International Journal of Environmental Research and Public Health最新文献

{"title":"Interventions to Support the Mental Health of Frontline Healthcare Workers During the COVID-19 Pandemic: A Systematic Review.","authors":"Rosechelle M Ruggiero, Hetal J Patel, Carol S North, Traci N Adams","doi":"10.3390/ijerph23081082","DOIUrl":"10.3390/ijerph23081082","url":null,"abstract":"<p><p>The COVID-19 pandemic led to distress and an increased prevalence of psychopathology among front-line (FL) healthcare workers (HCWs). A synthesis of the available data on the effectiveness of MH interventions among FL HCWs is essential to inform an MH plan for FL HCWs in future pandemics. The objective of this systematic review is to examine interventions used to support the MH of FL HCWs during the COVID-19 pandemic. All studies published between 1 January 2020 and 1 March 2026 that reported on MH interventions among FL HCWs during the COVID-19 pandemic were identified using PubMed, PsycINFO, Scopus, EMBASE, Cochrane Database of Systematic Reviews, Google Scholar, Medline, and Web of Science. Studies published in peer-reviewed journals that reported data on interventions to support the MH of FL HCWs were included. The study was conducted using the approach by the PRISMA guidelines. The search generated 1450 records, of which 309 were reviewed at length, and 153 studies (N = 153) were included. Interventions in these studies included identification of risk for psychopathology and linkage to mental health care (n = 3), PE/PFA (n = 44), psychotherapy (n = 26), mindfulness programs (n = 58), medications (n = 5), and multiple/combined psychosocial support interventions (n = 17). The majority of studies found their interventions to be beneficial, largely based on user satisfaction scores and symptom screening scores. Importantly, symptoms in the vast majority of control arms also improved over time, though not to the degree that symptoms in intervention arms improved. This systematic review suggests that an established disaster MH response framework may be useful in directing the design of MH responses to FL HCWs in future pandemics, offering screening for psychopathology and connection with formal psychiatric services for full evaluation and provision of MH care, as well as supportive care with mindfulness interventions, crisis-oriented counseling, PE, and PFA.</p>","PeriodicalId":49056,"journal":{"name":"International Journal of Environmental Research and Public Health","volume":"23 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13512522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palliative Care Involvement in Hospitalized Amyotrophic Lateral Sclerosis Patients.","authors":"Sumeet Bhardwaj, Anita Chakraborty, Jillian Mead, Kalli Stilos","doi":"10.3390/ijerph23081081","DOIUrl":"10.3390/ijerph23081081","url":null,"abstract":"<p><p>Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease associated with significant physical, psychological, and social distress. Given its terminal nature and high symptom burden, early integration of palliative care is essential. The inpatient Palliative Care Consult Team (PCCT) provides specialist palliative care to hospitalized patients with ALS. Hospitalizations are common throughout the ALS disease trajectory, particularly as patients experience progressive functional decline, respiratory compromise, and increasing care needs, making inpatient encounters important opportunities for specialist palliative care involvement. To extend palliative care beyond the inpatient setting and facilitate earlier involvement, an ALS ambulatory clinic was established in 2018. Despite the importance of palliative care, limited data describes its involvement among hospitalized ALS patients. This retrospective review examines the relationship between the PCCT and ALS patients admitted to a tertiary care facility between 2006-2019. Data collected included patient demographics, referral indications, clinical course, and disposition. Most patients referred to the PCCT had poor functional status and a guarded prognosis at initial consultation. Symptom management and support for complex decision-making were leading reasons for referral. Approximately half of patients died in the hospital within three months of referral. Most deaths occurred within one week, underscoring the importance of timely palliative care.</p>","PeriodicalId":49056,"journal":{"name":"International Journal of Environmental Research and Public Health","volume":"23 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13513876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148834070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Training Frontline Providers in Basic Obstetric Ultrasound to Promote Healthy Pregnancy in Zimbabwe: Trainer and Trainee Experiences from a Qualitative Phenomenological Study.","authors":"Cladious Verenga, Shalote Chipamaunga-Bamu, Farai D Madzimbamuto, Sunanda C Ray","doi":"10.3390/ijerph23081075","DOIUrl":"10.3390/ijerph23081075","url":null,"abstract":"<p><strong>Background: </strong>Limited access to trained providers remains a barrier to basic obstetric ultrasound use in low-resource antenatal care settings. This study aimed to explore trainer and trainee experiences of Zimbabwe's six-week Basic Obstetric Ultrasound Short Course (BOUSC) and its perceived relevance to promoting healthy pregnancy through antenatal risk recognition and referral readiness.</p><p><strong>Methods: </strong>A qualitative study using transcendental phenomenology was conducted in the Fetal Medicine Units of Sally Mugabe Central Hospital and Parirenyatwa Group of Hospitals. Sixteen semi-structured interviews were conducted between September and October 2023 with eight trainers and eight trainees purposively selected from course records. Interviews were audio-recorded, transcribed verbatim, and analysed using Moustakas' approach, including bracketing, horizontalisation, clustering of significant statements, and theme synthesis.</p><p><strong>Results: </strong>Thematic saturation was achieved. Four themes emerged: interactive and clinically situated teaching; confidence and basic skill development through supervised scanning; interprofessional learning that reduced hierarchy; and sustainability concerns related to equipment, mentorship, refresher training, and post-training practice. The most salient finding was that midwives trained as advanced obstetric sonographers were perceived as credible trainers for doctors and other cadres when operating within a supervised fetal medicine governance structure.</p><p><strong>Conclusions: </strong>Participants perceived the BOUSC as a practical and collaborative training model for basic obstetric ultrasound. The study does not demonstrate clinical outcome effects, but suggests that supervised basic ultrasound training may help promote healthy pregnancy when embedded within clear competency limits, quality assurance, and referral pathways.</p>","PeriodicalId":49056,"journal":{"name":"International Journal of Environmental Research and Public Health","volume":"23 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13513090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148834074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychosocial Well-Being at Work: Large-Sample Structural Validation of the Multidimensional Psychosocial Work Experience Scale for Employed Persons (MPWES).","authors":"Evija Nagle, Iluta Skrūzkalne, Maksims Zolovs, Jeļena Perevozčikova, Otto Andersen, Andrejs Ivanovs, Ieva Reine","doi":"10.3390/ijerph23081080","DOIUrl":"10.3390/ijerph23081080","url":null,"abstract":"<p><p>Psychosocial working conditions are important determinants of employee health, work ability, and organizational sustainability, yet existing instruments often assess job demands, job resources, psychosocial risks, or well-being outcomes separately. This study examined the structural validity of the Multidimensional Psychosocial Work Experience Scale for Employed Persons (MPWES), an instrument designed to assess a multidimensional occupational psychosocial profile comprising workplace conditions and demands, psychosocial resources, adverse exposures, health-related experiences, and subjective functioning. A cross-sectional validation study was conducted among 1631 employees from the pharmaceutical, energy, healthcare, and administrative sectors in Latvia. Confirmatory factor analysis with the robust WLSMV estimator was used to test the predefined measurement model. The refined eight-factor model demonstrated acceptable fit in the calibration subsample (N = 400; CFI = 0.930, TLI = 0.922, RMSEA = 0.066, SRMR = 0.078) and was replicated in the held-out validation subsample (N = 1231; CFI = 0.911, TLI = 0.901, RMSEA = 0.068, SRMR = 0.067). Reliability indices were acceptable for several domains, although some factors showed modest or borderline values. Discriminant validity was supported, with all HTMT values below 0.85, and measurement invariance testing supported configural, metric, scalar, and strict invariance across samples. The findings provide initial evidence of the MPWES's structural validity and measurement stability in the present sample. However, further studies using external validity criteria, longitudinal designs, and culturally diverse samples are needed before the scale can be considered fully validated for broader occupational and public health applications.</p>","PeriodicalId":49056,"journal":{"name":"International Journal of Environmental Research and Public Health","volume":"23 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13513784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148834241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fragrance-Free Policies in Practice: Identifying Perceived Implementation Gaps Through Lived Experience in a Qualitative-Dominant Mixed-Methods Study.","authors":"Sudipta Roy, Nene A Diallo, John Molot, Robert Lattanzio, Riina Bray, Jennifer Armstrong, Rohini Peris","doi":"10.3390/ijerph23081077","DOIUrl":"10.3390/ijerph23081077","url":null,"abstract":"<p><strong>Background: </strong>Indoor air quality (IAQ) represents a key public health and accessibility concern. Improving IAQ through policies and practices that reduce exposure to fragranced products and other indoor air contaminants may enhance accessibility and support equitable participation for individuals with Multiple Chemical Sensitivity (MCS).</p><p><strong>Methods: </strong>Using a qualitative-dominant mixed-methods design, we examined IAQ accessibility barriers and explored perceived implementation and accessibility gaps in existing fragrance-free policies among sixty individuals with MCS and related IAQ exposures across ten focus groups. Qualitative and quantitative data were collected in parallel, with thematic analysis conducted in NVivo. A structured IAQ and policy survey was administered to quantify reported experiences and policy impacts.</p><p><strong>Results: </strong>Approximately 63.3% of focus group participants reported dissatisfaction with the indoor environments they encountered. Qualitative findings highlighted indoor environments as inaccessible, inadequately controlled, and associated with ongoing exposure to fragranced products as well as other indoor pollutants. These findings indicate that current approaches often fail to ensure accessibility, leaving individuals with MCS exposed and excluded from full participation in workplaces, healthcare settings, and other public spaces.</p><p><strong>Conclusions: </strong>Comprehensive fragrance-free policies incorporating source control, education, ventilation, and accountability mechanisms may reduce exposure while improving accessibility and inclusion across the built environment.</p>","PeriodicalId":49056,"journal":{"name":"International Journal of Environmental Research and Public Health","volume":"23 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13513598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148834079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Applicability of Forest Therapy for Socially Isolated Young Adults: Parallel Changes in Psychological Distress and Mindfulness.","authors":"Yeji Yang, Ji-Eun Pyo, Yongjun Lee, Beom Lee, Chang-Hyou Kim, Jeong-Ho Choi, Jina Yu, Jisoo Lee, Kee-Hong Choi","doi":"10.3390/ijerph23081078","DOIUrl":"10.3390/ijerph23081078","url":null,"abstract":"<p><p>This study examined the applicability of forest therapy in alleviating psychological distress among socially isolated young adults, with a particular focus on their associations with the mindfulness. A total of 159 socially isolated young adults were recruited from the community and participated in a two-day, one-night forest therapy program. Psychological distress (depression, anxiety, loneliness, and stress) and mindfulness were assessed before and after the program. Multilevel analyses were conducted to examine changes in psychological distress and mindfulness following participation, as well as whether the five mindfulness subcomponents (nonreactivity, observing, acting with awareness, describing, and non-judging) were associated with individual differences in changes in these outcomes. The results indicated reductions in depression, anxiety, stress, and loneliness, along with an increase in overall mindfulness after the program. Among the mindfulness subcomponents, reductions in psychological distress over time occurred most closely in parallel with changes in nonreactivity, non-judging, and acting with awareness, whereas the parallel was weaker for describing and observing. These findings suggest that forest therapy may be a promising intervention for reducing psychological distress among socially isolated young adults, and that incorporating activities designed to cultivate mindfulness skills-particularly nonreactivity, non-judging, and awareness-could further enhance its mental health benefits. As this study did not include a control group, randomized controlled trials are needed to confirm these effects.</p>","PeriodicalId":49056,"journal":{"name":"International Journal of Environmental Research and Public Health","volume":"23 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13513809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148834073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When Disability Recognition Fails: Accommodation Refusals and Socioeconomic Challenges Among Canadians with Multiple Chemical Sensitivity.","authors":"Nene A Diallo, John Molot, Riina Bray, Adrianna Trifunovski, Rohini Peris","doi":"10.3390/ijerph23081076","DOIUrl":"10.3390/ijerph23081076","url":null,"abstract":"<p><strong>Background: </strong>Multiple chemical sensitivity (MCS), a recognized disability, is a chronic, multisystem condition in which exposure to common chemical substances provokes adverse health effects and functional impairment. Although population-level data and emerging clinical research support the pathophysiological basis of MCS, individuals living with the condition frequently encounter barriers to recognition and accommodation across employment, healthcare, and housing systems. This study examines patterns of accommodation requests, refusals, and associated socioeconomic impacts among adults living with MCS in Canada, with particular attention to how institutional recognition shapes access to supports. To our knowledge, this is the first national Canadian study to examine accommodation request outcomes across both employment and housing among adults with MCS, combining quantitative and qualitative data. A national cross-sectional survey of 119 Canadian adults living with MCS was conducted between January and February 2021. Quantitative data were analyzed descriptively to assess accommodation requests, outcomes, employment status, income, and housing stability. Qualitative responses were analyzed thematically to contextualize participants' experiences of disclosure, and accommodation outcomes. Participants were predominantly female (87%) with post-secondary education (90%). Among participants who reported being unemployed (29%), 94% attributed it primarily to MCS-related limitations. Accommodation denial was common: 85% of respondents reported requesting accommodations, and 78% of those experienced refusals. On housing conditions, 52% reported living in unsafe housing (defined as housing with the presence of mould or symptom-triggering exposures), while 17% reported being homeless (e.g., moving frequently, personal vehicle, tent). Findings should be interpreted in light of the cross-sectional design, self-reported data, and community-based recruitment, which may limit generalizability. The findings suggest that inconsistent institutional recognition of MCS can function as a barrier to accommodation, contributing to health, economic, and social inequities. Addressing these barriers requires clarified guidance on the duty to accommodate multiple chemical sensitivity, proactive scent-free and lowest-emission policies in workplaces and housing, and improved healthcare provider education to support accommodation documentation.</p>","PeriodicalId":49056,"journal":{"name":"International Journal of Environmental Research and Public Health","volume":"23 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13512570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Integrated Decentralised-Centralised Oncology Care Model to Improve Cancer Screening, Access, and Continuity of Care in Rural Eastern Cape, South Africa: Implementation Study at Nelson Mandela Academic Hospital.","authors":"Zukiswa Jafta, Muamabangu Jean Paul Milambo, Eric Maimela, Constance Rufaro Sewani-Rusike, Wilson Wezile Chitha","doi":"10.3390/ijerph23081079","DOIUrl":"10.3390/ijerph23081079","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background:&lt;/b&gt; Rural and resource-constrained settings face major barriers to timely cancer screening, diagnosis, and treatment due to limited specialist availability and centralised service-delivery models. In the Eastern Cape, a largely rural province with a constrained oncology workforce, a decentralised-centralised hybrid model was introduced to improve access to cancer care. Nelson Mandela Academic Hospital serves as the central referral hub within this model. This study evaluates the implementation process and impact of this decentralised cancer care model on service utilisation, access, and continuity of care. &lt;b&gt;Methods:&lt;/b&gt; A quantitative quasi-experimental pre-post implementation and quality improvement evaluation was conducted using retrospectively collected routine service utilisation and programme data from April 2023 to February 2025. The study assessed the impact of a decentralised oncology care model on access, service integration, and utilisation outcomes. Data from facility registers and district health information systems were managed using Microsoft Excel and analysed using Stata and IBM SPSS Statistics. Descriptive statistics, correlation analysis, and linear regression were used to compare pre- and post-implementation changes in patient volumes, screening coverage, referral completion, workforce capacity, gender distribution, and service uptake. The intervention decentralised screening, diagnosis, follow-up, and patient navigation services to district and satellite facilities while centralising specialised oncology care at referral centres to improve accessibility, efficiency, and continuity of care. &lt;b&gt;Results:&lt;/b&gt; Cancer patient attendance increased substantially over the study period, from 355 patients in April 2023 to a peak of 1039 in April 2024, with a sustained upward trend (B = 18.03, &lt;i&gt;p&lt;/i&gt; = 0.005), reflecting an average monthly increase of 18 patients. Female patients accounted for most visits, while male attendance showed a significant increasing trend (B = 8.03, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Service integration improved, with strong positive correlations between new patient registrations, follow-up care, palliative services, and inpatient admissions, indicating an expanding continuum of care. Breast and cervical cancers contributed the highest service burden, while cervical and lung cancers showed significant upward trends. Seasonal variation in attendance was observed, particularly during festive periods. From an implementation perspective, screening coverage for priority cancers increased by 18%, while 732,349 individuals were reached through community awareness initiatives. Access improved substantially, evidenced by a reduction of 56,400 km in cumulative patient travel distance over one year. Workforce capacity was strengthened through the training of 517 healthcare workers, and 1943 patients received structured navigation support. Referral efficiency and continuity of care improved, although persistent bot","PeriodicalId":49056,"journal":{"name":"International Journal of Environmental Research and Public Health","volume":"23 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13512574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extreme Heat and Emergency Health Impacts in the US (2018-2025).","authors":"Tyler Hecht, Baoyuan Zhou, Abhi Thanvi, Lelys Bravo de Guenni","doi":"10.3390/ijerph23081074","DOIUrl":"10.3390/ijerph23081074","url":null,"abstract":"<p><p>Future climate projections suggest an increase in heat-related mortality and a decrease in cold-related deaths under warming scenarios. Understanding the health impacts of extreme heat, and their implications for healthcare demand is essential for assessing the future burden of climate-related illnesses. In this study, we examined the relationship between extreme heat events and Emergency Department Visits (EDV) for heat-related illnesses (HRIs) across the United States from 2018 to 2025. Using data from the Centers for Disease Control and Prevention (CDC) Heat and Health Tracker and other relevant sources, we analyzed EDV rates standardized to 100,000 population. We aggregated daily into the 10 U.S. Health and Human Services (HHS) Regions. We used 0.5° × 0.5° gridded maximum daily temperature data (aggregated to HHS regions with proportional area weighting) and daily maximum heat index extracted from the CDC data portal (estimated using the US National Weather Service methodology and aggregated to HHS regions using total population weighting) to characterize seasonal patterns and regional variability. The association between peak heat events and EDV time series was explored using log-linear mixed-effects models, which accounted for seasonal trends, climate variables, and their regional variability. Random effects were used to capture regional heterogeneity in predictor-response relationships, accommodating variation in associations across regions. Model performance was evaluated using prediction error metrics and goodness-of-fit assessments. Maximum temperature and heat index were both significant predictors, with the heat index offering a slightly better fit. Associations were largely contemporaneous, with peak correlations at lag zero, underscoring the need for real-time response. EDV increased several days before peak environmental conditions, consistent with early exposure effects. While temperature-EDV relationships varied regionally, heat index associations were more stable. This work underscores the urgent need for regionally adaptive public health strategies in the face of intensifying climate extremes and outlines future directions for research and policy to strengthen health systems' preparedness in a warming world.</p>","PeriodicalId":49056,"journal":{"name":"International Journal of Environmental Research and Public Health","volume":"23 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13512812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148834043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Structural and Intermediate Social Determinants of Health Linked to Adolescent Pregnancy in the Peruvian Rural Context.","authors":"Suli Sánchez Gómez, Yshoner Antonio Silva-Diaz, Ruth Clarivel Vega-Rojas, Cintya Elisabeth Odar-Rojas, José Luis Rodriguez Medina, Miuller Raul Muñoz Zumaeta, Hitler Adolfo Vela Zuta","doi":"10.3390/ijerph23081067","DOIUrl":"10.3390/ijerph23081067","url":null,"abstract":"<p><strong>Background: </strong>Adolescent pregnancy is a public health problem in Latin America, with a higher prevalence in rural areas. This population faces barriers to accessing education and healthcare services, increasing the risk of maternal and neonatal complications.</p><p><strong>Methods: </strong>This study employed a cross-sectional analytical design and included 72 adolescents aged 12 to 17 years in Lonya Grande. The associations between structural and intermediate social determinants of health and the prevalence of adolescent pregnancy were assessed.</p><p><strong>Results: </strong>Among the structural determinants, extreme poverty (PR: 2.48; 95% CI: 1.23-5.03; <i>p</i> = 0.004), type of public health insurance (PR: 3.05; 95% CI: 1.21-7.72; <i>p</i> = 0.005), and parental educational level were associated with a higher prevalence of adolescent pregnancy. After adjustment, having public health insurance (aPR: 0.49; 95% CI: 0.36-0.66; <i>p</i> < 0.001) and having parents who had completed primary school (aPR: 1.67; 95% CI: 1.15-2.42; <i>p</i> = 0.01) were associated with a higher prevalence of adolescent pregnancy. Among the intermediate determinants, alcohol consumption (PR: 2.77; 95% CI: 1.85-4.16; <i>p</i> < 0.001), knowledge about contraceptives (PR: 0.21; 95% CI: 0.03-0.85; <i>p</i> = 0.04), and being 17 years old (PR: 4.44; 95% CI: 1.48-13.39; <i>p</i> = 0.01) were associated with adolescent pregnancy. In the adjusted model, adolescents aged 15 years (aPR: 3.15; 95% CI: 1.04-9.52; <i>p</i> = 0.04) maintained a higher prevalence compared with those aged 14 years.</p><p><strong>Conclusions: </strong>An association was found between structural and intermediate social determinants of health and adolescent pregnancy in rural settings. These findings suggest the need for additional studies to better understand interventions targeting these associated factors.</p>","PeriodicalId":49056,"journal":{"name":"International Journal of Environmental Research and Public Health","volume":"23 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13513928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}