma. This review aimed to synthesize the effectiveness of suicide prevention interventions targeting men and identify gender-tailoring strategies. METHODS: Studies evaluating suicide prevention interventions targeting men were included if conducted in male-only samples and reporting outcomes related to suicidality (e.g., suicide deaths, suicide attempts, suicidal ideation), depression, or help-seeking (e.g., behaviors, intentions, attitudes). Six databases (MEDLINE, Embase, PsycINFO, Cochrane Library, Web of Science, and CINAHL) were searched for peer-reviewed English-language studies published up to 31 December 2025. Risk of bias was assessed using RoB 2 and ROBINS-I. Due to heterogeneity, findings were synthesized narratively. The protocol was registered in PROSPERO (CRD420250655554). RESULTS: Seventeen articles evaluating 14 interventions were included. Only one study assessed suicide deaths, and none occurred. Among RCTs, no significant effects were observed for suicide attempts, suicidal ideation, or depression. Help-seeking behaviors and intentions showed mixed evidence of improvement, with no improvement in help-seeking attitudes. Gender-tailoring strategies were synthesized into seven categories: intervention design and development, risk targeting, content and messaging, outreach and recruitment, delivery modalities, male representation and role modeling, and communication and action orientation. CONCLUSIONS: Evidence for the effectiveness of suicide prevention interventions targeting men remains limited, with no clear effects on suicidality or depression and mixed evidence for improvements in help-seeking. Risk of bias was generally moderate to high. A wide range of gender-tailoring strategies was identified. Further development of gender-responsive approaches and more rigorous evaluation are needed to reduce male suicide mortality.
Polysubstance use in Canada: prevalence, patterns, and self-reported harms from the 2023 Canadian Substance Use Survey.
Albert OM, Arthur A
BMC Public Health · 2026 Jun · PMID 42337488 · Full text
BACKGROUND: Polysubstance use contributes substantially to substance-related morbidity and mortality in Canada, yet contemporary population-level estimates of alcohol-involved polysubstance use are limited. We estimated...
BACKGROUND: Polysubstance use contributes substantially to substance-related morbidity and mortality in Canada, yet contemporary population-level estimates of alcohol-involved polysubstance use are limited. We estimated national prevalence patterns and examined associations with self-reported harms using 2023 Canadian Substance Use Survey (CSUS) data. METHODS: We conducted a cross-sectional analysis of the 2023 CSUS public-use microdata file, including Canadians aged ≥ 15 years residing in the provinces. Past-year substance-use patterns were categorized as single-substance use, drug-only polysubstance use (≥ 2 drug classes without alcohol), and drug-plus-alcohol polysubstance use (alcohol plus ≥ 1 drug class). Weighted prevalence estimates were calculated using survey weights and 1,000 bootstrap replicate weights. Survey-weighted logistic regression examined associations with any self-reported harm. A primary model adjusted for sociodemographic confounders; a sensitivity model additionally adjusted for self-rated physical and mental health. RESULTS: Past-year polysubstance use was reported by 27.2% (95% CI 26.0-28.5) of respondents and was predominantly alcohol-involved (27.0%, 95% CI 25.7-28.3). Drug-only polysubstance use was uncommon (0.3%, 95% CI 0.2-0.4). Common patterns included alcohol plus cannabis (14.4%) and alcohol plus stimulants (11.6%). Compared with single-substance use, drug-plus-alcohol polysubstance use was associated with reporting any harm (adjusted odds ratio [aOR] 4.80; 95% CI 1.02-22.69). Results were robust in sensitivity analyses adjusting for self-rated health (aOR 4.41) and using a stricter concurrent-use definition (aOR 5.72). CONCLUSIONS: Past-year polysubstance use is common in Canada and is largely driven by alcohol co-use. Integration of alcohol into polysubstance prevention, screening, and surveillance frameworks may strengthen public health responses to substance-related harms.
Development of a women's health environmental pollution awareness scale and analysis of its psychometric properties.
Kılavuz M, Ağralı C, Kanbay Y
BMC Public Health · 2026 Jun · PMID 42332723 · Full text
AIM: Environmental pollution represents an important threat to women's health due to its potential effects on reproductive, maternal, hormonal, and general health outcomes. This study aimed to develop the Environmental P...
AIM: Environmental pollution represents an important threat to women's health due to its potential effects on reproductive, maternal, hormonal, and general health outcomes. This study aimed to develop the Environmental Pollution Awareness Scale for Women's Health (EPAS-WH) and evaluate its psychometric properties. METHODS: This methodological study was conducted with three independent samples consisting of a total of 760 women (Sample A: M age = 24.4 ± 7.8; Sample B: M age = 25.4 ± 8.7; Sample C: M age = 24.6 ± 8.2). The scale development process included item generation, expert evaluation, content validity analysis, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), reliability analyses, test-retest reliability, and criterion-related validity assessment. Content validity was evaluated using the Lawshe technique. Internal consistency was assessed using Cronbach's alpha and McDonald's omega coefficients, while criterion-related validity was examined through correlations with the Eco-Anxiety Scale. RESULTS: Content validity analysis supported the relevance of the scale items (CVI = 0.889). EFA revealed a unidimensional structure consisting of 8 items, explaining 66.5% of the total variance. CFA confirmed the single-factor structure and demonstrated good model fit. The EPAS-WH showed excellent internal consistency (Cronbach's α = 0.940; McDonald's ω = 0.932), strong construct reliability (CR = 0.93), and adequate convergent validity (AVE = 0.63). Test-retest analysis demonstrated good temporal stability (ICC = 0.87). In addition, significant positive correlations between EPAS-WH and eco-anxiety scores supported criterion-related validity. CONCLUSION: The EPAS-WH is a valid, reliable, and psychometrically robust measurement instrument for assessing women's awareness of environmental pollution-related health risks. The scale may be used in research, public health practices, and educational interventions aimed at evaluating and improving environmental health awareness among women.
Dynamic dementia risk before and after incident diabetes mellitus: a combined case-control and cohort study.
Liu Y, Dai Y, Pan Y … +6 more , Yang X, Zhu M, Diao X, Ma J, Huang X, Zheng F
BMC Public Health · 2026 Jun · PMID 42332710 · Full text
BACKGROUND: Evidence on the temporal dynamics of dementia risk before incident diabetes remains limited. We aimed to investigate the temporal pattern of dementia risk before and after incident diabetes, compared with mat...
BACKGROUND: Evidence on the temporal dynamics of dementia risk before incident diabetes remains limited. We aimed to investigate the temporal pattern of dementia risk before and after incident diabetes, compared with matched controls. METHODS: Case-control and cohort analyses were conducted by using data from the UK Biobank. Propensity score matching was performed to match participants with and without diabetes. Conditional logistic regression was adopted in case-control analysis to estimate dementia risk before incident diabetes. Cox proportional-hazard regression models were adopted in cohort analysis to estimate dementia risk following a diabetes diagnosis. RESULTS: A total of 44,166 participants with diabetes and 132,498 matched diabetes-free participants were included. During the 10-year period before diabetes, dementia occurred in 344 (0.78%) participants who later had diabetes and 530 (0.40%) diabetes-free participants. Compared to participants without diabetes, the dementia risk was significantly higher in participants with diabetes (Odds Ratio [OR]: 2.14, 95% Confidence Interval [CI]: 1.83-2.50), with the ORs gradually increasing as the time approached the diagnosis date. The adjusted OR was 3.86 (95% CI: 3.11-4.80) for dementia in the 2 years before diabetes. After a diabetes diagnosis, a higher risk for dementia remained in participants with incident diabetes (Hazard Ratio [HR]: 1.82, 95%CI: 1.68-1.97). Similar results were found for Alzheimer's disease and vascular dementia (VD), with VD showing a risk of over 6-fold. CONCLUSIONS: Dementia risk starts to increase 10 years before diabetes, and the 2-year period preceding diagnosis might represent a high-risk period that calls for closer cognitive monitoring for vulnerable individuals.
Anxiety, depression and psychological distress among small and medium-scale entrepreneurs in Lagos state, Southwest Nigeria.
Balogun M, Clayson A
BMC Public Health · 2026 Jun · PMID 42332694 · Full text
BACKGROUND: Entrepreneurs play a vital role in economic development but are exposed to significant psychosocial stressors, including financial uncertainty, long working hours, and job insecurity, which may adversely affe...
BACKGROUND: Entrepreneurs play a vital role in economic development but are exposed to significant psychosocial stressors, including financial uncertainty, long working hours, and job insecurity, which may adversely affect mental health. Evidence on anxiety, depression, and psychological distress among entrepreneurs in Nigeria remains limited. This study assessed the prevalence and predictors of anxiety, depression, and psychological distress among small and medium-scale entrepreneurs in Lagos State, Southwest Nigeria. METHODS: A cross-sectional study was conducted among 156 entrepreneurs registered with the National Association of Small and Medium Enterprises (NASME). Data were collected electronically using a structured questionnaire incorporating the Hospital Anxiety and Depression Scale (HADS), the General Health Questionnaire (GHQ-12), and a work-related stress scale based on the Job Demand-Control model. Descriptive statistics, Chi-square tests, and multivariable logistic regression analyses were used to examine associations between socio-demographic and occupational factors and mental health outcomes. RESULTS: Overall,12.9% of respondents had anxiety,12.3% had depression, and 17.9% had psychological distress. High work-related stress was reported in 25.6% of participants, while 60.6% reported feeling stressed at work. Male entrepreneurs were less likely to have depression. (AOR 0.13, 95% CI: 0.03-0.54). Entrepreneurs who had dependents were more likely to have psychological distress (AOR = 4.50; 95% CI: 1.08-18.78). Good job control was protective against anxiety (AOR 0.17, 95% CI: 0.05-0.57), depression (AOR 0.10, 95% CI: 0.02-0.40), and psychological distress (AOR = 0.13; 95% CI: 0.04-0.40). High work-related stress significantly increased the odds of anxiety (AOR 3.43, 95% CI: 1.10-10.69) and psychological distress (AOR 5.33, 95% CI: 1.70-16.72). Working more than 40 h per week was protective against depression and psychological distress. ( AOR = 0.24; 95% CI: 0.08-0.73) CONCLUSION: A substantial proportion of entrepreneurs in Southwest Nigeria experienced anxiety, depression, and psychological distress, largely associated with having dependents, high work-related stress and low job control while male entrepreneurs were less likely to have depression. These findings highlight the need for targeted mental health interventions, stress management support, and policies that promote healthier and more supportive work environments for entrepreneurs.
Gendered reacculturation and marriage negotiation among single Chinese female returnees.
Jin R, Wu B, Wei J … +1 more , Wang X
BMC Public Health · 2026 Jun · PMID 42332683 · Full text
BACKGROUND: Returning home after international study can involve complex readjustment, especially when personal life plans, family expectations, workplace experiences, and broader social norms do not fully align. In cont...
BACKGROUND: Returning home after international study can involve complex readjustment, especially when personal life plans, family expectations, workplace experiences, and broader social norms do not fully align. In contemporary China, never-married female returnees may encounter distinctive expectations concerning marriage timing, family responsibility, career development, and future life planning. METHOD: Drawing on Bronfenbrenner's Ecological Systems Theory and Patriarchal Bargaining, this study adopts a qualitative design based on in-depth semi-structured interviews with 22 never-married Chinese female returnees who had studied in Western countries and returned to China. FINDINGS: The findings suggest that participants' post-return experiences were shaped by multiple, interconnected layers of social life. At the family level, they encountered expectations related to marriage timing, filial responsibility, and socially approved life-course choices. At the workplace level, they described gendered assumptions, unequal professional opportunities, and concerns about career mobility. At the broader societal level, participants perceived public discussion around unmarried women and women with overseas experience as an additional source of pressure. These experiences shaped how participants evaluated marriage, with many approaching it cautiously while weighing family expectations, institutional conditions, reproductive concerns, and future quality of life. IMPLICATIONS: The study suggests that continued singlehood among female returnees should not be understood simply as individual preference or delayed transition. Rather, it can reflect an ongoing negotiation of gendered expectations during reacculturation. The study contributes to scholarship on return migration, singlehood, and gender by showing how family, workplace, and wider sociocultural contexts intersect in shaping women's post-return lives in contemporary China.
Assessing aflatoxin knowledge, perceptions, and related practices, in a rural coastal community: a population-based cross-sectional survey.
Iseme-Ondiek R, Abuodha J, Ngugi A … +2 more , Abayo I, Saleh M
BMC Public Health · 2026 Jun · PMID 42332677 · Full text
BACKGROUND: Aflatoxin contamination is a significant yet under-addressed food safety challenge in low-resource settings, driven by a complex interplay of environmental, agricultural, and socio-economic factors. Limited a...
BACKGROUND: Aflatoxin contamination is a significant yet under-addressed food safety challenge in low-resource settings, driven by a complex interplay of environmental, agricultural, and socio-economic factors. Limited access to agricultural inputs, inadequate post-harvest handling and storage, and weak regulatory enforcement alongside food scarcity and climate change heighten the risk of contamination and exposure. Human exposure is associated with serious health consequences, including hepatocellular carcinoma, immune suppression, and childhood stunting. Although aflatoxin is increasingly recognized as a global food safety concern, little is known about community-level knowledge, risk perceptions, and preventive practices. This study examined household heads' awareness, perceptions, and behaviours related to aflatoxin exposure and mitigation in a rural coastal community in Kenya. METHODS: We conducted a cross-sectional survey using a census approach within the Kaloleni-Rabai Health and Demographic Surveillance System (KRHDSS). Between July and December 2022, data were collected from 17,813 household heads through face-to-face, interviewer-administered, digitized questionnaires. RESULTS: Farming was the predominant occupation (n = 5,757; 32.3%). Maize was sourced primarily from household harvests and local markets, with over three-quarters (n = 13,818; 77.6%) of respondents consuming maize flour three or more times weekly. Despite maize being a dietary staple, awareness of aflatoxin was limited: only 49.5% (n = 8,816) had heard of aflatoxin. Even fewer (< 20%) respondents were able to identify foods at risk, signs of contamination, causes of fungal growth, or health consequences of exposure. Socio-economic status, rurality, education, and sex influenced aflatoxin-related knowledge, perceptions, and practices. CONCLUSION: Low awareness of aflatoxin constrains rural households' ability to prevent contamination and limit exposure. As aflatoxin risk arises at multiple points along the agricultural value chain, and vulnerability to exposure is heightened during periods of food scarcity, comprehensive control approaches are required. Effective prevention will depend on integrated strategies that combine educational initiatives, infrastructural support, and policy interventions targeting agricultural practices, food security, and consumer behaviour.
Post-earthquake life and health experiences of 3-6-year-old children through the eyes of mothers: a qualitative descriptive study.
Çaka SY, Topal S, Tanrıverdi G
BMC Public Health · 2026 Jun · PMID 42332669 · Full text
BACKGROUND: Earthquakes are among the most devastating disasters, profoundly affecting children's physical, psychological, and social well-being. Preschool children aged 3-6 are particularly vulnerable due to their devel...
BACKGROUND: Earthquakes are among the most devastating disasters, profoundly affecting children's physical, psychological, and social well-being. Preschool children aged 3-6 are particularly vulnerable due to their developmental characteristics. This study aimed to explore the life and health experiences of children aged 3-6 years following the 2023 Kahramanmaraş earthquakes. METHODS: A qualitative descriptive exploratory study was conducted with 21 mothers who had personally experienced the earthquakes, were still residing in the affected region, and were recruited through snowball sampling. Data were collected through semi-structured interviews and analyzed using an inductive thematic approach supported by MAXQDA software. RESULTS: Three main themes emerged: (1) disruptions in daily life and behaviors (sleep, nutrition, traumatic play, social withdrawal, increased maternal dependency), (2) health needs and barriers to accessing services (acute illnesses, hygiene problems, difficulties in accessing medicines and routine vaccinations), and (3) mothers' cultural and religious frameworks, including faith-based coping, family/community support, and traditional coping practices. CONCLUSION: From the mothers' perspectives, children experienced multidimensional impacts in the aftermath of the earthquake, while mothers relied on faith-based interpretations, traditional coping practices, and family/community support as important coping resources during this process. The findings highlight the need to develop child-centered disaster protocols, strengthen culturally sensitive psychosocial support, and integrate culture-based nursing approaches into disaster care.
Mental health literacy in youth: a quasi-experimental comparison of a reusable learning object in Saudi Arabia and Malaysia.
Zakaria N, Nik Farid ND, Muhamad H … +6 more , Mohd Noor NF, Ab Razak EN, Bawazir A, Mohsen A, Tiong SYX, Mofta D
BMC Public Health · 2026 Jun · PMID 42332651 · Full text
BACKGROUND: Mental health disorders such as depression, anxiety, and stress are significant public health concerns, affecting 10-20% of adolescents globally. In Saudi Arabia and Malaysia, youth mental health issues are g...
BACKGROUND: Mental health disorders such as depression, anxiety, and stress are significant public health concerns, affecting 10-20% of adolescents globally. In Saudi Arabia and Malaysia, youth mental health issues are growing, yet Mental Health Literacy remains low. MHL encompasses recognizing mental disorders, seeking appropriate help, and understanding treatment options. Reusable Learning Objects (RLO), offer a promising solution to provide evidence-based education. However, studies on the effectiveness of RLO in different cultural settings are limited. This study employed a protocol of a cross-country comparison study aimed at evaluating the potential effectiveness of RLO in supporting Mental Health Literacy among youth in Saudi Arabia and Malaysia. METHODS: A quasi-experimental design was employed among youth aged 16-24 years in two cities, Riyadh, Saudi Arabia, and Kuala Lumpur, Malaysia. RLO was developed using the ASPIRE methodology, and a validated English and Arabic MHL questionnaire was used in the study. Participants were assigned to intervention and control groups. The intervention group engaged with RLOs, while the control group completed the questionnaire without RLO exposure. Data were collected at baseline and post-intervention. Wilcoxon signed-rank tests compared baseline and post-intervention scores within groups, while Mann-Whitney U tests compared post-intervention change scores between countries. RESULTS: Wilcoxon signed-rank analyses revealed significant improvements in MHL among participants in Saudi Arabia and Malaysia. In Saudi Arabia, improvements were observed across all domains, including a reduction in erroneous beliefs (p = .021). Mann-Whitney U tests showed that Malaysian participants achieved greater gains in mental health disorder knowledge (p < .001) and overall MHL (p = .002) compared to Saudi Arabian participants, with small-to-medium effect sizes. In Malaysia, large gains were found in mental health disorder knowledge, help-seeking/first aid skill, self-help strategies, and total MHL (p < .001), whereas changes in erroneous beliefs were not significant. CONCLUSIONS: These findings highlight the promise of scalable, interactive RLOs for enhancing youth MHL in diverse cultural contexts, informing national digital mental health promotion strategies, school curricula integration, and policies to reduce stigma and improve early help-seeking in resource-constrained settings.
A cross-sectional study of health literacy and health behaviors among adults in South Korea: findings from a principal component analysis.
Shin H, Kim W
BMC Public Health · 2026 Jun · PMID 42332645 · Full text
BACKGROUND: Health literacy and health behaviors are closely related and play key roles in health promotion. Previous studies have reported that low health literacy is associated with unhealthy behaviors. It is important...
BACKGROUND: Health literacy and health behaviors are closely related and play key roles in health promotion. Previous studies have reported that low health literacy is associated with unhealthy behaviors. It is important to identify which latent dimensions of health literacy are particularly associated with health behaviors. This study aimed to examine the association between components of health literacy and health behaviors among South Korean adults. METHODS: A cross-sectional study design was used with data from the Korea Health Panel Survey. The principal component analysis was applied to the HLS-EU-Q16 to extract dimensions of health literacy, and multivariate logistic regression was conducted to assess their associations with health behaviors. RESULTS: Health literacy tertiles were significantly associated with socioeconomic status, insurance coverage, chronic disease, disability, self-rated health status, and health behaviors (p < .05). Principal component analysis identified two distinct components. Component 1 represented active engagement and the ability to access, appraise, and apply health information. Component 2 reflected a compliance-oriented dimension involving understanding and applying health-related information. Individuals with higher levels of active engagement were more likely to participate in regular physical activity (OR = 1.08, p < .01) and to attempt weight control (OR = 1.05, p < .05). By contrast, compliance-oriented health literacy was negatively associated with regular physical activity (OR = 0.93, p < .01) and positively associated with current alcohol consumption (OR = 1.10, p < .01). Similar patterns were observed in analyses stratified by educational attainment, particularly among individuals without a college education. CONCLUSIONS: This study used principal component analysis to identify two underlying components of health literacy and demonstrated that each component had a distinct relationship with health behaviors. The findings highlight the need for policies that foster proactive health literacy and encourage active information-seeking.
Implementation and systems impact of a systems-based health promotion programme at Danish vocational schools: results after 2-years follow-up.
Heinze C, Johnsen HR, Krølner RF … +1 more , Klinker CD
BMC Public Health · 2026 Jun · PMID 42332640 · Full text
BACKGROUND: Vocational schools are important settings for health promotion among young people from lower socioeconomic backgrounds, who are at an increased risk of engaging in health-compromising behaviours. However, hea...
BACKGROUND: Vocational schools are important settings for health promotion among young people from lower socioeconomic backgrounds, who are at an increased risk of engaging in health-compromising behaviours. However, health promotion interventions are rarely sustained in such settings. Systems approaches have been proposed as a promising approach to health promotion but remain unexplored in vocational school settings in Denmark. This study aimed to examine the implementation and systems impact of a systems approach to health promotion in Danish vocational schools and to elucidate the overarching pathways through which such impacts may emerge. METHODS: This longitudinal qualitative study was conducted as part of the Data Health programme, a systems-based initiative implemented across eight Danish vocational schools and four municipalities. Quarterly interviews with school coordinators or department managers (n = 59) were analysed using principles from Ripple Effect Mapping to visualise evolving actions and perceived impacts over a two-year period and identify enablers and barriers to systems impact. A cross-case analysis was used to identify plausible pathways enabling perceived systems impact. RESULTS: At two-year follow-up, 42 actions had been implemented, and systems impact (structural, relational, and/or transformative change) was perceived to have occurred at six out of eight schools. Two reinforcing systems impact pathways emerged: (1) internally driven change via committed staff and distributed leadership, and (2) externally supported change through collaboration with community actors. Key enablers included dedicated change agents, financial resources, student participation, external networks, and backbone support. Barriers included staff turnover, time constraints, and students alternating between school and workplace-based training. CONCLUSIONS: These findings provide valuable insights for the future adaptation of the Data Health programme and for informing broader systems-based strategies in vocational school settings. TRIAL REGISTRATION: Registered in ClinicalTrials.gov: NCT05308459, retrospectively registered on 4th April 2022.
Bridging Respiratory Exposures, Asthma, and Environmental Health in Corpus Christi (BREATHE-CC): a prospective cohort study protocol.
Warden DE, Meyers A, Almekhlabi H … +7 more , Kuchavaram M, Richmond E, Allison-Hoien M, Jin L, Johnson N, Roberts J, Melaram R
BMC Public Health · 2026 Jun · PMID 42332636 · Full text
BACKGROUND: Childhood asthma disproportionately affects Hispanic children in the United States. Nevertheless, few longitudinal cohorts exist in Gulf Coast communities where environmental exposures may compound sociodemog...
BACKGROUND: Childhood asthma disproportionately affects Hispanic children in the United States. Nevertheless, few longitudinal cohorts exist in Gulf Coast communities where environmental exposures may compound sociodemographic vulnerabilities. Corpus Christi, a majority-Hispanic city with high levels of petrochemical industrial operations, reports higher asthma prevalence than state and national averages. BREATHE-CC (Bridging Respiratory Exposures, Asthma, and Environmental Health in Corpus Christi) is a prospective cohort designed to investigate the role of air pollutants, household conditions, and social determinants of health in asthma exacerbations and wheezing phenotypes. METHODS: Approximately 200 children less than 10 years of age with asthma will be enrolled from Driscoll Children's Hospital. Enrolled participants complete baseline assessments and are followed monthly for up to 18 months using a parent-reported modified ISAAC (International Study of Asthma and Allergies in Childhood) questionnaire that captures household exposures, asthma exacerbations, and wheezing episodes. Questionnaire responses will be validated and supplemented with electronic health record (EHR) reviews. Daily air pollutant concentrations (PM, PM, O, SO) from the Texas Commission on Environmental Quality (TCEQ) and U.S. Environmental Protection Agency (EPA) monitoring stations will be linked to participants' addresses. Generalized Additive Models (GAMs) and Poisson regressions will assess the associations between air pollutant exposures, household risk factors, asthma exacerbations, and wheezing phenotypes, adjusting for age, sex, body mass index (BMI), and other sociodemographic indicators. Group-Based Trajectory Modeling (GBTM) will identify latent phenotypes of wheezing. DISCUSSION: This is a longitudinal cohort examining Hispanic children residing in the Gulf Coast petrochemical corridor. In particular, the study integrates granular geospatial environmental monitoring to link daily air pollutant exposure levels with asthma exacerbation risk. GBTM will also be used to identify latent wheezing phenotypes, especially focusing on differences between infectious and non-infectious wheezing. Recruitment will occur at a single hospital in the Coastal Bend region with a modest sample size, which may limit generalizability. REGISTRATION: Clinical trial number: not applicable. Open Science Framework [https://osf.io/tbg6y/overview?view_only=87309518c35b4d78a7bbe79d5fa70ceb].
Economic situation of informal caregivers for older adults in the context of changing long-term care policies: a mixed methods study.
Ishikawa M, Saarukka L, Zechner M
BMC Public Health · 2026 Jun · PMID 42332635 · Full text
BACKGROUND: Long-term care policies across Europe increasingly rely on informal care amid population ageing and constraints in public expenses. Cash-for-care schemes have been introduced to support informal care and alle...
BACKGROUND: Long-term care policies across Europe increasingly rely on informal care amid population ageing and constraints in public expenses. Cash-for-care schemes have been introduced to support informal care and alleviate socio-economic differences between caregivers. This mixed methods study investigates the subjective economic experiences of informal caregivers for older adults in Finland, where the policy initiative has gradually shifted the emphasis of care services from public provision to informal care with the support of Informal Care Allowance (ICA). METHODS: Drawing from a nationwide survey targeting informal caregivers, we focused on respondents who provided care for older adults aged 65 and over and answered the question on their economic situation (N = 1057). The study employed logistic regression analysis and qualitative content analysis to examine factors associated with economic hardship and caregivers' lived experiences. RESULTS: Quantitative findings revealed that younger caregivers, those with poor health, those caring for someone other than their spouse, caregivers providing various types of care, those lacking public sector support, those receiving adequate support from the church social work or having unmet church social work-related needs, non-recipients of informal care allowance, and individuals forced to leave employment faced significantly weakened economic situations. Qualitative analysis identified six themes on the economic impact of caregiving: dissatisfaction with the informal care allowance, utility of the informal care allowance, increase in care costs, adverse economic consequences, managing costs associated with care, and caregiving at the sacrifice of working life. CONCLUSIONS: Informal caregivers in Finland, especially those with low incomes or reduced work due to caregiving, are facing significant financial strain. This may reflect broader shifts in long-term care policy and a decreased public responsibility. While the informal care allowance can help improve caregivers' situations, it remains insufficient, particularly for working-age individuals whose earnings and career opportunities are affected. This could worsen social inequalities in both the short and long term. The divergent interpretations of the purpose of the ICA system underscore the scheme's inadequacy in meeting the diverse needs of caregivers. Future policies should better account for varying circumstances, providing stronger financial support and enabling caregivers to balance employment with care responsibilities.
Assessing implementation of the Maternal Death Surveillance and Response (MDSR) framework in North Aceh District, Indonesia: a qualitative study.
Sufri S, Jannah M
BMC Public Health · 2026 Jun · PMID 42332633 · Full text
BACKGROUND: Effective implementation of the Maternal Death Surveillance and Response (MDSR) framework is critical for reducing maternal mortality. In Aceh Province, Indonesia, maternal mortality remains high, with rates...
BACKGROUND: Effective implementation of the Maternal Death Surveillance and Response (MDSR) framework is critical for reducing maternal mortality. In Aceh Province, Indonesia, maternal mortality remains high, with rates exceeding the national average. Despite national policy adoption, limited evidence exists on how MDSR is implemented at the subnational level. This study assessed the implementation of the MDSR framework in North Aceh District by examining its five stages using eight implementation outcome variables. METHODS: A qualitative study was conducted using in-depth interviews with 60 participants, including policymakers, health practitioners, and community representatives across multiple administrative levels. In addition, five policy and program documents were reviewed. Data were analysed thematically using NVivo 12, guided by predefined implementation outcome variables (acceptability, adoption, appropriateness, feasibility, compliance, implementation cost, coverage, and sustainability). Findings were further interpreted using the Consolidated Framework for Implementation Research (CFIR) to identify multi-level factors influencing policy implementation. RESULTS: MDSR implementation was largely concentrated in the initial stage of maternal death identification, with limited progression to reporting, review, response, and monitoring and evaluation. While the framework was highly accepted and considered appropriate among policymakers, its implementation was constrained by inadequate public communication, low community engagement, limited capacity among frontline health workers, weak accountability and governance mechanisms, and frequent staff rotation. These challenges negatively affected adoption, coverage, compliance, and sustainability of the framework. CONCLUSIONS: MDSR implementation in North Aceh remains incomplete and uneven across stages, highlighting critical gaps in full-cycle implementation. Strengthening public communication, workforce capacity, accountability systems, and leadership commitment is essential to improve implementation performance. This study contributes to implementation science by demonstrating how implementation outcomes vary across MDSR stages and are shaped by multi-level determinants. The findings provide important insights for strengthening maternal death surveillance systems in Aceh and other similar decentralised health system contexts and may support efforts to accelerate progress towards maternal mortality reduction targets under the Sustainable Development Goals (SDGs).
Prevalence, predictors, and academic-related indicators associated with psychoactive drug use among students in tertiary institutions in Rivers State, Nigeria.
Brown H, Elekima I, Mike-Ogburia MI … +5 more , Anele PE, Jaja S, Olakanmi OO, Imafidon S, Oreh AC
BMC Public Health · 2026 Jun · PMID 42332630 · Full text
BACKGROUND: Psychoactive drug use among tertiary students is a public health concern with implications for well-being and academic functioning. This study investigated the prevalence, predictors, and academic-related ind...
BACKGROUND: Psychoactive drug use among tertiary students is a public health concern with implications for well-being and academic functioning. This study investigated the prevalence, predictors, and academic-related indicators associated with psychoactive drug use among students in tertiary institutions in Rivers State, Nigeria. METHODS: A cross-sectional study was conducted between August 2024 and February 2025 among 1,707 students recruited through multistage sampling from tertiary institutions in Rivers State. Data were collected using a validated, self-administered questionnaire. Descriptive statistics summarised respondent characteristics, drug-use patterns and academic-related indicators. Chi-square tests and independent t-tests assessed group differences, while multivariable logistic regression identified predictors of psychoactive drug use. Multiple linear regression examined the association between psychoactive drug use and self-reported CGPA, with statistical significance set at p ≤ 0.05. RESULTS: The prevalence of psychoactive drug use was 7.7% (95% CI: 6.6%-9.1%). Alcohol (68.9%) and marijuana (30.3%) were the most commonly used substances, while stress relief (42.4%) and recreational use (29.5%) were the leading reasons for use. Male students (aOR = 2.28; 95% CI: 1.54-3.37), undergraduates (aOR = 2.65; 95% CI: 1.22-6.57), students earning ₦25,000 - ₦125,000 (aOR = 2.42; 95% CI: 1.46-4.08), and those earning ≥₦125,001 (aOR = 4.52; 95% CI: 2.19-9.17) had higher odds of drug use. Compared with non-users, drug users more frequently reported difficulty concentrating, sleeping during lectures, missing lectures, missing continuous assessments, failing at least one course, and dropping an academic semester or year. However, no significant difference was observed in mean CGPA or satisfaction with CGPA between the two groups and psychoactive drug use was not significantly associated with self-reported CGPA in multiple linear regression (aβ = -0.09; 95% CI: -0.21-0.04). CONCLUSIONS: Psychoactive drug use was observed among students in tertiary institutions in Rivers State, especially males, undergraduates, and students with higher personal income. Although psychoactive drug use was not significantly associated with self-reported CGPA, it was linked to certain adverse academic-related indicators, including poorer concentration, absenteeism, missed assessments, course failure, and dropping an academic semester or year. These findings support the need for targeted prevention strategies, campus-based counselling, and accessible rehabilitation referral services.
Risk perception of electromagnetic fields among school teachers and nursery school teachers: a mixed-methods study.
Lüthy K, Riesmeyer C, Kühn J … +3 more , Forster F, Radon K, Weinmann T
BMC Public Health · 2026 Jun · PMID 42332615 · Full text
BACKGROUND: Although there is no evidence for adverse health effects from non-ionising electromagnetic fields (EMFs) exposure below legal limits, this concern is widespread among the general population. School teachers a...
BACKGROUND: Although there is no evidence for adverse health effects from non-ionising electromagnetic fields (EMFs) exposure below legal limits, this concern is widespread among the general population. School teachers and nursery school teachers are considered multipliers of health-related information as they impart knowledge to parents and children. However, there is a lack of knowledge about the risk perception regarding EMFs among these professional groups. The extent to which school teachers and nursery school teachers are in contact with questions concerning EMFs and health in their work has not been investigated. Nor is there any knowledge about the information level of school teachers and nursery school teachers regarding EMFs. Data on teachers' perception regarding EMFs is important though to meet information needs. METHODS: A cross-sectional study among school teachers and nursery school teachers in Germany was carried out in 2024, combining an online survey (N = 1400) with focus groups (N = 29). We calculated prevalence estimates for participants' risk perception, subjective information level, and EMFs relevance in everyday work with correction for non-response. Furthermore, we conducted a latent class analysis to identify types of EMFs risk perception. RESULTS: A third of all participating school teachers (32%) and nursery school teachers (33%) indicated that, in their view, EMF exposure below legal limits may cause adverse health effects. Five types of risk perception concerning EMFs were identified using latent class analysis, with the high risk perception class comprising 11% of the participants. Many school teachers (56%) and nursery school teachers (77%) perceived themselves as poorly informed about EMFs. The group discussions provided deeper insights and supported these findings. The interviews revealed that both professional groups had concerns about the health effects of EMFs. Knowledge of scientific evidence concerning EMFs and health was low. Moreover, the discussions revealed a desire for more information on EMFs and health. CONCLUSIONS: A notable proportion of school teachers and nursery school teachers indicated considerable risk perception towards EMFs. Most participants indicated low subjective information levels, expressing a need for information on EMF health effects. Communication formats tailored to this target group should be developed and evaluated.
Determinants of depression severity among university students in KwaZulu-Natal, South Africa: socio-economic, food security and disaster-related predictors.
Cele T, Mkhize X
BMC Public Health · 2026 Jun · PMID 42332614 · Full text
BACKGROUND: Mental health is increasingly recognised as a major public health concern among university students, particularly in low- and middle-income settings where financial insecurity, food access constraints, and en...
BACKGROUND: Mental health is increasingly recognised as a major public health concern among university students, particularly in low- and middle-income settings where financial insecurity, food access constraints, and environmental disruptions may exacerbate vulnerability. However, limited empirical evidence from South Africa has examined how these structural stressors jointly influence depression severity. METHODS: A cross-sectional online survey was administered to registered students at a university in KwaZulu-Natal (n = 445). Findings reflect associations within a single institution and should not be interpreted as representative of all university students in KwaZulu-Natal or South Africa. Depression severity was measured using the Patient Health Questionnaire-9 (PHQ-9) and categorised into five ordered levels (none to severe). Socio-demographic, economic, food security, and disaster exposure variables were assessed. An ordered probit model with marginal effects was employed to identify determinants of depression severity. RESULTS: Approximately 59.8% of students reported moderate-to-severe depressive symptoms. Female students exhibited a 7.4% higher probability of severe depression relative to males. Greater dietary diversity was associated with a 2.4% lower probability of severe symptoms, while reliance on less stable funding sources increased risk by 1.1%. Exposure to the July 2021 unrest and April 2022 floods raised the likelihood of severe depression by 3.5% and 3.4%, respectively. Students with advanced age showed a modest protective effect. Other covariates were not statistically significant. CONCLUSION: Depression severity among students is associated with gender, food security, financial stability, and exposure to socio-environmental shocks. These findings suggest that university mental health strategies should extend beyond clinical services to include food, financial, and disaster-resilience support. Addressing these determinants aligns with Sustainable Development Goals (SDGs) related to health, food security, education, and climate resilience.
Relative contributions of climate factors and air pollution to childhood allergic diseases in Chongqing, China.
Sun R, Nie L, Tang X … +3 more , Pan B, Liang J, Hu D
BMC Public Health · 2026 Jun · PMID 42324536 · Full text
BACKGROUND: Climate and air pollution are associated with pediatric allergic diseases; however, their relative impacts remain poorly understood, particularly in subtropical climates. This study quantified and compared th...
BACKGROUND: Climate and air pollution are associated with pediatric allergic diseases; however, their relative impacts remain poorly understood, particularly in subtropical climates. This study quantified and compared the contributions of meteorological variables and air pollutants to childhood allergic rhinitis (AR), asthma and atopic dermatitis (AD). METHODS: We analyzed 1,516,996 pediatric hospital visits in Chongqing, China (2014-2019, 2023-2024), including AR (n = 456,807), asthma (n = 775,181), and AD (n = 285,008). Using distributed lag non-linear models, we examined associations with temperature, humidity, atmospheric pressure, wind speed, PM₂.₅, PM₁₀, NO₂, SO₂, CO, and O₃, comparing effect magnitudes through standardized coefficients and attributable disease burdens. RESULTS: Temperature demonstrated the strongest associations across all diseases, with opposing effects: positive associations with respiratory allergies (AR: RR = 1.25, 95% CI: 1.16-1.35 at 30 °C, attributing 84,640 cases [18.5% of total burden]; asthma: RR = 1.10, 95% CI: 1.05-1.16 at 32 °C, attributing 58,058 cases [7.5%]) versus inverse association with AD (RR = 0.75, 95% CI: 0.68-0.83 at 30 °C, associated with 58,270 fewer cases [20.4% reduction]). Seasonal analyses demonstrated marked heterogeneity: summer concentrated AR burden (temperature attributing 18,896 cases, 22.3% of annual burden), while winter concentrated asthma NO₂ effects (21,558 cases, 11.1% of winter burden). Individual air pollutants showed substantially smaller effects than temperature. CONCLUSIONS: Temperature demonstrated stronger short-term associations with childhood allergic disease burden than individual air pollutants in subtropical settings. Disease-specific environmental susceptibility patterns (opposing temperature effects for respiratory versus dermatological allergies) necessitate tailored prevention strategies. These results support integrating climate adaptation measures alongside air quality management in pediatric environmental health policies, with season-specific interventions during high-burden periods.
Temporal patterns and risk factors of recurrent influenza infection: a population-based epidemiological study.
Zhou L, Li Z, Zhou X … +6 more , Dong S, Ma Y, Yang B, Hu F, Cheng X, Xiao C
BMC Public Health · 2026 Jun · PMID 42324534 · Full text
BACKGROUND: The continuous mutation and seasonal dominance of influenza viruses subject people to the danger of repeated infection. Nonetheless, comprehensive studies on the temporal patterns and risk differentials of in...
BACKGROUND: The continuous mutation and seasonal dominance of influenza viruses subject people to the danger of repeated infection. Nonetheless, comprehensive studies on the temporal patterns and risk differentials of influenza reinfection at the population level are few. METHODS: The study analyzed surveillance data from 2,834,112 influenza cases in Sichuan Province from 2023 to 2025. Follow-up continued until week 156 after infection. The Kaplan-Meier method measured cumulative reinfection incidence, whereas the Andersen-Gill count process model examined different factors on reinfection risk. Reinfection temporal distribution by age group was characterized using kernel density estimation. RESULTS: The Kaplan-Meier curves showed a progressive increase in reinfection risk every 52 weeks, reaching 5.5% at 156 weeks. The log-rank test showed a substantial correlation between gender, age, occupation, residence, and case classification and reinfection likelihood (P < 0.001). A multivariate Andersen-Gill analysis showed that people aged 0-5 and 6-19 had a considerably higher reinfection risk than those aged 20-45 and ≥ 61 years. Kernel density analysis showed that reinfection occurred between 9 and 12 months after the original infection, with children having the highest prevalence and adults having a bimodal distribution. CONCLUSION: Influenza reinfection risk varies annually, notably in children, adolescents, and high-exposure occupational groups. Significant disparities in risk among groups suggest that age and sociodemographic variables affect influenza immune protection and exposure patterns. Epidemiological data from these studies can improve stratified immunization programs and focused prevention efforts for key groups.
Determinants of out-of-home food consumption: development and validation of a multidimensional scale in a Brazilian sample.
Lopes LFD, Pegoraro D, de Oliveira RC … +3 more , Lopes EG, Saragozo RA, da Silva DJC
BMC Public Health · 2026 Jun · PMID 42324459 · Full text
BACKGROUND: Out-of-home food consumption has become an integral component of contemporary dietary patterns, particularly in urban contexts. Evidence suggests that eating outside the home is associated with diet quality,...
BACKGROUND: Out-of-home food consumption has become an integral component of contemporary dietary patterns, particularly in urban contexts. Evidence suggests that eating outside the home is associated with diet quality, nutritional intake, and broader public health outcomes. However, Brazil lacks validated multidimensional instruments capable of comprehensively assessing the economic, behavioral, and experiential determinants underlying this behavior. This study aimed to develop and validate the Scale of Determinant Factors in Out-of-Home Food Consumption (SDF-OHFC) and to examine the structural relationships among its dimensions. METHODS: A cross-sectional study was conducted with 426 Brazilian adults who reported consuming food outside the home at least once per week. Data were collected through an online survey and analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). The measurement model was assessed for reliability, convergent and discriminant validity. Structural relationships were tested using bootstrapping procedures (5,000 resamples), and predictive performance was evaluated through R², Q², RMSE, and MAE. Measurement invariance was examined across sex, marital status, and geographic regions. RESULTS: The SDF-OHFC comprises five dimensions: economic aspects, convenience, habits and personal preferences, social and experiential aspects, and perceived food quality. The scale demonstrated satisfactory internal consistency (Cronbach's α = 0.705-0.762), composite reliability (> 0.70), and convergent validity (AVE > 0.50). All hypothesized structural relationships were statistically significant (p < 0.05). Economic aspects played a central antecedent role, positively influencing convenience and habits, and negatively influencing social and experiential aspects. Convenience and social and experiential dimensions were positively associated with perceived food quality. Structural invariance was confirmed across all tested demographic groups. CONCLUSIONS: The SDF-OHFC is a valid and reliable multidimensional instrument for assessing determinants of out-of-home food consumption in Brazil. By integrating economic, behavioral, and experiential factors within a single framework, the scale supports public health research and policy development aimed at improving urban food environments, promoting healthier eating practices, and addressing structural determinants of dietary behavior.
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