Objective To examine association between 24-h movement behaviour and quality of life (QoL) among caregivers of children with intellectual disabilities and to estimate QoL differences under hypothetical time reallocations. Methods This cross-sectional study included 225 caregivers in Jinan, China, from October 2025 to January 2026 (mean age, 39.40 ± 8.66 years; 81.78% female). Movement behaviours were measured using ActiGraph accelerometers, and QoL was assessed using the World Health Organization Quality of Life-Brief Version (WHOQOL-BREF). Compositional analysis was used to describe movement behaviour, estimate associations using pivot isometric log-ratio regression, and model 10- and 30-min reallocations among sleep, sedentary behaviour, light physical activity and moderate-to-vigorous physical activity. Results Caregivers spent 411.03 min/day sleeping, 624.84 min/day sedentary, 357.29 min/day in light physical activity, and 46.84 min/day in moderate-to-vigorous physical activity. The overall WHOQOL-BREF score was 49.66. Sedentary behaviour was associated with lower QoL (γ = −7.63; 95% CI, −13.65, −1.60), whereas moderate-to-vigorous physical activity was associated with higher QoL (γ = 8.26; 95% CI, 6.07, 10.46). Reallocating 30 min/day from sedentary behaviour to moderate-to-vigorous physical activity predicted a 3.87-point higher score. Conclusions Caregivers' 24-h movement behaviour was associated with QoL. These findings support further investigation of strategies to reduce avoidable sedentary time and facilitate physical activity.
Objectives Regional disparities in maternal and reproductive health persist in developing countries. This study investigates geographical differences and hierarchical factors influencing fertility in Bangladesh. Methods Using 2017–18 Bangladesh Demographic and Health Survey data, this study models the cumulative fertility of ever-married women aged 15–49. It applies a two-level hierarchical multilevel Poisson regression to separate individual socioeconomic factors from community context. Additionally, global Moran's I and local Getis-Ord (Gi*) analyses identify geographical hot and cold spots of childbearing across communities. Results Significant geographic clustering of fertility in Bangladesh, with hot spots in Sylhet and Chittagong and cold spots in the northwest and southwest. Regression indicated that individual factors like child marriage and low maternal education increased parity. Community factors such as socioeconomic disadvantage and high fertility norms also independently influenced reproductive outcomes. Conclusions Fertility behaviors in Bangladesh are shaped by both individual traits and the normative characteristics of shared spaces. National family planning campaigns are no longer enough; interventions must focus on community-level, geographically segregated strategies that address local infrastructural and sociocultural barriers within high-fertility hot spots.
Objective Little is known about the joint associations of diet quality and physical activity with healthcare utilization. We examined these associations in a nationally representative sample of Korean adults. Methods This cross-sectional study analyzed 37,059 adults aged 20 years or older in the Korea National Health and Nutrition Examination Survey, South Korea, 2014–2021. Participants were cross-classified into four groups by the sample median of the Korean Healthy Eating Index (KHEI) and physical activity level (≥150 moderate-equivalent minutes/week). Inpatient visits (past 12 months) and outpatient visits (past two weeks) were self-reported. Survey-weighted two-part models adjusted for sociodemographic and clinical covariates. Results The High KHEI & Active group showed a lower probability of inpatient visits (OR, 0.89; 95% CI, 0.79, 0.99) than the Low KHEI & Inactive reference. The High KHEI & Inactive group showed a higher probability of outpatient visits (1.19; 1.09, 1.30). Inpatient associations were strongest among women, older adults, and adults with chronic diseases. Conclusions Combined high diet quality and sufficient physical activity was associated with a lower probability of inpatient healthcare utilization, particularly among women, older adults, and those with chronic diseases. These findings support integrated health promotion strategies targeting both diet quality and physical activity.
Objective Medicaid recipients in rural populations experience higher rates of food insecurity. Produce prescription (PRx) programs subsidize the cost of fruits and vegetables (F/V) and may improve health outcomes. This study was designed to test whether a PRx program using a community supported agriculture (CSA) model would improve health outcomes and reduce healthcare utilization among rural Medicaid patients with/at risk of chronic illnesses. Methods A federally qualified health center referred patients to a food bank, which delivered CSA boxes with produce to them for six months. A total of 136 participants completed the baseline survey, and 73 participants completed the post-survey. Main outcomes include F/V intake, food security status, and healthcare utilization. Descriptive statistics were used to summarize demographic characteristics. Chi-squared tests and paired t-tests were conducted to assess associations and mean differences. Results Daily fruit intake and health status did not significantly change. Significant outcomes include increased vegetable consumption (p = 0.04); and decreased food insecurity status (84% to 66%; p = 0.03). Conclusions These findings suggest that PRx programs can be effective nutrition interventions for rural Medicaid populations. This insight can help inform health providers and policymakers about strategies to address chronic disease management and treatment.
Objectives Although the benefits of a healthy lifestyle are well recognized, little is known about how sleep and physical activity patterns jointly relate to multiple well-being outcomes – namely quality of life, self-rated health, and happiness. This study was designed to address that gap. Methods A cross-sectional survey was conducted across five western provinces of Iran (in october 2024), involving 1187 residents aged 16 years and older. A person-centered cluster analysis was applied to explore the combined associations of sleep quality and physical activity behaviors with the three outcome measures. Results Significant differences emerged among clusters for all outcomes (p < 0.01). Cluster 3 consistently reported the highest mean scores for quality of life (3.57 ± 0.88), self-rated health (4.05 ± 0.76), and happiness (2.38 ± 0.82). Effect sizes were 0.15, 0.19, and 0.10, respectively – large for quality of life and self-rated health, and medium-to-large for happiness. Conclusion Overall, the findings indicate that specific configurations of sleep quality and physical activity are meaningfully linked to well-being indicators. However, given the cross-sectional design, causal inferences cannot be drawn. The results nonetheless offer valuable insights for future research and for tailoring health interventions to population subgroups.
Objectives This study explored relationships of social connection with physical and mental health in older adults, specifically examining the effects of comorbidities on these relationships and the influence of sociodemographic variables on the strength of these associations. Methods This cross-sectional study enrolled 174 community-dwelling adults aged 60 years and older residing in Hampton Roads, Virginia, USA. Data were collected from April to August 2025. Hierarchical linear regression analyses examined the associations of social connection with physical and mental health. Moderated mediation analysis examined if comorbidities mediated these relationships and whether sociodemographic factors moderate the strengths of these associations. Results In hierarchical linear regression models, comorbidity burden was significantly associated with poorer mental and physical health, explaining an additional 3% and 10% of the variance, respectively, beyond sociodemographic factors. Moderated mediation analysis revealed social connection had an indirect effect on mental health, where social connection was associated with higher comorbidities, which in turn was associated with poorer mental health, among Black relative to White participants (b = −0.80, 95% CI = −1.85, −0.02). Conclusion A conditional indirect pathway linked social connection to mental health through comorbidity burden among Black older adults, though the incremental contribution of social connection was minimal.
Objective Private well contamination poses underappreciated cancer risks in rural communities where screening rates remain low. We examined whether personalized well water testing and environmental health education framed by the Champion Health Belief Model (CHBM), influence cancer screening intent among rural private well owners in southeast Georgia. Methods Between July and October 2025, a 14-week study enrolled 100 private well owners assigned to an education-plus-testing group (n = 50) or a testing-only group (n = 50). Pre- and post-intervention surveys assessed CHBM constructs and screening intent. Binary logistic regression identified psychosocial and environmental predictors. Results Overall, 68% of wells contained at least one contaminant, with radon exceeding 300 pCi/L in 56% of samples. Cancer screening intent rose 32% in the education-plus-testing group and 36% in the testing-only group. Understanding personalized well results was the strongest predictor of screening intent (Adjusted Odds Ratio (AOR) = 4.75, p = .029), and detection of any contaminant was independently associated with higher intent (AOR = 2.67, p = .039). Conclusions Personalized environmental exposure information may serve as a social-determinants-informed cue to action, bridging environmental risk communication and cancer prevention in underserved rural communities.
Objectives Impaired fasting glucose (IFG) is a prediabetic precursor of type 2 diabetes (T2DM). Few long-term cohorts with substantial competing mortality compare risk estimates from logistic, Cox and Fine-Gray regression. This study aimed to examine cross-model discrepancies and demonstrate model-dependent bias in IFG risk inference. Methods We followed 913 Chinese IFG adults recruited in Liuzhou, Guangxi (2004–2008) for up to 20 years until 31 December 2024 (median 17.83 years). Three regression models were used to identify fully adjusted T2DM predictors. Results Fasting glucose, body fat percentage and older age were consistent positive predictors; female sex was persistently protective. Body mass index (BMI) ≥28 kg/m2 and waist-to-hip ratio showed divergent results across models. Hypertension lacked independent effects in all models, and enrollment year was significant only in Cox regression. Conclusions Statistical model choice alters risk factor conclusions in IFG cohorts with high competing mortality. Joint interpretation of complementary regression methods is recommended.
Objectives In May 2023, under the Public Health (Alcohol) Act 2018, Ireland introduced mandatory labels on alcohol products from May 2026, containing cancer and liver disease warnings, nutritional information and pregnancy pictogram. In July 2025, compliance date was postponed until September 2028, following industry opposition and political pressures. However, anecdotal reports showed occasional early adoption. This study assessed the proportion of alcohol products displaying warning labels shortly after the postponement announcement and five months later. Methods Five Dublin stores were selected based on size and geographical representation and visited at two time points: 26 August–8 September 2025 and 30 January–10 February 2026. Products with warning labels were counted across beers, wines, and spirits. Additional product characteristics were recorded. Results At the first audit, 6.7% (45/671) of products displayed alcohol warning labels, increasing to 8.3% (54/650) at follow-up, most commonly on wine. Most warning labels were positioned horizontally on the back (93.3%). QR codes featured on 84.4% of products and 13.3% included additional voluntary health-related information. Conclusions A limited number of audited alcohol products contained warning labels ahead of the original compliance deadline. Ongoing monitoring is essential to track whether this momentum continues ahead of the September 2028 deadline.
Objective:To compare smoking prevalence, smoking intensity, quit attempts, and quit ratio across four glycemic groups among US adults. Methods:We analyzed National Health and Nutrition Examination Survey data collected in the United States from 2011 through 2023 among adults aged 20 years or older. Glycemic status was classified as no diabetes, prediabetes, controlled diabetes, or uncontrolled diabetes. Survey-weighted analyses estimated smoking outcomes and adjusted associations using models adjusted for demographic, socioeconomic, behavioral, and clinical factors. Results:Among 29,096 adults, current smoking prevalence was 17.45%, 19.63%, 14.30%, and 19.83% across the four groups, respectively (P < 0.01). Smoking intensity differed across groups (P<0.01). Quit attempt prevalence did not differ significantly (P = 0.06), whereas quit ratio differed (56.36%, 57.20%, 71.28%, and 59.69%; P < 0.01). In fully adjusted models, prediabetes (adjusted odds ratio [aOR]: 1.31; 95% confidence interval [CI]: 1.10, 1.57) and uncontrolled diabetes (aOR: 1.37; 95% CI: 1.02, 1.83) were associated with higher odds of current smoking. Prediabetes was associated with a lower quit ratio among ever smokers (aOR: 0.80; 95% CI: 0.66, 0.98). Conclusions:Smoking burden remained substantial among adults with prediabetes and uncontrolled diabetes, supporting targeted cessation interventions across the glycemic spectrum and informing future public health planning.
Objective:To compare online ratings between male and female healthcare professionals practicing in Moscow, Russia. Methods:This cross-sectional study used a publicly available dataset containing profiles of healthcare professionals practicing in Moscow, Russia, extracted from the Napopravku and DocDoc healthcare platforms; data extraction and analysis were performed in May 2026. Healthcare professionals with missing sex or rating data were excluded. Healthcare professions were grouped into 20 categories. Ratings were compared between men and women using the Wilcoxon rank-sum test and adjusted median regression analyses. Results:A total of 64,939 healthcare professionals were included, including 23,454 men (36.1%) and 41,485 women (63.9%). Median ratings were identical in men and women (8.6/10), although rating distributions differed significantly (p < 0.01). In adjusted median regression analyses, female healthcare professionals had slightly lower ratings than men after adjustment for professional experience and number of reviews (β = -0.031; p < 0.01). Median ratings were higher among men in 11 of 20 healthcare profession categories, whereas no category showed higher median ratings among women. Conclusions:Online ratings of healthcare professionals in Moscow were overall highly positive. Although differences were modest, male healthcare professionals tended to receive slightly more favorable ratings than female healthcare professionals across several healthcare profession categories.
Objective:To analyze the spatiotemporal clustering of mumps in Hunan Province from 2015 to 2024 and its influencing factors and to explore the policy effect of adjusting the immunization schedule. Methods:Spatial autocorrelation, spatiotemporal clustering, geographically and temporally weighted regression (GTWR), and interrupted time series (ITS) analyses were performed on county-level mumps surveillance data obtained from Hunan Province for 2015-2024 to identify mumps clustering, quantify socioeconomic drivers and assess the two-dose mumps-containing vaccine (MuCV) policy impact. Results:In total 157,502 cases were reported, and 89.7% of patients were aged 0-14 years. The global Moran's I increased from 0.20 to 0.67 (P < 0.01), indicating intensified clustering. Despite the decreasing provincial incidence, high-high hotspot geographic coverage expanded because of widening spatial disparities. The primary hotspot was in northeastern Hunan (Nov 2016-Dec 2019). GTWR revealed that per capita gross domestic product (GDP) and population mobility intensity had positive local effects in northeastern counties (adjusted R 2 = 0.45). ITS showed an immediate significant decline after the 2020 policy (β 2 = -2.50, P < 0.01). Conclusions:Persistent hotspots in northeastern Hunan may be driven by per capita GDP and intercounty mobility. The two-dose policy reduced overall incidence but exacerbated regional inequalities.
Objective To estimate the lifetime risks of developing and dying from respiratory system cancers across 185 countries and territories and to examine their associations with socioeconomic development and air pollution. Methods GLOBOCAN 2022 data for 185 countries and territories were combined with United Nations life tables to estimate lifetime risks using an adjusted-for-multiple-primaries framework. Country-level air pollution indicators for 2022 were obtained from OpenWeather. Estimates were stratified by Human Development Index (HDI) and World Bank income groups, and associations between lifetime risk and PM2.5, PM10, NO2, and SO2 were assessed using univariable linear regression. Results Globally, the lifetime risk of developing and dying from lung cancer was 4.92% and 4.08%, respectively, far exceeding those for laryngeal cancer (0.33% and 0.20%). A marked socioeconomic gradient was identified: lung cancer incidence risk ranged from 0.34% in low-HDI countries to 5.45% in very high-HDI countries. All four pollutants were positively associated with lifetime risk, with PM2.5 showing the strongest correlation in the primary univariable analyses. Conclusions Substantial geographic and socioeconomic disparities exist in respiratory cancer lifetime risk, with lung cancer as the dominant driver. The observed ecological associations with air pollutants support further investigation of environmental factors in cancer prevention.
Objective:To characterize hearing, noise behaviors, and awareness of hearing difficulty in predominantly Hispanic/Latino short-haul truck drivers, and to compare measured thresholds with age- and sex-based norms. Methods:In this cross-sectional pilot study we studied 50 short-haul truck drivers in Los Angeles, California, USA, in July 2023. Each completed a health and noise survey and automated audiometry from 250 to 8000 Hz; workplace and in-cab sound levels were measured with a smartphone meter. Thresholds were compared with ISO 7029:2017 age- and sex-based normative values, including their position within the normative distribution. Results:Mean age was 51.8 years; 88.6% identified as Hispanic/Latino and 87.0% used no hearing protection. Thresholds exceeded normative medians at every frequency; the sample median fell at or above the 76th percentile across frequencies, most extreme at low frequencies. In an exploratory model, age was associated with the better-ear pure-tone average; years of driving, noise sensitivity, and cardiovascular risk showed no independent association. Among drivers with measured high-frequency loss, 59% reported no perceived decline. Conclusions:Short-haul truck drivers had hearing poorer than age- and sex-based norms across frequencies, rarely used protection, and were often unaware of measurable loss. These findings support accessible hearing screening and protection in this underserved workforce.
Objective:Examine school-level associations between school characteristics, health-related fitness, and academics. Methods:This observational study included schools in the NFL PLAY60 FitnessGram® project. We used 2022-2023 school year school-level data from three sources: 1) school characteristics data from the National Center for Education Statistics website; 2) cardiorespiratory fitness (CRF) and body mass index (BMI) data; and 3) academic data (students at or above grade-level for math and English Language Arts (ELA)) from state department of education websites. We used mixed effects linear regression models to examine aims. Results:One-hundred-sixty-six schools had CRF data and 67 had BMI data. Economic disadvantage was inversely associated with students meeting Healthy Fitness Zone (HFZ) BMI standards (β = -0.10, p < 0.001, R2 = 0.60), and academic performance (math, β = -0.38, p < 0.001, R2 = 0.52; ELA, β = -0.42, p < 0.001, R2 = 0.59). There were differences in the percentage of students meeting HFZ standards and academic performance across schools with different racial/ethnic compositions. School-level CRF was directly associated with academic performance (math, β = 0.10, p = 0.04, R2 = 0.52; ELA, β = 0.13, p = 0.006, R2 = 0.59), and there were no significant relations between BMI and academic performance (math, β = 0.26, p = 0.25, R2 = 0.54; ELA, β = 0.18, p = 0.47, R2 = 0.71). Conclusions:Findings highlight fitness and academic disparities related to economic disadvantage and race/ethnicity, and relations between fitness and academics.
Background: Somalia has introduced a new Community Health Strategy to strengthen primary health care (PHC) and improve health system resilience. The strategy addresses persistent gaps in service delivery, limited access to essential health services in rural and underserved communities, and inadequate capacity to respond to public health emergencies. Methods: This correspondence presents a descriptive policy analysis of Somalia's newly launched Community Health Strategy using national policy documents and relevant peer-reviewed literature to assess its priorities and implications for community-based health service delivery. Results: The strategy prioritizes expansion of community health worker programs, integration of preventive and promotive services, strengthened referral pathways between communities and primary health facilities, improved workforce capacity, enhanced supervision, and stronger coordination among government and implementing partners. It also emphasizes preparedness for disease outbreaks and other public health emergencies to improve health system resilience. Conclusions: Somalia's Community Health Strategy represents an important step toward strengthening primary health care and building a more resilient health system. Effective implementation could improve equitable access to essential services, enhance community-level disease prevention and response, and accelerate progress toward universal health coverage.
Objectives: In 2025, Florida officials announced plans to end vaccine mandates, including school-based vaccine requirements. This study assessed whether Florida parents/caregivers reported changes in pediatric vaccination intentions related to the state's announcement and identified correlates of reported changes.Methods: We conducted an online survey with 519 Florida parents/caregivers of school-aged children in December 2025. Eligibility criteria included being aged 18 or older, having at least one school-aged child, residing in Florida, and speaking English. Measures included sociodemographic characteristics, political affiliation, vaccine hesitancy, and self-reported changes in vaccination intention following the policy announcement. Descriptive statistics and multivariate regression models examined correlates of vaccine hesitancy and vaccination intention change.Results: Overall, 42% of participants reported being more likely to vaccinate children following the announcement, 38% reported no change, and 20% reported being less likely. Vaccine hesitancy was the only variable independently associated with reported intention change. Hesitant respondents were more likely than non-hesitant respondents to report decreased vaccination intentions (44% vs 13%) and less likely to report increased intentions (16% vs 50%).Conclusions: Findings suggest vaccine hesitancy shapes responses to vaccine policy change. Such policies may reinforce existing vaccination attitudes, resulting in divergent vaccination intentions among caregivers with differing levels of hesitancy.
Background Primary care providers are well-positioned to educate patients about alcohol-related health risks, such as breast cancer, but little is known about their awareness of the alcohol-breast cancer (ABC) link or their counseling practices. This study aimed to assess the level of awareness of alcohol as a breast cancer risk factor among providers; to assess the prevalence of provider counseling discussions with their patients about the alcohol-breast cancer link; and identify predictors of level of awareness and counseling discussion about the alcohol-breast cancer link. Methods We conducted a cross-sectional survey of primary care providers in Alabama between September and December 2023. A 3-min online questionnaire assessed provider knowledge of the ABC link, counseling practices, and perceived barriers to patient education. Descriptive statistics, bivariate analyses, and logistic regression were used to identify predictors of awareness and counseling behavior. Results Among 123 respondents, only 19.5% reported counseling patients about the ABC link. Awareness was significantly higher among counseling providers (95.8%) compared to non-counseling providers (41.7%, p < 0.001). Older age and female gender were associated with greater awareness (OR = 1.08 per year, p = 0.001; OR = 5.26 for females, p = 0.003). Counseling was more likely among providers who were female (OR = 5.26, p = 0.041), did not engage in binge drinking (OR = 12.5, p = 0.045), and had higher patient loads (OR = 1.02 per patient, p = 0.019). The most cited barrier to counseling was lack of awareness (49.4%), while increased provider education was the most frequently proposed solution (45.3%). Conclusions Despite the critical role of providers in preventive health, most providers do not counsel patients about the ABC link. Awareness is a key driver of counseling but not sufficient on its own. Targeted educational interventions are needed to enhance provider engagement in alcohol-related cancer prevention.
OBJECTIVE:This study examined whether primary drug of choice is associated with risk of being injured or threatened by a gun. METHODS:The sample included 401 Medicaid-eligible adults receiving addiction treatment services in the Midwest United States who completed life-course history surveys between 2021 and 2023 as part of the Removing Barriers to Recovery randomized controlled trial. Bivariate and multivariate analyses were conducted. RESULTS:Bivariate analyses showed marginally and statistically significant differences in firearm victimization risk between individuals identifying alcohol as their primary drug of choice and those identifying cocaine, heroin/opioids, or crystal meth. Individuals identifying marijuana as their primary drug of choice had the lowest risk of gun victimization. Differences in drug use behaviors, demographics, family history, housing insecurity, behavioral health history, and criminality helped explain variation in firearm victimization across substances. CONCLUSIONS:Firearm victimization was common among people receiving addiction treatment, though less frequent among those preferring marijuana. Risk did not differ significantly by race or ethnicity. More than 40% of participants reported gun victimization, underscoring firearm violence as a major public health concern for this population and by association, their families.
Objective:To explore definitions of nonfatal opioid overdoses with study populations based in the United States and Canada, to improve nonfatal overdose monitoring. Methods:We searched five databases: PubMed, Medline, Web of Science, Embase, and PsycInfo, including studies published between January 2013-October 2024. We combined overdose-related terms (e.g., overdose, poisoning) and hospital-related terms (e.g., diagnosis code, International Classification of Diseases [ICD], electronic health records) and extracted data from 214 studies that defined opioid overdoses. Results:Most studies reported on opioid overdoses due to any opioid (n = 175). Studies varied in terms of specific ICD codes. Among studies using ICD, Tenth Revision, Clinical Modification (ICD-10-CM) codes (n = 79), key sources of variation included intent specifications and encounter type; nearly one-third did not specify whether codes reflected an initial encounter, a subsequent visit, or sequelae (n = 24, 30.8%). Of studies that specified, most used all three encounter types (n = 27, 34.6%) or initial only (n = 21, 26.9%). Few specified both initial and sequelae (n = 4, 5.1%) or initial and subsequent encounters (n = 2, 2.6%). Similar patterns were observed across all opioid subtype definitions. Conclusions:We observed substantial variation in definitions. Detailed, standardized reporting methods when applying diagnostic codes may improve consistency and transparency and could improve public health monitoring.
