Public Health最新文献

{"title":"Building climate-resilient primary care: A convergent mixed-methods climate vulnerability and capacity assessment in the Cederberg subdistrict, South Africa","authors":"Robert Mash ,&nbsp;Stacey Blows ,&nbsp;Sa'ad Lahri ,&nbsp;Melissa McRae ,&nbsp;Christian Lokotola ,&nbsp;Kiran Jobanputra ,&nbsp;Patricia Nayna Schwerdtle","doi":"10.1016/j.puhe.2025.106106","DOIUrl":"10.1016/j.puhe.2025.106106","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the climate resilience of primary care facilities and services in the Cederberg subdistrict of the Western Cape, South Africa.</div></div><div><h3>Study design</h3><div>We conducted a convergent parallel mixed-methods study to assess the climate vulnerability and adaptive capacity of a primary care network. Quantitative facility audits and qualitative focus groups were undertaken, with subsequent integration to identify risks and generate context-specific adaptation options.</div></div><div><h3>Methods</h3><div>The study combined a structured audit of primary care facilities with a rapid qualitative assessment involving focus groups with health workers. Quantitative and qualitative datasets were analysed separately and then synthesised to map vulnerabilities and propose feasible adaptation measures. The subdistrict management team later used the integrated findings to prioritise adaptation actions.</div></div><div><h3>Results</h3><div>Across six primary care facilities, extreme heat was the most significant hazard, particularly where indoor temperatures rose above 40 °C, contributing to staff fatigue, overcrowding as community members sought refuge, and a higher risk of heat-related illness. Heat was also linked to increased drought and wildfire risk. Irregular and excessive rainfall further disrupted service delivery through flooding, road closures, delays in essential supplies, and increased waterborne and respiratory illness. Coastal facilities faced additional exposure to storm surge and sea-level rise. Environmental and operational sustainability challenges, including reliance on carbon-intensive electricity, waste-related emissions, inconsistent water quality, and limited backup water supply, amplified these climate-related risks. The assessment identified a consolidated set of risks across heat, rainfall, flooding, and sustainability domains, and generated 42 feasible adaptation options across infrastructure; governance; service delivery; workforce; energy; and water, sanitation and waste.</div></div><div><h3>Conclusions</h3><div>This study demonstrated that facility-level VCA assessments can successfully guide climate resilience planning in African primary care settings. The VCA process identified context-specific hazards, risks and feasible adaptation options across key domains of health system function. The approach provides an adaptable framework for other African settings seeking to strengthen primary care resilience to climate impacts. Transitioning from assessment to implementation will require local capacity to conduct VCAs independently and access to sustainable climate finance to support action.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106106"},"PeriodicalIF":3.2,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between dairy consumption and Parkinson's disease: A systematic review and meta-analysis","authors":"Gaurav Nepal ,&nbsp;Dan Yang ,&nbsp;Rajeev Ojha ,&nbsp;Zhilan Tu","doi":"10.1016/j.puhe.2026.106143","DOIUrl":"10.1016/j.puhe.2026.106143","url":null,"abstract":"<div><h3>Objectives</h3><div>Parkinson's disease (PD) is a progressive neurodegenerative disorder with no cure and rising global prevalence. Genetic, environmental, and dietary factors may influence risk. Dairy intake, may influence risk through gut microbiome changes and alpha-synuclein spread along the gut–brain axis, though epidemiological evidence is mixed. This meta-analysis examines the association between dairy consumption and PD risk in observational studies.</div></div><div><h3>Study design</h3><div>This study is a systematic review and meta-analysis of published literature.</div></div><div><h3>Methods</h3><div>PubMed and EMBASE were searched for original, peer-reviewed observational studies examining dairy intake and PD risk. Pooled risk estimates were calculated using fixed- or random-effects models depending on heterogeneity (I² threshold: 50 %). Subgroup analyses by dairy type and sex were conducted. This study adhered to PRISMA guidelines.</div></div><div><h3>Results</h3><div>Nine studies (eight cohort, one case-control) comprising diverse populations from the U.S., Europe, and Asia were included. A total of 15 results from 9 observational studies were analyzed. The combined cohort studies encompassed 634,327 participants with 4285 incident PD cases, while the case-control studies included 617 individuals (368 controls and 249 PD cases). High total dairy intake was significantly associated with increased PD risk (RR = 1.211; 95 % CI: 1.071–1.37; p = 0.002), with a stronger effect in males (RR = 1.282) than females (RR = 1.019). Milk consumption was also associated with increased PD risk (RR = 1.13; 95 % CI: 1.079–1.20; p &lt; 0.001), with consistent sex-specific results. No significant associations were found for yogurt/fermented milk, cheese, butter, or ice cream.</div></div><div><h3>Conclusions</h3><div>Higher consumption of total dairy and plain milk is associated with an increased risk of developing PD. Further studies involving diverse populations and ethnicities should explore this association, stratified by genetic and sporadic forms of PD.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106143"},"PeriodicalIF":3.2,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing patient-reported outcome measures: A scoping review of existing guidance across clinical trials, practice and registries","authors":"Randi Thisakya Jayasinghe ,&nbsp;Susannah Ahern ,&nbsp;Ashika D. Maharaj ,&nbsp;Lorena Romero ,&nbsp;Rasa Ruseckaite","doi":"10.1016/j.puhe.2026.106138","DOIUrl":"10.1016/j.puhe.2026.106138","url":null,"abstract":"<div><h3>Objectives</h3><div>To identify existing guiding documents such as guidelines, frameworks, checklists and recommendations on implementing patient-reported outcome measures (PROMs) in clinical trials, clinical practice and clinical registries.</div></div><div><h3>Study design</h3><div>Scoping Review.</div></div><div><h3>Methods</h3><div>A literature search of five scientific databases was conducted from database inception to June 2024. Google Scholar and grey literature sites were searched to identify relevant guiding documents. Existing documentation, including guidelines, frameworks, checklists, and recommendations for implementing PROMs in clinical trials, practice, and clinical registries, was included. A narrative synthesis of selected publications was conducted.</div></div><div><h3>Results</h3><div>In total, 4905 records were identified and assessed for eligibility, and 177 publications underwent full-text screening, resulting in 38 guiding documents in this review. Of the 38, 18 (47 %) were guiding documents for PROMs use in clinical trials, 12 (32 %) in clinical practice, and eight (21 %) in clinical registries. Most guidelines and recommendations were on PROMs implementation in clinical trials and clinical practice, with only a few recommendations published for clinical registries.</div></div><div><h3>Conclusions</h3><div>This review mostly identified guiding documents for implementing PROMs in clinical trials and practice. There is a gap in the literature regarding guidelines for implementing PROMs in clinical registries. Given the growing recognition of clinical registries and PROMs data for healthcare quality improvement and patient-centred care, an evidence-based standard guideline to implement PROMs in clinical registries efficiently will be beneficial.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106138"},"PeriodicalIF":3.2,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antenatal lifestyle interventions to reduce gestational weight gain: Where should we start and how much will it cost?","authors":"Melanie Lloyd ,&nbsp;Yanan Hu ,&nbsp;Emily Callander ,&nbsp;Helena Teede ,&nbsp;Zanfina Ademi","doi":"10.1016/j.puhe.2026.106137","DOIUrl":"10.1016/j.puhe.2026.106137","url":null,"abstract":"<div><h3>Objectives</h3><div>Antenatal lifestyle interventions are effective in reducing negative outcomes associated with excess gestational weight gain. While strong cost-effectiveness has also been demonstrated, the cost of implementation is potentially a barrier to uptake. We aimed to estimate whether targeted implementation in high risk clinical groups (categorized by age, body mass index (BMI) and gravidity) returns greater health cost savings through a reduction in aggregate incidence of adverse pregnancy and birth outcomes.</div></div><div><h3>Study design</h3><div>Distributional budget impact analysis utilising population level linked data collections.</div></div><div><h3>Methods</h3><div>Total budget expenditure (cost of intervention minus cost savings from the associated reduction in adverse pregnancy outcomes) of implementing the lifestyle intervention in risk targeted population sub-groups was estimated, stratified by health system (public vs. private funding).</div></div><div><h3>Results</h3><div>Total annual budget expenditure if the intervention is routinely provided to 80 % of pregnant women in New South Wales and Queensland, Australia, is projected to be AU$11,654,857 for n = 94,539 public patients, and AU$6,527,434 for n = 33,516 private patients. If implemented in the BMI ≥30 kg/m² group only, expenditure is reduced to AU$643,339 for n = 10,298 public patients, and AU$579,003 for n = 5018 private patients, while for implementation in the Age ≥35 years group, it was AU$1,290,965 (n = 21,071 public) and AU$2,169,851 (n = 12,776 private). The number of adverse pregnancy outcomes averted per women was greatest in the BMI ≥30 kg/m² group.</div></div><div><h3>Conclusions</h3><div>Women in the highest BMI category should be prioritised for implementation of effective and cost-effective antenatal lifestyle intervention to reduce the aggregate budgetary impact of adverse pregnancy outcomes.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106137"},"PeriodicalIF":3.2,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying lifetime productivity loss attributable to cigarette smoking in Taiwan","authors":"Wei-Cheng Lo ,&nbsp;Tsuey-Hwa Hu ,&nbsp;Fuhmei Wang ,&nbsp;Ta-Chien Chan ,&nbsp;Jing-Shiang Hwang","doi":"10.1016/j.puhe.2026.106149","DOIUrl":"10.1016/j.puhe.2026.106149","url":null,"abstract":"<div><h3>Objectives</h3><div>Evaluating long-term health and economic burden of smoking is critical for assessing the effectiveness of tobacco control policies. This study aimed to estimate lifetime productivity loss attributable to smoking among adults in Taiwan.</div></div><div><h3>Study design</h3><div>Longitudinal cohort study.</div></div><div><h3>Methods</h3><div>We analyzed data from the MJ cohort, linking medical and demographic information with National Health Insurance Research Database and Taiwan Death Registry database to estimate participants’ monthly earnings and confirm vital status. Lifetime productivity loss was assessed using survival and earnings functions of comparative groups estimated through a rolling extrapolation algorithm, incorporating inverse probability of treatment weighting to address confounders.</div></div><div><h3>Results</h3><div>Among 215,852 participants aged 30–64 years, those who had smoked had lower baseline employment rates and median monthly incomes. Smoking was associated with reduced life expectancy by 2.0 years (95 % CI: 1.54–2.35) for men and 1.37 years (95 % CI: −0.47 – 2.12) for women, and reduced employment time by 0.70 years (95 % CI: 0.26–1.30) for men and 1.82 years (95 % CI: 0.97–2.44) for women. The estimated average lifetime productivity loss attributable to smoking was US$ 45,572 for men and US$ 61,552 for women. Aggregating across Taiwan's population, this translates to a total lifetime productivity loss of US$ 80,589 million (95 % CI: 56,691 million to 103,743 million). The loss per annum was US$ 4563 million (95 % CI: 3602–5574 million), accounting for 0.6 % of Taiwan's GDP in 2022 (0.49 % from males, 0.11 % from females).</div></div><div><h3>Conclusions</h3><div>This study provides a data-driven analytical framework and demonstrates substantial lifetime and annual productivity losses attributable to smoking in Taiwan. These findings underscore the economic imperative for strengthening tobacco control measures to mitigate the long-term health and financial burden of smoking.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106149"},"PeriodicalIF":3.2,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Educational disparities in mortality mediated by modifiable behavioral factors: Findings from the Japan Multi-Institutional Collaborative Cohort Study","authors":"Masayoshi Zaitsu ,&nbsp;Kazuhiko Watanabe ,&nbsp;Mako Nagayoshi ,&nbsp;Hiroaki Ikezaki ,&nbsp;Takuma Furukawa ,&nbsp;Yasufumi Kato ,&nbsp;Yuriko N. Koyanagi ,&nbsp;Nobuaki Michihata ,&nbsp;Chihaya Koriyama ,&nbsp;Sadao Suzuki ,&nbsp;Daisuke Matsui ,&nbsp;Kiyonori Kuriki ,&nbsp;Naoyuki Takashima ,&nbsp;Masashi Ishizu ,&nbsp;Itsuki Kageyama ,&nbsp;Takashi Tamura ,&nbsp;Kenji Wakai ,&nbsp;Keitaro Matsuo ,&nbsp;for the Japan Multi-Institutional Collaborative Cohort (J-MICC) Study","doi":"10.1016/j.puhe.2026.106142","DOIUrl":"10.1016/j.puhe.2026.106142","url":null,"abstract":"<div><h3>Objectives</h3><div>The extent to which modifiable behavioral factors mediate educational disparities in mortality nationally remains unelucidated. Therefore, we examined whether educational level affects overall and cause-specific mortalities in Japan.</div></div><div><h3>Study design</h3><div>A multi-centered cohort study.</div></div><div><h3>Methods</h3><div>This national, multicenter study included 58,831 participants (57 % female) from the Japan Multi-Institutional Collaborative Cohort Study (mean age: 54 years). Baseline data were collected between 2004 and 2014, with a maximum 12-year follow-up period. Outcomes included mortalities from cancer, cardiovascular disease, and other causes. Participants were categorized by educational level: high school or lower, junior college, and university or higher. The hazard ratio (HR) for mortality was estimated using Cox regression, with the university or higher cohort as the reference. Causal mediation analysis was conducted to assess the mediated effect of modifiable behaviors on education-related mortality risk.</div></div><div><h3>Results</h3><div>Among male participants, the high school or lower cohort exhibited a higher overall mortality rate (adjusted HR: 1.23; 95 % confidence interval = 1.08–1.41) and elevated risks for cancer-related and other causes of death (HRs: 1.18 and 1.75, respectively). This disparity was most pronounced in men aged 35–59 years. Smoking, excessive alcohol consumption, and inadequate leisure-time physical activity accounted for 11 %, 9 %, and 12 % of the educational mortality discrepancy, respectively. Female participants did not exhibit a significant educational mortality disparity.</div></div><div><h3>Conclusions</h3><div>Educational disparities in mortality persist among the younger male population in Japan, with modifiable behavioral risks identified as key mediators.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106142"},"PeriodicalIF":3.2,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional inequities in colon cancer surgical care: Patterns of treatment delay across U.S. facilities","authors":"Rushabh H. Doshi ,&nbsp;Bhav Jain ,&nbsp;Rachana Tanksali ,&nbsp;Tenzin Dhondup ,&nbsp;Shamik Bhat ,&nbsp;Nina N. Sanford ,&nbsp;Miranda B. Lam ,&nbsp;Edward Christopher Dee","doi":"10.1016/j.puhe.2025.106091","DOIUrl":"10.1016/j.puhe.2025.106091","url":null,"abstract":"<div><h3>Objectives</h3><div>Timely surgical resection is critical for optimal survival in colon cancer, yet delays remain common. Persistent inequities in access to surgery may contribute to these delays, but how these disparities vary across U.S. regions and over time is not well understood. We aimed to assess regional variation in surgical treatment delays (&gt;8 weeks from diagnosis) for Stage I–III colon cancer in the United States and determine how racial, insurance, and geographic disparities manifest and evolve across regions from 2004 to 2021.</div></div><div><h3>Study design</h3><div>Retrospective cohort study.</div></div><div><h3>Methods</h3><div>We analyzed patients treated at Commission on Cancer-accredited facilities across the nine U.S. Census Divisions using data from the National Cancer Database (2004–2021). Adults diagnosed with Stage I-III colon cancer who underwent surgical resection as first-course treatment and had complete demographic, clinical, and facility data available were included. The primary outcome was surgical delay &gt;8 weeks from diagnosis to surgery. Multivariable logistic regression models were used to assess factors associated with surgical delay and interactions to evaluate variation by U.S. Census Division and over time. Odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated, with adjusted predicted probabilities for disparities by region and year.</div></div><div><h3>Results</h3><div>Of 664,312 patients, 48,579 (7.3 %) had surgical delays &gt;8 weeks, increasing from 4.5 % in 2004 to 12.2 % in 2021 (aOR 2.77; 95 % CI, 2.61–2.94). Compared with New England, delays were less common in East South Central (aOR 0.60) and West North Central (aOR 0.67) regions. Higher odds occurred among Black (aOR 1.34), American Indian/Alaska Native/Aleut/Eskimo (aOR 1.24), Asian American (aOR 1.06), Medicaid (aOR 1.19), and Other/Unknown/Government-insured patients (aOR 1.16). Disparities varied by region (p &lt; 0.001), with the largest Black–White gap in West North Central (9.0 % vs 4.9 %) and the smallest in East South Central (5.2 % vs 4.6 %). The Pacific had the steepest delay increase over time.</div></div><div><h3>Conclusions</h3><div>From 2004 to 2021, colon cancer surgery delays rose nationwide, with substantial regional variation in racial, insurance, and geographic disparities. Targeted strategies are needed to address systemic and regional barriers.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106091"},"PeriodicalIF":3.2,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How early adversity shapes adult physical health: Structural disadvantage and gendered pathways to cardiovascular risk","authors":"Hayun Jang ,&nbsp;Jinho Kim","doi":"10.1016/j.puhe.2026.106134","DOIUrl":"10.1016/j.puhe.2026.106134","url":null,"abstract":"<div><h3>Objectives</h3><div>Adverse childhood experiences (ACEs) are well-established predictors of mental health problems, yet their long-term impact on physical health, especially cardiovascular disease (CVD), remains less well understood. Guided by a life course perspective, this study investigates the association between ACEs and adult CVD risk, with a focus on the mediating role of structural disadvantage and gender-specific pathways.</div></div><div><h3>Study design</h3><div>Using data from Waves I, III, and IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health), we analyzed a sample of 12,224 individuals.</div></div><div><h3>Methods</h3><div>Longitudinal regression models with school fixed effects were used to estimate the association between ACEs and a 30-year Framingham CVD risk score in adulthood. We examined four mediators measured in early adulthood: educational attainment, personal earnings, incarceration history, and unmet healthcare needs. Multivariate bootstrapped mediation models and gender-stratified analyses were conducted.</div></div><div><h3>Results</h3><div>ACEs were significantly associated with higher CVD risk in adulthood, even after adjusting for individual, familial, and contextual factors. Structural disadvantage, most notably lower educational attainment, partially explained this association. Incarceration history and unmet healthcare needs also served as mediators. Gender-stratified models revealed distinct pathways: incarceration was a stronger mediator among men, while unmet healthcare needs were more salient for women.</div></div><div><h3>Conclusions</h3><div>Findings underscore the enduring influence of early adversity on adult cardiovascular health and highlight the importance of structural pathways in shaping health trajectories. Policy interventions targeting educational access, healthcare equity, and criminal justice reform, with attention to gender-specific mechanisms, may help mitigate the long-term health burden of childhood adversity.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106134"},"PeriodicalIF":3.2,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facilitators and barriers to mainstreaming climate change adaptation and mitigation into sub-national health systems: Perspectives from primary health care managers in low-resourced settings of Ghana","authors":"Rudolf Abugnaba-Abanga ,&nbsp;Dzigbodi Adzo Doke ,&nbsp;Maximillian Kolbe Domapielle ,&nbsp;Duncan Alemna Adogboba ,&nbsp;Kei Ostuki","doi":"10.1016/j.puhe.2026.106135","DOIUrl":"10.1016/j.puhe.2026.106135","url":null,"abstract":"<div><h3>Objectives</h3><div>This article explores the perspectives of primary healthcare managers on context-specific facilitators and barriers to mainstreaming climate change adaptation and mitigation into the operations in three primary healthcare (PHC) systems in low-resourced settings of the Upper East Region of Ghana.</div></div><div><h3>Study design</h3><div>A framework approach utilising inductive coding, guided by the Consolidated Framework for Implementation Research Index (CFIR Index) dimensions, to examine the perspectives of PHC managers on facilitators and barriers to mainstreaming climate change adaptation and mitigation in PHC operations.</div></div><div><h3>Methods</h3><div>Between October 31 and November 25, 2022, 18 purposively sampled PHC managers from three PHCs in the Upper East Region of Ghana participated in key informant interviews on facilitators and barriers to mainstreaming the WHO frameworks on building climate resilience and environmentally sustainable health systems. Key-informant interview guides were used to generate the data. Inductive codes were generated along secondary themes of suitability of the framework for PHC, PHC systems and stakeholders, PHC programming attributes and culture, and PHC managers’ identification with the WHO framework.</div></div><div><h3>Results</h3><div>The WHO framework is perceived as suitable because of its alignment with health systems/PHC vision and its potential to enhance staff safety and client satisfaction. PHC programming attributes and culture, such as positive and open learning environments, strong networks, and well-developed systems and structures, were reported as facilitators. Furthermore, high-risk perception, perceived service improvements, and self-efficacy were reported as facilitators. PHC systems and stakeholders are reported as barriers due to the absence of policy frameworks and incentives, inadequate staff and system capacities, and the cost of mainstreaming.</div></div><div><h3>Conclusion</h3><div>Mainstreaming climate action into PHC policies, protocols, and programmes with built-in accountability mechanisms and financing is critical for sustained action.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106135"},"PeriodicalIF":3.2,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of the Israeli sugar sweetened beverage tax implementation and repeal on beverage price and purchases","authors":"Naomi Fliss Isakov ,&nbsp;Yitzhak Ben Menachem ,&nbsp;Michal Yackobovitch Gavan ,&nbsp;Caroline Parker ,&nbsp;Adi Levy ,&nbsp;Ronit Endevelt ,&nbsp;Laura Sol Grinshpan ,&nbsp;Moran Blaychfeld Magnazi","doi":"10.1016/j.puhe.2025.106118","DOIUrl":"10.1016/j.puhe.2025.106118","url":null,"abstract":"<div><h3>Objectives</h3><div>Israel's sugar-sweetened beverage (SSB) tax, combining ad-valorem and tiered components, was implemented in January 2022 and repealed after one year. We evaluated the effect of tax implementation and repeal, on beverage price and sales.</div></div><div><h3>Study design</h3><div>A longitudinal analysis using national sales data.</div></div><div><h3>Methods</h3><div>Beverages were categorized by sugar content and volume into 6 beverage groups: Large non-taxed, large reduced-tax, large full-tax, small non-taxed, small reduced-tax and small full-taxed beverages. Changes in price and sales across three periods (pre-tax, tax and post-tax) were assessed between groups using Welch ANOVA test (Games-Howell post-hoc analysis, Bonferoni adjustment), and the linear mixed-effects model with restricted maximum likelihood estimation.</div></div><div><h3>Results</h3><div>With implementation of the tax, the prices of all beverage categories increased by 3.03–38.89 % and remained high after tax repeal by 6.8–13.63 %, compared to pre-tax levels. Negative correlations between the change in beverage price and sales were observed during the tax (r = −0.54, p &lt; 0.001) and post-tax (r = −0.29, p &lt; 0.001) periods. A price increase of ≥17 % was associated with significant sales declines during the year of the tax. Sales of large reduced-tax beverages declined by −30.7 % and those of large full-taxed beverages by −24.1 % following tax implementation. After tax repeal, sales levels gradually increased compared to those during the tax period, but remained below pre-tax levels by −24 % and −13 %, respectively. Small-taxed beverages showed no significant change in sales between study periods<strong>.</strong></div></div><div><h3>Conclusions</h3><div>The Israeli SSB tax implementation and repeal, provides critical insights regarding the significant effectiveness of this public health policy. The tax led to a significant increase in the price of all beverage categories, and reduced sales of large-taxed beverages, which contribute the vast majority of national beverage sales. Tax repeal was followed by a gradual rise in sales of taxed beverages, having a potentially negative effect on public health. An effective policy should consider higher tax rates for smaller packaged beverages. Future studies should address longer follow-up and assessment of individual purchase and consumption practices.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106118"},"PeriodicalIF":3.2,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145929273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}