BMC Public Health
ISSN / EISSN : 1471-2458 / 1471-2458
Published by: Springer Nature (10.1186)
Total articles ≅ 18,120
Latest articles in this journal
BMC Public Health, Volume 21, pp 1-13; https://doi.org/10.1186/s12889-021-11916-0
Background In Australia, Chinese migrants are among the populations most affected by hepatitis B virus (HBV) infection but often experience late diagnosis or access to clinical care. This study aims to explore approaches to increase HBV testing in Australia’s Chinese community and inform evaluation planning, specifically to i) assess the feasibility and acceptability of HBV educational programs, and ii) compare HBV testing uptake in people receiving a tailored education resource focussing on liver cancer prevention compared with a standard HBV education package. Methods This is a pre-post mixed-methods pilot and feasibility study. People of Chinese ethnicity and unsure of their HBV infection or immunity status were recruited from ten community sites in Melbourne, Australia in 2019–2020. Participants were randomised to receive an education package (comprised of a leaflet and in-person one-on-one educational session) with a focus on either 1) standard HBV-related information, or 2) liver cancer prevention. Participants completed a baseline questionnaire prior to receiving the intervention and were followed up at 6 months’ time for a questionnaire and an opt-in semi-structured interview. Primary study outcomes included feasibility of study procedures, measured by recruitment, participation, and retention rates; acceptability of the education program assessed by acceptability scores; and HBV testing uptake rate in each arm. Secondary outcomes include HBV-related knowledge change, assessed by pre-post comparison; and factors affecting participants’ testing behaviour analysed using qualitative data. Results Fifty-four participants received an education package; baseline and follow-up data from 33 (61%) were available. The study procedures of recruitment and retention were feasible; the acceptability of the education program was moderate with improved HBV-related knowledge observed. Four participants self-reported being tested: one (1/15, 7%) in the standard HBV information group and three (3/18, 17%) in the liver cancer prevention information group. Factors identified as affecting testing included perceived relevance and seriousness of HBV, healthcare access and costs of testing, and perceptions of the role of primary care providers in HBV-related care. Conclusion A tailored education program targeting ethnic Chinese in Australia was feasible with moderate acceptability. A larger study is required to determine if a liver cancer prevention message would improve HBV testing uptake in Chinese community than standard HBV education message. Supports from healthcare providers, community-based testing programs, and public health education programs are likely needed to motivate diagnostic testing among Chinese people at risk of HBV infection.
BMC Public Health, Volume 21, pp 1-14; https://doi.org/10.1186/s12889-021-11931-1
Background Socio-behavioural adaptations during the COVID-19 pandemic may have significantly affected adolescents’ lifestyle. This study aimed to explore possible reasons affecting changes in physical activity and sedentary behaviour in Indonesian adolescents during the pandemic based on mothers’ perspectives. Methods We recruited parents (n = 20) from the Yogyakarta region of Indonesia (July–August 2020) using purposive and snowball sampling. Individual interviews were audio-recorded, transcribed verbatim and anonymised. Data were imported into NVivo software for a reflexive thematic analysis. Results The interviews lasted between 38 and 113 min (M = 65 min). Participants’ age ranged between 36 and 54 years (M = 42.6 years). Participants’ children ranged in age from 12 to 15 years (M = 13.7 years, female: 9, male: 11). Themes related to changes in physical activity during the pandemic were 1) self-determination and enjoyment, 2) supports from others, and 3) physical activity facilities and equipment. Themes related to changes in sedentary behaviour during the pandemic included 1) educational demands, 2) psychological effects due to the pandemic, 3) devices and internet availability, 4) parental control, and 5) social facilitators. Conclusions During the pandemic, mothers perceived their children to be less active and using more screen-based devices, either for educational or recreational purposes, compared to before. The present themes might be useful when developing interventions and policies promoting physical activity and reducing sedentary behaviour in adolescents. Interventions could, for example, consider increasing parents’ and adolescents’ awareness on current activity guidelines, providing education on healthier recreational screen time, and involving parents, peers, and teachers. Increasing the accessibility of physical activity facilities and equipment, making use of adolescents’ favourite program and social media for interventions, and providing activities that are fun and enjoyable may also important.
BMC Public Health, Volume 21, pp 1-12; https://doi.org/10.1186/s12889-021-11942-y
Background Conflicting schedules and geographic access limit prospects for mutually beneficial relationships between experts and early career professionals. A formal long-distance mentorship program could address these barriers and potentially bridge the gap of traditional face-to-face mentorship. This study was done to determine the feasibility of implementing a formal long-distance mentorship program amongst public health physicians of Nigeria. Method A mixed-method study comprising of in-depth interviews and surveys was used to collect information from members of the Association of Public Health Physicians in Nigeria. A total of 134 survey participants were recruited consecutively during an annual scientific meeting of the association. In-depth interviewees were purposively selected to ensure diversity in expertise, experience, and social stratifiers such as age. Quantitative data were analyzed using descriptive and inferential statistics, while qualitative data were analyzed using thematic content analysis. Results Public health physicians of Nigeria are willing to participate in a formal Long-Distance Mentorship Program, and four elements of feasibility were highlighted as necessary for implementing the program. Namely i) capacity to coordinate LDMP, ii) technical expertise and individual competence to provide mentorship, iii) financial capacity to implement and sustain LDMP, and iv) demand for mentorship by mentees. There is a consensus that the organizational structure of the National Postgraduate Medical College of Nigeria and West African College of Physicians provide an enabling environment to initiate a LDMP for public health physicians of Nigeria. The vast human resources with various expertise and the annual National conferences can be leveraged upon to champion and administer the program. However, there is a need for an administrative structure and technical expertise to enable proper coordination. More so, the need for demand creation and the financial requirement was considered gaps that need to be filled to be able to ensure feasibility. Bivariate analysis showed a significant relationship between the dependent variable (preferred role- mentor/mentee) and independent variables (age, year of graduation, and the number of years of practice), while the binary logistic regression model showed that physicians are more likely to participate as mentors with each unit increase in the number of years of practice. This further buttressed the need to commence the mentoring process as soon as trainees gain entrance into the program, as mentorship does not just prepare them for excellent public health practice, but also builds their capacity to mentor the younger and upcoming public health physicians. Conclusion There are enabling structures to incorporate a formal long-distance mentorship program for public health physicians in Nigeria, and physicians are willing to participate in such a program. However, the feasibility of establishing a successful and sustainable program will require robust coordination, technical expertise, demand creation, and financial commitment at both institutional and college levels.
BMC Public Health, Volume 21, pp 1-11; https://doi.org/10.1186/s12889-021-11825-2
Background Secondhand smoke (SHS) exposure can affect physical development in children. An understanding of parental risk perception of SHS could guide efforts to develop measures for prevention of SHS exposure among children. This study aimed to assess parental risk perceptions of SHS and action taken by parents to minimise SHS exposure in their children. Methods This cross-sectional nationwide study conducted in 2018 recruited convenience sample of 289 parents with children up to age 12 at public areas. Parents were asked to rate the risk level from 1 (no risk) to 5 (extremely high risk) by looking at photographs of an adult smoking in the presence of a child in 8 different situations. The implementation of smoking restriction rules was assessed. Mean scores were calculated with higher scores representing higher risk perception of SHS to child’s health. Linear regression analysis was used to determine factors associated with the level of parental risk perception of SHS exposure to their children’s health. Results A total of 246 parents responded. Their mean age was 35 years (SD 6.4). The majority were mothers (75.6%), Malays (72.0%) and had tertiary education level (82.5%), and non-smoker (87.1%). The mean age of respondents’ youngest child was 3 years (SD 3.1). The risk perception level was high [mean scores: 4.11 (SD: 0.82)]. Most parents implemented household (65.0%) and car (68.3%) smoking restriction rules. Lower levels of risk perception were observed among participants who were current smokers (p < 0.001), lived with a smoker (p < 0.001), allowed household smoking with an open window (p = 0.027). Conclusion Most parents perceived that risks of SHS exposure to their children were high but only two-thirds of them had set rules prohibiting smoking. Health policymakers should pay attention to factors associated with lower risk perception among parents. Trial registration This study was approved by the Medical Research Ethics Committee, Ministry of Health Malaysia (Registration Number: NMRR-18-3299-44967).
BMC Public Health, Volume 21, pp 1-11; https://doi.org/10.1186/s12889-021-11914-2
Background Diet, as a modifiable factor, plays an important role in cognitive function. However, the association between adherence to the 2015–2020 Dietary Guidelines for Americans (DGA), measured by Healthy Eating Index (HEI)-2015, and cognitive function remains unclear. This study aims to explore whether HEI-2015 is associated with various cognitive domains and whether such association is modified by age, gender, or ethnicity in the US adults aged 60 years or older using data from the National Health and Nutrition Examination Survey (NHANES) 2011–2014. Methods HEI-2015 scores were calculated from 24-h dietary recall interviews. Cognitive function was evaluated by Digit Symbol Substitution Test (DSST, a measure of processing speed), Animal Fluency Test (AFT, a measure of executive function), a subtest from Consortium to Establish a Registry for Alzheimer’s disease (CERAD, a measure of memory), and a composite-z score calculated by summing z scores of individual tests. The associations between HEI-2015 scores and cognitive performance were explored using multiple linear regression models. Results A total of 2450 participants aged 60 years or older were included. Participants with higher HEI-2015 scores were more likely to have higher DSST, AFT as well as composite-z scores (P<0.05). Significant interaction effects were identified between HEI-2015 and ethnicity in specific cognitive domains (P interaction<0.05). Among HEI-2015 components, higher intakes of whole fruits and seafood and plant protein were associated with better cognitive performance (P<0.05). Conclusion Higher adherence to DGA is associated with better cognitive performance, especially regarding processing speed and executive function among the US adults aged 60 years or older.
BMC Public Health, Volume 21, pp 1-9; https://doi.org/10.1186/s12889-021-11894-3
Background Children and adolescents with obesity are more likely to become adults with obesity. Therefore, obesity prevention in adolescence is essential for eliminating complications associated with obesity, which can affect health throughout the lifespan. This study examined the influences of adolescents’ obesity based on BMI and that of obesity based on adolescents’ perception of their well-being and stress, as well as the moderating effect of gender on these influences. Methods Data were analyzed for 61,861 adolescents aged 12–18, who participated in the 2019 Korean Adolescent Health Behavior Survey, an online self-administered questionnaire. Adolescents’ obesity based on perception was based on their self-rating as underweight, healthy weight, or obese. Chi-squared tests were used to determine whether well-being and stress perception were related to obesity based on BMI and obesity based on perception, and a general linear model was used to examine the main and interaction effects of obesity based on BMI, obesity based on perception, and gender on well-being and stress perception. Results Obesity based on BMI and obesity based on perception coincided in 58.7% of the sample. However, the degree of obesity was overestimated and underestimated by 19.2 and 24.3% of the sample, respectively. Obesity based on BMI and obesity based on perception varied by gender, age, economic status, and academic achievement. The main effect of obesity based on BMI was not statistically significant on both well-being and stress perception, and only the main effect of obesity based on perception was statistically significant on stress perception. The interaction between obesity based on perception and gender was significant for well-being and stress perception. Herein, males scored higher on well-being and lower on stress perception. However, the association patterns were similar for males and females, with significant differences between underweight, healthy weight, and overweight/obese; however, for only females, there was no difference in well-being scores between underweight and those who perceived themselves as having a healthy weight. Conclusion The well-being and stress perception are influenced by obesity based on perception rather than obesity based on BMI, and this influence varies according to gender in adolescents.
BMC Public Health, Volume 21, pp 1-9; https://doi.org/10.1186/s12889-021-11712-w
Background Time-use surveys can closely monitor daily activities, times of stress and relaxation, and examine predictors and trajectories with regard to health. However, previous studies have often neglected the complex interaction of daily activities when looking at health outcomes. Methods Using latent profile analysis, this study examined patterns of self-reported daily time use (0–12h hours) for nine types of behaviour (work, errands, housework, childcare, care of persons in need, education, repairs and gardening, physical activity, and hobbies/leisure-time activities) in the 2018 wave of the German Socio-Economic Panel (N = 30,152; 51.9% female; M = 46.87 years). Sociodemographic variables, affective wellbeing, general and domain-specific life satisfaction, and self-rated health were inspected as predictors via multinomial logistic regression models. Results Six latent profiles emerged: full-time work (47.2%), leisure (33.8%), childcare (8.9%), education (7.0%), part-time work & care (2.6%), and care (0.5%). Overall, the care and part-time work & care profiles showed the lowest wellbeing scores, lower subjective health, and life satisfaction. Women were more likely to be members of the care and childcare profiles. Men were more likely to belong to the full-time work profile, and they reported significantly higher wellbeing than women. Conclusions The analysis revealed distinct patterns of time use and a burden on women, given their investment in care and childcare. Part-time work, and care seemed particularly demanding, and thus, are important areas for prevention, for instance, regarding mental health problems. However, time use was assessed via self-reports, therefore future studies could implement objective measures like digital trackers to validate findings.
BMC Public Health, Volume 21, pp 1-17; https://doi.org/10.1186/s12889-021-11923-1
Background Handwashing with soap is a cost-effective, efficient health behavior to prevent various diseases. Despite its immense health benefits, the lowest prevalence of handwashing is found in low-income countries. Here, its practice is not only determined by individual behavior, but also heavily shaped by deprivations in the social and structural ecology. Moreover, handwashing barriers are not equally experienced as overlapping social identities (e.g., age and gender) intersect and create inequities between members of different social groups. To embrace the complexities of handwashing beyond individual-level behavior and singular social identities, a combined socioecological and intersectional perspective is employed. This multi-level approach with regards to intersecting privileges and disadvantages serves as a basis to promote this highly important health behavior. Methods This study used a qualitative, theory-based approach and combined data from two samples: experts in health promotion (n = 22) and local citizens stratified by gender and rural/urban location (n = 56). Data was collected in face-to-face interviews in Sierra Leone between November 2018 and January 2019 and analyzed using thematic analysis and typology of the qualitative data. Results The conceptualization of multi-level determinants of handwashing within a socioecological model showed the high relevance of inhibiting social and structural factors for handwashing practice. By establishing seven distinguishing social identity dimensions, data demonstrates that individuals within the same social setting yet with distinct social identities experience strikingly differing degrees of power and privileges to enact handwashing. While a local leader is influential and may also change structural-level determinants, a young, rural wife experiences multiple social and structural constraints to perform handwashing with soap, even if she has high handwashing intentions. Conclusion This study provides a holistic analytical framework for the identification of determinants on multiple levels and accumulating intersections of socially produced inequalities for handwashing and is applicable to other health topics. As the exploration of handwashing was approached from a solution-focused instead of a problem-focused perspective, the analysis can guide multi-level intervention approaches (e.g., using low-cost, participatory activities at the community level to make use of the available social capital).
BMC Public Health, Volume 21, pp 1-9; https://doi.org/10.1186/s12889-021-11808-3
Background The use of face masks has become ubiquitous in Taiwan during the early COVID-19 pandemic. A name-based rationing system was established to enable the population of Taiwan to purchase face masks. This study is to assess the extent and fairness of face mask supply to the public in Taiwan. Methods The weekly face marks supplies were collected from name-based rationing system administrative statistics included national health insurance card and e-Mask selling record. National registered population statistics by age, gender, and district were collected from department of statistics ministry of the interior. The number of COVID-19 non-imported cases of Taiwan was collected from Taiwan centers of disease control. Results A total of 146,831,844 person times purchase records from February 6, 2020, to July 19, 2020, the weekly average face mask supply is 0.5 mask (per person) at the start of name-based rationing system, and gradually expanded to the maximum 5.1 masks (per person). Comparing the highest weekly total face mask supply (from Apr 9, 2020, to Apr 15, 2020) in aged 0–9 -, 10–19 -, 20–29 -, 30–39 -, 40–49 -, 50–59 -, 60–69 -,70–79 -, 80–89 -, 90–99, and > 100 years to the register population showed similar distribution between mask supplied people and total population (all standardized difference < 0.1). Conclusion The masks supply strategies has gradually escalated the number of face masks for the public, it not only has dominant decreased the barrier of acquiring face mask, but a fair supply for total population use of Taiwan.
BMC Public Health, Volume 21, pp 1-10; https://doi.org/10.1186/s12889-021-11832-3
Background In an industrial area, the asymmetry between the weights of the economic interests compared to the public-health needs can determine which interests are represented in decision-making processes. This might lead to partial interventions, whose impacts are not always evaluated. This study focuses on two interventions implemented in Taranto, Italy, a city hosting one of the largest steel plants in Europe. The first intervention deals with measures industrial plants must implement by law to reduce emissions during so called “wind days” in order to reduce PM10 and benzo [a] pyrene concentrations. The second one is a warning to the population with recommendations to aerate indoor spaces from 12 pm to 6 pm, when pollutant concentrations are believed to be lower. Methods To analyse the impact of the first intervention, we analysed monthly PM10 data in the period 2009–2016 from two monitoring stations and conducted an interrupted-time-series analysis. Coefficients of time-based covariates are estimated in the regression model. To minimise potential confounding, monthly concentrations of PM10 in a neighbourhood 13 km away from the steel plant were used as a control series. To evaluate the second intervention, hourly concentrations of PM10, SO2 and polycyclic-aromatic-hydrocarbons (PAHs) were analysed. Results PM10 concentrations in the intervention neighbourhood showed a peak just a few months before the introduction of the law. When compared to the control series, PM10 concentrations were constantly higher throughout the entire study period. After the intervention, there was a reduction in the difference between the two time-series (− 25.6%). During “wind days” results suggested no reduction in concentrations of air pollutants from 12 pm to 18 pm. Conclusion Results of our study suggest revising the warning to the population. Furthermore, they evidence that in complex highly industrialised areas, air quality interventions cannot focus on only a single pollutant, but rather should consider the complex relationships between the different contaminants. Environmental interventions should be reviewed periodically, particularly when they have implications for social constraints. While the results of our study can be related only to the specific situation reported in the article, the methodology applied might be useful for the environmental management in industrial areas with similar features.