Frontiers in Public Health最新文献

{"title":"Exploring behavioral factors and emotional mechanisms underlying older adult users' adoption of smart health services: evidence from PLS-SEM and fsQCA.","authors":"Ming-Xi Sun, Zhi-Feng Zhao","doi":"10.3389/fpubh.2025.1673340","DOIUrl":"10.3389/fpubh.2025.1673340","url":null,"abstract":"<p><strong>Introduction: </strong>In a population aging society, home-based older adult care as the primary model have experienced a robust growth in demand for smart health services (SHS), reflecting an active response to evolving older adult care needs. However, older adult users' adoption rates are constrained by the interplay of technological and emotional factors, with the underlying mechanisms remain unclear.</p><p><strong>Methods: </strong>To address this concern, this study integrates the Technology Acceptance Model (TAM) and Emotional Durable Design (EDD) theory to uncover the behavioral factors and emotional driving mechanisms behind older adult users' adoption of SHS. A total of 244 valid questionnaires from older adult users were collected. Partial Least Squares Structural Equation Modeling (PLS-SEM) was employed to analyze the net effects of variables, combined with fuzzy-set Qualitative Comparative Analysis (fsQCA) to identify configurational paths.</p><p><strong>Results and discussion: </strong>The results show that perceived ease of use, perceived usefulness, and perceived emotion directly and positively influence behavioral intention. Mental interaction, self-actualization, and dynamic adaptation in emotional durable design exert indirect effects on behavioral intention through internalization processes. fsQCA identified 7 configurational paths leading to high behavioral intention, confirming the combined effects of \"technology-emotion\" factors, with no single factor constituting a necessary condition. This study contributes to expanding the emotional explanatory dimension of TAM, providing a theoretical foundation and practical guidelines for the human-centered design and promotion of SHS.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"13 ","pages":"1673340"},"PeriodicalIF":3.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12512665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spatiotemporal inequality and financial toxicity of leukemia in post-poverty China: a national analysis of 832 counties (2019-2024).","authors":"Wenping Li, Zhiyu Lv, Mengdi Chen, Dong Xia, Jiayue Wang, Jiapeng Chen, Lulu Zhang","doi":"10.3389/fpubh.2025.1611102","DOIUrl":"10.3389/fpubh.2025.1611102","url":null,"abstract":"<p><strong>Background: </strong>Leukemia remains a critical public health challenge in China's post-poverty regions, where high treatment costs perpetuate the \"disease-poverty\" trap. Despite nationwide efforts to improve healthcare access, the evolving spatiotemporal dynamics and economic burden of leukemia in these regions remain understudied.</p><p><strong>Methods: </strong>Using population-based data from China's Health Poverty Alleviation Platform (2019-2024), we analyzed 97,472 leukemia cases across 832 poverty-alleviated counties. Age/sex-standardized incidence and mortality rates were calculated using 2020 census data. Spatiotemporal trends were evaluated via Joinpoint regression, and spatial clustering was mapped through global/local Moran's I and Getis-Ord Gi* analyses. The economic burden was assessed by Out-Of-Pocket (OOP) payment ratios and costs.</p><p><strong>Results: </strong>Longitudinal analysis of 97,472 leukemia cases across 832 Chinese poverty-alleviated counties (2019-2024) revealed: (1) Significant reductions in age-standardized incidence (AAPC = -59.4%, <i>p</i> = 0.015) and mortality (AAPC = -67.5%, <i>p</i> = 0.012), with persistently higher male incidence (χ² = 1554.4, <i>p</i> < 0.001); (2) Spatiotemporal transition from Northeast/Central clustering (Moran's I > 0.38, <i>p</i> < 0.001; 2019-2021) to Western hotspot expansion (Getis-Ord Gi*, <i>p</i> < 0.001; 2022-2024), indicative of improved diagnostic coverage; (3) Severe financial toxicity in Eastern China (median OOP ratio = 39.7%, approaching WHO catastrophic thresholds) and high absolute OOP cost clustering in Central regions, driven by therapy costs and insurance fragmentation.</p><p><strong>Conclusion: </strong>While China's poverty alleviation policies effectively reduced the leukemia burden, persistent regional disparities and financial toxicity demand targeted interventions. The westward hotspot migration post-2022 marks a diagnostic catch-up in resource-limited regions. Crucially, elevated male/youth incidence necessitates targeted screening in emerging clusters, while diverging financial toxicity demands region-specific solutions: for Eastern China's catastrophic OOP ratios (39.7%), reform must prioritize novel-therapy reimbursement; Central China's cost-clustering urges cross-provincial care networks to offset abandonment risks.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"13 ","pages":"1611102"},"PeriodicalIF":3.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12511132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current status of KAB in health education for Chinese college students and SEM validation exploration.","authors":"Yuehui Zhao, Yangyang Guan, Zihao Chen, Hailin Gong","doi":"10.3389/fpubh.2025.1671692","DOIUrl":"10.3389/fpubh.2025.1671692","url":null,"abstract":"<p><strong>Introduction: </strong>In the field of health education, the KAB theory is an authoritative theoretical model worldwide; however, there is not much empirical evidence supporting its application in university health education. Therefore, the purpose of this paper is to use data from Chinese universities to test the pathways and universality of the KAB model, as well as to provide certain suggestions for future health education in universities through a situational analysis.</p><p><strong>Methods: </strong>We used a random sampling method to conduct a questionnaire survey of 4,508 college students from 76 universities in Jiangsu Province (752 from sports majors and 3,756 from non-sports majors). We employed a self-developed four-point scale questionnaire (20 questions on health knowledge, 14 on attitudes, and 10 on behaviors), which demonstrated good reliability and validity (Cronbach's <i>α</i>: 0.958-0.969). Exploratory factor analysis was conducted to extract the dimensions of attitude and behavior, and structural equation modeling (SEM) was used to verify the K → A → B theoretical pathway.</p><p><strong>Results: </strong>Current status: The awareness of sexual and reproductive health was highest (89.7%-98%), while knowledge of disease prevention was the weakest (awareness of antibiotic hazards was only 57.5%); sports majors scored significantly higher in health knowledge than non-sports majors (e.g., 15.7% higher in disease prevention knowledge). In terms of behavior, the rate of developing exercise habits among non-sports majors (87.6%) was significantly lower than that of sports majors (97.9%), and only 69.6% actively consulted health issues, showing that students are hesitant to talk to their teachers. Model validation: The SEM fit indices were good (GFI = 0.972, RMSEA = 0.065), confirming three key pathways: knowledge → attitude (<i>β</i> = 0.42), attitude → behavior (<i>β</i> = 0.33), and knowledge → behavior (<i>β</i> = 0.55). Multi-group analysis showed that the model has universality across genders and majors, but the pathway from knowledge to behavior was stronger for males (<i>β</i> difference +0.11), while the pathway from attitude to behavior was more pronounced for females (<i>β</i> difference +0.09).</p><p><strong>Discussion: </strong>The KAB model is applicable to the college student population, where health knowledge not only directly influences behavior (<i>β</i> = 0.55) but also has an indirect effect through attitude. We need to focus more on teaching disease prevention, such as the hazards of antibiotics, design behavioral intervention courses for non-sports majors, and we should also notice that students are less willing to seek health advice in person. The study validates the universality of the KAB theoretical pathway, giving solid proof for health education in universities.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"13 ","pages":"1671692"},"PeriodicalIF":3.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12511103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"We're closer than ever to ending AIDS-let's not lose ground.","authors":"Peter Sands","doi":"10.3389/fpubh.2025.1655240","DOIUrl":"10.3389/fpubh.2025.1655240","url":null,"abstract":"","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"13 ","pages":"1655240"},"PeriodicalIF":3.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12510978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of HPV educational intervention on knowledge and vaccination intentions among Ukrainian migrant and refugee parents in Poland.","authors":"Maria Ganczak, Paweł Kalinowski, Marta Kowalska-Babiak, Mufida Nazrieva, Serhij Nyankovskyy, Michael Edelstein","doi":"10.3389/fpubh.2025.1647569","DOIUrl":"10.3389/fpubh.2025.1647569","url":null,"abstract":"<p><strong>Background: </strong>Despite the availability of HPV vaccines, uptake remains low among Ukrainian adolescents. Educational interventions can enhance parents' knowledge and intent regarding HPV vaccination.</p><p><strong>Objective: </strong>To evaluate the effects of a prospective, culturally tailored, evidence-based HPV vaccine face-to-face educational intervention on knowledge and vaccine intent among Ukrainian migrant and refugee (UMR) parents in Poland, utilizing a pre-post design.</p><p><strong>Methods: </strong>A study was conducted among 178 UMR parents between February and July 2024. Using telephone calls, research staff recruited consecutive parents registered to the network of primary care clinics \"Medyk\" in Rzeszów, Poland. Eligible parents were those having children aged 9-17 years, who had not completed the HPV vaccination. They completed pre- and post-data on HPV knowledge and intent. Four female Ukrainian GPs were trained to deliver 9 group interventions (2 h each); this had to be changed to 27 individual 1-h sessions after an erroneous suspicion of HPV vaccine adverse effects, which spread out in the Ukrainian community and resulted in a recruiting crisis. Data were analyzed using McNemar's test and multilevel regression analysis.</p><p><strong>Results: </strong>The majority of participants were female (84.3%) and aged >30 years (77.5%); 59.6% of UMR parents presented a low knowledge level (≤50%). Only 30.3% knew all possible routes of HPV transmission, and 39.9% knew male HPV-related neoplasms. The intervention significantly improved HPV knowledge by 63.4% (pre: 5.2, SD ± 2.1; post: 8.2, SD ± 1.7; <i>p</i> < 0.0001). Parents who attended individual education had lower pre-intervention scores but outperformed parents who participated in the group sessions in post-intervention knowledge. Ukrainian mothers and parents with higher SES showed a significant improvement in vaccine intent after the intervention, from 56.6 to 64.8%, <i>p</i> = 0.04, and from 55.3 to 73.9%, <i>p</i> = 0.046, respectively.</p><p><strong>Conclusion: </strong>The study finds that educational interventions for UMR parents can improve their understanding of HPV and support informed vaccination decisions for their children. The integration of specific approaches-such as culturally sensitive messaging, the utilization of trained Ukrainian presenters, and tailored health literacy strategies based on the community needs-may provide critical support for future implementation efforts.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"13 ","pages":"1647569"},"PeriodicalIF":3.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12511083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying depression and the risk of chronic liver diseases: results from a large-scale longitudinal cohort study.","authors":"Hailiang Wang, Shuju Zhao, Xueqing Wang, Xiaoyang Liu","doi":"10.3389/fpubh.2025.1584211","DOIUrl":"10.3389/fpubh.2025.1584211","url":null,"abstract":"<p><strong>Background: </strong>Chronic liver diseases and depression are both major public health concerns worldwide, particularly among aging populations. However, evidence on the prospective association between depressive symptoms and the risk of developing chronic liver diseases remains limited. The aim of this study is to explore the potential association in middle-aged and older Chinese adults.</p><p><strong>Methods: </strong>Data for this study were obtained from the China Health and Retirement Longitudinal Study (CHARLS), and 11,272 participants without prior liver disease were finally included in this study. Depression was assessed using the CESD-10, with scores analyzed as continuous variables and chronic liver diseases were self-reported based on physician diagnosis. By adjusting for multiple covariates, Cox proportional hazards regression models were used to estimate hazard ratios and restricted cubic spline models were applied to assess the potential non-linear relationships.</p><p><strong>Findings: </strong>Over a mean follow-up period of 6.85 years, a total of 570 participants were finally diagnosed with chronic liver diseases. Multivariate regression analyses revealed a significant association between CESD scores and the risk of liver diseases among study participants even accounting for all potential covariates (HR: 1.020, 95% CI: 1.006-1.033, <i>p</i> = 0.004).</p><p><strong>Conclusion: </strong>We identified a significant association between depressive symptoms and subsequent development of chronic liver diseases. Based on observational findings, depressive symptoms may represent a potential early marker of liver disease risk. These findings highlight the importance of integrating mental health assessments into early routine clinical care.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"13 ","pages":"1584211"},"PeriodicalIF":3.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12511029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors and drug resistance of non-tuberculous mycobacteria in HIV/AIDS patients: a retrospective study in southern China.","authors":"Jing Ye, Qingpeng Yang, Yan Huang, Mei Lin, Xiaomin Xian, Liwen Huang, Huifang Qin, Chongxing Zhou, Yingkun Zhang, Xiaoyan Liang, Jin Ou, Zhezhe Cui","doi":"10.3389/fpubh.2025.1660472","DOIUrl":"10.3389/fpubh.2025.1660472","url":null,"abstract":"<p><strong>Background: </strong>The incidence and infection rate of <i>Non-tuberculous Mycobacteria</i> (NTM) are increasing across different regions, with regional variations in the types, distribution, and drug resistance profiles. Our objective was to investigate the risk factors, distribution of predominant Mycobacteria species, and phenotypic drug resistance profiles in co-infected HIV/AIDS patients in southern China.</p><p><strong>Methods: </strong>Blood and sputum samples were collected from 2,985 HIV/AIDS patients without prior history of pulmonary tuberculosis (PTB) in five designated hospitals in Guangxi, southern China from January 2019 to December 2020. Univariate analysis and binary logistic regression models were used to explore the related risk factors of HIV/AIDS patients with NTM infection and those with <i>Mycobacterium tuberculosis</i> (MTB) infection, respectively. Interferon-γ release assay (IGRA) tests and CD4+ counts were performed on blood samples, Roche medium was used for sputum culture, and positive isolates underwent species identification and drug susceptibility testing.</p><p><strong>Results: </strong><i>Mycobacterium tuberculosis</i> and NTM culture positivity rates were 1.2% (35/2985) and 2.2% (66/2985), respectively (<i>χ</i> ² = 9.679, <i>p</i> = 0.002). Predominant NTM pathogens were <i>Mycobacterium avium</i> (28.8%, 19/66), <i>Mycobacterium fortuitum</i> (21.2%, 14/66), and <i>Mycobacterium chelonae/abscessus complex</i> (16.7%, 11/66). Multivariate analysis revealed cough (Adj. OR: 192.47, 95%<i>CI</i>: 15.71-2357.63, <i>p</i> < 0.001) and farming (Adj. OR: 20.92, 95%<i>CI</i>: 1.33-328.93, <i>p</i> = 0.031) as risk factors for NTM co-infection, whereas other pulmonary symptoms increased risk of MTB infection (Adj. OR: 3.37, 95% <i>CI</i>: 1.03-11.08, <i>p</i> = 0.045). Cough significantly differed between NTM and MTB groups (<i>χ</i> ² = 66.070, <i>p</i> < 0.001). Sixty-six NTM strains were tested for resistance to 10 common antibiotics. The drug resistance rates of para-aminosalicylic acid (PAS), Isoniazid (INH), Levofloxacin (LFX), Kanamycin (K), Ethambutol (EMB), Capreomycin (CPM), Rifampin (RFP), Moxifloxacin (MFX) and Amikacin (AM) exceeded 50.0%., while Protionamide (TH1321) was 25.8%. There was no significant in interferon status distribution across CD4+ counts groups (<i>p</i> = 0.574).</p><p><strong>Conclusion: </strong>For HIV/AIDS patients presenting with cough symptoms, it is recommended that molecular biology techniques be employed concurrently with MTB testing to screen for and identify NTM, thereby clarifying the specific type of mycobacterial infection present. IGRA cannot completely distinguish MTB from NTM, and more auxiliary examinations are needed.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"13 ","pages":"1660472"},"PeriodicalIF":3.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12510969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Data-driven hierarchical causal modeling of risk propagation in bridge operations: evidence from 132 accidents in China.","authors":"Peng Peng, Zuocai Wang, Peng Cui, Xiaokang Hu, Junfeng Yao, Sainan Lyu","doi":"10.3389/fpubh.2025.1686346","DOIUrl":"10.3389/fpubh.2025.1686346","url":null,"abstract":"<p><p>Aging bridges worldwide face growing safety challenges due to extended service life and environmental stressors. However, most existing studies lack a systemic perspective and mainly rely on fragmented, expert-driven assessments. Such approaches fail to capture the interplay of risk factors. This gap in understanding the interactions and propagation of risks limits the development of effective safety strategies for bridge operation. To address this gap, this study aims to identify and structure key risk factors affecting bridge safety in operational contexts by adopting a data-driven hierarchical model. Utilizing 132 officially documented accident reports from national safety databases in China (2007-2024), text mining techniques are applied to extract lexical risk items, which are subsequently refined through expert workshops and association rule mining to capture factor relationships. The Decision-Making Trial and Evaluation Laboratory (DEMATEL) method, integrated with Adversarial Interpretive Structural Modeling (AISM), is applied to construct a multi-level causal hierarchy of safety risks. The findings reveal 19 distinct risk factors, structured into seven levels with 20 transmission pathways. Notably, insufficient informatization management and unqualified managerial competence are identified as foundational factors, while overweight vehicle passage, inadequate inspection and maintenance, and geological and meteorological hazards emerge as direct triggers of safety incidents. The constructed hierarchy demonstrates a clear propagation chain from latent management deficiencies to observable surface-level hazards. Theoretically, the study advances the understanding of risk interaction mechanisms by integrating quantitative data analysis with expert interpretation. Practically, it provides infrastructure safety managers with a structured roadmap for targeted interventions, emphasizing the importance of enhancing digital management systems, traffic load regulation, and emergency preparedness in bridge operation contexts.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"13 ","pages":"1686346"},"PeriodicalIF":3.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12511089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health benefits versus economic costs: welfare analysis of energy conservation and emission reduction.","authors":"Hongkun Zhao, Zhuo Chen, Nan Feng","doi":"10.3389/fpubh.2025.1662116","DOIUrl":"10.3389/fpubh.2025.1662116","url":null,"abstract":"<p><strong>Introduction: </strong>A multidimensional and comprehensive evaluation of the impact of energy conservation and emission reduction (ECER) on residents' health and welfare is conducive to resolving conflicts between economy and environment on a worldwide scale.</p><p><strong>Methods: </strong>Based on China's ECER demonstration city policy, this paper uses a staggered difference-in-differences method to examine the impact of ECER on residents' health and labor market performance, and conservatively estimates the welfare effect of ECER in conjunction with a theoretical model.</p><p><strong>Results: </strong>The results show that ECER significantly improves residents' health, raises self-rated health (<i>β</i> = 0.06, <i>p</i> < 0.05, 95% CI = -0.17 to 0.13), reduces the probability of illness affecting work (<i>β</i> = -0.004, <i>p</i> < 0.05, 95% CI = -0.01 to 0.01), and lowers medical expenditures (<i>β</i> = -0.183, <i>p</i> < 0.05, 95% CI = -0.64 to 0.10). However, ECER negatively affects residents' labor market performance, reducing employment status (<i>β</i> = -0.032, <i>p</i> < 0.10, 95% CI = -0.11 to 0.06) and wage (<i>β</i> = -0.055, <i>p</i> < 0.05, 95% CI = -0.23 to 0.00). Mechanism analysis suggests that ECER primarily improves health by reducing emissions of pollutants such as urban industrial wastewater, industrial sulphur dioxide, and industrial fumes and dust, and negatively influences labor market performance by promoting industrial restructuring. Heterogeneity analysis shows that there is a selection effect in the impacts, the health benefits and economic costs of ECER are mostly achieved and borne by groups in rural areas, non-provincial capitals, and those suffering from chronic diseases and not engaging in physical activity. Welfare analysis suggests that the health benefits of ECER result in higher welfare gains than the negative welfare impacts of its economic effects.</p><p><strong>Conclusion: </strong>Future policies should progressively move towards an integrated assessment of the costs and benefits of ECER, paying particular attention to welfare losses among groups that bear higher costs.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"13 ","pages":"1662116"},"PeriodicalIF":3.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12511090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A qualitative interview study exploring barriers and facilitators to uptake of measles vaccination among healthcare workers at a London hospital.","authors":"Nikki Heinze, Louise E Smith, Carmel Curtis, Dale Weston, Jasmin Islam, G James Rubin","doi":"10.3389/fpubh.2025.1621699","DOIUrl":"10.3389/fpubh.2025.1621699","url":null,"abstract":"<p><strong>Introduction: </strong>Healthcare workers (HCW) are at increased risk of measles due to their occupational exposure. Yet, there is evidence of low vaccination rates, inadequate immunity among this group, and many do not know their vaccination status. The aim of this qualitative study is to explore barriers and facilitators to measles vaccination and reasons why some HCW do not know their vaccination status.</p><p><strong>Methods: </strong>We conducted 23 online semi-structured interviews with HCW recruited from a teaching hospital in London. HCW were eligible to participate if they had direct patient contact, had not had measles, and were either (a) unsure of their vaccination status, (b) unvaccinated, (c) partially vaccinated, or (d) vaccinated after joining the hospital. We used framework analysis to identify themes and subthemes.</p><p><strong>Results: </strong>Facilitators to measles vaccination included protection of self and others, being prompted and pragmatic considerations such as being required to be vaccinated for work. Barriers included the accessibility of vaccination, concerns about vaccine safety, and low perceived risk of and from measles. Fractured vaccination records and a lack of perceived importance of measles vaccination may contribute to some HCW not knowing their vaccination status.</p><p><strong>Conclusion: </strong>Making vaccination accessible, increasing knowledge and awareness of measles and measles vaccination, and prompting those who require vaccination may support vaccination decisions. A central, easy-to-access App or portal which sends reminders for boosters may reduce the number of HCW who are unsure of their vaccination status.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"13 ","pages":"1621699"},"PeriodicalIF":3.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12511023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}