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Background: The global population is aging, increasing demand for informal caregivers. In Lebanon - where caregiving is primarily family-based due to cultural norms and limited institutional care -research on caregiver burden and mental health is limited.

Aims: This study provides the first community based, multi-governorate evidence from Lebanon quantifying caregiver burden, examining its association with mental health and exploring gender differences in an under-researched Arab sociocultural setting.

Method: Data based on two cross-sectional studies (2013-2017) across three governorates. Among 739 informants of older adults, 144 informal caregivers providing occasional or frequent care were analyzed. Caregiver burden and mental health measured using validated tools (Zarit burden interview and self-reporting questionnaire). Bivariate and logistic regression analyses identified correlates and quantified the burden-mental health association.

Results: Of the 144 caregivers, 10% (n = 14) reported caregiver burden and 19% (n = 27) experienced mental health disorders. Caregiver burden was strongly and directionally associated with worse mental health (OR = 17, 95% CI = 4-74; p < 0.001). Being female, living with care-recipient, providing hands-on care, and caring for someone who requires assistance most of the time significantly increased burden. All burdened caregivers were female.

Conclusion: This community-based study provides new insight into caregiver burden and mental health in Lebanon. Caregiver burden in Lebanon appears low but may be under-reported due to cultural norms. When present, burden is strongly linked to poorer mental health, particularly among women. These findings should be interpreted as exploratory signals that align with global literature and highlight the need for culturally sensitive, gender-responsive caregiver support and mental health services. Results can inform policy and future research in Lebanon and similar Arab contexts.

Supplementary information: The online version contains supplementary material available at 10.1186/s12982-026-01466-4.

Context: This report shares the results of a novel environmental health needs assessment designed by the Environmental Health Sciences Research Center in collaboration with our community partners for the four-state region of Iowa (IA), Nebraska (NE), Missouri (MO), and Kansas (KS).

Objective: The goal of the needs assessment was to understand considerations about health and the environment among people living in the central Midwest states of Iowa, Nebraska, Kansas and Missouri, including their concerns, what they see as solutions, and what and how populations are vulnerable. These findings will inform future community engagement by the Environmental Health Sciences Research Center at the University of Iowa to improve environmental health.

Design: The assessment used a mixed-methods approach which included an online survey that collected quantitative and qualitative data and three focus groups with young adults, older rural adults, and immigrant and communities of color in eastern Iowa.

Setting: University of Iowa Environmental Health Sciences Research Center in collaboration with our community partners for the four-state region of Iowa, Nebraska, Kansas, and Missouri and focus groups in eastern Iowa.

Participants: Over 400 participants from four states.

Main outcome measures: Describing residents' perceptions of the connections between environment and health in the 4-state area and identifying notable differences between rural, urban, and suburban populations.

Result: Top issues of concern were water quality, outdoor air quality, climate change, chemical contaminants, and natural disasters. Respondents identified better policies, access to medical services, and financial resources as key components of reducing personal risk to environmental health issues. The focus group sessions highlighted concerns about housing, social capital, and the need for trusted sources of information.

Conclusions: These data suggest a holistic approach to environmental health topics, interest in policy interventions in rural communities, and potential for engagement with clinicians.

Supplementary information: The online version contains supplementary material available at 10.1186/s12982-025-01323-w.

Background: Latine children face structural and contextual challenges affecting sleep health, and unique factors surrounding diet and physical activity. Formative research to understand the contexts surrounding these behaviors is needed to inform potential intervention targets and strategies.

Methods: We conducted in-depth semi-structured interviews in 2019 with 18 custodial parents of Latine children aged 2-5. Interviews explored sleep parenting: daily routines, dietary preferences, sleep schedules, and physical activity habits. A bottom-up (de novo) coding process was used where two independent coders identified themes through line-by-line coding and inductive thematic analysis.

Results: Several factors related to sleep parenting influence a child's diet and physical activity. Parents shared that their child's diet and physical activity affected sleep latency, duration, and quality at night; and that sleep, in turn, also affected diet preferences and engagement with physical activity the following day. Parents identified that this cycle was altered by several factors within the household and outside of the household. Specifically, eating high-sugar foods and external disruptions that reduced physical activity (i.e., disruptions in school or caregiving routines) negatively impacted sleep, while eating heavy, homemade foods and high engagement with play and organized sports during the day positively impacted sleep. Some parents described taking proactive steps to enhance their child's sleep quality, while other parents perceived no relationship between sleep, diet, and physical activity.

Discussion: Parental approaches to managing children's health behavior varied, highlighting the need for culturally sensitive interventions to address the role of diet and physical activity on sleep among Latine children.

Background: Personal protective behaviours (PPBs) played a crucial role in limiting infection spread during the COVID-19 pandemic, yet adherence varied across communities. Understanding the factors influencing adherence is important, as PPBs will remain critical in future pandemics. Using behavioural science, we investigated the influences on adherence to PPBs, focusing on face mask wearing, social distancing, and lateral flow testing (LFT).

Methods: Two online surveys were conducted in July and August 2021 in England and Wales (N = 20,488 (survey 1) and N = 26,613 (survey 2)). Survey questions were informed by the Capability, Opportunity, Motivation model of Behaviour (COM-B). Multivariate models examined associations between behavioural influences and adherence to PPBs.

Results: Most respondents reported wearing a face mask in public indoor places (88.5%) and maintaining a 1 + metre distance (86.8%) all or most of the time. After two doses of COVID-19 vaccine, adherence declined with 48.3% reporting meeting friends or family and 38.3% visiting indoor places more frequently. Motivation, Opportunity and Capability factors were significantly associated with increased odds of wearing a face mask and social distancing (p < .05). Among those using LFTs (68% of the sample), 50.4% engaged in routine testing, while 55.3% of non-users cited a perceived lack of necessity for testing. Routine testing was significantly associated with accurate interpretation of test results.

Conclusions: Despite reduced restrictions and high vaccination rates, overall adherence to PPBs remained high. Behavioural influences played a significant role in PPB use. These findings can inform tailored public health interventions and support future community-level emergency preparedness.

Supplementary information: The online version contains supplementary material available at 10.1186/s12982-026-01375-6.

Background: The prevalence of obesity, a risk factor for other chronic illnesses, in the US continues to rise and disproportionately affects racial/ethnic minorities. Several weight management interventions are now being delivered remotely to address this disparity, but little is known about whether this has increased access and efficacy of treatment among racial/ethnic minorities, especially from participants' perspectives. We qualitatively explored perceived barriers and facilitators to engagement and behavioral enactment during weight management interventions among a nationally decentralized sample of racial/ethnic minorities in the US.

Methods: Thirty-eight self-identified racial/ethnic minority participants who completed the active intervention phase of the parent EVO trial were invited to participate in interviews. Interviews were conducted via Zoom using a guide with open-ended questions. Transcripts were analyzed using NVivo, codebook was developed a priori, but was updated with inductive codes emerging from analysis. Themes were categorized using an adapted version of the Social Determinants of Health and further subgrouped as barriers or facilitators.

Results: Twenty-six participants responded and completed interviews between April and August 2024. Participants were mostly female (88.5%), from Southern states (50%), non-Hispanic (76.9%), and Black/African American (53.8%), with a mean (SD) age of 50.3 (10.1) years. Participants identified cultural, environmental, social, personal, and study-related factors as important to successful engagement in the intervention. Some participants' unique identities, such as being immigrants, impacted the ease of engaging with study components, including diet self-monitoring. Some factors perceived as barriers by some participants were perceived as facilitators by others.

Conclusions: Perceived barriers and facilitators to successful engagement in weight management interventions are complex and are likely impacted by personal needs and contexts of participants. This underscores the need for multifaceted interventions.

Supplementary information: The online version contains supplementary material available at 10.1186/s12982-026-01435-x.

Little is known about the health needs and status of Sub-Saharan African (SSA) immigrants in the U.S. To address this, the California Health Interview Survey (CHIS) began collecting disaggregated Black data in 2021 to better understand the health profiles of SSA immigrants. This cross-sectional study utilizes the 2021-2022 CHIS two-year public use dataset for adults aged 18 and over to examine the demographics, economic well-being, health status, healthcare access, health insurance access, health behaviors, and other social determinants of health of SSA immigrants in California. Descriptive analyses were used to summarize the demographic and health characteristics of SSA immigrants. We found a balanced gender distribution showing females slightly outnumbering males, with most identifying as heterosexual and residing in urban areas. SSA immigrants are generally well-educated, with 57% holding college degrees, and 66% employed full-time. However, 16% live below the poverty line, and 16% experience food insecurity, surpassing national averages. Health status indicates 16% report fair to poor health, with prevalent chronic conditions like asthma and diabetes. Despite 96% having health insurance, 18% delay necessary healthcare. Social determinants highlight high adverse childhood experiences and systemic discrimination, though resilience is evident through positive childhood experiences. These findings highlight the need for targeted interventions to address the unique challenges faced by SSA immigrants, enhancing their access to resources and support systems to improve overall health and well-being.

The Icelandic Prevention Model (IPM) is a sequential 10-step community-driven collaborative intervention that is designed to support the prevention of substance use in youth by establishing healthy developmental contexts. The IPM has been implemented across Iceland for over 20 years and is now being implemented in other countries. Recognizing the need to explore how to adapt the IPM to new contexts and document the implementation of the model, this paper describes a process evaluation of the first three steps of the IPM within a Canadian rural community to capture experiences during the early development. Specifically, this study addresses the following research questions: (1) What are the processes of development and contextual features that influence the implementation of the IPM within Lanark County, Ontario? and (2) What adaptations are needed to successfully implement the IPM in Canada? Semi-structured interviews were conducted to examine experiences and lessons learned through the implementation of the model. Thematic analyses were completed using QSR NVivo. A deductive and inductive approach was applied, whereby some interview guide questions were derived from the IPM implementation steps and others were more exploratory, examining context and processes of development. Nine interviews were conducted with key partners who were leading the implementation of the IPM. Themes highlighting cultural factors that influence implementation, processes of development related to community engagement, and themes relating to youth participation, fidelity issues, fundraising, health equity and challenges related to the COVID-19 pandemic were identified. This paper contributes new scientific knowledge related to implementation processes within upstream prevention of substance use and practical information that is useful for communities interested in implementing the IPM.

Objective: Understanding a patient's nutrition literacy weaknesses may aid in improving the patient's nutrition literacy and diet quality. The Nutrition Literacy Assessment Instrument (NLit) was developed to fill this knowledge gap. Global NLit cutoff scores were previously developed; however, subscale NLit cutoff scores are needed.

Design: In this secondary analysis, individual post hoc linear regressions were calculated for each NLit subscale to determine scoring thresholds for each NLit subscale. Scoring thresholds were determined for both long- and short-form NLit subscales.

Setting: Two University-affiliated general practice clinics and two University-affiliated safety net clinics were used as recruitment sites.

Participants: Patients (n = 402) with self-reported hyperlipidemia, hypertension, diabetes, or obesity were included in primary analysis from which data in this secondary analysis were derived.

Results: Subscale scores were associated with predicted Healthy Eating Index (HEI)-2010 scores linked to increased risk for mortality. Tenth-percentile NLit scores were associated with HEI-2010 scores between 59.33 and 62.27 (by subscale) for the long-form NLit, and between 60.12 and 61.77 for the short-form NLit.

Conclusions: NLit cutoff scores can pinpoint capacity with nutrition information by subscale. Identifying nutrition literacy deficits may allow nutrition professionals to better focus interventions.

Supplementary information: The online version contains supplementary material available at 10.1186/s12982-025-00677-5.

Background: The unpredictable nature of firefighting, characterized by lifting and carrying of heavy equipment, forceful upper body movements in confined spaces, and exposure to extreme conditions, predisposes firefighters (FFs) to a range of work-related shoulder disorders (WSDs). The unique occupational demand of firefighting underscores the need for targeted intervention and occupational health programs tailored to the demands of firefighting.

Objective: To explore the: (1) Management strategies that FFs employ after WSDs (2) Needs and preferences of FFs with WSDs in relation to their occupational health and recovery.

Methods: Using an interpretive descriptive methodology, we interviewed 14 firefighters (males, n = 9; females, n = 5) with an average age of 47 years, who experienced WSDs in their careers. Semi-structured one-on-one virtual interviews were conducted using online video conference software and were transcribed verbatim. Data was analyzed using thematic analysis.

Result: Four themes emerged from firefighters as management strategies following WSDs: (1) Appropriate diagnostic precision and tailored management; (2) The critical role of early medical and physiotherapy intervention; (3) Comprehensive social support systems; (4) Adaptive coping mechanisms. Two themes also emerged as needs and preferences in relation to their occupational health and recovery: (1) Formal and targeted training exercise programs; (2) Mandatory health and wellness monitoring programs.

Conclusion: The unique occupational demands of firefighting necessitate a multifaceted and holistic approach to shoulder injury management and prevention. This approach encourages the development of tailored intervention programs that address the specific challenges and perceived needs of firefighters with WSDs.

Supplementary information: The online version contains supplementary material available at 10.1186/s12982-025-00739-8.

Objective: Early childhood caries (ECC) are prevalent among ethnic minoritized children in the US. Specifically, American Indian/Alaska Native (AI/AN) children face the highest burden of ECC compared to other children. Oral health (OH) interventions using adapted Motivational Interviewing (MI) to educate AI/AN parents/caregivers have demonstrated some promise. This study assessed the feasibility and short-term impact of a culturally adapted MI intervention designed for AI/AN pregnant women and mothers with young children.

Methods: We partnered with two tribal Community Advisory Boards who helped culturally tailor program materials including adapted MI sessions. Community Health Representatives (CHRs) from both tribes were trained in adapted MI and conducted the OH education sessions with eligible mothers. OH knowledge and attitude assessments were conducted before and after the adapted MI sessions.

Results: CHRs were able to recruit participants and implement the intervention as intended. Following the adapted MI sessions, we observed increases in general OH knowledge and modest increases in ratings of the importance of oral hygiene, oral self-efficacy, and perceived benefits of engaging in recommended OH behavior. No post-MI changes were observed in perceived severity of, or susceptibility to, OH problems.

Conclusions: This study demonstrated the feasibility of developing and implementing a culturally tailored, MI-based OH intervention for AI/AN caregivers, resulting in improved OH knowledge and self-efficacy. Given no significant change in other outcome variables, suggests a need for longer-term follow-up and integration with additional preventive strategies (e.g., fluoride varnish). Future research should explore the effectiveness of MI-based approaches in reducing ECC incidence over time.