Pub Date : 2025-11-01DOI: 10.1016/j.healthplace.2025.103578
Marco J. Haenssgen , Nutcha Charoenboon , Thipphaphone Xayavong , Toum Lathsamee , Prasit Leepreecha , Eric Deharo , Giacomo Zanello , Chittur S. Srinivasan
The study of food environments helps the understanding of food and nutrition insecurity, but its static, quantitative and physical focus requires complementary research through people's “lived experiences.” Through exploratory qualitative and participatory research, we aimed to capture communities' views of food environments, how they navigate these spaces, and what constitutes inequitable exclusion therein. We conducted participatory mapping and focus group discussions with 90 participants across 16 rural and peri-urban communities in northern Thailand and northern Lao PDR between November 2022 and February 2023. The inductive qualitative analysis resulted in four key themes: i) Diverse and dynamic foodscapes require careful study for dietary diversity assessments; ii) The food environment contains strong relational elements and varied experiences across gender and ethnic groups; iii) Food security had important local expressions of food sovereignty and food solidarity; and iv) Food-related behaviour was deeply embedded in a broader livelihood and human insecurity context. We link these themes to the concept of social and physical “activity spaces,” advancing food environment research towards lived experiences, behavioural dynamics, and invisible forms of exclusion. This approach highlights the limitations of standardised dietary diversity measures; and it can enable research and interventions that are sensitive to local realities and the broader human security context.
{"title":"Conceptualising food environments as social activity spaces: Insights from lived experience research in Thailand and Laos","authors":"Marco J. Haenssgen , Nutcha Charoenboon , Thipphaphone Xayavong , Toum Lathsamee , Prasit Leepreecha , Eric Deharo , Giacomo Zanello , Chittur S. Srinivasan","doi":"10.1016/j.healthplace.2025.103578","DOIUrl":"10.1016/j.healthplace.2025.103578","url":null,"abstract":"<div><div>The study of food environments helps the understanding of food and nutrition insecurity, but its static, quantitative and physical focus requires complementary research through people's “lived experiences.” Through exploratory qualitative and participatory research, we aimed to capture communities' views of food environments, how they navigate these spaces, and what constitutes inequitable exclusion therein. We conducted participatory mapping and focus group discussions with 90 participants across 16 rural and peri-urban communities in northern Thailand and northern Lao PDR between November 2022 and February 2023. The inductive qualitative analysis resulted in four key themes: i) Diverse and dynamic foodscapes require careful study for dietary diversity assessments; ii) The food environment contains strong relational elements and varied experiences across gender and ethnic groups; iii) Food security had important local expressions of food sovereignty and food solidarity; and iv) Food-related behaviour was deeply embedded in a broader livelihood and human insecurity context. We link these themes to the concept of social and physical “activity spaces,” advancing food environment research towards lived experiences, behavioural dynamics, and invisible forms of exclusion. This approach highlights the limitations of standardised dietary diversity measures; and it can enable research and interventions that are sensitive to local realities and the broader human security context.</div></div>","PeriodicalId":49302,"journal":{"name":"Health & Place","volume":"96 ","pages":"Article 103578"},"PeriodicalIF":4.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145474219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.healthplace.2025.103577
Danyi Li , Sandrah P. Eckel , Louisiana M. Sanchez , Mary Ann Pentz , Alyssa F. Harlow
Cannabis and nicotine vaping are common among adolescents and associated with mental, physical, and behavioral health issues. Neighborhood disadvantage is an important determinant of health and may impact adolescent substance use, but its impact on vaping outcomes is poorly understood. This study examined the independent and joint association of subjective (i.e., perceived) and objective (i.e., census-derived) neighborhood disadvantage with nicotine and cannabis vaping using five semi-annual waves (2022–2024) of a prospective cohort of Southern California high school students (n = 3278; baseline mean age = 15.7 years). Mixed-effects modified Poisson models examined associations of subjective neighborhood disorder scale (NDS) and objective census-derived area deprivation index (ADI) at baseline with repeated measures of current (past-30-day) cannabis and nicotine vaping over five follow-up waves, adjusting for individual-level sociodemographic factors. There was a positive weak correlation between NDS and ADI scores (Pearson's r = 0.27). Higher NDS scores (i.e., subjective disadvantage) were positively associated with risk of cannabis (Risk Ratio, RR = 1.04, 95 %CI: 1.02–1.06) and nicotine (RR = 1.04, 95 %CI: 1.01–1.06) vaping. There was no independent association between ADI score (i.e., objective disadvantage) and vaping outcomes. Compared to youth with both low NDS and low ADI scores, risk of nicotine vaping was elevated for youth with both high NDS and high ADI scores (RR = 1.73, 95 %CI: 1.07–2.81); cannabis vaping was elevated for youth with high NDS scores and low ADI scores (RR = 2.04, 95 %CI: 1.43–2.13). Findings suggest that subjective neighborhood perceptions may be more impactful measures of neighborhood disadvantage than objective census indicators for associations with youth vaping of either cannabis or nicotine.
{"title":"Prospective associations of subjective and objective neighborhood disadvantage with cannabis and nicotine vaping among Southern California adolescents","authors":"Danyi Li , Sandrah P. Eckel , Louisiana M. Sanchez , Mary Ann Pentz , Alyssa F. Harlow","doi":"10.1016/j.healthplace.2025.103577","DOIUrl":"10.1016/j.healthplace.2025.103577","url":null,"abstract":"<div><div>Cannabis and nicotine vaping are common among adolescents and associated with mental, physical, and behavioral health issues. Neighborhood disadvantage is an important determinant of health and may impact adolescent substance use, but its impact on vaping outcomes is poorly understood. This study examined the independent and joint association of subjective (i.e., perceived) and objective (i.e., census-derived) neighborhood disadvantage with nicotine and cannabis vaping using five semi-annual waves (2022–2024) of a prospective cohort of Southern California high school students (n = 3278; baseline mean age = 15.7 years). Mixed-effects modified Poisson models examined associations of subjective neighborhood disorder scale (NDS) and objective census-derived area deprivation index (ADI) at baseline with repeated measures of current (past-30-day) cannabis and nicotine vaping over five follow-up waves, adjusting for individual-level sociodemographic factors. There was a positive weak correlation between NDS and ADI scores (Pearson's r = 0.27). Higher NDS scores (i.e., subjective disadvantage) were positively associated with risk of cannabis (Risk Ratio, RR = 1.04, 95 %CI: 1.02–1.06) and nicotine (RR = 1.04, 95 %CI: 1.01–1.06) vaping. There was no independent association between ADI score (i.e., objective disadvantage) and vaping outcomes. Compared to youth with both low NDS and low ADI scores, risk of nicotine vaping was elevated for youth with both high NDS and high ADI scores (RR = 1.73, 95 %CI: 1.07–2.81); cannabis vaping was elevated for youth with high NDS scores and low ADI scores (RR = 2.04, 95 %CI: 1.43–2.13). Findings suggest that subjective neighborhood perceptions may be more impactful measures of neighborhood disadvantage than objective census indicators for associations with youth vaping of either cannabis or nicotine.</div></div>","PeriodicalId":49302,"journal":{"name":"Health & Place","volume":"96 ","pages":"Article 103577"},"PeriodicalIF":4.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.healthplace.2025.103565
Imelda K. Moise , Cyril O. Wilson , Sigismond A. Wilson , Fenda A. Akiwumi , Solomon P. Gbanie
This study used spatial and non-spatial analyses to examine the drivers of diarrheal disease in the Rokel-Seli River watershed, Sierra Leone. Data sources included fecal coliform sampling (E. coli), land use and climate metrics, household surveys (n = 280), and medical records (n = 26,909 episodes from 139 health facilities). A dual modeling strategy: Poisson generalized linear models (GLM) and geographically weighted Poisson regression (GWPR) captured both household-level and subbasin-level predictors. Diarrhea was significantly associated with low educational attainment, inadequate toilet facilities and contaminated water sources (p < 0.05). Slope and housing density emerged as localized environmental risk factors, while rainfall and temperature showed weaker associations. Diarrhea clustered in both high- and low-density districts, with Magburaka reporting the highest burden. Findings underscore the need for targeted investments in education, sanitation and water infrastructure. This integrated spatial framework offers a scalable model for waterborne disease mitigation in watershed communities.
{"title":"Spatial determinants of diarrheal disease in the Rokel-Seli river watershed, Sierra Leone","authors":"Imelda K. Moise , Cyril O. Wilson , Sigismond A. Wilson , Fenda A. Akiwumi , Solomon P. Gbanie","doi":"10.1016/j.healthplace.2025.103565","DOIUrl":"10.1016/j.healthplace.2025.103565","url":null,"abstract":"<div><div>This study used spatial and non-spatial analyses to examine the drivers of diarrheal disease in the Rokel-Seli River watershed, Sierra Leone. Data sources included <em>fecal coliform</em> sampling (<em>E. coli</em>), land use and climate metrics, household surveys (n = 280), and medical records (n = 26,909 episodes from 139 health facilities). A dual modeling strategy: Poisson generalized linear models (GLM) and geographically weighted Poisson regression (GWPR) captured both household-level and subbasin-level predictors. Diarrhea was significantly associated with low educational attainment, inadequate toilet facilities and contaminated water sources (<em>p</em> < 0.05). Slope and housing density emerged as localized environmental risk factors, while rainfall and temperature showed weaker associations. Diarrhea clustered in both high- and low-density districts, with Magburaka reporting the highest burden. Findings underscore the need for targeted investments in education, sanitation and water infrastructure. This integrated spatial framework offers a scalable model for waterborne disease mitigation in watershed communities.</div></div>","PeriodicalId":49302,"journal":{"name":"Health & Place","volume":"96 ","pages":"Article 103565"},"PeriodicalIF":4.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-24DOI: 10.1016/j.healthplace.2025.103553
Yuxi Cai Katherine , John P. Wilson
In recent years, loneliness has increased along with epidemics and extreme weather events, leading to adverse effects on the physical and mental health of the global population. With a special focus on human-environment interactions, this study investigated the influence of physical environment on loneliness across various cultural backgrounds. Following the guidelines of Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), the study identified 344 peer-reviewed articles and retained 26 of them for analysis after title/abstract and full-text screenings. The primary selection criteria were: 1) studies in which the outcome of interest included loneliness; 2) consideration of people's interaction with the physical environment; 3) population-based studies (i.e., without a focus on certain professions or diseases); and 4) the inclusion of cultural factors or description of the cultural/demographic settings. The study found that environments perceived as safe and supportive with resources - foundational infrastructure in the Global South and high-quality amenities in the Global North, mobility, and nature engagement opportunities, were consistently associated with reduced loneliness in most cultural settings. However, the cultural meaning of places, environmental needs, and focused aspects of the environment vary across cultural contexts. The results indicate a need for further research to analyze the potential mediating role of subjective perception and nature engagement on the association between the physical environment and loneliness. For policymakers, the study highlights health disparities caused by loneliness, emphasizing the need for culturally specific, participatory spatial interventions that go beyond merely providing amenities and instead design places that foster a subjective sense of belonging and enable social engagement.
{"title":"Physical environment and loneliness across cultures: A scoping review","authors":"Yuxi Cai Katherine , John P. Wilson","doi":"10.1016/j.healthplace.2025.103553","DOIUrl":"10.1016/j.healthplace.2025.103553","url":null,"abstract":"<div><div>In recent years, loneliness has increased along with epidemics and extreme weather events, leading to adverse effects on the physical and mental health of the global population. With a special focus on human-environment interactions, this study investigated the influence of physical environment on loneliness across various cultural backgrounds. Following the guidelines of Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), the study identified 344 peer-reviewed articles and retained 26 of them for analysis after title/abstract and full-text screenings. The primary selection criteria were: 1) studies in which the outcome of interest included loneliness; 2) consideration of people's interaction with the physical environment; 3) population-based studies (i.e., without a focus on certain professions or diseases); and 4) the inclusion of cultural factors or description of the cultural/demographic settings. The study found that environments perceived as safe and supportive with resources - foundational infrastructure in the Global South and high-quality amenities in the Global North, mobility, and nature engagement opportunities, were consistently associated with reduced loneliness in most cultural settings. However, the cultural meaning of places, environmental needs, and focused aspects of the environment vary across cultural contexts. The results indicate a need for further research to analyze the potential mediating role of subjective perception and nature engagement on the association between the physical environment and loneliness. For policymakers, the study highlights health disparities caused by loneliness, emphasizing the need for culturally specific, participatory spatial interventions that go beyond merely providing amenities and instead design places that foster a subjective sense of belonging and enable social engagement.</div></div>","PeriodicalId":49302,"journal":{"name":"Health & Place","volume":"96 ","pages":"Article 103553"},"PeriodicalIF":4.1,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145364010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-23DOI: 10.1016/j.healthplace.2025.103564
Carlos Rojas Roque , Yirui Qian , Laura Bojke , Rita Santos , Kimon Krenz , Lisa Dowling , Emily Nix , Sarah E. Rodgers , Rosemary R.C. McEachan
Background
Place-based interventions—modifying physical and social environments—are promising in reducing non-chronic disease risks but lack comprehensive economic evaluations. This scoping review aims to identify, evaluate, and synthesise evidence on the cost-effectiveness of urban place-based interventions, to better inform policy and resource allocation.
Methods
Following PRISMA-ScR guidelines, we searched MEDLINE, Embase, PsycINFO, and grey literature for full economic evaluations of urban place-based interventions with no date restrictions. Standardised tools were used for data extraction, critical appraisal, and synthesis of methodological quality, geographic distribution, and intervention types.
Results
Among 53 studies included, transport-related interventions dominated (70 %), followed by green/blue spaces (19 %), housing (7.5 %), and services and facilities (4 %). Only four out of 53 studies classified the intervention as not cost-effective. Geographically, included studies were concentrated in the United States and the United Kingdom. Cost-benefit analysis (64 %) is the most used economic evaluation method, and a societal perspective is used in 59 % of cases. However, significant inconsistencies were noted, particularly in synthesising effectiveness estimates and justifying discount rates. Key gaps included limited equity considerations and non-health outcomes.
Conclusion
While place-based interventions demonstrate potential for improving health outcomes, conclusions regarding their cost-effectiveness are limited by methodological shortcomings and gaps in geographic and intervention scope. To enhance policy relevance, future research should adopt more rigorous methodologies, incorporate equity considerations, and expand the scope of outcomes to capture the full societal value of these interventions. Addressing these gaps will be essential for informing policies that maximise health and societal benefits.
{"title":"Building healthier and sustainable cities: A scoping review to establish the cost-effectiveness of place-based interventions","authors":"Carlos Rojas Roque , Yirui Qian , Laura Bojke , Rita Santos , Kimon Krenz , Lisa Dowling , Emily Nix , Sarah E. Rodgers , Rosemary R.C. McEachan","doi":"10.1016/j.healthplace.2025.103564","DOIUrl":"10.1016/j.healthplace.2025.103564","url":null,"abstract":"<div><h3>Background</h3><div>Place-based interventions—modifying physical and social environments—are promising in reducing non-chronic disease risks but lack comprehensive economic evaluations. This scoping review aims to identify, evaluate, and synthesise evidence on the cost-effectiveness of urban place-based interventions, to better inform policy and resource allocation.</div></div><div><h3>Methods</h3><div>Following PRISMA-ScR guidelines, we searched MEDLINE, Embase, PsycINFO, and grey literature for full economic evaluations of urban place-based interventions with no date restrictions. Standardised tools were used for data extraction, critical appraisal, and synthesis of methodological quality, geographic distribution, and intervention types.</div></div><div><h3>Results</h3><div>Among 53 studies included, transport-related interventions dominated (70 %), followed by green/blue spaces (19 %), housing (7.5 %), and services and facilities (4 %). Only four out of 53 studies classified the intervention as not cost-effective. Geographically, included studies were concentrated in the United States and the United Kingdom. Cost-benefit analysis (64 %) is the most used economic evaluation method, and a societal perspective is used in 59 % of cases. However, significant inconsistencies were noted, particularly in synthesising effectiveness estimates and justifying discount rates. Key gaps included limited equity considerations and non-health outcomes.</div></div><div><h3>Conclusion</h3><div>While place-based interventions demonstrate potential for improving health outcomes, conclusions regarding their cost-effectiveness are limited by methodological shortcomings and gaps in geographic and intervention scope. To enhance policy relevance, future research should adopt more rigorous methodologies, incorporate equity considerations, and expand the scope of outcomes to capture the full societal value of these interventions. Addressing these gaps will be essential for informing policies that maximise health and societal benefits.</div></div>","PeriodicalId":49302,"journal":{"name":"Health & Place","volume":"96 ","pages":"Article 103564"},"PeriodicalIF":4.1,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145363959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-17DOI: 10.1016/j.healthplace.2025.103563
Stephanie L. Enkel , Chicky Clements , Hannah M.M. Thomas , Tracy McRae , Ingrid Amgarth-Duff , Marianne Mullane , Lisa Wiese , Liam Bedford , Nina Lansbury , Jonathan R. Carapetis , Asha C. Bowen
Remote Aboriginal communities in Australia are located on traditional lands holding deep cultural significance and meaning for residents. However, systemic inequity rooted in colonisation has driven persistent housing and health disparities, with inadequate environmental health conditions within homes and communities a prominent example. Embedded within the SToP (See, Treat, Prevent) Skin Sores and Scabies Trial, which aimed to reduce skin infections in children aged 5–9 years by 50 % across nine Kimberley communities, this qualitative sub-study sought to understand access to and perceptions of environmental health initiatives by yarning with those living and working in remote Aboriginal communities. Between 2019 and 2022, 208 people participated in individual or group yarning activities. Using a political economy of health lens, analysis of 137 yarning sessions revealed barriers to health, including infrequent services, inadequate housing, and entrenched challenges to achieving household maintenance. These obstacles stem from governance, procurement and logistics arrangements; a direct result of colonisation and land appropriation rather than individual behaviour. Addressing these barriers requires equitable standards in service provision, as well as clear decision rights over land and housing assets, procurement options enabling timely repairs, resourced local maintenance with guaranteed response times and sustained funding. Equity and reconciliation will only be achieved once structural barriers are removed.
{"title":"“You can't heal yourself in that setting and you wouldn't expect other people in this country to”: Yarning about housing and environmental health in remote Aboriginal communities of Western Australia","authors":"Stephanie L. Enkel , Chicky Clements , Hannah M.M. Thomas , Tracy McRae , Ingrid Amgarth-Duff , Marianne Mullane , Lisa Wiese , Liam Bedford , Nina Lansbury , Jonathan R. Carapetis , Asha C. Bowen","doi":"10.1016/j.healthplace.2025.103563","DOIUrl":"10.1016/j.healthplace.2025.103563","url":null,"abstract":"<div><div>Remote Aboriginal communities in Australia are located on traditional lands holding deep cultural significance and meaning for residents. However, systemic inequity rooted in colonisation has driven persistent housing and health disparities, with inadequate environmental health conditions within homes and communities a prominent example. Embedded within the SToP (See, Treat, Prevent) Skin Sores and Scabies Trial, which aimed to reduce skin infections in children aged 5–9 years by 50 % across nine Kimberley communities, this qualitative sub-study sought to understand access to and perceptions of environmental health initiatives by yarning with those living and working in remote Aboriginal communities. Between 2019 and 2022, 208 people participated in individual or group yarning activities. Using a political economy of health lens, analysis of 137 yarning sessions revealed barriers to health, including infrequent services, inadequate housing, and entrenched challenges to achieving household maintenance. These obstacles stem from governance, procurement and logistics arrangements; a direct result of colonisation and land appropriation rather than individual behaviour. Addressing these barriers requires equitable standards in service provision, as well as clear decision rights over land and housing assets, procurement options enabling timely repairs, resourced local maintenance with guaranteed response times and sustained funding. Equity and reconciliation will only be achieved once structural barriers are removed.</div></div>","PeriodicalId":49302,"journal":{"name":"Health & Place","volume":"96 ","pages":"Article 103563"},"PeriodicalIF":4.1,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-17DOI: 10.1016/j.healthplace.2025.103558
Hannah Jayne Robinson , Barbara Evans , Paul Hutchings , Lata Narayanaswamy , Ravikirankumar Bokam , Dani Jennifer Barrington
This article examines the challenges faced by transgender and gender non-confirming individuals when attempting to access sanitation in urban India. It highlights how the experiences of these individuals intersect with broader social dynamics related to appearance, which can affect people of all genders. Using an iterative and inductive approach, the study combines insights from interviews with activists, academics and government practitioners, along with focus group discussions involving transgender and gender-nonconforming cisgender participants, to explore gaps in policy and implementation. The research highlights how ‘gendered’ sanitation programming and policy largely neglects non-cisgender communities, focusing predominantly on cisgender women, and often fails to address the nuanced sanitation needs of Transgender and Gender non-conforming persons, particularly transgender women. While sanitation programming emphasises technical infrastructure, social dimensions of sanitation, particularly appearance-based discrimination, remain largely unaddressed, creating exclusionary environments. Drawing on Goffman's theory of stigma, Meyer's Minority Stress Theory, and Bourdieu's concept of symbolic capital, the research elucidates how social stigma, chronic stress from discrimination, and the policing of gendered appearances converge to limit access and safety in sanitation spaces. These intersecting barriers affect both transgender and cisgender individuals who do not conform to normative gender expressions. The research urges a more intersectional, gender-sensitive approach to sanitation that confronts both technical and deeply embedded social obstacles. This research contributes to the limited literature on transgender access to basic services in India and underscores the necessity of addressing appearance-based discrimination to foster truly inclusive sanitation environments.
{"title":"“Who gets to belong?” Navigating appearance-based discrimination and transgender access to urban toilets in India","authors":"Hannah Jayne Robinson , Barbara Evans , Paul Hutchings , Lata Narayanaswamy , Ravikirankumar Bokam , Dani Jennifer Barrington","doi":"10.1016/j.healthplace.2025.103558","DOIUrl":"10.1016/j.healthplace.2025.103558","url":null,"abstract":"<div><div>This article examines the challenges faced by transgender and gender non-confirming individuals when attempting to access sanitation in urban India. It highlights how the experiences of these individuals intersect with broader social dynamics related to appearance, which can affect people of all genders. Using an iterative and inductive approach, the study combines insights from interviews with activists, academics and government practitioners, along with focus group discussions involving transgender and gender-nonconforming cisgender participants, to explore gaps in policy and implementation. The research highlights how ‘gendered’ sanitation programming and policy largely neglects non-cisgender communities, focusing predominantly on cisgender women, and often fails to address the nuanced sanitation needs of Transgender and Gender non-conforming persons, particularly transgender women. While sanitation programming emphasises technical infrastructure, social dimensions of sanitation, particularly appearance-based discrimination, remain largely unaddressed, creating exclusionary environments. Drawing on Goffman's theory of stigma, Meyer's Minority Stress Theory, and Bourdieu's concept of symbolic capital, the research elucidates how social stigma, chronic stress from discrimination, and the policing of gendered appearances converge to limit access and safety in sanitation spaces. These intersecting barriers affect both transgender and cisgender individuals who do not conform to normative gender expressions. The research urges a more intersectional, gender-sensitive approach to sanitation that confronts both technical and deeply embedded social obstacles. This research contributes to the limited literature on transgender access to basic services in India and underscores the necessity of addressing appearance-based discrimination to foster truly inclusive sanitation environments.</div></div>","PeriodicalId":49302,"journal":{"name":"Health & Place","volume":"96 ","pages":"Article 103558"},"PeriodicalIF":4.1,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145319036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-14DOI: 10.1016/j.healthplace.2025.103561
Karla T. Washington , Klaudia Kukulka , Archana Bharadwaj , Olivia J. Landon , Masako Mayahara , Jacquelyn J. Benson
This study examined rural Missourians’ conceptualization of pain and their attitudes toward pharmacological and non-pharmacological pain management strategies. The study sample consisted of twenty-five (N = 25) community-dwelling adults residing in rural Missouri counties. Researchers conducted semi-structured qualitative interviews and applied thematic analysis techniques to interpret the data. Results indicated that participants often viewed pain as a limitation and associated its experience and treatment with weakness. Their attitudes toward pharmacological pain management were influenced by a prevalent social stigma surrounding pain medications (particularly opioid analgesics), fear of losing control, and a general aversion to medications. In contrast, their attitudes toward non-pharmacological pain management were decidedly positive. Participants expressed a strong preference for natural interventions and emphasized preventive measures to manage pain. Study findings support previously published research suggesting that rural individuals may minimize medical interventions and prioritize self-sufficiency. To address these cultural norms effectively, a strong clinician-patient relationship and multimodal pain management approaches that incorporate non-opioid strategies are recommended.
{"title":"Rural Missourians’ perspectives on pain: “I like to be in control of my life”","authors":"Karla T. Washington , Klaudia Kukulka , Archana Bharadwaj , Olivia J. Landon , Masako Mayahara , Jacquelyn J. Benson","doi":"10.1016/j.healthplace.2025.103561","DOIUrl":"10.1016/j.healthplace.2025.103561","url":null,"abstract":"<div><div>This study examined rural Missourians’ conceptualization of pain and their attitudes toward pharmacological and non-pharmacological pain management strategies. The study sample consisted of twenty-five (N = 25) community-dwelling adults residing in rural Missouri counties. Researchers conducted semi-structured qualitative interviews and applied thematic analysis techniques to interpret the data. Results indicated that participants often viewed pain as a limitation and associated its experience and treatment with weakness. Their attitudes toward pharmacological pain management were influenced by a prevalent social stigma surrounding pain medications (particularly opioid analgesics), fear of losing control, and a general aversion to medications. In contrast, their attitudes toward non-pharmacological pain management were decidedly positive. Participants expressed a strong preference for natural interventions and emphasized preventive measures to manage pain. Study findings support previously published research suggesting that rural individuals may minimize medical interventions and prioritize self-sufficiency. To address these cultural norms effectively, a strong clinician-patient relationship and multimodal pain management approaches that incorporate non-opioid strategies are recommended.</div></div>","PeriodicalId":49302,"journal":{"name":"Health & Place","volume":"96 ","pages":"Article 103561"},"PeriodicalIF":4.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145305076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-14DOI: 10.1016/j.healthplace.2025.103539
Leah Garnet-Carroll, Catherine Trundle
With increasing temperatures due to climate change, public health and health promotion bodies in Australia have increasingly developed resources to promote awareness and protect the public from heat stress risks. Utilizing an ethnographic document analysis method, this article critically examines a sample of Australian public health and health promotion online resources from the last five years. We explore how relational environments, material resources, self-care, health and routines, and informational agency are emphasized and discursively represented. Utilizing a critical public health lens and theoretical ideas of responsibilization, we evaluate the documents from a health justice perspective and consider whose experiences and realities are missing or invisible in public health advice for staying safe in the heat. We find the documents ignore the lived realities and experiences of Indigenous Australians, women, rural and remote Australians, young people, and Australians experiencing family conflict, violence, social isolation, and gendered burdens of care. They also exclude the realities of renters, workers with limited workplace control and agency, and those with low or insecure incomes. We then reimagine these documents from a climate justice and health equity perspective and suggest ways to shift the documents from a personal responsibility paradigm, to one that embeds social support and collective forms of responsibility.
{"title":"Who's responsible for health during extreme heat events? An ethnographic document analysis of health promotion materials in Australia","authors":"Leah Garnet-Carroll, Catherine Trundle","doi":"10.1016/j.healthplace.2025.103539","DOIUrl":"10.1016/j.healthplace.2025.103539","url":null,"abstract":"<div><div>With increasing temperatures due to climate change, public health and health promotion bodies in Australia have increasingly developed resources to promote awareness and protect the public from heat stress risks. Utilizing an ethnographic document analysis method, this article critically examines a sample of Australian public health and health promotion online resources from the last five years. We explore how relational environments, material resources, self-care, health and routines, and informational agency are emphasized and discursively represented. Utilizing a critical public health lens and theoretical ideas of responsibilization, we evaluate the documents from a health justice perspective and consider whose experiences and realities are missing or invisible in public health advice for staying safe in the heat. We find the documents ignore the lived realities and experiences of Indigenous Australians, women, rural and remote Australians, young people, and Australians experiencing family conflict, violence, social isolation, and gendered burdens of care. They also exclude the realities of renters, workers with limited workplace control and agency, and those with low or insecure incomes. We then reimagine these documents from a climate justice and health equity perspective and suggest ways to shift the documents from a personal responsibility paradigm, to one that embeds social support and collective forms of responsibility.</div></div>","PeriodicalId":49302,"journal":{"name":"Health & Place","volume":"96 ","pages":"Article 103539"},"PeriodicalIF":4.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145305112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-14DOI: 10.1016/j.healthplace.2025.103557
Jane Law , Alexander T. Petric
Drug & opioid overdoses in Toronto, Canada, have risen substantially in recent years. To explore possible causes, we spatially analyze associations between overdose incidence data over 2019–2022 and select socioeconomic & built-environment variables among Toronto neighbourhoods. Using spatiotemporal analysis, we also assess average area trends and local hotspots before/after two major events: Canada's 2018 legalization of cannabis (2017–2020) and COVID-19 pandemic lockdowns (2019–2022). Previous discussions frame cannabis as a possible alternative to more dangerous drugs, while pandemic lockdowns were likely to reduce mental health and access to care. We find 1) overdose incidence shows positive association with household/neighbourhood instability and percent building coverage, 2) notable overdose increases in Toronto's suburban neighbourhoods, and 3) rising mean-area overdose rates, despite cannabis legalization. Potentially outsized effects of high-potency illicit opioids and pandemic lockdowns may influence these results. Policymakers should monitor post-lockdown overdose trends and explore harm reduction approaches and improved housing options as policy responses to reduce impacts from Toronto's ongoing drug crisis, especially in areas outside the downtown that have rising overdose rates.
{"title":"Neighbourhood risk factors and spatiotemporal trends for overdoses following cannabis legalization and pandemic restrictions in Toronto, Canada","authors":"Jane Law , Alexander T. Petric","doi":"10.1016/j.healthplace.2025.103557","DOIUrl":"10.1016/j.healthplace.2025.103557","url":null,"abstract":"<div><div>Drug & opioid overdoses in Toronto, Canada, have risen substantially in recent years. To explore possible causes, we spatially analyze associations between overdose incidence data over 2019–2022 and select socioeconomic & built-environment variables among Toronto neighbourhoods. Using spatiotemporal analysis, we also assess average area trends and local hotspots before/after two major events: Canada's 2018 legalization of cannabis (2017–2020) and COVID-19 pandemic lockdowns (2019–2022). Previous discussions frame cannabis as a possible alternative to more dangerous drugs, while pandemic lockdowns were likely to reduce mental health and access to care. We find 1) overdose incidence shows positive association with household/neighbourhood instability and percent building coverage, 2) notable overdose increases in Toronto's suburban neighbourhoods, and 3) rising mean-area overdose rates, despite cannabis legalization. Potentially outsized effects of high-potency illicit opioids and pandemic lockdowns may influence these results. Policymakers should monitor post-lockdown overdose trends and explore harm reduction approaches and improved housing options as policy responses to reduce impacts from Toronto's ongoing drug crisis, especially in areas outside the downtown that have rising overdose rates.</div></div>","PeriodicalId":49302,"journal":{"name":"Health & Place","volume":"96 ","pages":"Article 103557"},"PeriodicalIF":4.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145305068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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