Frontiers in Public Health最新文献

Background: In the U.S., tobacco use affects 19.8% of adults (49.2 million) as of 2022, with rates highest among those with mental health conditions. Mental health facilities offering cessation counseling present critical opportunities to support these vulnerable populations. This study aims to examine how ownership structure influences smoking cessation counseling provision in U.S. outpatient mental health facilities.

Method: This cross-sectional study derived data on 9,645 outpatient (OPD) mental facilities from the 2019 N-MHSS-a census of all public and private mental health treatment facilities in the United States. We used multiple logistic regressions to examine how facility ownership would be associated with smoking cessation counseling provision, controlling for other facility characteristics. Models adjusted for state-level clustering for correlated random variances in service provisions across facilities in the same state.

Result: Of the outpatient facilities surveyed, 41.72% of OPD provided smoking cessation counseling. Compared to public facilities, private for-profit facilities were 30% less likely to provide smoking cessation counseling [odds ratio (OR) = 0.70, 95% confidence interval (CI) = 0.59-0.82; p < 0.05]. Private non-profit facilities were 27% less likely to provide smoking cessation counseling (OR = 0.73, CI = 0.64-0.83; p < 0.05), while controlling for other confounders.

Conclusion: Publicly-owned facilities demonstrate higher rates of smoking cessation counseling provision compared to both private non-profit and for-profit counterparts. This disparity in service availability raises concerns for tobacco control efforts, particularly as privatization in mental healthcare continues to expand. The observed pattern suggests potential misalignment between public health priorities and service delivery in private settings. Future policy initiatives should address these gaps and investigate underlying factors driving ownership-based differences in cessation services for patients with mental illness.

Background: The COVID-19 pandemic exposed and intensified existing challenges in immunization uptake, particularly in countries like Pakistan where vaccine hesitancy persists due to historical mistrust and misinformation. This study aims to assess parental perceptions toward COVID-19 vaccination and general immunization in a post-pandemic context, using the Health Belief Model (HBM) to contextualize behavioral drivers and barriers.

Methods: A cross-sectional survey was conducted from March to June 2023 at two tertiary hospitals in Pakistan-Combined Military Hospital, Lahore, and Fazaia Ruth Pfau Medical College, Karachi. Using convenience sampling, 298 parents of children aged 5-15 years completed a validated, pilot-tested questionnaire assessing demographic variables, COVID-19 vaccine perceptions, and general immunization attitudes. Data were analyzed using SPSS v26.0, employing descriptive statistics, non-parametric tests, and Spearman's correlation.

Results: Of the 298 participants (64.1% male; mean age = 34.2 years), 93.6% had at least a high school education. The COVID-19 Perception Scale showed a moderate overall score (Mean = 41.3, SD = 10.1), with moderate perceived vulnerability (Mean = 13.6, S.D = 4.5), high trust in vaccine information (Mean = 17.8, SD = 6.0), but low awareness (Mean = 2.4, SD = 1.2) and willingness to vaccinate children (Mean = 3.9, SD = 1.6). The Immunization Perception Scale indicated generally positive attitudes (Mean = 1.6, SD = 0.7), though moderate hesitancy persisted (Mean = 1.7, SD = 1.2). Significant associations emerged between personal or familial COVID-19 experience and both COVID-19 perception (r = 0.269, p < 0.01) and immunization perception (r = 0.121, p < 0.05). Mapping findings to the HBM revealed gaps in cues to action and self-efficacy, despite relatively high perceived benefits.

Conclusion: Parental trust in vaccine information is evident, yet awareness and pediatric vaccine uptake remain low. These findings call for context-specific, HBM-informed public health strategies that strengthen cues to action, reduce perceived barriers, and foster community trust to improve immunization outcomes in Pakistan.

Objective: Inconsistent associations between shift work and metabolic dysfunction-associated fatty liver disease (MAFLD) have been suggested. This study aimed to investigate the association between shift work characteristics and MAFLD in subway workers.

Methods: This cross-sectional study was conducted in Wuhan, China, between December 2018 and January 2019, with 9,105 subway workers included after excluding participants with missing data on shift work or ultrasonography, with cancer, or with insufficient data to diagnose MAFLD. All participants were on-duty employees, covering various functional positions such as train drivers, station attendants, maintenance technicians, and administrative staff. Information on demographics, occupational history, and lifestyles was collected through standardized questionnaires. We used logistic regression models to estimate the association of shift work duration and types with MAFLD, and restricted cubic spline regression to examine the potential nonlinear relationship. Mediation analyses were employed to evaluate the potential mediating role of body mass index (BMI).

Results: Compared with participants with no shift work, the multivariable-adjusted ORs (95% CIs) for those with ≤3, 3-6, and >6 years of shift work were 0.80 (0.68, 0.94), 1.21 (1.04, 1.41), and 1.60 (1.37, 1.88), respectively. A J-shaped relationship between shift work duration and MAFLD (P _overall < 0.001, P _nonlinear = 0.002) was observed, with the likelihood of MAFLD substantially increased after 3 years of shift work. Compared with participants with no shift work, MAFLD risk increased by 13% (OR:1.13, 95% CI: 0.95, 1.34), 22% (OR: 1.22, 95% CI: 1.05, 1.42), and 21% (OR: 1.21, 95% CI: 1.02, 1.42) for those worked in two-shift, three-shift, and four-shift, respectively. BMI adjustment attenuated these associations, with mediation analyses revealing significant mediation effects: mediation proportion was 48.5% (34.0, 64.0%) for shift work duration, 42.9% (5.0, 99.4%) for three-shift, and 47.5% (4.4, 111.5%) for four-shift systems (all P < 0.05).

Conclusion: Both shift work duration and rotation systems were associated with MAFLD risk in subway workers, with BMI mediating approximately half of these relationships.

Quality of life is a multifaceted issue that affects an individual's overall perception of their life, depending on their expectations. It is primarily dictated by subjectively perceived physical health, mental health or social relationships. Our study aimed to examine the quality of life in a group of organic and conventional fruit growers. Fifty-three participants took part in the survey. The WHOQOL-BREF questionnaire was used to measure quality of life. The participants were also asked additional questions about their health situation, financial education, and the length of their farming experience. Body mass and height measurements were taken. Participants mostly rated their economic and health situations as good, with organic fruit growers rating their health situation as better than that of conventional fruit growers. Overall, participants scored 300 (231-388), with organic fruit growers scoring significantly higher than those in conventional production (p = 0.041). In the individual domains of quality of life, the participants mainly scored high. Organic fruit growers scored significantly more than conventional fruit growers in the aspect of social relationships (p = 0.047). Self-assessed health status compared to peers was correlated with physical health and psychological domains (p < 0.05). At the same time, the number of chronic diseases was associated with physical health and social relationship domains (p < 0.05). In conclusion, the quality of life among the group of fruit growers was at a reasonable level; however, the organic fruit growers scored better in self-rated health, overall quality of life, and the social relationships domain.

Aim: With the rapid progression of population aging in China, community sports parks are becoming vital venues for older adults' physical activity and social interaction. However, deficiencies in age-friendly design remain evident. This study investigates older adults' service demands in community sports parks using the Kano model, aiming to identify attributes that shape satisfaction and inform the development of older adults friendly facilities.

Methods: A survey was conducted in three representative parks in Jinan, Rizhao, and Weihai (Shandong Province) between May and July 2025. A total of 900 questionnaires were distributed, with 838 valid responses collected (93.1%). The instrument covered six dimensions and 25 service items in functional/dysfunctional pairs. Reliability and validity tests were performed with SPSS 26.0, and Kano analysis was applied to classify demand attributes.

Results: Indifferent attributes accounted for the largest proportion (36%), while attractive, must-be, and one-dimensional attributes represented 28, 20, and 16%, respectively. Public service facilities, sports facilities, multi-sharing, professional fitness guidance and sports skills training were identified as must-be requirements. Lighting system, environmental quality, maintenance management, greening facilities, social adaptability, health education, health monitoring activities were attractive attributes, while site protection, spatial comfort, recreational fitness facilities, recreational sports activities were one-dimensional expectations. Dimensional analysis highlighted that convenience and openness were critical to avoiding dissatisfaction, whereas environmental comfort was the strongest driver of satisfaction.

Conclusion: Older adults' needs for community sports parks are multi-layered, encompassing safety, accessibility, comfort, sociability, and activity diversity. Essential functions must be guaranteed, while improvements in comfort, enrichment of activities, and intergenerational integration are crucial to enhancing satisfaction and participation. These findings provide empirical evidence to guide the age-friendly transformation of community sports parks and support the broader implementation of active aging strategies.

Introduction: Malnutrition and poor growth among children remain a public health challenge, largely driven by socioeconomic disparities that limit access to nutritious food. This study examines association of socioeconomic characteristics with food security, diet quality, and growth among Malaysian children.

Methods: Cross-sectional data from South East Asian Nutrition Surveys (SEANUTS II) Malaysia, involving 2,973 children aged 0.5-12.9 years, were analysed. Socioeconomic characteristics, including information on children and households, were collected via questionnaires. Food insecurity was assessed using the 10-item Radimer/Cornell instrument. Dietary intake was assessed using a 24-h recall, with diet quality determined by Mean Adequacy Ratio (MAR), derived from average Nutrient Adequacy Ratio for 15 nutrients based on Estimated Average Requirement (EAR). Growth outcomes were examined using body mass index-for-age (BAZ), height-for-age (HAZ), and weight-for-age (WAZ) z-scores. Complex samples ANOVA compared food security, diet quality, and growth indicators with socioeconomic characteristics.

Results: Over half of the children (59.8%) were from low-income households. Although 47.8% had low food expenditure and 41.7% were food insecure, overall diet quality was reflected in MAR scores of 0.84 (maximum = 1.00). Child hunger was more common in rural areas, in households with lower parental education, unemployed mothers, lower income, lower food expenditure, and more siblings (p < 0.01). Younger, urban children, boys, Chinese or other ethnicities, from households with higher maternal education, and fewer siblings had better diet quality (p < 0.05). Lower HAZ and WAZ were more common among younger children, Malays, households with non-working mothers, lower incomes, lower food expenditures, and more siblings (p < 0.05). Children from rural areas had lower HAZ (p < 0.01). Younger children, girls, lower household income, and lower food expenditure had lower BAZ (p < 0.05).

Conclusion: Socioeconomic disparities are significantly associated with compromised food security, poorer diet quality, and suboptimal growth among Malaysian children. Findings highlight the importance of addressing socioeconomic inequalities through targeted policies and evidence-based interventions ensuring equitable nutritional health and growth among vulnerable children.

This paper presents the findings of the Siemens Healthineers SHIFT Innovation Pan-Africa Capacity Building Program, which aims to improve access and affordability of healthcare across Africa through knowledge sharing and the transfer of best practices. The study focuses on comparing the cost of treating liver cancer, lung cancer, coronary artery disease (CAD), and stroke in different African countries. These conditions represent a major and growing share of the non-communicable disease (NCD) burden across the African continent. They are also strategic focus areas for Siemens Healthineers due to their high clinical impact, complex diagnostic requirements, and the significant health system resources needed for effective management. These diseases serve as suitable proxies for assessing broader access challenges because they require timely detection, advanced imaging, laboratory diagnostics, specialized treatment pathways, and long-term follow-up care. Any gaps in diagnostic capacity, equipment availability, clinical workflow efficiency, workforce skills, or financing structures become immediately visible along these patient pathways. Comparing the differences with the best practices and challenges of each country, the programme aims to facilitate cross-cultural learning to bridge the gap between high- and low-value treatments. The study draws on detailed data on medical expenditure in several African countries, including public and private health services. Cost differences are analyzed taking into account medical procedures, drugs, diagnostic tests and hospital costs. In addition, the factors contributing to these cost variations, including healthcare delivery, resource availability, regulatory framework, and socio-economic factors, examined to develop standardized strategies to reduce medical costs and improve overall health outcomes. The results of this study will be a valuable resource for policy makers, healthcare providers and stakeholders to identify areas for improvement and take targeted actions. Ultimately, the aim is to improve access, affordability and quality of healthcare across Africa and ensure that life-saving treatments are readily available and affordable for all people on the continent.

Purpose: The PRAYAS Individual Patient Data Meta-analysis (IPD-MA) database aims to estimate the prevalence of anemia among children under 18 years, non-pregnant and non-lactating (NPNL) women, and pregnant women (by trimester), with further stratification by age group, year, and region of India. Beyond prevalence, it seeks to address the etiological contribution of iron and other erythropoietic micronutrient deficiencies and to evaluate the effectiveness of anemia prevention and treatment interventions, including factors associated with non-response. This will directly support India's "test-treat-track" approach under the Anemia Mukt Bharat program.

Participants: Children (0-18 years), pregnant women, and NPNL women in India.

Findings to date: The database currently includes 88 datasets (1994-2023), with 319,721 participants for prevalence analysis-children (19,762), NPNL women (17,883), and pregnant women (282,076). Intervention studies comprise 59,292 participants-children (13,435), NPNL women (11,594), and pregnant women (34,263). Over half the datasets (55.7%, 49/88) are randomized controlled trials, while 35.2% (31/88) are observational. Geographically, 43.2% (38/88) are from northern India, 22.7% (20/88) from the west, and 18.2% (16/88) from the south. Most studies (67%, 59/88) are community-based. Median ages were 26 years (IQR 23-32) for NPNL and 23 years (IQR 21-25) for pregnant women, while children's data covered 6 months to 18 years. Mean gestational age at enrollment in pregnancy was 10.24 weeks (SD 17.65). Of the total sample, 10.8% had complete blood count data, 9% ferritin, and 4.5% vitamin B12.Among interventions, pregnant women received intravenous iron sucrose, ferric carboxymaltose, iron isomaltoside, combined IV iron with vitamin B12/folic acid/niacinamide, integrated packages, and low-dose calcium supplementation. NPNL women were often part of trials comparing 60 mg daily ferrous sulfate with 120 mg on alternate days. Children's interventions mainly included ferrous sulfate, food supplementation, and select Ayush-based approaches.

Future plans: PRAYAS will generate robust, policy-relevant evidence to refine anemia prevention and treatment strategies. Findings will directly inform the Anemia Mukt Bharat program, supporting targeted, evidence-driven interventions to reduce anemia and associated health burdens across children, women, and pregnant populations in India.

Clinical trial registration: OSF-https://doi.org/10.17605/OSF.IO/6YRXF.

Intracerebral haemorrhage (ICH) is a rapidly fatal cerebrovascular catastrophe that claims a disproportionate share of stroke deaths among older adults despite decades of progress in acute care. Emerging research now implicates a constellation of non-biomedical contextual stressors ambient fine particulate matter, traffic-derived gases and noise, thermal volatility, and bio-accumulative heavy metals, themselves patterned by social determinants of health and political-commercial decision-making as pivotal but still under-recognised drivers of small-vessel rupture. This review synthesises epidemiological, behavioural and translational evidence to illuminate how pollutant-driven sympathetic arousal, sleep fragmentation, physical inactivity and impaired thermoregulation converge on age-accentuated endothelial fragility, thereby lowering the haemodynamic threshold for cerebral bleeding. We further map the geo-temporal and socio-spatial inequities in these exposures rooted in social, political and commercial determinants of health that tether disadvantaged communities to higher exposure loads and outline the corresponding gradients in ICH incidence, mortality and disability-adjusted life-years. We appraise the preventive leverage of integrated structural policies that decarbonise urban transport, regulate commercial determinants, dampen nocturnal noise, expand equitable green infrastructure and fortify climate resilience. By advancing a behavioural-environmental framework that links modifiable exposures to actionable pathways, this article furnishes clinicians, public-health practitioners and policymakers with a coherent agenda for mitigating the impending surge of environmentally mediated cerebral haemorrhage in ageing societies.

Objective: To explore the caregiving challenges encountered by family caregivers of older adults with mild cognitive impairment (MCI), and to proffer recommendations for optimizing older adults' care services in China and enhancing the quality of long-term care for older adults with MCI.

Methods: A phenomenological approach was employed to conduct semi-structured interviews with 20 family caregivers of older adults with mild cognitive impairment (MCI). This study employed the Colaizzi analytical method and systematically organized and analyzed the data using NVivo 12.0 software.

Results: Three core themes and nine sub-themes were identified: (1) Inadequate adaptability of external support systems (structural gaps in community-based home care policies and evaluation frameworks, shortages in caregiving knowledge and skills provision, sustainability challenges in financial support); (2) Dual social and emotional burdens faced by caregivers (disruption of social networks and isolation, accumulation of negative emotional experiences and burnout, moral conflicts over family perceptions and responsibility allocation); (3) Obstacles in smart older adults' care technology use (Privacy concerns from smart monitoring systems, the digital divide, lack of emotional connectivity in human-computer interaction).

Conclusion: Relevant departments should focus on the burdens and challenges family caregivers face in caring for older adult individuals with mild cognitive impairment. This will enable them to develop further diverse community-based home and smart older adults' care services, ultimately promoting the high-quality development of China's older adults' care sector.