BMC Public Health最新文献

{"title":"Natural environmental factors at birth on risk for rheumatoid arthritis: the impact of season, temperature, latitude, and sunlight exposure.","authors":"Liang Luo, Jia Yi Hee, Sitian Zang, Zhike Liu, Kun Tang, Xuewu Zhang, Chun Li","doi":"10.1186/s12889-025-22448-2","DOIUrl":"10.1186/s12889-025-22448-2","url":null,"abstract":"<p><strong>Background: </strong>Environmental factors contribute to approximately 41% of the risk of rheumatoid arthritis (RA). Previous studies have focused on anthropogenic environmental factors, while much less attention has been given to natural environmental factors. Our study explored the potential influence of natural environmental factors at birth on the risk of RA.</p><p><strong>Methods: </strong>This large retrospective study utilized data from the China Kadoorie Biobank. A restricted cubic spline (RCS) model was employed to explore nonlinear relationships between natural environmental factors and the risk of RA. Additionally, a multivariable Cox regression model, adjusted for confounding factors, was used to examine correlations between season of birth, geographic, climate, and the risk of RA.</p><p><strong>Results: </strong>A total of 512,715 participants were included in this study, of which 2889 (0.56%) were diagnosed with RA. The RCS analysis revealed that the monthly average temperature at birth (p < 0.001), the latitude (p = 0.027) of the birthplace, and the sunshine rate (p < 0.001) exhibited a nonlinear relationship with the risk of RA. Multivariable Cox regression analysis revealed that participants born in Spring and Summer (HR 1.13, 95% CI 1.05-1.23) had an increased risk of RA compared to those born in Autumn and Winter. Additionally, participants born at latitudes ≤ 24°N (HR 1.49, 95% CI 1.32-1.68), with sunshine rate ≤ 28% (HR 2.00, 95% CI 1.75-2.29) or ≥ 60% (HR 1.22, 95% CI 1.08-1.38) had an increased risk of RA. Being born in regions with a monthly average temperature ≥ 27 °C (HR 0.82, 95% CI 0.72-0.95) was associated with a decreased risk of RA.</p><p><strong>Conclusion: </strong>Being born in Spring and Summer, as well as early-life exposure to low-latitude regions and extreme sunlight environments increases the risk of RA. Our study revealed significant associations between the risk of RA and natural environmental factors at birth, emphasizing the impact of the early-life environment on the onset of RA.</p>","PeriodicalId":9039,"journal":{"name":"BMC Public Health","volume":"25 1","pages":"1267"},"PeriodicalIF":3.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The structural and organizational aspects of human papillomavirus vaccine affecting immunization coverage in Europe: a systematic review.","authors":"Ronan Lemwel Valdecantos, Michele Sorrentino, Michelangelo Mercogliano, Vincenzo Giordano, Ugo Trama, Maria Triassi, Raffaele Palladino","doi":"10.1186/s12889-025-22343-w","DOIUrl":"https://doi.org/10.1186/s12889-025-22343-w","url":null,"abstract":"<p><p>The introduction of HPV vaccinations, that can prevent most prevalent HPV-related cancers of various body districts, is a public health milestone. Despite broad immunization programs, European Health Systems face structural and organizational difficulties that hinder care. This study examined structural and organizational elements that may affect HPV vaccine coverage. We searched numerous databases from January 1, 1995 to May 15, 2023, for literature on HPV immunization research methodologies. Structural and Organizational aspects that cause HPV vaccine concerns in women and men were examined in the outcome evaluations and the research examined vaccination willingness factors. Ottawa, JBI's critical appraisal tool, and Amstar quality assessment assessed bias. A total of 10 articles from 312 studies met the inclusion criteria. Studies were undertaken in Italy, Belgium, England, Switzerland, France, the UK, and Spain. There were also combined-diverse studies in 15 and 27 European countries. Several primary healthcare strategies have increased HPV vaccination rates. These include vaccine procurement and cost-effectiveness, school-based immunization programs, electronic health databases, health professional training, health education and communication, and monitoring and surveillance.</p>","PeriodicalId":9039,"journal":{"name":"BMC Public Health","volume":"25 1","pages":"1254"},"PeriodicalIF":3.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and reliability and validity test of the sleep health literacy scale for college students.","authors":"ZhengDa Long, LiPing Huang","doi":"10.1186/s12889-025-22455-3","DOIUrl":"10.1186/s12889-025-22455-3","url":null,"abstract":"<p><strong>Purpose: </strong>It is evident that there are some discrepancies in the connotations and substance of sleep health literacy and health literacy. The latter encompasses a broader construct, including health-related knowledge and the capacity for decision-making in domains such as diet, exercise, mental well-being and disease prevention. In contrast, sleep health literacy is a more specialised domain that aims to assist individuals in optimising their sleep quality and modifying their sleep behaviour.Sleep health literacy is defined as a specialized extension of general health literacy, with a specific focus on sleep-related knowledge and behaviors. Sleep health literacy is defined as the ability of an individual to obtain, understand, analyse and apply basic sleep health information or services and to make correct sleep health decisions.However, no formal assessment tool for sleep health literacy has been developed to date. Therefore, the Sleep Health Literacy Scale for College Students (SHLS-ST) was developed and its reliability was tested.</p><p><strong>Methods: </strong>The present study is founded upon extant theoretical frameworks and scales, in addition to comprehensive literary research, group interviews, and the Delphi expert consultation method. We administered questionnaires to on 300 college students, and the survey data were used for item analysis, exploratory factor analysis, confirmatory factor analysis, convergent validity, discriminant validity, and correlation analysis. These analyses were used to test the structural validity and reliability of the SHLS-ST.</p><p><strong>Results: </strong>The Sleep Health Literacy Scale for College Students was developed with 26 items. Exploratory factor analysis yielded five common factors, with a cumulative variance contribution of 72.05%, and Pearson's correlation coefficients between the five factor scores and the total scale score ranging from 0.568 to 0.947. The overall Cronbach's α coefficient of the scale was 0.960, the overall split-half reliability of the scale was 0.922, and the reliability coefficient of the test-retest reliability of 77 college students after an interval of half a month was 0.974.</p><p><strong>Conclusion: </strong>The Sleep Health Literacy Scale for College Students has a good reliability and validity, and is suitable for the assessment of college students' sleep health literacy. However, the length of the scale may affect its usability and participants' engagement in the assessment process.</p>","PeriodicalId":9039,"journal":{"name":"BMC Public Health","volume":"25 1","pages":"1257"},"PeriodicalIF":3.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal and geospatial patterns of hepatitis C virus prevalence: a longitudinal examination using national health insurance service data in the Republic of Korea (2005-2022).","authors":"Hwa Young Choi, Moran Ki","doi":"10.1186/s12889-025-21777-6","DOIUrl":"https://doi.org/10.1186/s12889-025-21777-6","url":null,"abstract":"<p><strong>Background: </strong>Viral hepatitis, recognized as a significant global public health threat by the World Health Organization (WHO), has spurred efforts to establish elimination goals by 2030. In Republic of Korea (Korea), the prevalence of Hepatitis C virus (HCV) infection exhibits significant regional disparities, necessitating tailored infection control measures at the regional level. This study aimed to analyze the HCV prevalence trend by area (region/town) in Korea, from 2005 to 2022, and identify the areas requiring priority management.</p><p><strong>Methods: </strong>A comprehensive analysis of HCV prevalence trends across different geographical regions and towns from 2005 to 2022 was conducted. Using data from the National Health Insurance Service, individuals diagnosed with acute or chronic HCV during this period were included in the analysis. HCV prevalence was adjusted by area, year, sex, and age. Additionally, trends in annual percent changes (APC) and average APC (AAPC) in HCV prevalence were examined using Joinpoint regression analysis.</p><p><strong>Results: </strong>Age, sex, and region adjusted HCV prevalence per 100,000 people declined from 151 in 2005 to 98 in 2022. During the 18 years, the highest HCV prevalence was recorded in the southern regions of Korea (Busan, Jeonnam, and Gyeongnam) and in the towns of Namhae-gun of Gyeongnam, Boeun-gun of Chungbuk, and Sunchang-gun of Jeonbuk. The age-, sex-, and region-adjusted annual HCV prevalence decreased significantly at an APC of -2.5% (95% confidence interval [CI]: -3.5, -1.4) and AAPC of -2.7% (95%CI: -4.3, -1.0). By town, the prevalence decreased the most in Boeun-gun of Chungbuk (AAPC: -23.7%; 95%CI: -30.2, -16.5) and increased the most in Gunwi-gun of Gyeongbuk (AAPC: 3.0%; 95%CI: 1.1, 4.9).</p><p><strong>Conclusions: </strong>Over 18 years, a notable decline in HCV prevalence was observed in Korea, although this trend exhibited regional disparities. To effectively achieve the WHO hepatitis elimination goals by 2030, targeted interventions should prioritize areas with persistent or emerging prevalence.</p>","PeriodicalId":9039,"journal":{"name":"BMC Public Health","volume":"25 1","pages":"1248"},"PeriodicalIF":3.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimorbidity patterns and premature mortality in a prospective cohort: effect modifications by socioeconomic status and healthy lifestyles.","authors":"Qingping Xue, Shanshan Zhang, Xue Yang, Yan-Bo Zhang, Yidan Dong, Fan Li, Shuo Li, Nianwei Wu, Tong Yan, Ying Wen, Chun-Xia Yang, Jason Hy Wu, An Pan, Yunhaonan Yang, Xiong-Fei Pan","doi":"10.1186/s12889-025-22216-2","DOIUrl":"10.1186/s12889-025-22216-2","url":null,"abstract":"<p><strong>Background: </strong>Few studies have explored the impact of multimorbidity patterns on premature mortality. This study aimed to assess the associations between multimorbidity patterns and long-term mortality and whether the associations were modified by socioeconomic status (SES) and healthy lifestyles.</p><p><strong>Methods: </strong>Data were from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 in the US. The latent class analysis was used to establish multimorbidity patterns based on 11 chronic conditions. Mortality outcomes were ascertained by linking with the public-use mortality data from the National Death Index through December 31, 2019. Accelerated failure time models were used to estimate time ratios (TRs) and corresponding 95% confidence intervals (CIs) for the associations between multimorbidity patterns and all-cause and CVD mortality and to exmine the extent to which SES and healthy lifestyles modified those associations.</p><p><strong>Results: </strong>In our study, six multimorbidity patterns were identified, including \"relatively healthy\", \"hypercholesterolemia\", \"metabolic\", \"arthritis-respiratory\", \"CKD-vascular-cancer\", and \"severely impaired\" classes. Compared with the \"relatively healthy\" class, TRs for all-cause and CVD mortality progressively decreased across the multimorbidity classes, with the \"severely impaired\" class showing the shortest survival time (TR, 0.53; 95% CI: 0.48, 0.58 for all-cause mortality; 0.42; 0.35, 0.50 for CVD mortality). A significant interaction was noted between SES and multimorbidity patterns for survival time, with a stronger positive association in individuals with low SES. Adherence to healthy lifestyles was related to longer survival time across all multimorbidity patterns, especially in those with relatively less severe multimorbidity.</p><p><strong>Conclusions: </strong>Multiple multimorbidity patterns were identified and associated with mortality. Lower SES was associated with higherexcess multimorbidity-associated mortality, while adopting healthy lifestyles contributed to longer survival regardless of multimorbidity patterns. Efforts should be mobilized to reduce SES gaps and promote healthy lifestyles to alleviate the health burden of multimorbidity.</p>","PeriodicalId":9039,"journal":{"name":"BMC Public Health","volume":"25 1","pages":"1262"},"PeriodicalIF":3.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing and validating a nomogram prediction model for osteoporosis risk in the UK biobank: a national prospective cohort.","authors":"Xinning Tong, Shuangnan Cui, Huiyong Shen, Xiaoxin Iris Yao","doi":"10.1186/s12889-025-22485-x","DOIUrl":"10.1186/s12889-025-22485-x","url":null,"abstract":"<p><strong>Background: </strong>Osteoporosis is a prevalent bone disease that increases frailty. Developing a nomogram prediction model to predict osteoporosis risk at multiple time points using bone mineral densities, behavioral habits, and clinical risk factors would be essential to identify individual risk and guide prevention.</p><p><strong>Methods: </strong>The study population from the UK Biobank was followed from 2014 to December 31st, 2022. The study outcome was identified as the first occurrence of osteoporosis in the UK Biobank during the follow-up period. After rebalancing with the synthetic minority over-sampling technique, a nomogram prediction model was developed using a LASSO Cox regression. Model discrimination between different risk levels was visualised with Kaplan-Meier curves, and model performance was evaluated with integrated c-index, time-dependent AUC, calibration curves and decision curve analysis (DCA).</p><p><strong>Results: </strong>The model identified several risk factors for osteoporosis, including higher age, underweight, and various clinical risk factors (such as menopause, lower hand grip strength, lower bone mineral density, fracture history within 5 years, and a history of chronic disease including hypercholesterolemia, cardiovascular disease, bone disease, arthritis, and cancer). Kaplan-Meier curves showed that risk levels predicted by the nomogram model were significantly distinct. The c-indexes were 0.844 and 0.823 for training and validation datasets, respectively. Time-dependent AUC, calibration curves and DCA indicated good discrimination, model fit and clinical utility, respectively.</p><p><strong>Conclusions: </strong>The nomogram model could properly quantify the five-year risk of osteoporosis and identify high-risk individuals. This might effectively reduce the burden of osteoporosis on the population.</p>","PeriodicalId":9039,"journal":{"name":"BMC Public Health","volume":"25 1","pages":"1263"},"PeriodicalIF":3.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Covid-19 pandemic on azithromycin, chloroquine/hydroxychloroquine and ivermectin outpatient consumption in Brazil: a joinpoint regression analysis.","authors":"Michele Costa Caetano, Isabel Cristina Martins Emmerick, Mônica Rodrigues Campos, Débora Castanehira Pires, Veronika J Wirtz, Vera Lucia Luiza","doi":"10.1186/s12889-025-21712-9","DOIUrl":"https://doi.org/10.1186/s12889-025-21712-9","url":null,"abstract":"<p><strong>Background: </strong>The endorsement of unproven COVID-19 treatment marked the political bias in Brazil's pandemic response. This study aimed to analyze the trends in the consumption of azithromycin (AZI), chloroquine/ hydroxychloroquine (CQ/HCQ), and ivermectin (IVM) considering COVID-19 cases and key political events.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted to analyze the weekly outpatient dispensing records of AZI, CQ/HCQ, and IVM from the National Database of Actions and Services of Pharmaceutical Services in SUS (BNAFAR) and the COVID-19 incidence rates from January 2019 to December 2021. A joinpoint regression analysis was employed to assess shifts in COVID-19 incidence rates and AZI, CQ/HCQ, and IVM consumption in outpatients, expressed as Defined Daily Dose per 1,000 inhabitants per day (DID), in Brazil and its five geographical regions taking into consideration the timing of three political events.</p><p><strong>Results: </strong>There was a significant increase in AZI, CQ/HCQ, and IVM consumption during the COVID-19 pandemic in Brazil of 62.8%, 504.6%, and 525.7%, respectively. Adults and women had higher DID; however, a higher proportional rise was observed among men, especially for CQ/HCQ. A notable increase in the consumption of CQ/HCQ during the first COVID-19 wave, IVM in the second, and AZI in both waves was more pronounced in the South, Midwest, and North of Brazil. This pattern coincided closely with the timeline of COVID-19 incidence rates and showed an upward trend in all three medicines after key political events that endorsed their use, particularly in these three regions. No corresponding downward trend in COVID-19 cases was observed despite the increased use of these medicines. A significant reduction in consumption nationwide was observed after an increase in vaccination coverage, resulting in a DID near pre-pandemic levels.</p><p><strong>Conclusion: </strong>The study provides substantial evidence on the relationship between COVID-19 incidence, political events, and the consumption of AZI, CQ/HCQ, and IVM during the pandemic in Brazil. The findings suggest that consumption trends were aligned with regional political affiliations and the COVID-19 incidence rates. These highlight the importance of political determinants of inappropriate medicine utilization that wastes scarce resources and increases the risk of adverse health outcomes and antimicrobial resistance.</p>","PeriodicalId":9039,"journal":{"name":"BMC Public Health","volume":"25 1","pages":"1250"},"PeriodicalIF":3.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-healthcare system interventions and COVID-19 daily cases: a multilevel time series analysis.","authors":"Hao Ma, Lei Lei, Aonan Liu, Yanfang Yang","doi":"10.1186/s12889-025-22389-w","DOIUrl":"https://doi.org/10.1186/s12889-025-22389-w","url":null,"abstract":"<p><strong>Background: </strong>The global COVID-19 pandemic has significantly impacted public health and socio-economic development worldwide. This study aims to investigate the effects of non-healthcare system interventions on the daily new cases of COVID-19 from January 2020 to October 2022.</p><p><strong>Methods: </strong>With the aid of multilevel approach, we identified income group, region and country as stratification factors that affect the number of COVID-19 daily new cases. Data on COVID-19 cases collected by Johns Hopkins University were used, and policy implementation details were recorded through the Oxford COVID-19 Government Response Tracker dataset. To analyze the effects of national, regional, and income group factors on the number of daily new COVID-19 cases, we implemented three multilevel sequential mixed-effects models and applied restricted maximum likelihood to estimate the variance of random effects.</p><p><strong>Results: </strong>Our results indicate a correlation between income group and the rise in intercepts of random effects in the multilevel sequential mixed-effects models. High-income countries recorded the highest intercept at 713.26, while low-income countries showed the lowest at -313.79. Under the influence of policies, the implementation of \"Canceling public events\" and \"International travel restrictions\" has been shown to significantly reduce the daily number of new COVID-19 cases. In contrast, \"Restrictions on gatherings\" appear to have the opposite effect, potentially leading to an increase in daily new COVID-19 cases.</p><p><strong>Conclusions: </strong>In designing epidemic control policies, due consideration should be given to factors such as income group, as well as medical, demographic, and social differences among nations influenced by economic factors. In policy-making, policymakers should pay greater attention to policy implementation and people's responses, in order to maximize the effectiveness and adherence of such policies.</p>","PeriodicalId":9039,"journal":{"name":"BMC Public Health","volume":"25 1","pages":"1251"},"PeriodicalIF":3.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socioeconomic inequalities in cervical cancer screening practices in Vietnam: a decomposition analysis.","authors":"Thi Bich-Van Nguyen, Kim-Duy Vu, Lam Tung Ngoc Cu, Minh Hai Nguyen Ngoc, Hoang-Dung Ho","doi":"10.1186/s12889-025-22511-y","DOIUrl":"https://doi.org/10.1186/s12889-025-22511-y","url":null,"abstract":"<p><strong>Background: </strong>In Vietnam, cervical cancer remains a critical public health issue, with disparities in screening uptake reflecting broader socioeconomic inequalities.</p><p><strong>Objective: </strong>This study aims to dissect socioeconomic disparities in cervical cancer screening uptake among Vietnamese women, using data from the 2020-2021 Multiple Indicator Cluster Survey 6 (MICS).</p><p><strong>Methods: </strong>Employing a cross-sectional design, we analysed MICS Survey data for women's cervical cancer screening reports over the past three years. The study utilised decomposition analysis to unravel the contributions of various determinants to socioeconomic disparities in screening uptake, employing Poisson regression with robust variance models to explore the association between socioeconomic status, quantified through Wealth Index quintiles, and screening practices.</p><p><strong>Results: </strong>Among participants, 28.2% reported receiving cervical cancer screening. The positive Erreygers concentration index value (ECI) was overall 0.296, which was statistically significant at a 1% level, indicating that cervical cancer screening was predominantly concentrated among individuals with higher wealth index scores. Decomposition analysis indicated that ethnic minority status significantly contributed to this disparity, alongside factors such as education and residency.</p><p><strong>Conclusion: </strong>The use of the concentration index in this study elucidates significant socioeconomic and ethnic inequalities in cervical cancer screening in Vietnam. It underlines the necessity of tailored interventions aimed at the most disadvantaged groups, including ethnic minorities and low-income populations, to mitigate these disparities. Strategic policy reforms and targeted health initiatives are essential for promoting equitable access to cervical cancer screening and improving public health outcomes across Vietnam.</p>","PeriodicalId":9039,"journal":{"name":"BMC Public Health","volume":"25 1","pages":"1253"},"PeriodicalIF":3.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the barriers and enablers of oral health care utilisation and safe oral sex practices among transgender women in Malaysia: a qualitative study.","authors":"Lahari A Telang, Hezreen Shaik Daud, Abdul Rashid, Aoife G Cotter","doi":"10.1186/s12889-025-22417-9","DOIUrl":"10.1186/s12889-025-22417-9","url":null,"abstract":"<p><strong>Background: </strong>Transgender women in Malaysia face social and healthcare marginalisation. Research about their oral health and oral health care utilisation is sparse. Despite growing clinical evidence highlighting the risk of transmission of sexually transmitted infections (STIs) through oral sexual practices, research in this area remains less explored. This study aimed to understand the experiences of transgender women in Malaysia by exploring oral health care needs and the barriers and enablers of oral health care utilisation as well as safe sexual practices relating to oral transmission of STIs.</p><p><strong>Methods: </strong>Participants were recruited through a snow-balling method of sampling with the help of community workers. Semi-structured in-depth interviews (IDIs) with transgender women in northern Malaysia and Focus group discussion (FGD) with a mixed group of transgender women and health care professionals were conducted to gain insights into the needs of the community. Data obtained from IDIs and FGD were coded, transcribed, and thematically analysed to derive codes and themes through the interpretative lens of the Information, Motivation and Behavioural skills (IMB) theory.</p><p><strong>Results: </strong>Participants of the IDIs were transgender women (n = 20, median age 39.8 (9.75 IQR) years). Aesthetic dental needs were prioritised, yet poor utilisation of dental services was reported, with many opting for self-medication or care from a non-qualified dental practitioner. Routine engagement in oral sex practices, primarily receptive fellatio with or without ejaculation with multiple cis-gender male partners, was reported. Low awareness of oral STIs, along with a perceived low risk of transmission of STIs through oral sex, was reported, with most (18, 90%) not using condoms for clients/partners or inconsistently using them during oral sexual practices. The themes identified from IDIs and FGD included: 'Place in the society' 'Attitudes and beliefs linked with dental care', 'Access to dental care', 'Lack of trans-specific health care' and 'Use of condoms for oral sex'.</p><p><strong>Conclusion: </strong>The study's findings report poor dental service utilisation among transgender women despite aesthetics being prioritised. Gaps in knowledge regarding the oral transmission of STIs were also noted. These insights underscore the need for trans-specific health campaigns designed to address these concerns and enhance awareness through an integrated approach to improve access to inclusive oral health care and sexual health care for this vulnerable population.</p>","PeriodicalId":9039,"journal":{"name":"BMC Public Health","volume":"25 1","pages":"1261"},"PeriodicalIF":3.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}