International Journal Of Environmental Research And Public Health[JOURNAL]
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200 papers
Association Between Food Environment Characteristics and Overweight and Anemia in Socially Vulnerable Children Living in Favelas.
Silva-Neto LGR, de Menezes RCE, Leal VS … +2 more , Dos Santos TLF, de Menezes Toledo Florêncio TM
Int J Environ Res Public Health · 2026 Jun · PMID 42354331 · Full text
BACKGROUND: The food environment plays a significant role in determining children's nutritional status, especially in socially vulnerable settings, where the high availability of ultra-processed beverages can contribute...
BACKGROUND: The food environment plays a significant role in determining children's nutritional status, especially in socially vulnerable settings, where the high availability of ultra-processed beverages can contribute to both overweight and nutritional deficiencies, such as anemia. Thus, this study aimed to assess the association between the availability of fruits, vegetables, and ultra-processed beverages in the food environment and the occurrence of overweight and anemia in children living in socially vulnerable areas. METHODS: This is a cross-sectional study with an ecological component, conducted between 2020 and 2021, involving 665 children residing in 40 favelas and urban communities in Maceió, Alagoas, Brazil. Socioeconomic, anthropometric, and hematological data were collected, along with a characterization of the food environment in 624 establishments using the AUDITNOVA tool, focusing on the availability of fruits, vegetables, and ultra-processed beverages. The outcomes investigated were overweight (BMI-for-age z-score > +2) and anemia (hemoglobin < 11 g/dL). Multilevel models were used to assess the associations between the food environment and the outcomes of interest. RESULTS: The prevalence of overweight was 19.7%, while anemia affected 50.4% of the children assessed. Greater availability of fruits and vegetables was associated with a lower chance of being overweight (OR: 0.82; 95% CI: 0.79-0.98). In contrast, high availability of ultra-processed beverages was associated with a higher chance of being overweight (OR: 1.35; 95% CI: 1.07-1.84) and anemia (OR: 1.53; 95% CI: 1.04-2.29). CONCLUSION: Food environments characterized by widespread availability of ultra-processed beverages were associated with a higher prevalence of overweight and anemia among children. In comparison, greater availability of fresh or minimally processed foods was associated with a lower prevalence of overweight. These findings highlight the importance of public policies that promote healthier food environments in socially vulnerable areas.
Characterization of Carcinogenic and Non-Carcinogenic Metal(loid)s in Water Within a Uranium-Mining-Impacted Region in Northwestern New Mexico, USA.
Samuel-Nakamura C, Ali AS
Int J Environ Res Public Health · 2026 Jun · PMID 42354330 · Full text
More than 500 unreclaimed mines and about 1100 associated waste sites remain on the Navajo Nation as a result of uranium (U) mining. This study evaluated the impact of U-mining water contamination in a region of Northwes...
More than 500 unreclaimed mines and about 1100 associated waste sites remain on the Navajo Nation as a result of uranium (U) mining. This study evaluated the impact of U-mining water contamination in a region of Northwestern New Mexico. The goal of this study was to determine historical baseline concentrations of selected metal(loid)s: those found to be highly associated with cancer (arsenic (As), cadmium (Cd), lead (Pb)) and other associated metals: cesium (Cs), molybdenum (Mo), selenium (Se), thorium (Th), U, and vanadium (V), using inductively coupled plasma-mass spectrometry. Cadmium drinking water concentrations (10.64 μg/L) exceeded the United States Environmental Protection Agency Maximum Contaminant Levels (MCLs) of 5 μg/L. Overall, water mean concentration levels were 11.04 μg/L of Pb, 4.21 μg/L of As, 3.53 μg/L of U, 278.67 μg/L for Mo, 21.70 μg/L for V, 2.39 μg/L for Cs, and 7.75 μg/L for Se. These findings underscore the importance of improving access to safer water sources and highlight the need for continued environmental monitoring and research on exposure pathways associated with carcinogenicity and other negative health outcomes.
Factors Influencing Water and Sweet Beverage Purchasing Decisions and Behaviours Among Low-Income Households in Four Peri-Urban Communities in Accra: An Exploratory Study.
Amegah CD, Odei Obeng-Amoako GA, Ng SW … +2 more , Lambon-Quayefio M, Adu-Afarwuah S
Int J Environ Res Public Health · 2026 Jun · PMID 42354329 · Full text
BACKGROUND: In May 2023, Ghana implemented a 20% ad valorem tax on bottled water and sweet beverages (SBs), replacing a 17.5% tax; sachet water remained untaxed. The effect on low-income consumers' purchasing decisions a...
BACKGROUND: In May 2023, Ghana implemented a 20% ad valorem tax on bottled water and sweet beverages (SBs), replacing a 17.5% tax; sachet water remained untaxed. The effect on low-income consumers' purchasing decisions and consumption patterns remains poorly understood. OBJECTIVE: We aimed to explore factors influencing water and SB purchasing behaviours among low-income households in four peri-urban Accra communities. METHODS: This study employed a convergent parallel mixed-methods design. Four focus group discussions ( = 36) and a cross-sectional survey ( = 43) were conducted among purposively sampled household primary shoppers in early 2025 across Oyarifa, Teiman, Kweiman, and Danfa. Data were analysed thematically and descriptively. RESULTS: Of 43 participants, 67% were female and 65% had junior high school education. Water insecurity was common (60%), and sachet water was the main drinking source (77%). SB purchasing was driven by taste and convenience, while sachet water choices were linked to perceived safety, price, and availability. Tax awareness was moderate (56%); many perceived bottled water taxation as unfair and reported intentions to switch to cheaper local alternatives. CONCLUSIONS: Limited tax awareness and perceived inequities suggest the need for policy refinements to better align fiscal measures with public health objectives.
Reliability and Validation of the Vietnamese Utian Quality-of-Life Scale in Postmenopausal Women.
Thao NDP, Tuyen LTT, Quan DT … +1 more , Hoa DTK
Int J Environ Res Public Health · 2026 Jun · PMID 42354328 · Full text
The absence of a culturally adapted instrument to assess menopause-specific quality of life in Vietnamese women limits both clinical practice and research in this population. This study aimed to translate, culturally ada...
The absence of a culturally adapted instrument to assess menopause-specific quality of life in Vietnamese women limits both clinical practice and research in this population. This study aimed to translate, culturally adapt, and psychometrically validate the Vietnamese version of the Utian Quality of Life (VN-UQOL) Scale. A cross-sectional design was employed with 384 community-dwelling postmenopausal women aged 46-65 years. The UQOL was translated and adapted following established guidelines, including forward-back translation, expert review, and pilot testing. Internal consistency was evaluated using Cronbach's alpha, construct validity through confirmatory factor analysis (CFA), and concurrent validity via Pearson correlations with the Vietnamese Menopause Rating Scale (VN-MRS). The VN-UQOL demonstrated excellent internal consistency, with a total scale Cronbach's alpha of 0.87 and sub-scale alphas ranging from 0.81 to 0.93. Content validity indices (I-CVI, S-CVI) were 1.0. CFA confirmed the original four-factor structure, with all factor loadings exceeding 0.50 and good model fit indices (CFI = 0.921, RMSEA = 0.072). Concurrent validity was supported by significant negative correlations between the VN-UQOL sub-scales and corresponding VN-MRS domains ( < 0.01). The VN-UQOL is a reliable and valid instrument for assessing menopause-specific quality of life in Vietnamese women, providing a valuable tool for clinical practice and research in this underserved population.
Dental Treatment Needs and Cost Burden Among Older Adults: A K-Means Cluster Analysis to Inform Oral Health Policies.
Aksoy B, Akmansoy ŞC, Özkan Y … +1 more , Mumcu G
Int J Environ Res Public Health · 2026 Jun · PMID 42354327 · Full text
Oral health problems among older adults represent a growing public health concern due to increasing life expectancy and treatment needs. This study aimed to assess dental treatment needs and cost burden within the contex...
Oral health problems among older adults represent a growing public health concern due to increasing life expectancy and treatment needs. This study aimed to assess dental treatment needs and cost burden within the context of oral health policies. This retrospective study included anonymized data from 250 patients aged ≥65 years (F/M: 121/129; 65-89 years). Sociodemographic characteristics, treatment needs, and costs were obtained from the Hospital Information Management System (HIMS). Costs were adjusted to 2025 Turkish lira values using the Consumer Price Index and converted to international dollars using purchasing power parity (PPP). Patients were classified by total treatment costs using K-means cluster analysis. Periodontal (61.2%), restorative (36.0%), and endodontic (41.2%) treatment needs, which are largely preventable through oral hygiene practices, were more frequent among patients with a lower mean age, whereas tooth loss and prosthodontic treatment needs (89.6%) increased with mean age. Cluster analysis identified two groups: a low-cost group (67.6%) and a high-cost group (32.4%). The high-cost group had a lower mean age (68.84 ± 4.27 years) compared to the low-cost group (70.73 ± 5.18 years), indicating that relatively younger patients needed more complex and costly treatments. Out-of-pocket payments were notable for prosthodontic and surgical treatments, although Social Security Institution (SSI) payments constituted most of the costs. Preventive and early dental care strategies are essential to reduce treatment complexity and cost burden among older adults within the framework of oral health policy.
Sociodemographic and Structural Risk Factors for Dengue in a Rapidly Developing Indonesian District.
Lubis IND, Siregar NKS, Yanni GN … +2 more , Fujiati II, Sihotang LE
Int J Environ Res Public Health · 2026 Jun · PMID 42354326 · Full text
BACKGROUND: Dengue infection is an expanding public health threat in Indonesia, increasingly reported in semi-urban areas undergoing rapid demographic and environmental change, where household-level determinants remain p...
BACKGROUND: Dengue infection is an expanding public health threat in Indonesia, increasingly reported in semi-urban areas undergoing rapid demographic and environmental change, where household-level determinants remain poorly characterised. METHODS: We conducted a case-control study in the Deli Serdang district, North Sumatra, evaluating sociodemographic and environmental risk factors for dengue. Patients admitted to the district referral hospital (July-September 2024) were screened via medical records. Laboratory-confirmed dengue cases were compared with non-dengue febrile controls. Housing conditions and sociodemographic characteristics were assessed using a validated electronic questionnaire with photographic documentation. Multivariable logistic regression identified independent risk factors. RESULTS: Of 238 individuals screened, 39 dengue cases and 78 controls were enrolled. Male sex (aOR 6.7, 95% CI 1.3-33.7), student status (aOR 7.8, 95% CI 1.1-56.5), absence of window screens (aOR 12.9, 95% CI 3.1-53.8), and surrounding vegetation (aOR 7.3, 95% CI 1.7-31.9) were independently associated with dengue infection. Rural residence was overrepresented among cases, suggesting expansion beyond traditional urban boundaries. CONCLUSIONS: Dengue risk in a transitional setting is shaped by demographic exposure and modifiable structural vulnerabilities. Integrated prevention strategies, including window screening, covered water storage, environmental management, and school-based vector control, are needed in rapidly urbanising districts.
Decomposing Wealth-Based Inequalities in Neonatal Mortality in India: Evidence from National Family Health Survey (2019-2021).
Gautam D, Pandey AK, Thomas M B … +1 more , Neogi SB
Int J Environ Res Public Health · 2026 Jun · PMID 42354325 · Full text
India exhibits substantial variation in neonatal mortality across regions and socioeconomic groups. This study used nationally representative survey data (2019-2021) to examine wealth-based inequalities in neonatal morta...
India exhibits substantial variation in neonatal mortality across regions and socioeconomic groups. This study used nationally representative survey data (2019-2021) to examine wealth-based inequalities in neonatal mortality. Socioeconomic disparities were assessed using Erreygers' Normalized Concentration Index (ECI) and concentration curves, with subgroup analyses by residence, state development status (Empowered Action Group (EAG) vs. non-EAG), district typology, and region. Inequality was further decomposed using the Wagstaff method. Analysis of 176,843 most recent live births revealed marked rural-urban disparities, with neonatal mortality in rural areas (18.3 per 1000 live births) 1.6 times higher than in urban areas (11.5). Neonatal mortality was significantly concentrated among poorer households (ECI: -0.0123; < 0.001), with greater inequality in urban areas, EAG states, and non-aspirational districts. Regional variation was evident, with the highest inequality in the Western and Central regions. Decomposition analysis showed that inequality was primarily driven by adverse household conditions and maternal risk factors concentrated among poorer populations. Key contributors included unclean cooking fuel, higher parity, large family size, normal delivery and inadequate antenatal care. These findings highlight the need for equality-focused strategies addressing both social determinants and gaps in access to quality maternal and newborn care.
What Characterizes Employees with Emotional Exhaustion and Employees with Work Overload?
Elster-Kann CC, Muschalla B
Int J Environ Res Public Health · 2026 Jun · PMID 42354324 · Full text
Emotional exhaustion has been discussed as a major contributor to work ability problems, with substantial economic, individual, and social consequences. Research largely focuses on specific professions and sometimes over...
Emotional exhaustion has been discussed as a major contributor to work ability problems, with substantial economic, individual, and social consequences. Research largely focuses on specific professions and sometimes overlooks that exhaustion and work overload problems are partly distinct. This study uses a differential analysis to explore working conditions and individual characteristics in employees with emotional exhaustion or perceived work overload, aiming to identify potential common risk factors. A representative German cross-sectional sample of 2289 employees aged 15-67, working at least 10 h per week, was analyzed. Employees with and without treatment for exhaustion, and with and without perceived work overload, were compared using variance analysis. Overloaded employees reported more work demands, while exhausted employees appear to be more often female and not in their preferred occupation. Several psychosocial work factors (e.g., responsibility) were more consistently associated with the overload and exhaustion groups than many of the physical work conditions. Employee characteristics such as openness and internal locus of control appeared to be similarly distributed across groups. Overload without exhaustion can be distinguished from combined exhaustion and overload, suggesting that work overload may occur with or without exhaustion, in relation to individual psychosocial resources. Preventive interventions for work ability may benefit from addressing overload as a distinct risk factor, besides illness-related exhaustion.
Influence of the rs1695 Polymorphism on Mercury Levels and Memory Performance in the Suruí Indigenous from the Brazilian Amazon.
Silva MCD, Basta PC, Pinto BD … +5 more , Machado DE, Pessoa-Silva FO, de Oliveira RAA, de Vasconcellos ACS, Perini JA
Int J Environ Res Public Health · 2026 Jun · PMID 42354323 · Full text
Mercury (Hg) is a major neurotoxicant and public health concern and gold mining is a significant source of Hg contamination in the Amazon. There, Indigenous peoples are vulnerable to this exposure. Individual susceptibil...
Mercury (Hg) is a major neurotoxicant and public health concern and gold mining is a significant source of Hg contamination in the Amazon. There, Indigenous peoples are vulnerable to this exposure. Individual susceptibility influences both internal mercury levels and related clinical outcomes. In this context, the gene stands out due to its role in detoxification of xenobiotics. The objectives were to assess the associations between: (1) Hg levels and neurotoxicity signs; (2) the rs1695 polymorphism and Hg levels; and (3) whether the rs1695 polymorphism modifies the effect of mercury on neurotoxicity signs. A cross-sectional study was conducted between April and May 2023, with 113 Paiter-Suruí Indigenous people. Sociodemographic and clinical data were collected using a validated methodology. Hair and oral mucosa cells were collected to assess Hg levels and the rs1695 polymorphism. Hg levels ranged from 0.1 μg/g to 6.5 μg/g (median = 1 μg/g, IQR = 1.43). Individuals with impaired memory and muscle strength had significantly higher mercury levels (β = 4.39 and β = 1.24). Carriers of the AA genotype showed a 0.46-point reduction for each 1 μg/g increase in mean Hg levels, compared to individuals with the GG genotype (β = -0.46). These results may support public policies by identifying priority groups for intervention based on genetic profiles.
Examine Facilitators and Barriers to Return to Work (RTW) for Employees with Common Mental Disorder (CMD) Symptoms: A Multi-Stakeholder Qualitative Study.
Khatter N, Chotai S, Kadra-Scalzo G
Int J Environ Res Public Health · 2026 Jun · PMID 42354322 · Full text
Returning to work (RTW) following sickness absence due to common mental disorder (CMD) symptoms, such as anxiety, depression and stress, is increasingly recognised as a critical yet complex phase of recovery. Despite thi...
Returning to work (RTW) following sickness absence due to common mental disorder (CMD) symptoms, such as anxiety, depression and stress, is increasingly recognised as a critical yet complex phase of recovery. Despite this, individuals do not always experience the process as supportive or straightforward. This study explored the factors shaping RTW by examining the perspectives of service users, employment advisors (EAs) and human resource (HR) professionals. In a qualitative study, using purposive sampling, we recruited 17 participants across the three stakeholder groups. Data were collected through semi-structured interviews and analysed using thematic analysis. The findings suggest that RTW is shaped by a dynamic interplay between individual experiences, workplace relationships and organisational structures. Participants described returning to work as an ongoing and often uncertain process, influenced by shifts in confidence, expectations of support and the extent to which workplaces were able to respond flexibly to individual needs. While some accounts reflected collaborative and supportive environments, others highlighted disconnection, misalignment and unmet expectations across stakeholders. Overall, the findings point to RTW as a negotiated process, requiring alignment between employees, managers and organisational systems. The study highlights the importance of consistent, flexible and context-sensitive approaches to support sustainable RTW following CMD-related absence.
The Mediation Effect of Eudaimonic Well-Being in the Relationship Between Self-Determination and Somatic Symptoms.
Marcinko I, Kurtovic A, Babic Cikes A
Int J Environ Res Public Health · 2026 Jun · PMID 42354321 · Full text
The majority of somatic symptoms have unexplained medical causes, and it is claimed that psychological factors are important in the initiation and exacerbation of somatic complaints. This study, cross-sectional and corre...
The majority of somatic symptoms have unexplained medical causes, and it is claimed that psychological factors are important in the initiation and exacerbation of somatic complaints. This study, cross-sectional and correlational in nature, investigated the mediating role of eudaimonic well-being on the relationship between self-determination and somatic symptoms. Mediations were examined at both the whole-construct and component levels to better understand these relationships. A total of 486 participants took part in this study, comprising 403 females (82.9%) and 83 males (17.1%), with an age range of 18 to 36 years ( = 22, = 2.27). Self-determination, eudaimonic well-being, and somatic symptoms were measured using questionnaires. Mediations were tested at the construct and component levels using the PROCESS macro. The results show that eudaimonic well-being mediates the relationship between self-determination and somatic symptoms ( = -0.21, = 0.03, 95% = [-0.32, -0.10]). Component-level analyses reveal that the relationship between controlling motives and somatic symptoms is mediated by negative affect ( = 0.39, = 0.08, 95% [0.23, 0.56]). These findings identify the variables that may explain the origin of somatic symptoms, emphasising self-determination as a starting point and eudaimonic well-being as a mechanism by which motivational factors affect health outcomes.
Suicide and Coping: Specific Coping Behaviours Associated with Suicidal Ideation and Differences Between Predicted and Actual Coping Among Help-Seeking Individuals.
Hallford DJ, Wallman EJ, Kaplan RA … +1 more , Melvin GA
Int J Environ Res Public Health · 2026 Jun · PMID 42354320 · Full text
Suicide is a substantial contributor to global mortality, with suicidal ideation (SI) a significant predictor of suicide. Research has demonstrated relationships between dispositional coping styles and SI. This study aim...
Suicide is a substantial contributor to global mortality, with suicidal ideation (SI) a significant predictor of suicide. Research has demonstrated relationships between dispositional coping styles and SI. This study aimed to advance this research by examining the specific coping strategies people use when experiencing SI. Further, it assessed predicted use of coping strategies of people with a history of SI would differ from the actual coping strategies employed by people have experienced SI. Seventy-seven help-seeking adults (Mage = 31.6, SD = 10.4) with (n = 49) or without (n = 28) history of SI completed the Brief Coping Orientations to Problems Experienced (Brief COPE) adapted to SI-related coping and current emotional distress measured by the 21-item version of the Depression Anxiety Stress Scale (DASS-21). An ANCOVA, while controlling for current emotional distress levels, showed a greater predicted Problem-Focused coping use than actual use reported by participants with SI history. Facet-level ANCOVAs attributed this to differences in Active Coping, Use of Informational Support, and Planning strategies. There were no group differences in emotion-focused or avoidant coping. The preliminary findings suggest individuals without a history of SI may prognosticate more frequent use adaptive coping strategies, relative to how frequently people actually employ them during these times. Future research may examine the factors explaining these differences to help inform programs related to SI and coping.
Community-Driven Grassroots Intervention on Adolescent Vaping Attitudes, Harm Perceptions, and Knowledge: Randomized Controlled Trial.
Beg MAA, Dawood Y, Patten SB
Int J Environ Res Public Health · 2026 Jun · PMID 42354319 · Full text
This study evaluated the effectiveness of a youth-developed vaping intervention created by the Airdrie Board of Youth Affairs (ABYA) in changing Grade 7 and 8 students' knowledge, attitudes, and harm perceptions regardin...
This study evaluated the effectiveness of a youth-developed vaping intervention created by the Airdrie Board of Youth Affairs (ABYA) in changing Grade 7 and 8 students' knowledge, attitudes, and harm perceptions regarding e-cigarette use. The vaping video trial followed a preceding local education program on smoking harms. A total of 107 students were randomly assigned to either the intervention group (ABYA video) or the control group (expert-developed video). Four instruments were used: the Video Survey, Personal Information Questionnaire, Knowledge and Attitudes Regarding E-cigarette Ingredients, Safety, and Addictive Properties (KAS), and the E-cigarette Harm Perception and Reduction (EHI). Pre- and post-intervention data were analyzed using -tests and Mann-Whitney U tests. Compared with controls, the intervention group showed a significantly larger mean decrease in total EHI scores (mean change 9.05 vs. 2.06; t(105) = 3.34, = 0.001; Cohen's d = 0.65), indicating that the youth-developed video increased the perceived risk of vaping relative to cigarettes to a greater extent than the expert-developed video. Students also rated the ABYA video significantly higher on a 5-point scale for overall enjoyment (3.13 vs. 2.33; < 0.001; Cohen's d = 0.81) and for perceived increase in knowledge about vaping (3.34 vs. 2.84; = 0.023; Cohen's d = 0.44). The KAS instrument showed low internal consistency in this sample, so item-level KAS findings were treated as exploratory. Notably, unlike the expert-developed video, which explicitly acknowledged uncertainty, the ABYA video conveyed a clearer and more direct message, which may have contributed to its greater appeal while also carrying a risk of overstating absolute risk of e-cigarettes relative to cigarettes. Overall, these findings suggest that grassroots, youth-led interventions may be an effective approach for adolescent vaping education and may offer advantages over traditional expert-developed messaging in some contexts.
Hospitalizations After Bicycle Accidents: Injury Patterns, Severity and Costs.
Guerrero Serrano JA, Martín SL, Sánchez García J … +2 more , Arroyo Hernández M, Caba Doussoux P
Int J Environ Res Public Health · 2026 Jun · PMID 42354318 · Full text
UNLABELLED: Background Although cycling has definite health benefits, it is certainly not a risk-free activity; its increasing use is associated with a rise in accidents. This study aims to characterize cycling injuries...
UNLABELLED: Background Although cycling has definite health benefits, it is certainly not a risk-free activity; its increasing use is associated with a rise in accidents. This study aims to characterize cycling injuries and their associated factors in a tertiary trauma center, including injury severity, accident circumstances, and in-hospital costs. METHODS: A retrospective observational study was conducted on patients over 15 years of age hospitalized after a cycling accident. Collected variables included the characteristics of the accident, the epidemiology of musculoskeletal injuries, helmet use, injury severity as assessed using the Abbreviated Injury Scale (AIS), the Injury Severity Score (ISS), and costs. RESULTS: A total of 131 patients were included, of whom 90.8% were male, with a mean age of 43.2 ± 14.1 years. Most accidents were due to falls (83.7%). Accidents occurred in urban areas (56.3%), inter-urban roads (28.1%), and rural areas (15.6%). Upper limb fractures, particularly clavicle fractures (13.7%), were the most frequent injuries (31.0%). Traumatic brain injury (TBI) was present in 30.0% of patients, and 17.6% were polytraumatized. Injury severity was higher in males ( = 0.009) and in collisions compared with falls ( = 0.033). It was also correlated with length of hospital stay (r = 0.376). Patients with TBI exhibited significantly higher ISSs ( < 0.001). Helmet use was reported in 71.1% of patients and was more frequent in rural areas ( < 0.001) and associated with lower neurological AIS scores ( = 0.031). The mean cost per patient was €8545 ± 15,298, increasing with severity of injury ( < 0.001), and was higher in polytraumatized patients ( < 0.001) and in those with TBI. CONCLUSIONS: Cycling accidents most frequently resulted in upper limb fractures. Helmet use was more common where mandatory and was associated with less severe neurological injuries but not with a lower incidence of TBI. Costs increased with injury severity, particularly in patients with TBI and longer hospital stays.
Association of Park Size, Access and Neighbourhood Walkability with Physical Activity and Obesity: A Cross-Sectional Analysis.
Fazli GS, Polsky J, Johns A … +3 more , Gozdyra P, Luo J, Booth GL
Int J Environ Res Public Health · 2026 Jun · PMID 42354317 · Full text
BACKGROUND: We examined whether higher access to parks and greenspace is independently associated with an increase in physical activity and lower rates of obesity when neighbourhood walkability is accounted for and wheth...
BACKGROUND: We examined whether higher access to parks and greenspace is independently associated with an increase in physical activity and lower rates of obesity when neighbourhood walkability is accounted for and whether neighbourhood walkability and park access have synergistic effects on these outcomes. MATERIALS AND METHODS: We used cross-sectional data from the Canadian Community Health Survey between 2007 and 2014 for adults aged 20 to 74 in Ontario, Canada. Neighbourhood-level park access exposures included size of parks and number of parks within 800 m of residential areas, and neighbourhood walkability was based on a validated index. The main outcomes were physical activity during leisure time (LPA), both leisure and transportation physical activity (LTPA), and obesity. Descriptive and multivariate logistic regression analyses were conducted, stratified by age groups, accounting for sex, income, ethnicity, and season. RESULTS: Among 41,945 respondents, park access was associated with higher LPA and LTPA, with effects modified by neighbourhood walkability ( < 0.001). Physical activity was highest in neighbourhoods with high walkability and park access and lowest in low walkability areas without parks. In highly walkable neighbourhoods, ≥1 small- or medium-sized park was associated with 29% higher odds of LPA (OR: 1.29, 95%CI: 1.21-1.37) and 48% higher odds of LTPA (OR: 1.48, 95%CI: 1.38-1.57) than low walkability/no park access. In contrast, associations were modest in low-walkability neighbourhoods (4-7%). High walkability was also associated with lower obesity and marked reductions when combined with very high access to large parks (OR: 0.72, 95%CI: 0.55-0.94). Findings were consistent across age groups. CONCLUSIONS: High neighbourhood walkability was the strongest predictor of physical activity and lower obesity risk, with park access providing additional benefits primarily in already walkable environments. These findings suggest that population health interventions targeting urban design need to consider the combined benefits of neighbourhood walkability and park access on health.
Substance Use and Traumatic Brain Injury: Evidence from a Rural Trauma Center.
Lininger MR, Anastario M
Int J Environ Res Public Health · 2026 Jun · PMID 42354316 · Full text
: Traumatic brain injury (TBI) and substance use disorder (SUD) frequently co-occur due to shared risk factors and a potentially bidirectional relationship. However, epidemiological patterns in rural populations remain u...
: Traumatic brain injury (TBI) and substance use disorder (SUD) frequently co-occur due to shared risk factors and a potentially bidirectional relationship. However, epidemiological patterns in rural populations remain understudied despite known disparities in access and outcomes. This study aimed to characterize the relationship between TBI and SUD in a rural Southwestern population, including demographic and clinical patterns of diagnostic sequencing. : A retrospective observational study was conducted using electronic health records and trauma registry data (2022-2023) from a rural trauma center. Cohort one included 24,389 emergency department encounters with ICD-10 codes for TBI or SUD. Cohort two included 248 trauma registry patients with TBI and SUD diagnoses. Descriptive statistics and multinomial logistic regression models were used to evaluate diagnostic patterns and associated demographic factors. : Males were more likely to have co-occurring TBI and SUD (Relative Risk Ratio [RRR] = 1.35), while increasing age was associated with TBI-only diagnoses. Among patients with multiple visits and diagnoses, 16% had co-diagnoses, while 9% had sequential diagnoses. American Indian/Alaska Native patients had higher co-diagnosis risk compared to White patients (RRR = 2.21, < 0.001). Higher blood alcohol concentration was associated with lower Glasgow Coma Scale scores (r = -0.15, = 0.022), indicating greater severity. : TBI and SUD frequently co-occur in rural populations, with notable disparities by sex and race/ethnicity. Emergency Departments are critical points of care for interventions such as screening for both substance use and head injury when either is suspected, and employing culturally responsive education and referral pathways upon discharge.
Community Coalition Building and Human-Centered Design Strategies to Advance Homeless Health Systems: A Case Study from Rural North Carolina.
Jarrett A, Fleming O, Shomali J … +1 more , Romani W
Int J Environ Res Public Health · 2026 Jun · PMID 42354315 · Full text
In Burke County, North Carolina, a Hepatitis A outbreak among unsheltered residents exposed gaps in access to clinic-based care and prompted early, ad hoc "backpack medicine" outreach efforts to deliver care directly in...
In Burke County, North Carolina, a Hepatitis A outbreak among unsheltered residents exposed gaps in access to clinic-based care and prompted early, ad hoc "backpack medicine" outreach efforts to deliver care directly in nontraditional settings. While this approach addressed immediate needs, it highlighted the inadequacy of isolated interventions, prompting local partners to pursue more structured, coordinated, and community-driven approaches to homeless health system design. This project report describes how Burke County Public Health, in partnership with the University of North Carolina at Chapel Hill, applied systems thinking, community coalition building, and human-centered design to transition from reactive outreach to a structured, sustainable mobile health delivery model for people experiencing homelessness. Guided by Community Coalition Action Theory (CCAT), partners used human-centered design methods to engage over 40 community stakeholders and 10 individuals with lived experience of homelessness or housing instability. Through empathy mapping, iterative prototyping, and thematic analysis, the team identified priority service gaps, defined operational requirements, and developed prototype service models, while building cross-agency readiness for implementation.
Spatiotemporal Associations Between Ambient Air Pollution and Neoplasm Morbidity in Eastern Kazakhstan: Age-Specific Patterns and Spatial Heterogeneity, 2014-2024.
Sadykanova G, Kumarbekuly S, Yessimbekova A … +1 more , Kalelova G
Int J Environ Res Public Health · 2026 Jun · PMID 42354314 · Full text
Industrial settlements of the East Kazakhstan Region face a persistent technogenic burden driven by the dense concentration of non-ferrous metallurgy and heat-and-power enterprises, further compounded by unfavorable poll...
Industrial settlements of the East Kazakhstan Region face a persistent technogenic burden driven by the dense concentration of non-ferrous metallurgy and heat-and-power enterprises, further compounded by unfavorable pollutant dispersion conditions inherent to the region's mountain-basin topography. This study evaluated spatiotemporal associations between annual mean concentrations of NO, SO, HS, and CO, the integrated air pollution index (API), and primary neoplasm morbidity across five settlements over the period 2014-2024. A retrospective ecological analysis was carried out for Ust-Kamenogorsk, Ridder, Altai, Shemonaikha, and the settlement of Glubokoe, incorporating Spearman's rank correlation, lag analysis (1-3 years), and the Mann-Kendall trend test. Throughout the study period, neoplasm morbidity in the region consistently exceeded the national average by a factor of 1.3 to 2.0. In Ust-Kamenogorsk-where metallurgical SO and NO emissions are most heavily concentrated-strong positive associations were found in children for SO ( = 0.791, < 0.05) and in adolescents for NO and CO, reflecting elevated inhalation exposure under conditions of chronic pollution. The negative associations with API observed in Ridder and Altai, where the index showed a statistically significant downward trend, are interpreted as evidence of the inertial character of oncological processes and the lasting influence of cumulative past exposure. Across all studied settlements, SO emerged as the most consistent predictor of morbidity variation. These findings support prioritizing stricter emission controls for SO and NO from metallurgical and energy facilities, establishing oncological screening programs for children and adolescents in chronically polluted areas, and strengthening ambient air monitoring-measures whose effective implementation will require coordinated action between public health authorities and environmental regulators.
Implementing Caring Technologies and Social Mobilisation for Older Adults: A Mixed-Methods Evaluation Across Seven European Case Studies.
Wright T, England M, Thompson T … +3 more , Hulbert S, Fotis T, Hatzidimitriadou E
Int J Environ Res Public Health · 2026 Jun · PMID 42354313 · Full text
Population ageing presents growing challenges for health and social care systems, particularly in supporting older adults to remain independent and involved in decisions concerning their own health and wellbeing. The EMP...
Population ageing presents growing challenges for health and social care systems, particularly in supporting older adults to remain independent and involved in decisions concerning their own health and wellbeing. The EMPOWERing individuals and communities to manage their own CARE (EMPOWERCARE) project evaluated asset-based initiatives designed to support older adults in managing their health and wellbeing across seven pilot sites in Belgium, France, the Netherlands and the United Kingdom. Initiatives were categorised as caring technologies, which focused on digital tools and assistive technologies to improve autonomy, promote self-management, and support independent living, and social mobilisation initiatives aimed at building stronger community networks, reducing loneliness, and fostering engagement. A multi-site, embedded case study design combined quantitative and qualitative methods. Survey data were collected at baseline (T0; n = 187) and endpoint (T2; n = 105) between July 2021 and January 2023. Outcomes included self-efficacy, mental wellbeing, loneliness and digital literacy. Descriptive statistics and repeated-measures -tests were conducted, while Photovoice and focus group data were analysed using summative content analysis. Findings indicated improvements in self-efficacy and mental health among some participants, alongside positive trends in digital literacy and internet-based health-seeking behaviour. Qualitative findings further highlighted increased confidence, social connectedness and empowerment among participants.
Reply to Villafuerte, R.; Funa, A. Comment on "Skjerve et al. Using Simulations to Help Public Health Students Overcome Language Barriers for Better Health Outcomes. 2023, , 6259".
Skjerve H, Braaum LE, Goth US … +1 more , Sørensen A
Int J Environ Res Public Health · 2026 Jun · PMID 42354312 · Full text
We sincerely thank the authors of the comment [...].
We sincerely thank the authors of the comment [...].
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