Journal Detail

Research Article

ArticleID :HPH/2025/11/01/01

Joint analysis of blood pressure changes over time and survival of hypertensive patients under treatment at Sawula hospital in Southern Ethiopia

Issue No. 01 (Jan-Mar)

Authors: Markos Abiso Erango, Tademe Fiseha and Galgalo Jaba Nura

Introduction:  Hypertension is among the most significant non-communicable public health issues worldwide. High blood pressure, or hypertension, has been associated with severe health consequences, including death, aneurysms, stroke, chronic renal disease, eye damage, heart attack, heart failure, peripheral artery disease, and vascular dementia. Consequently, this study aimed to investigate the predictors linked to survival time and the progression of blood pressure measurements in hypertensive patients.

Methods: This study on retrospective cohort analysis was conducted among hypertensive patients receiving follow-up treatment. A total of 200 hypertensive patients were screened during their follow-up at Sawula General Hospital. Multivariate joint models typically combine a multivariate linear mixed-effects model for repeated measurements with a Cox model for time-to-event outcomes.

Result:  The baseline characteristics of patients indicated that, out of 200 hypertensive patients, the majority were male, totaling 116 (58%). Regarding alcohol consumption, 72 (36%) of the hypertensive patients reported using alcohol, while 128 (64%) did not. The multivariate joint model emerged as the most effective model in this study. The analysis revealed that observation time, economic status, sex, place of residence, baseline FBS, and age significantly influenced log FBS, while visiting time, age, sex, pulse rate, place of residence, and baseline DBP were identified as significant factors for log diastolic blood pressure.

Conclusion:  The multivariate joint model exhibited superior performance. Hypertension continues to be a non-communicable disease and a public health issue in Sawula and Ethiopia, deserving greater attention.

How To Cite this Article

Erango, M.A., Fiseha, T. & Nura, G.J. Joint analysis of blood pressure changes over time and survival of hypertensive patients under treatment at Sawula hospital in Southern Ethiopia. BMC Public Health 25, 23 (2025). https://doi.org/10.1186/s12889-024-21176-3

Research Article

ArticleID :HPH/2025/11/01/02

What makes an epidemic a disaster: the future of epidemics within the EM-DAT International Disaster Database

Issue No. 01 (Jan-Mar)

Authors: Margo Tonnelier, Damien Delforge, Regina Below, Juan Armando Torres Munguía, Claude Saegerman, Valentin Wathelet, Joris A. F. van Loenhout and Niko Speybroeck

Background: Reporting on and monitoring epidemics is a public health priority. Several initiatives and platforms provide epidemiological data, such as the EM-DAT International Disaster Database, which has 1525 epidemics and their impact reported since 1900, including 892 epidemics between 2000 and 2023. However, EM-DAT has inconsistent coverage and deficiencies regarding the systematic monitoring of epidemics data due to the lack of a standardized methodology to define what will be included under an epidemic disaster.

Methods: We conducted a sequential study that included an online survey of experts in infectious diseases, public health emergencies, and related data, followed by committee discussions with disaster experts. This approach aimed to identify appropriate definitions and entry criteria for archiving disease outbreak events.

Results: The survey had 21 respondents from universities and international organizations, with experts primarily specialized in infectious disease surveillance. Experts agreed that epidemics should be considered as disasters. Experts cited challenges in defining epidemic thresholds. However, they proposed pathogen-based criteria and agreed that disruption to society, especially to the healthcare system, serves as a determinant of epidemic disasters. The experts favored deaths and confirmed cases as key indicators, alongside suggestions on refining EM-DAT’s entry criteria and improving epidemic impact assessment.

Discussion: This article offers valuable insights into epidemic disasters, a topic previously underdefined in the literature, thereby enhancing understanding for policymakers and public health professionals.

How To Cite this Article

Tonnelier, M., Delforge, D., Below, R. et al. What makes an epidemic a disaster: the future of epidemics within the EM-DAT International Disaster Database. BMC Public Health 25, 21 (2025). https://doi.org/10.1186/s12889-024-21026-2

Research Article

ArticleID :HPH/2025/11/01/03

Stakeholder perspectives on barriers and facilitators to hypertension control in urban Haiti: a qualitative study to inform a community-based hypertension management intervention

Issue No. 01 (Jan-Mar)

Authors: Reichling St Sauveur, Rodney Sufra, Marie Christine Jean Pierre, Joseph Inddy, Mirline Jean, Nour Mourra, Radhika Sundararajan, Margaret L. McNairy, Jean W. Pape, Vanessa Rouzier

Background: Uncontrolled hypertension is the leading modifiable risk factor for cardiovascular disease mortality and remains high in low-middle income countries like Haiti. Barriers and facilitators to achieving hypertension control in urban Haiti remain poorly understood. Elucidating these factors could lead to development of successful interventions.

Methods: We conducted semi-structured interviews with healthcare providers (10) and patients with hypertension (10) from the Haiti Cardiovascular Disease Cohort, using guides developed using the Consolidated Framework for Implementation Research. Participants were recruited using purposive sampling, and thematic content analysis was conducted in NVIVO software.

Results: At the individual level, barriers to hypertension control included hypertension is asymptomatic, hypertension is due to stress, difficulty changing behaviors within shared households, and fear of becoming dependent on medications. Facilitators included spiritual faith in doctors, high awareness of diet and exercise, belief in medication effectiveness, and family as motivation to treat hypertension. At the inner setting clinic level, barriers included limited physician–patient time during visits, residual stigma around cardiovascular services located on same campus as HIV care, and patient preference for physician guidance. Facilitators included patients treated with respect at clinic, and strong provider-patient rapport. At the outer setting societal level, only barriers were mentioned, including extreme poverty, civil insecurity, and stress making hypertension worse.

Conclusions: These findings can inform the development of future efforts to design interventions to improve hypertension control in Haiti.

How To Cite this Article

St Sauveur, R., Sufra, R., Jean Pierre, M.C. et al. Stakeholder perspectives on barriers and facilitators to hypertension control in urban Haiti: a qualitative study to inform a community-based hypertension management intervention. BMC Public Health 25, 18 (2025). https://doi.org/10.1186/s12889-024-20793-2

Research Article

ArticleID :HPH/2025/11/01/04

Changing patterns of cardiovascular diseases and subtypes induced by kidney dysfunction among 25–64 years in China from 1992 to 2021

Issue No. 01 (Jan-Mar)

Authors: Guoqiang Zeng, Hongliang Wang, Pinghui Cao, Jinyang Zhao, Lingyun Liu and Hui Guo

Background: Cardiovascular diseases (CVD) remain a significant global health burden, particularly in China, where kidney dysfunction (KD) is a key risk factor. This study analyzed trends in the burden of KD-induced CVD and subtypes among the working-age population (25–64 years) in China over the past 30 years and explored its association with age, period, and birth cohort.

Methods: This study extracted data from the Global Burden of Disease (GBD) 2021, focusing on deaths and disability-adjusted life years (DALYs) caused by KD-induced CVD and subtypes, including ischemic heart disease (IHD), stroke, and lower extremity peripheral artery disease (LEPAD) among 25–64 years globally and in China from 1992 to 2021. Trends in disease burden were described by calculating age-standardized mortality rates (ASMR) and age-standardized DALYs rates (ASDR). Additionally, an age-period-cohort (APC) model was employed to estimate the overall annual percentage change in mortality (net drift), the annual percentage change for specific age groups (local drift), the relative risks of period and cohort effects, and the age-specific rates adjusted for period bias (age effect).

Results: From 1992 to 2021, the number of deaths and DALYs caused by KD-induced IHD and LEPAD among 25–64 years globally and in China showed an upward trend, while the number caused by stroke decreased. However, the ASMR and ASDR demonstrated a declining trend, with the disease burden in China being lower than the global level. Notably, the ASMR for IHD and LEPAD in Chinese males showed an upward trend. The declines in ASMR and ASDR were more pronounced in females than in males. The net drift for CVD and subtypes showed a downward trend, with differing patterns between males and females. Mortality rates from stroke in males was increasingly affecting younger populations, while LEPAD was more prevalent in older individuals. Aside from male IHD, the relative risks for CVD and subtypes across cohort and period analyses showed a slight decline. Females exhibited higher relative risks in earlier periods, but their decline in both period and cohort analyses was faster than that of males. Mortality rates for IHD and stroke increased with age, with males exhibiting higher mortality rates across all age groups compared to females.

How To Cite this Article

Zeng, G., Wang, H., Cao, P. et al. Changing patterns of cardiovascular diseases and subtypes induced by kidney dysfunction among 25–64 years in China from 1992 to 2021. BMC Public Health 25, 26 (2025). https://doi.org/10.1186/s12889-024-21183-4

Research Article

ArticleID :HPH/2025/11/01/05

A qualitative study on the impact and participation in the AGELESS multidomain intervention: Insights from older adults with cognitive frailty and their caregivers

Issue No. 01 (Jan-Mar)

Authors: Ying Qian Ong, Suzana Shahar, A’isyah Mohd Safien, Norhayati Ibrahim, Ai-Vyrn Chin, Francesca Mangialasche, Miia Kivipelto and Devinder Kaur Ajit Singh

Background: Cognitive frailty (CF) is a major precursor to dementia, and multidomain interventions have the potential to delay, prevent or reverse its early onset. However, the successful translation and sustainability of such interventions in real-life settings remain uncertain. In this study, we aimed to explore the insights of older adults with CF and their caregivers regarding the impact and participation in the AGELESS multidomain intervention.

Methods: This qualitative study was conducted following the completion of AGELESS multidomain intervention. Semi-structured interviews covering domains such as perceptions, benefits, barriers, facilitators, and program preferences were conducted among 17 older adults with CF and 10 caregivers following the completion of the intervention. The data obtained were transcribed verbatim and analyzed using thematic analysis. Each transcript was reviewed and coded to identify prevailing themes derived from the interview data.

Results: The analysis revealed five distinct themes: (1) impact of the program, (2) facilitators enhancing participation, (3) barriers hindering participation, (4) suggestions for improving participation and (5) challenges to adopt digital platforms. Based on the findings, the AGELESS multidomain intervention had a positive impact on the participants and their caregivers. It was noted that they showed preference for in-person sessions over virtual ones. The study highlighted key factors critical for successful participation, including diversity and inclusivity. It emphasized incorporating a multi-component, group-based approach with social aspects. The intervention should be people-centered, dignified, affordable, and customized to meet the unique needs of each participant.

Conclusions: The AGELESS multidomain intervention was well received by older adults with CF and their caregivers who participated in this study. Moving forward, it is recommended that future initiatives focus on identifying opportunities to implement existing evidence-based programs on a larger scale for the prevention of dementia in older adults.

How To Cite this Article

Ong, Y.Q., Shahar, S., Mohd Safien, A. et al. A qualitative study on the impact and participation in the AGELESS multidomain intervention: Insights from older adults with cognitive frailty and their caregivers. BMC Public Health 25, 7 (2025). https://doi.org/10.1186/s12889-024-20704-5

Research Article

ArticleID :HM/2025/11/02/01

Methods used to find clients and risky sexual behavior among female sex workers in China: a cross-sectional study

Issue No. 02 (Apr-June)

Authors: Zhujun Lian, Ke Xu, Jie Jin, Xingliang Zhang and Junfang Xu

Methods: HIV sentinel surveillance data were collected from Zhejiang Province, China, between 2016 and 2021. In total, 4,798 FSWs were included in our analysis. We collected information related to socio-demographic variables, HIV knowledge, methods used to find clients, and condom use. Descriptive statistics were used to analyze the socio-demographic characteristics of FSWs. Univariate and sequential logistic regression models were employed to determine the influence of methods used to find clients on risky sexual behavior after controlling for other factors.

Results: The average age of the 4,798 FSWs was 33.0 ± 7.4 years. The majority (70.6%) who find clients online reported always using condoms over the past month. The proportion of FSWs engaging in risky sexual behavior, defined as not using condoms at the last sexual encounter or not using them consistently over the past month, was lowest among those who find clients online, whereas the risk was highest among those who worked at a fixed site (p < 0.001). Sequential logistic regression demonstrated that compared to FSWs who find clients at a fixed site, those finding clients online (OR = 0.6, p < 0.001) were significantly associated with risky sexual behavior. 

Conclusion: FSWs had a high knowledge regarding acquired immunodeficiency syndrome (AIDS), but with greater likelihood of risky sexual behavior, particularly among FSWs who find customers at a fixed site. The risk of engaging in condomless sex among FSWs who find client at fixed sites was higher than those online. Therefore, it is essential to explore health interventions that improve condom use among FSWs.

How To Cite this Article

Lian, Z., Xu, K., Jin, J. et al. Methods used to find clients and risky sexual behavior among female sex workers in China: a cross-sectional study. BMC Public Health 25, 1232 (2025). https://doi.org/10.1186/s12889-025-22395-y

Research Article

ArticleID :HPH/2025/11/02/01

Correlates of duration between initial drug use and first drug injection among people who inject drugs in Iran, 2020

Issue No. 02 (Apr-June)

Authors: Zahra Abdolahinia, Zahra Jaafari, Ali Karamoozian, Soheil Mehmandoost, Nima Ghalekhani, Mehrdad Khezri, Ghazal Mousavian, Mostafa Shokoohi, Ali Mirzazadeh, Ali Akbar Haghdoost

Background: People who use non-injection drug use are at risk of transitioning to injecting drugs, which increases their vulnerability to HIV and other blood-borne infections. This study aimed to investigate the correlates of the duration between the first drug use and the first drug injection among people who inject drugs (PWID) in Iran, as well as the reasons for injection initiation.

Methods: We analyzed data from the fourth national bio-behavioral surveillance survey among PWID in Iran, conducted in 2020 across 11 cities using respondent-driven sampling (n = 2,684). A generalized linear mixed model with a gamma-distributed dependent variable and log link function was used to investigate the correlates of transition time from non-injection to injection drug use.

Results: Among 2,356 participants included in the analysis, the mean ± SD of the duration between the first drug use and the first drug injection was 9.37 ± 6.8 years. Factors associated with earlier injection initiation included: age under 30 years (p-value < 0.001), being single (p-value < 0.001) or divorced/widowed (p-value = 0.007), history of incarceration (p-value = 0.001), sexual debut before age 18 (p-value < 0.001), and history of depression (p-value < 0.001). Peer influence (665;29.1%) and pleasure-seeking behavior (534; 23.3%) were the most common motives for injection initiation.

Conclusions: The transition to injection drug use among PWID in Iran often occurs within a decade of initial drug use and is influenced by demographic, social, and psychological factors. Prevention strategies should focus on early intervention for at-risk youth, address mental health needs, and leverage peer influence. Policymakers should prioritize evidence-based, multi-faceted approaches that target both individual and structural factors to delay or prevent the transition to injection drug use and reduce associated health risks.

How To Cite this Article

Abdolahinia, Z., Jaafari, Z., Karamoozian, A. et al. Correlates of duration between initial drug use and first drug injection among people who inject drugs in Iran, 2020. BMC Public Health 25, 1229 (2025). https://doi.org/10.1186/s12889-025-22357-4

Research Article

ArticleID :HPH/2025/11/02/03

Explanation of factors affecting food choice among Iranian young adults (18 to 24 years old): a qualitative study

Issue No. 02 (Apr-June)

Authors: Maryam Mohammadzadeh, Zahra Namkhah, Elaheh Abdolahzadeh, Mehrsadat Mahdizadeh and Seyyed Reza Sobhani

Background: The young adult period, encompassing the ages of 18 to 24, is characterized by a rapid increase in weight, particularly among individuals born in recent decades, during which environments have become saturated with inexpensive, palatable, and processed foods. While physiological, environmental, and social factors significantly impact health conditions, decisions such as food selection, also play a critical role over time. Understanding food choices is crucial for developing effective health promotion efforts aimed at addressing the root causes of disease and mortality. The aim of this study is to explain the factors affecting the food choices of Iranian youth. 

Methods: The study population comprised young individuals from Mashhad, and interviews continued until data saturation was reached to capture exhaustive insights on the phenomenon. This qualitative study employed semi-structured in-person interviews for data collection, alongside content analysis using an inductive approach based on the methodologies developed by Granheim and Lundman. Data analysis followed a systematic procedure involving transcription, re-reading, categorization of meaning units, coding, and theme extraction, leading to the identification of new concepts. Data were analyzed using MAXQDA 2020 software. 

Results: The results indicated that factors influencing young people’s food choices were categorized into three overarching themes: Self-concepts: Personal reflections on food behaviors, Abundance of inventory and manifestation of food quality, and the module of the surrounding social environment. The first theme encompasses categories reflecting various influences on individual-centric food choices. The second theme highlights characteristics of the food itself. Lastly, the third theme focuses on the social and environmental impacts of food selection. 

Conclusion: This research explains the multifaceted factors affecting the food choices of young individuals, emphasizing the roles of individual characteristics, social environments, and dietary potential. It underscores the need for targeted interventions that address the diverse influences on dietary behaviors to promote healthier eating among youth.

How To Cite this Article

Mohammadzadeh, M., Namkhah, Z., Abdolahzadeh, E. et al. Explanation of factors affecting food choice among Iranian young adults (18 to 24 years old): a qualitative study. BMC Public Health 25, 1228 (2025). https://doi.org/10.1186/s12889-025-22478-w

Research Article

ArticleID :HPH/2025/11/02/04

The experience and influence of youth in China in coping with stressful life events during the post-COVID-19 pandemic era: a qualitative study

Issue No. 02 (Apr-June)

Authors: Yannan Guo, Ziruo Xu, Hexiao Ding, Cailing Wang, Xinran Peng, Yuping An, Jing Wang, Wangjing Hu, Sicheng Li, Zhengyang Hui and Wei Xia

Background: The COVID-19 pandemic has had a profound effect on the mental well-being of individuals, particularly among the youth. The experience of stressful life events has been linked to increased poor mental health. While the immediate effects have been documented, there is evidence to suggest that the pandemic’s impact on mental health could persist in the long run. Additionally, the pandemic has influenced coping strategies and forms of social support.

Methods: A phenomenological descriptive study was conducted to elucidate the changes in strategies adopted by youth to cope with stressful life events during the COVID-19 era. Thirty-three Chinese youths aged 15 to 24 years who have experienced regular COVID-19 pandemic prevention and control were invited to complete a semi-structured interview. Colaizzi’s method was used to analyze the data. Triangulation was adopted to ensure the validity.

Results: Four key themes were generated, including (1) negative changes in mental health, (2) positive changes in mental health, (3) changes in the adoption of coping strategies, and (4) the utilization of internet-based coping strategies.

Conclusions: The results could guide the development of interventions to help the youth cope with stressful life events and further promote mental health among this population.

Trial registration: This study has prospectively been registered on the Chinese Clinical Trial Registry (ID: ChiCTR2200060894) on 14/06/2022.

How To Cite this Article

Guo, Y., Xu, Z., Ding, H. et al. The experience and influence of youth in China in coping with stressful life events during the post-COVID-19 pandemic era: a qualitative study. BMC Public Health 25, 1421 (2025). https://doi.org/10.1186/s12889-025-22597-4

Research Article

ArticleID :HPH/2025/11/02/05

Adolescents’ health literacy perspectives and implications

Issue No. 02 (Apr-June)

Authors: Adamu Amanu Asari, Zewdie Birhanu and Ameyu Godesso

Background: Adolescence is an essential stage of life during which individuals develop knowledge, attitudes, and behaviors that can have significant impacts on their present and future health. Therefore, health literacy issue among adolescents is a pressing matter. Understanding adolescents’ perspectives of health literacy is crucial for making informed interventions. However, the topic remains unexplored in developing countries like Ethiopia. This study seeks to explore adolescents’ perspectives of health literacy within their socio-environmental context in Ethiopia and draw out the implications. 

Methods: This study employed qualitative research approach, utilizing in-depth interviews and focus group discus sions as methods of data collection. Data collection took place from March to October 2023, involving 86 participants (41 male and 45 female) selected through purposive sampling (maximum variation sampling) to capture a wide range of perspectives on the issue. The data analysis followed a thematic analysis approach, using Atlas.ti (version 7.5.18) software. 

Results: From the adolescents’ perspectives, health literacy or being health literate is regarded as comprising vari ous competencies and qualities essential for health, including health awareness and knowledge, abilities to deal with health information, practicing healthy behaviors, upholding healthy norms and values of the community, and being a responsible citizen. The adolescents regard health literacy or being health literate as highly beneficial in healthcare, disease prevention, health maintenance and enhancement, and in taking responsibility not only for ones’ own health but also for the health of others, thereby benefiting those around them and their community and society. However, this study found notable gaps in health literacy among the adolescents, influenced by various factors ranging from individual to community and societal levels. 

Conclusion: The study explored health literacy from adolescents’ perspectives in Ethiopia, and contributed to under standing of the issue. It identified notable gaps in adolescent health literacy and provided insights into the enabling and hindering factors. This study laid the ground for developing a health literacy tool sensitive to the Ethiopian socio cultural context and for broader studies to enhance understanding and to develop effective interventions to improve and promote health literacy among adolescents and within the broad society.

How To Cite this Article

Asari, A.A., Birhanu, Z. & Godesso, A. Adolescents’ health literacy perspectives and implications. BMC Public Health 25, 1233 (2025). https://doi.org/10.1186/s12889-025-22341-y

Research Article

ArticleID :HPH/2025/11/03/01

The effects of immigrant women’s anxiety levels on their sexual distress: A cross-sectional study

Issue No. 03 (July-Sept)

Authors: Zibulnesa Makhdom and Zehra Demet Ust Tasgin

Background: During the migration process, people do not merely change their geographical location, but also enter a phase of interaction and adaptation between different cultures. Migration often leads to a radical break from cultural values and brings about profound changes in individuals’ lives. The literature suggests that individuals who become separated from their culture may experience psychosomatic symptoms such as anxiety and depression, and that there is a relationship between cultural adaptation and sexual life. The present research was conducted to determine the effects of immigrant women’s anxiety levels on their sexual distress.

Methods: This descriptive and cross-sectional study was conducted with 300 immigrant women living in Istanbul between March 15, 2024, and August 31, 2024. The research data were collected using the Information Form, Beck Anxiety Inventory, and Female Sexual Distress Scale. Number, percentage, mean, standard deviation, minimum and maximum scores, ANOVA, independent samples t-test, Cronbach’s α, Pearson’s correlation tests, and linear regression analysis were used to analyze the data.

Results:  Women’s mean age is 32.56 ± 8.98, 22.7% are high school graduates, 63% have social security, and 28.3% live in traditional families. The highest number of immigrants are from Syria, and the most obvious reason for migration is war. Of immigrants, 37.3% preferred Türkiye since it is safe, and 54% experience communication barriers and social problems the most since they are immigrants. Women scored an average of 32.68 ± 17.32 points on the Beck Anxiety Inventory, and 59% had severe anxiety. Furthermore, they scored an average of 25.66 ± 15.03 points on the Female Sexual Distress Scale, and 74% had sexual distress.

Conclusion:  There is a statistically significant, positive, and high-level correlation between women’s anxiety levels and sexual distress levels. The level of anxiety explains 88% of the change in sexual distress

How To Cite this Article

Makhdom, Z., Ust Tasgin, Z. The effects of immigrant women’s anxiety levels on their sexual distress: A cross-sectional study. BMC Public Health 25, 2501 (2025). https://doi.org/10.1186/s12889-025-23647-7

Research Article

ArticleID :HPH/2025/11/03/02

Sex-specific associations of social isolation and loneliness with residual life expectancy at age 45 years among middle-aged and older adults in China

Issue No. 03 (July-Sept)

Authors: Meng Zhao, Xiaoyang Huo, Haihong Zhang, Chen Wu, Sijing Peng, Zuyun Liu, Sha Sha, Ming Li and Kefang Wang

Background: Globally, one-third of older adults experience social isolation or loneliness, making them critical public health priorities. However, the impact of social isolation and loneliness on life expectancy remains underexplored. This study investigated the separate and joint associations of social isolation and loneliness with residual life expectancy at age 45 years, alongside the sex-specific variations in these associations with the aim of informing targeted strategies for mitigating social health disparities in rapidly ageing populations.

Methods: This prospective cohort study was conducted using data from the China Health and Retirement Longitudinal Study. A total of 11,315 community dwellers (5,274 men; 6,041 women) aged 45 years and above included. After the baseline 2011 assessment year, participants from the 2013, 2015, 2018, and 2020 waves were followed up. The measurements included the following: social isolation, assessed on the basis of social network usage, activities, and engagements; loneliness, evaluated on the basis of the subjective feeling of loneliness; and a flexible parametric Royston–Parmar model to estimate hazard ratios (HR) for all-cause mortality and to predict residual life expectancy differences.

Results: In men, socially isolated and lonely individuals had the greatest reduction in residual life expectancy at age 45 years, losing 4.61 years (95% CI: 1.49–7.74) compared to those with neither experience. Social isolation alone (3.82 years lost) and loneliness alone (2.83 years lost) resulted in significant reductions. In women, social isolation alone was significantly associated with reduced residual life expectancy (3.11 years lost, 95% CI: 0.68–5.55), whereas loneliness alone and combined exposure did not show statistically significant effects.

Conclusions:  Significant sex-specific differences were identified in the impact of social isolation and loneliness on residual life expectancy. Thus, implementing sex-specific public health strategies that focus on dual psychosocial intervention for men and social integration for women is crucial to mitigate premature deaths in ageing populations.

How To Cite this Article

Zhao, M., Huo, X., Zhang, H. et al. Sex-specific associations of social isolation and loneliness with residual life expectancy at age 45 years among middle-aged and older adults in China. BMC Public Health 25, 2499 (2025). https://doi.org/10.1186/s12889-025-23708-x

Research Article

ArticleID :HPH/2025/11/03/03

Using time use diaries to assess physical activity and sedentary behavior in jail populations

Issue No. 03 (July-Sept)

Authors: Ricky Camplain, Sara Shuman, Adrienne Alonso, Elizabeth Schmitter, Javier Lopez, Amy Gelatt, Rebecca Annorbah, Isabel Fangman, Morgan Occhino, Brooke de Heer, Dirk de Heer,

Background:  People incarcerated have limited access to physical activity and there are challenges to accurately measure their physical activity in jail settings. We aimed to (1) determine the feasibility of time use diaries to measure physical activity and sedentary time among people incarcerated in jail and (2) estimate time spent in physical activity and sedentary behaviors, overall and by gender and job assignment.

Methods: In July 2023, we recruited women and men from two housing units at Yavapai County Detention Facility, a county jail in Camp Verde, Arizona. Participants were asked to complete a four-day time use diary, documenting activities in 10-minute increments. Participants provided feedback about the diary during listening sessions after the four-day period. Feasibility was measured as the proportion of people recruited who participated and the proportion of completed and returned diaries. Activities documented in the diaries were linked to the Compendium of Physical Activities to determine intensity and duration of physical activity and sedentary behavior. Average daily time spent in physical activity and sedentary behavior was calculated for each participant.

Results: Of the 24 women and 41 men recruited, 24 (100%) women and 40 (97.5%) men agreed to participate in the study. All diaries were returned. Most (82.8%) participants completed all four days in the diary. Participants were enthusiastic about filling out the diaries because they helped pass the time and felt the work would further knowledge and wellbeing in jails. Participants made concrete recommendations including altering the diary format to allow for additional detail about their time in jail. Participants spent on average 571 minutes sedentary, 79 minutes in light activity, and 60 minutes in moderate activity per day. Women spent 66 more minutes per day engaged in light activities compared to men. Women with job assignments spent 179 less minutes in sedentary behavior and 245 more minutes in moderate activity compared to women who did not have a job assignment. 

Conclusions: Time use diaries are a feasible and appropriate way to measure physical activity and sedentary behavior among people incarcerated in jail. 

How To Cite this Article

Camplain, R., Shuman, S., Alonso, A. et al. Using time use diaries to assess physical activity and sedentary behavior in jail populations. BMC Public Health 25, 2503 (2025). https://doi.org/10.1186/s12889-025-23706-z

Research Article

ArticleID :HPH/2025/11/03/04

Unhealthy food consumption and its determinants among children aged 6–23 months in Bangladesh: insights from the Demographic and Health Survey 2022

Issue No. 03 (July-Sept)

Authors: Rafid Hassan, Md. Shahadoth Hossain, Md. Jarif Mahbub, Md. Ruhul Amin and Sanjib Saha

Background: Low- and middle-income countries (LMICs), including Bangladesh, are experiencing a nutritional transition characterized by rising unhealthy food consumption (UFC), which increases the risk of nutrient deficiencies and chronic diseases in children. Despite this concern, research on UFC among Bangladeshi children aged 6–23 months is limited. Therefore, this study aims to estimate the prevalence and identify the factors contributing to UFC in this age group.

Methods: This study analyzed the Bangladesh Demographic and Health Survey (BDHS) 2022 dataset, including 2,499 children aged 6–23 months. UFC was defined as the consumption of sweetened beverages or sentinel unhealthy foods within the past 24 hours. Multivariate logistic regression was used to identify factors associated with UFC.

Results: The prevalence of UFC among children was 61.8%, with 49.2% consuming sentinel unhealthy foods and 31.4% consuming sweetened beverages. The strongest predictor of UFC was older child aged 18–23 months (AOR: 3.31, 95% CI: 2.55–4.32), and consuming minimum diversified diet (AOR: 2.50, 95% CI: 1.98–3.15). Other significant factors included recent morbidity (AOR: 1.24, 95% CI: 1.01–1.53), maternal employment (AOR: 1.36, 95% CI: 1.04–1.77), media exposure (AOR: 1.28, 95% CI: 1.02–1.59), and lower paternal education [primary (AOR: 1.72, 95% CI: 1.21–2.44); secondary (AOR: 1.58, 95% CI: 1.14–2.18)]. However, maternal decision-making power (AOR: 0.75, 95% CI: 0.58–0.96) and intended pregnancies (AOR: 0.76, 95% CI: 0.59–0.97) were associated with lower odds of UFC. Regional disparities were observed, with higher UFC prevalence in Dhaka, Khulna, Mymensingh, Rajshahi, and Rangpur.

Conclusion: The study highlights Bangladeshi children’s high prevalence of UFC, which demands public health interventions together with integrating behavior change communication into health, community and family-level services.

How To Cite this Article

Hassan, R., Hossain, M., Mahbub, M. et al. Unhealthy food consumption and its determinants among children aged 6–23 months in Bangladesh: insights from the Demographic and Health Survey 2022. BMC Public Health 25, 2498 (2025). https://doi.org/10.1186/s12889-025-23668-2

Research Article

ArticleID :HPH/2025/11/03/05

Implementation and maintenance of breast cancer screening among Chinese rural women: a mixed-methods evaluation based on RE-AIM framework

Issue No. 03 (July-Sept)

Authors: Huijiao Yan, Qiankun Wang, Le Dang, Xianzhi Duan, Zhirong Bai, Yinhui Feng, Linlin Zhang, Suyala Qimuge, Haiying Gao, Xinchun Wang, Min Sun, Shuxia Ma, Cailing Yan, Fanghui Zhao

Background: Significant disparities in breast cancer screening coverage existed between high-income and low-income regions. This study aims to assess the implementation, effectiveness, and sustainability of a breast cancer screening program in China to provide insights into developing an effective implementation strategy suitable for rural areas with limited health resources.

Methods: This study employed the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to assess the implementation, effectiveness, and sustainability of a breast cancer screening program in Ordos, Inner Mongolia, China. An explanatory mixed methods design was applied, in which qualitative data were used to explain unexpected quantitative findings. The quantitative study, conducted from 2016 to 2020, analyzed screening records and survey data from 177,107 women aged 35–64. The qualitative study, conducted in 2024, collected data through semi-structured interviews with nine health workers and analyzed the transcripts using thematic analysis. The qualitative themes and quantitative findings were matched within the RE-AIM framework.

Results: The screening program covered 52.24% of the women by the end of 2020, with a total of 177,107 women receiving screening. The cancer detection rate was 0.56/1000, ranging from 0.09/1000 in women aged 35–39 to 1.58/1000 in those aged 60–64. The Positive Prediction Value (PPV) for biopsy was over 64.9%, but few patients who were referred for further examinations (mammography and biopsy) completed the procedure. Key facilitators included strong patient-provider communication, staff involvement, adequate funding and training, and strict supervision, while barriers involved geographical distance, lack of multi-sector support, limited service capacity, and low health awareness. The “rural outreach” model (where MCHHs conduct screenings by visiting rural villages and setting up temporary clinics at local village health centers), along with routine hospital screening, was seen as the most effective solution for reaching dispersed populations with low health awareness and literacy. Increased awareness from prior screenings improved participation and compliance in subsequent programs. A key challenge in program maintenance was the reduction in quality control, supervision, and training efforts.

Conclusion: To improve cancer detection in rural areas, it is essential to strengthen both the screening capacity of primary healthcare facilities and the patient referral system for timely diagnosis. “Rural outreach” is an effective way to reduce health inequity in marginalized women and increase their awareness at the same time. Further research is needed to assess long-term outcomes and develop customized implementation strategies for overcoming the identified barriers.

How To Cite this Article

Yan, H., Wang, Q., Dang, L. et al. Implementation and maintenance of breast cancer screening among Chinese rural women: a mixed-methods evaluation based on RE-AIM framework. BMC Public Health 25, 2502 (2025). https://doi.org/10.1186/s12889-025-23679-z

Research Article

ArticleID :HPH/2025/11/04/01

Place-based communication methods and prior knowledge increase public perceptions regarding West Nile virus risk and personal protective behaviors in Colorado

Issue No. 04 (Oct-Dec)

Authors: Shelby M. Cagle, Cheyenne M. Schad, Aidan K. Wolfe, Madison Bristol, Christopher M. Roundy and Nicole C. Kelp

Background: Incidences of emerging and re-emerging infectious diseases are increasing as disease vector populations and habitats expand due to climate change. Public health organizations must communicate effectively to guide public health behaviors to safeguard against vector-borne diseases. Specifically in Colorado, West Nile virus (WNV) burden is increasing.

Methods: In this study, we used the Health Belief Model (HBM) as a theoretical framework to examine public risk perceptions and behaviors related to WNV and changes in these constructs related to different forms of messaging. We utilized a survey experiment with n = 358 participants across Colorado, testing the impact of four communication interventions spanning social media infographics, narrative messaging, and place-based risk information, including trailhead infographics and risk heatmaps.

Results: We found that any form of messaging about WNV statistically increased some HBM constructs regarding personal protective behaviors. However, the infographic displayed at a trailhead and the heatmap interventions led to statistically significant increases in more HBM constructs. Additionally, higher pre-existing knowledge about WNV increased the magnitude of change in perceived susceptiblity induced by the interventions.

Conclusion: This study suggests that public health organizations could utilize place-based information regarding real-time, real-place risk to guide public health decision-making during emergence of vector-borne infectious diseases. Additionally, there appears to be a synergy of messaging with a beneficial effect of pre-existing knowledge, highlighting the need for diverse, longitudinal messaging strategies to reach people multiple times

How To Cite this Article

Cagle, S.M., Schad, C.M., Wolfe, A.K. et al. Place-based communication methods and prior knowledge increase public perceptions regarding West Nile virus risk and personal protective behaviors in Colorado. BMC Public Health 25, 3618 (2025). https://doi.org/10.1186/s12889-025-24831-5

Research Article

ArticleID :HPH/2025/11/04/02

Retrospective analysis of malaria surveillance data in the former Southern Nations, Nationalities, and peoples’ region, Ethiopia (2017–2021)

Issue No. 04 (Oct-Dec)

Authors: Daniel Dansa Dana, Tadele Shiwito Ango, Sefonias Getachew and Wakgari Deressa

Background: Malaria remains a major public health concern in many low-income nations, including Ethiopia. Monitoring malaria trends through surveillance data is critical for informing control efforts and guiding stakeholders. As a result, we analyzed the five-year trend of malaria morbidity and mortality, distribution of malaria cases by Plasmodium species, demographic characteristics, and geographic areas, and identified potential gaps in malaria control efforts in the former Southern Nations, Nationalities, and Peoples’ Region (SNNPR), Ethiopia, from 2017 to 2021 retrospectively.

Objective: This study aimed to conduct a retrospective analysis of malaria surveillance data in the former SNNPR, Ethiopia (2017–2021).

Methods: A retrospective analysis of malaria surveillance data from the former SNNPR was conducted from February 1 to 28, 2022. Data were collected, entered, cleaned, and analyzed using Microsoft Excel 2016. Descriptive analysis was performed, and results were presented using figures and maps.

Results: Overall, 6,292,147 suspected malaria cases were tested, with 999,687 (15.89%) confirmed positive in the laboratory and treated. Among confirmed malaria cases, 679,787 (68%) were caused by Plasmodium falciparum and 319,900 (32%) by Plasmodium vivax. Additionally, 16,023(1.6%) were clinically diagnosed without laboratory confirmation. Malaria cases increased from 214,095 (13 per 1,000) in July 2021 to 270,274 (16 per 1,000) in December 2021. Over the five years, the highest malaria cases were reported in South Omo (22%), Gamo (19%), Wolaita (17%), Gofa (10%), and Hadiya (5%) zones. On average, 206,942 malaria cases were reported annually, with an incidence rate of 12 cases per 1,000 population, indicating a moderate risk level for the region. The malaria burden strata of the former SNNPR showed that transmission levels were moderate (annual parasite incidence (API) 10–100 cases per 1000) [Basketo, South Omo, Gofa, Konso, Gamo, Derashe, Ale, Wolaita, and Burji]; low (API 1–10 cases per 1,000) [Halaba, Amaro, Kambata, Silte, Hadya, Gedeo, and Gurage]; and very low or pre-elimination (API < 1 case per 1,000) [Yem special district]

Conclusion:  Malaria continues to be a significant health challenge in the former SNNPR, with ongoing transmission in South Omo, Basketo, Gofa, Gamo, Derashe, Ale, Wolaita, and Burji. Seasonal peaks and increasing trends in 2021 highlight the need for action. We recommend enhancing surveillance, focusing on high-burden regions, and expanding vector control and community education, especially before peak seasons, to reduce transmission and achieve elimination goals.

How To Cite this Article

Dana, D.D., Ango, T.S., Getachew, S. et al. Retrospective analysis of malaria surveillance data in the former Southern Nations, Nationalities, and peoples’ region, Ethiopia (2017–2021). BMC Public Health 25, 3616 (2025). https://doi.org/10.1186/s12889-025-24946-9

Research Article

ArticleID :HPH/2025/11/04/03

Social isolation and lung function in middle-aged and older adults: identifying modifiable pathways across two populations

Issue No. 04 (Oct-Dec)

Authors: Yihui Du, Xiaoqing Ni, Zhaoyang Zhao, Chengmin Yuan, Xiaojiang Ran, Xiaonan Cui, Haiyan Ma and Lilu Ding

Background: Limited evidence exists on the relationship between social isolation and lung function, with few studies exploring underlying mechanisms. This study examined the association between social isolation and lung function decline, and the mediating roles of smoking, income, physical activity, and BMI in U.S. and Chinese populations.

Methods: This study utilized data from adults aged ≥ 45 years in NHANES (2007–2012, cross-sectional) and CHARLS (2011 and 2015, longitudinal). Lung function metrics from NHANES included Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 s (FEV1), and Peak Expiratory Flow (PEF), while CHARLS provided PEF data. Social isolation was assessed using marital status, living alone, and social participation in both studies, with NHANES including daily life difficulties and CHARLS incorporating infrequent child contact. Weighted linear regression models were used to assess associations. A parallel mediation model was constructed using structural equation modeling, and statistical analysis was performed using the “lavaan” package in R version 4.3.2. Standardized coefficients with p-values and mediation proportions are presented.

Results: A total of 3,575 individuals from NHANES (mean age 63.49 ± 8.27) and 3,752 from CHARLS (mean age 61.00 ± 9.23) were included. Social isolation was significantly associated with lower FVC, FEV1, and PEF in both datasets. In NHANES, mediation analysis revealed significant total indirect effects for: FVC (-0.0628, p < 0.001), 67.0% mediated by smoking, income, activity, and BMI; FEV1 (-0.0666, p < 0.001), 79.3% mediated by the same factors; and PEF (-0.0643, p < 0.001), 49.1% mediated by smoking, income, and activity. Across all three lung function metrics, income contributed the largest proportion of the mediated effect, accounting for 35.32% of FVC, 37.26% of FEV1, and 26.28% of PEF. In CHARLS, only BMI had a significant indirect effect on PEF (-0.0088, p = 0.004), mediating 6.37% of the association.

Conclusions: Social isolation is associated with poorer lung function in both U.S. and Chinese populations aged ≥ 45 years, with distinct mediating pathways. In the U.S., income, smoking, and physical activity play significant roles, while in China, BMI is the primary mediator. Cultural and societal contexts are crucial when addressing the impact of social isolation on respiratory health. 

How To Cite this Article

Du, Y., Ni, X., Zhao, Z., Yuan, C., Ran, X., Cui, X., ... & Ding, L. (2025). Social isolation and lung function in middle-aged and older adults: identifying modifiable pathways across two populations. BMC Public Health, 25(1), 4169.

Research Article

ArticleID :HPH/2025/11/04/04

Cervical cancer screening and its associated factors among women of reproductive age in senegal: evidence from 2023 continuous demographic and health survey in Senegal

Issue No. 04 (Oct-Dec)

Authors: Jovinary Adam and Ndèye Marème Sougou

Introduction: In 2022, approximately 660,000 new cases and 350,000 deaths from cervical cancer were reported worldwide, making it the fourth most common malignancy among women globally. 

Objective: To determine the prevalence and the factors associated with cervical cancer screening among women of reproductive age in Senegal.

Method: The study analyzed secondary data from the 2023 Continuous Demographic and Health Survey. The study included a weighted sample of 16,583 women. The study used the “svy” command in Stata to assign the sample weight. Multivariable logistic regression was used to assess significant factors associated cervical cancer screening and statistical significance was set at a 5% significance level. 

Results:  In Senegal, 9.5% of women of reproductive age had undergone cervical cancer screening (95% CI = 8.67, 10.41). The prevalence cervical cancer screenings ranged greatly by location, from 2.4% in Matam to 14.6% in Thies. The results revealed that factors associated with cervical cancer screening among women of reproductive age included being aged 30-49 (AOR = 1.54, 95% CI = 1.25, 1.90), being married (AOR = 2.97, 95% CI = 1.92, 4.60) or separated (AOR = 2.48, 95% CI = 1.55, 3.97), belonging to middle (AOR = 1.50, 95% CI = 1.17, 1.91) and rich wealth indices (AOR = 1.66, 95% CI = 1.27, 2.16), being employed (AOR = 1.27, 95% CI = 1.05, 1.54), having health insurance (AOR = 1.37, 95% CI = 1.11, 1.69), having 1-2 children (AOR = 1.80, 95% CI = 1.28, 2.52), having 3 or more children (AOR = 1.95, 95% CI = 1.34, 2.85), having experienced a terminated pregnancy (AOR = 1.38, 95% CI = 1.15, 1.65), visiting health facility (AOR = 1.59, 95% CI = 1.33, 1.91), and watching television (AOR = 1.30, 95% CI = 1.01, 1.67).

Conclusion: The study highlights low screening prevalence of 9.5%, compared to the WHO recommendation of 70%. Factors such as age, marital status, and wealth status, employment, significantly impacted screening rates. The study underscores the need for tailored programs aimed at increasing cervical cancer screening, including mobile screening initiatives, increased outreach programs, and enhanced health insurance coverage for all women.

How To Cite this Article

Adam, J., & Sougou, N. M. (2025). Cervical cancer screening and its associated factors among women of reproductive age in senegal: evidence from 2023 continuous demographic and health survey in Senegal. BMC Public Health, 25(1), 3617.

Research Article

ArticleID :HPH/2025/11/04/05

Promoting unstructured recess activity in urban high school: a case study of combined spatial planning and behavioural guidance strategies

Issue No. 04 (Oct-Dec)

Authors: Yiping Yan, Yucheng Liu, Youzhi Ke and Yang Liu

Objective: Recess duration and available space are limited. To promote unstructured recess activity in high school from the perspective of time and space utilization, this case study aimed to examine the effects of an unstructured recess intervention involving a combination of spatial planning and a behavioural guidance strategy based on geographic information systems (GIS) on adolescent moderate to vigorous physical activity (MVPA) in an urban high school.

Methods: An urban high school outdoor environment was used as a case study with 485 students (mean age: 16.96 ± 0.71 years; boys: 47.2%). The effect of the intervention was assessed by a self-controlled experiment. The intervention combined the relocation of sports equipment and student activity maps, both designed using GIS. The number of participants engaging in physical activity behaviours was obtained through direct observation. Physical activity time was measured with accelerometers. Focus group interviews with students and school staff were used to explain the effects of the intervention in a semistructured manner.

Results: The number of students who participated in MVPA in school outdoor areas increased from 216 at baseline to 294 at follow-up; significant increases (p < 0.05) in the number of participants engaging in MVPA were observed in informal and formal sports areas. In terms of least-active students, posttest and follow-up assessments revealed significantly increased MVPA time (β = 0.90, p < 0.05); age and sex were not significant moderators in the intervention (Sex: β = -0.65, p > 0.05; Age: β = 0.16, p > 0.05); and recess duration was a significant moderator in the intervention (β = 1.84, p < 0.01).

Conclusions: The combined spatial planning and behavioural guidance intervention for unstructured recess demonstrated the potential to increase the number of students engaging in MVPA and to enhance MVPA time among the least-active students. This cost-effective intervention holds promise for integration into high school recess activity programs.

How To Cite this Article

Yan, Y., Liu, Y., Ke, Y., & Liu, Y. (2025). Promoting unstructured recess activity in urban high school: a case study of combined spatial planning and behavioural guidance strategies. BMC Public Health, 25(1), 3620.