BMJ public health最新文献

{"title":"Pregnancy risk behaviour among sexually active adolescent girls aged 10-17 years in high HIV prevalence districts in Uganda: a cross-sectional secondary analysis of the 2018 AGYW survey data.","authors":"Alex Mulyowa, Juliana Namutundu, Rhoda K Wanyenze, Joseph K B Matovu","doi":"10.1136/bmjph-2025-002673","DOIUrl":"10.1136/bmjph-2025-002673","url":null,"abstract":"<p><strong>Introduction: </strong>Although global adolescent birth rates steadily declined over the past decade, they remain persistently high within the African region. However, there is limited evidence on why they remain high. We estimated the prevalence of pregnancy risk behaviour and associated factors among sexually active adolescent girls (AG) aged 10-17 years in high HIV prevalence districts in Uganda.</p><p><strong>Methods: </strong>This was a secondary analysis of data collected as part of a large cross-sectional study conducted among AGs and young women (AGYW) aged 10-24 years in July 2018. This analysis focused on AGs aged 10-17 years reporting sexual intercourse in the past 12 months. The primary outcome was prevalence of pregnancy risk behaviour, defined as engaging in sex without using pregnancy protection or using ineffective pregnancy prevention methods. Descriptive analysis and modified multivariable Poisson regression were used to determine the prevalence and factors associated. Statistical significance was set at p<0.05. Analyses were performed using Stata V.16.</p><p><strong>Results: </strong>Of the 8236 AGYW enrolled into the large study, 53.6% (n=4414) had ever had sex. Of these, 80.6% (n=3560) had sex in the past year, of whom 9% (n=323) were AGs aged 10-17 years. Two-thirds of the 10-17 years old (66.3%, n=214) were out-of-school. Of 323 AGs, 63.8% (95% CI: 58.5% to 69.0) engaged in pregnancy risk behaviour in the past year. Being Anglican (adjusted prevalence ratio (aPR)=1.28; 95% CI: 1.01 to 1.61) and having two or more sexual partners in the past year (aPR=1.20; 95% CI: 1.02 to 1.43) increased the likelihood of engaging in pregnancy risk behaviour while having secondary or higher education was protective (aPR=0.67; 95% CI: 0.45 to 0.98).</p><p><strong>Conclusion: </strong>6 in 10 AGs aged 10-17 years engaged in pregnancy risk behaviour. Findings suggest that attaining higher levels of education is beneficial against pregnancy risk behaviour and underscore the need of keeping girls in school longer.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e002673"},"PeriodicalIF":0.0,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12410629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145017026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nowhere to go: a qualitative study examining the health of people who experience emergency shelter service restrictions in Hamilton, Ontario, Canada.","authors":"Suraj Bansal, Stephanie Di Pelino, Jammy Pierre, Kathryn Chan, Amanda Lee, Rachel Liu, Olivia Mancini, Avital Pitkis, Fiona Kouyoumdjian, Larkin Lamarche, Robin Lennox, Marcie McIlveen, Timothy O'Shea, Claire Bodkin","doi":"10.1136/bmjph-2025-002639","DOIUrl":"10.1136/bmjph-2025-002639","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency shelters offer temporary accommodation to people deprived of housing. Service restriction is the practice of limiting or denying access to emergency shelters in response to behaviours deemed harmful to staff, community members or other clients. This community-based qualitative study describes the characteristics, healthcare utilisation and morbidity of people experiencing service restrictions.</p><p><strong>Methods: </strong>We recruited 20 people who had experienced service restrictions in Hamilton, Ontario, Canada. Semistructured interviews were conducted and analysed using reflexive thematic analysis. To contextualise participants' experiences, we reviewed their medical records from 1 January 2018 to 31 December 2021 and calculated simple descriptive statistics. We employed community-based research principles, including a research team with lived experiences of being service restricted, implementing service restrictions or providing front-line care to people who are service restricted.</p><p><strong>Results: </strong>Participants averaged 17.4 primary care visits, 11 emergency department visits and 4 hospital admissions over 4 years. Common visit reasons included infections, traumatic injuries and substance use-related concerns. Service restriction exacerbated participants' health by increasing exposure to violence, infectious disease and psychological distress. Participants were dehumanised by being labelled, stigmatised and treated without compassion in healthcare and shelter settings. Institutional rules-particularly abstinence-based policies-created barriers to shelter access, while shifting to encampments worsened participants' physical and mental health. Despite these challenges, participants highlighted the strength of peer networks and community-led care. These findings illustrate how exclusionary policies and practices in shelters and healthcare settings shape the health and well-being of people who are service restricted.</p><p><strong>Conclusions: </strong>Service restriction worsened participants' health by pushing people into unsheltered homelessness, separating them from their belongings, networks and access to their usual health and social services, and increasing their likelihood of criminalisation. Abstinence-based shelter policies were important contextual factors that increased the use and harm of service restrictions. Participants practised care for themselves and others to navigate these barriers. Health and social services should champion an inclusion health approach by building on the wisdom of people with lived experience to reduce the use and impact of service restrictions.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e002639"},"PeriodicalIF":0.0,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12410648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145017087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postcode health inequalities in aortic valve surgery in North East England: retrospective study of disparities in presentation and hospital outcomes.","authors":"Benjamin Irene Omoregbee, Emeka B Kesieme, Dumbor L Ngaage","doi":"10.1136/bmjph-2024-001336","DOIUrl":"10.1136/bmjph-2024-001336","url":null,"abstract":"<p><strong>Introduction: </strong>Variations and avoidable differences in healthcare between different geographical regions cause health inequality. Postcode lottery in population health could have implications for management of aortic valve disease, for which surgery is the standard of care. We examine disparities in the presentation and outcome of aortic valve replacement (AVR) between three postcode towns in North East England.</p><p><strong>Methods: </strong>Clinical data for all patients who had AVR±other procedures at our institution between February 1999 and October 2022 were reviewed. Excluding those from outside our catchment area, we grouped patients according to their postcode towns, namely: Kingston upon Hull (HU), Doncaster (DN) and York (YO), with corresponding health index scores of 77.5, 91.5 and 105.2. We obtained the index of multiple deprivation (IMD) for the postcode towns and compared clinical presentation and in-hospital outcomes between the postcode towns and IMD deciles for their neighbourhoods.</p><p><strong>Results: </strong>There were 4639 patients (HU=1699, YO=1736, DN=1204). Compared with other postcode towns, more HU patients were unemployed and active smokers, and they often presented with advanced symptoms, cardiac failure and higher predicted operative risk. They also often underwent urgent or emergency operations and had longer postoperative hospital stays. However, in-hospital mortality was similar for patients from the three postcode towns. By IMD ranking, HU had the most deprived neighbourhood. Multivariable analysis did not identify postcode town or IMD decile as predictors of in-hospital mortality.</p><p><strong>Conclusions: </strong>There are disparities in the clinical presentation and outcomes of AVR between the three postcode towns in North England which align with the level of multiple deprivation. These findings support postcode health inequalities in the surgical management of aortic valve disease and warrant policy-directed changes to enhance public awareness and timely access for aortic valve disease management.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e001336"},"PeriodicalIF":0.0,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-medical costs incurred by critically ill patients with dengue, sepsis and tetanus within a major referral hospital in Southern Vietnam: a cost of illness study.","authors":"Trinh Manh Hung, Thanh Nguyen Nguyen, Mau Toan Le, Phuc Hau Nguyen, Thanh Phong Nguyen, Thi Hue Tai Luong, Buu Chau Le, Ba Thanh Pham, Thi Trang Khiet Tieu, Thi Diem Thuy Tran, Minh Yen Lam, Sophie Yacoub, Sayem Ahmed, Louise Thwaites, Hugo C Turner","doi":"10.1136/bmjph-2024-002169","DOIUrl":"10.1136/bmjph-2024-002169","url":null,"abstract":"<p><strong>Introduction: </strong>Improving the knowledge of the costs of critical care is vital for informing health policy. However, cost data remain limited, particularly for low- and middle-income countries. The aim of this cross-sectional study is to describe the direct/indirect non-medical costs incurred by critically ill tetanus, sepsis and dengue patients and their families during their hospitalisation, using data from a major referral hospital in Vietnam.</p><p><strong>Methods: </strong>This study was conducted within the Hospital for Tropical Diseases in Ho Chi Minh City, a tertiary referral hospital specialising in infectious diseases serving Southern Vietnam. Patients who were admitted to the intensive care unit (ICU) and diagnosed with either tetanus, dengue or sepsis were enrolled between April and November 2022. In total, 94 patients (and their caregivers) were interviewed. Structured questionnaires were used to estimate the direct non-medical costs and indirect costs (costs related to productivity/time losses) incurred during their hospitalisation by the patients and their caregivers (ie, the patients' perspective).</p><p><strong>Results: </strong>Overall, the estimated median total direct/indirect non-medical costs of the sample varied between US$511 and US$814 per patient, depending on the approach used to value the indirect costs. These total costs were broadly similar among sepsis and tetanus cases, but lower for dengue cases. The estimated indirect costs were highly sensitive to the approach used to monetise productivity losses and the valuation of informal care.</p><p><strong>Conclusion: </strong>This study demonstrates that patients admitted to the ICU with a severe infection of these diseases can incur notable direct/indirect non-medical costs. These results highlight the importance of further research in this area. These findings are particularly relevant in the context of universal health coverage targets, as even with 100% coverage of medical costs, many families are still likely to suffer financial hardship.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e002169"},"PeriodicalIF":0.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the Flo Cycle Tracking App on menstrual knowledge and health in low-income and middle-income countries: a longitudinal study.","authors":"Frederick G B Goddard, Carley Prentice, Adam C Cunningham, April M Ballard, Liudmila Zhaunova","doi":"10.1136/bmjph-2025-002822","DOIUrl":"10.1136/bmjph-2025-002822","url":null,"abstract":"<p><strong>Abstract: </strong></p><p><strong>Introduction: </strong>Over two billion people menstruate worldwide. Many lack the resources and knowledge to manage their menstruation, which can lead to reproductive health issues and stigma.</p><p><strong>Methods: </strong>This longitudinal study set out to describe menstrual health and hygiene (MHH) knowledge levels among adult women across global regions and estimate changes in knowledge from exposure to health information through the mobile application (app) Flo Health. Furthermore, the study quantified changes for psychosocial, menstrual and quality of life outcomes and explored whether these were mediated by improvements in MHH knowledge. At installation of the Flo app, 6165 participants across 52 countries were recruited for a baseline assessment. Follow-up data collection was conducted after at least 3 months of app access. Two study designs were used, following 513 respondents in a pre-post design and recruiting an additional 1346 respondents to match to baseline participants lost to follow-up in a repeated cross-sectional design.</p><p><strong>Results: </strong>MHH knowledge was low at baseline, with on average only one-third of knowledge quiz questions answered correctly. Compared with the baseline, MHH knowledge was 18.7% higher in the matched sample, while it increased by 8.1% in the pre-post sample after 3 or more months of access to Flo. Other changes included higher menstrual awareness (matched and pre-post: 9.0%), sexually transmitted infection awareness (matched: 1.7%; pre-post: +3.1%), quality of life (matched: +1.8%; pre-post: +3.5%) and lower menstrual stigma (matched: -8.1%) and menstrual impact on daily life (pre-post: -6.7%). In the matched sample between 23 and 66% of associations between app access and select outcomes were mediated by MHH knowledge.</p><p><strong>Conclusions: </strong>The poor MHH knowledge found in this study highlights the opportunities for improvement, which in turn could lead to better psychosocial, menstrual and quality of life outcomes. Mobile apps may represent an important tool for better MHH knowledge and associated benefits at scale.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e002822"},"PeriodicalIF":0.0,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can we adapt fairly? Scoping review of health equity implications of flood risk in coastal communities.","authors":"Grace Turner, Sari Kovats, Rachel Brisley, Sally Brown, Owen Landeg, Louise O'Connor","doi":"10.1136/bmjph-2025-002588","DOIUrl":"10.1136/bmjph-2025-002588","url":null,"abstract":"<p><strong>Background: </strong>As climate change progresses, it is critical to assess the equity of health impacts, adaptation interventions and policies. Climate change can contribute to coastal hazards like flooding resulting in loss of life, property and land, leading to potential long-term physical or mental health impacts. Additionally, some UK coastal populations often face social deprivation and limited healthcare access, which can be worsened by environmental changes.</p><p><strong>Methods: </strong>We conducted a scoping review of UK evidence on (a) inequalities in coastal flood risk and (b) the equity of measures to manage climate-related flood risks. Interventions included plans, flood insurance and infrastructure, including natural flood management. Following the screening of 19 329 references, we included 11 papers in the final review.</p><p><strong>Results: </strong>Four studies examined the differentials in current and future coastal flood impacts, and seven assessed the equity of adaptation measures. Coastal flood risk is unevenly distributed across the UK. Policies and practices like household insurance and property resilience measures may increase inequalities, while community engagement, planning and structural solutions can reduce disparities, depending on local context and implementation.</p><p><strong>Conclusions: </strong>Adaptation to UK coastal flood risk requires both short-term and long-term strategies. Approaches relying on individual behaviour or household income may worsen health inequalities. Further evaluations and better evidence are needed to improve flood planning and incident management. Climate change presents a challenge for organisations to deliver national and local policy responses ensuring that adaptation is effective and equitable in the immediate and longer term.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e002588"},"PeriodicalIF":0.0,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the associations of weather and climate with HIV in sub-Saharan Africa: a systematic review.","authors":"Matylda Buczkowska, Adam Trickey, Gina E C Charnley, Anthea Gabot, George Hutchings, Collins C Iwuji, Ilan Kelman","doi":"10.1136/bmjph-2024-001805","DOIUrl":"10.1136/bmjph-2024-001805","url":null,"abstract":"<p><strong>Background: </strong>Joint United Nations Programme on HIV/AIDS has previously hypothesised that in sub-Saharan Africa, extreme weather/climate and HIV might be associated. A systematic review was conducted to summarise current evidence on the indirect associations between weather/climate variability and HIV-related measures (such as risk behaviours and access to care) in sub-Saharan Africa. This review does not assess environmental mediation of viral transmission.</p><p><strong>Methods: </strong>Five literature databases (Web of Science, PubMed, SCOPUS, EMBASE and Global Health) were searched for relevant qualitative and quantitative studies that contained data on associations between weather/climate variables (including extreme weather events and changes in precipitation and temperature) and HIV measures (including HIV risk behaviours and measures of HIV transmission and progression) in the general population of sub-Saharan Africa up to 6 April 2024. Results were summarised through narrative synthesis.</p><p><strong>Results: </strong>Overall, 5853 non-duplicate papers were retrieved for abstract screening, with 57 studies selected for full-text screening. Of those, 20 studies (14 quantitative and 6 qualitative) were included in the review. Most studies suggested that weather/climate variability was associated with worsening of HIV-related outcome measures. Drought was the most frequently reported weather/climate exposure (12 studies in total), while HIV prevalence and antiretroviral therapy uptake were the most frequently reported HIV measures (10 and 9 studies, respectively). Few studies analysed data from longitudinal datasets and research gaps were identified on West and Central Africa, children and key populations such as female sex workers.</p><p><strong>Conclusions: </strong>Despite potential associations between weather/climate variability and HIV measures, primarily between droughts and HIV prevalence, there has been limited research published on the topic. The current evidence base is sparse, heterogeneous and insufficient to establish causality. The review highlighted the need for using longitudinal datasets to assess directionality and mediators of weather/climate-HIV relationships, while data on West and Central Africa, children and key populations should be incorporated in future research.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e001805"},"PeriodicalIF":0.0,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of firefighters' work schedule on cardiovascular disease risk, wellbeing and safety in firefighters: protocol for the SWIFT study, a multidisciplinary prospective and cross-sectional study.","authors":"Walaa F Abdelmoaty, Shelby L Watkins, Aanuoluwakiitan Ayeni, David A Hurtado, Andrew W McHill, Jeremy J Biggs, Kurt T Hegmann, Steven A Shea, Todd Bodner, Nicole P Bowles","doi":"10.1136/bmjph-2024-002427","DOIUrl":"10.1136/bmjph-2024-002427","url":null,"abstract":"<p><strong>Introduction: </strong>Firefighters face frequent physical and psychosocial stressors, increasing their risk for hypertension. Rising call volumes with a stable workforce have heightened occupational burdens. To meet their occupational demands while increasing time off-duty, fire departments across the country have switched from a 24 hours on 48 hours off (termed '24/48') work schedule to one that increases the number of consecutive days off (eg, 1 day on, 3 days off, 2 days on, 3 days off (termed '1/3/2/3') or 48 hours on 96 hours off (termed '48/96')). However, these schedule changes come at the expense of increasing time on-duty, which may have negative health and safety consequences. This paper provides the framework and methods to investigate how these schedules (24/48, 1/3/2/3 and 48/96) impact hypertension risk, well-being and safety among firefighters.</p><p><strong>Methods and analysis: </strong>This quasi-experimental study assesses hypertension risk (primary outcome) markers, including 48-hour ambulatory blood pressure and safety (secondary outcome) using the psychomotor vigilance test and incidence of injuries. The study encompasses a cross-sectional analysis that examines three distinct schedules (24/48, 1/3/2/3 and 48/96) and a prospective analysis, capitalising on a pre-planned schedule transition from a 24/48 to a 1/3/2/3, as a natural experiment without any intervention from the study team. Additionally, the mediating role of sleep (assessed objectively using actigraphy and subjectively using questionnaires) and daily stress in the relationship between work schedule and hypertension risk or sustained attention is investigated to inform both mechanisms and general considerations for developing and promoting a healthy work design for firefighters. The feasibility and acceptability of the three schedules are assessed using validated surveys and qualitative interviews.</p><p><strong>Ethics and dissemination: </strong>The study received approval from the institutional review boards of Oregon Health & Science University (IRB# 20553) and the University of Utah (IRB#165866) and engages fire departments in the Pacific Northwest and Utah. It leverages community engagement with these fire departments, offering an exceptional opportunity to examine the physical and mental impacts of firefighters' work schedules. Aggregate findings will be disseminated through practical resources, benefiting both regional and national firefighting communities.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e002427"},"PeriodicalIF":0.0,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Family planning in Jordan: a cross-sectional study on service availability, knowledge and attitudes among women.","authors":"Yousef Khader, Sara Abu Khudair, Mohanad Nsour, Mohammad S Alyahya, Eman Badran, Raeda AlQutob","doi":"10.1136/bmjph-2025-002926","DOIUrl":"10.1136/bmjph-2025-002926","url":null,"abstract":"<p><strong>Background: </strong>Despite progress made in improving family planning (FP) services in Jordan, significant barriers remain. This study aimed to assess the availability of FP services in primary care settings and explore women's knowledge and attitudes toward FP to support the development of more person-centred FP services and interventions.</p><p><strong>Methods: </strong>The Service Availability and Readiness Assessment (SARA) was conducted in 2022 in six governorates to assess FP service availability in Jordan. Also, a cross-sectional study was conducted among women who attended primary health centres (PHCs) for postpartum care or immunisation of newborns to assess their knowledge, attitude and past experience of using FP, and family support.</p><p><strong>Results: </strong>SARA results showed limited healthcare capacity for FP services with inadequate FP training mainly in PHCs and village centres, and a lack of reproductive health training in most centres. Among 972 women, 6% had never heard of FP, and only 47.1% received FP counselling before their last delivery. About 76% considered contraceptives expensive, despite being free for Jordanians and refugees. Only 22.7% discussed contraceptive use with their husbands. The proportion of women who visited PHC for antenatal care ≤8 times was 56.8% among Syrian women and 46.3% among Jordanian women, while it was 68.7% among women living in Mafraq governorate and 36.8% in Irbid governorate.</p><p><strong>Conclusion: </strong>Barriers to FP services include limited availability in rural areas, insufficient knowledge and negative attitudes, with evidence of disparities in antenatal care access across demographics and regions. Awareness programmes and enhanced staff capacity are recommended to improve FP service access and utilisation.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e002926"},"PeriodicalIF":0.0,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI4HealthyCities: a protocol for a mixed-method ethnographic study on the social determinants of cardiovascular health in New York City.","authors":"Anna-Maria Volkmann, Elizabeth Adamson, Emma Boxley, David Napier, Peter Speyer, Reekarl Pierre, Wenqin Zhang, Yongkang Zhang","doi":"10.1136/bmjph-2024-002382","DOIUrl":"10.1136/bmjph-2024-002382","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiovascular disease is a leading cause of morbidity and mortality globally and in New York City. Significant disparities in prevalence and risk factors persist across city neighbourhoods and among populations of varying socio-economic status, racial and ethnic backgrounds. These disparities are shaped and sustained by the complex interplay of social determinants of health, including housing, employment, access to healthcare and structural inequities. This study builds on prior quantitative research conducted under the AI4HealthyCities initiative, which applied machine learning to identify spatial clusters of cardiovascular vulnerability and social disadvantage. This research addresses key gaps in that work by generating disaggregated, qualitative data on underrepresented populations. The study also aims to explore the mechanisms through which specific social determinants may contribute to cardiovascular risk, including the role of behavioural and demographic mediators. By combining lived experiences and system-level perspectives, the research will provide contextualised insights to support local stakeholders in designing more effective, equity-oriented interventions.</p><p><strong>Methods and analysis: </strong>This mixed-method ethnographic study will collect data in three phases: expert interviews, community roundtables and vulnerability assessments across three New York City boroughs (Brooklyn, the Bronx and Queens). Qualitative data will be analysed using a combination of deductive and inductive approaches. Thematic synthesis will be used to identify patterns across and within boroughs. Study design and interim findings will be reviewed in collaboration with community stakeholders, a research steering group and the AI4HealthyCities Global Expert Council.</p><p><strong>Ethics and dissemination: </strong>This study has received ethical approval from the Ethics Committee of Weill Cornell Medicine (code number: 23-04025988). The findings of the project will be disseminated via conferences, speaking engagements and peer-reviewed publications.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e002382"},"PeriodicalIF":0.0,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}