BMC Public Health is an open access, peer-reviewed journal that considers articles on the epidemiology of disease and the understanding of all aspects of public health. The journal has a special focus on the social determinants of health, the environmental, behavioral, and occupational correlates of health and disease, and the impact of health policies, practices and interventions on the community.


The Globethics Library has Vol. 1(2001) to current. See also BMC International Health and Human Rights (has merged with BMC Public Health as of 2021)

Recent Submissions

  • Impact of capitation prepayment on the medical expenses and health service utilization of patients with coronary heart disease: a community policy intervention program in a county in China

    Jincao Yan; Yunke Shi; Jiani Zhang; Siwei Chen; Xinran Huo; Yue Shen; Ning Zhang (BMC, 2023-11-01)
    Abstract Background Medical costs have been rising rapidly in recent years, and China is controlling medical costs from the perspective of health insurance payments. Objectives To explore the impact of the capitation prepayment method on medical expenses and health service utilization of coronary heart disease (CHD) patients, which provides a scientific basis for further improvement of the payment approach. Methods The diagnosis records of visits for CHD in the database from 2014 to 2016 (April to December each year) were selected, and two townships were randomly selected as the pilot and control groups. Propensity score matching (PSM) and difference-in-difference (DID) model were used to assess changes in outpatient and inpatient expenses and health service utilization among CHD patients after the implementation of the capitation prepayment policy. Results There were eventually 3,900 outpatients and 664 inpatients enrolled in this study after PSM. The DID model showed that in the first year of implementing the reform, total outpatient expenses decreased by CNY 13.953, drug expenses decreased by CNY 11.289, as well as Medicare payments decreased by CNY 8.707 in the pilot group compared to the control group. In the second year of implementing the reform, compared with the control group, the pilot group had a reduction of CNY 3.123 in other expenses, and a reduction of CNY 6.841 in Medicare payments. There was no significant change in inpatient expenses in the pilot group compared to the control group, but there was an increase of 0.829 visits to rural medical institutions, and an increase of 0.750 visits within the county for inpatients. Conclusions The capitation prepayment method has been effective in controlling the outpatient expenses of CHD patients, as well as improving the medical service capacity of medical institutions within the Medical Community, and increasing the rate of inside county visits for inpatients.
  • Do Brazilian regulatory measures promote sustainable and healthy eating in the school food environment?

    Luana Lara Rocha; Nayhanne Gomes Cordeiro; Mariana Zogbi Jardim; Aline Yukari Kurihayashi; Patrícia Chaves Gentil; Giorgia Castilho Russo; Larissa Loures Mendes (BMC, 2023-11-01)
    Abstract Background Regulatory measures regarding food in the school environment aim to promote a healthier food environment in public and private schools. In Brazil, implementing regulations in the school food environment does not occur the same way across states and cities, and no national regulation covers public and private schools. The present study aims to analyze regulatory measures for school food environments in Brazilian states and cities and develop a score to evaluate them. Methods A systematic search of the regulatory measures in force and implemented until 2021 was conducted. The score was developed based on the Model Law Project prepared by the Brazilian Institute for Consumer Protection. It considered food and nutrition education actions, restrictions on the sale and distribution of food, a ban or restriction on food advertising and marketing, and points of excellence. These points included regulations that addressed the importance of supervision and social control, laws regulated by decree, the mention of a ban on ultra-processed foods, and whether the regulatory measures covered public and private schools. Results Sixty-five cities and states regulatory measures in force were found to be evaluated jointly by a federal entity (n = 43). Among the federal entities evaluated, only 13.95% fulfilled the function of promoting sustainable and healthy eating (8–12 points). Conclusions Brazilian children and adolescents are exposed to a school food environment with regulations that partially fulfill the function of promoting an adequate, healthy, and sustainable diet. In this sense, it is necessary to improve regulatory measures or to encourage states and cities to develop effective legal provisions that are in line with the food guide for the Brazilian population and with the perspective of a healthy school food environment for the effective promotion of adequate, healthy and sustainable and healthy food in schools.
  • PTSD, FOMO and fake news beliefs: a cross-sectional study of Wenchuan earthquake survivors

    Chen Gong; Yijin Ren (BMC, 2023-11-01)
    Abstract Background Post-traumatic stress disorder (PTSD) sufferers show problematic patterns of Internet use such as fear of missing out (FOMO) and sharing misinformation and fake news. This study aimed to investigate these associations in survivors of the 2008 earthquake in Wenchuan, China. Methods A self-reported survey was completed by 356 survivors of the Wenchuan earthquake. A mediated structural equation model was constructed to test a proposed pattern of associations with FOMO as a mediator of the relationship between PTSD symptoms and belief in fake news, as well as moderators of this pathway. Results PTSD was directly associated with believing fake news (β = 0.444, p < .001) and with FOMO (β = 0.347, p < .001). FOMO mediated the association between PTSD and fake news belief (β = 0.373, p < .001). Age moderated the direct (β = 0.148, t = 3.097, p = .002) and indirect (β = 0.145, t = 3.122, p = .002) pathways, with effects more pronounced with increasing age. Gender was also a moderator, with the indirect effect present in females but not in males (β = 0.281, t = 6.737, p < .001). Conclusion Those with higher PTSD symptoms are more likely to believe fake news and this is partly explained by FOMO. This effect is present in females and not males and is stronger in older people. Findings extend knowledge of the role of psychological variables in problematic Internet use among those with PTSD.
  • Social capital and well-being of the elderly ‘left-behind’ by their migrant children in India

    Manoj Dakua; Ranjan Karmakar; Hemkhothang Lhungdim (BMC, 2023-11-01)
    Abstract Background The study aims to examine the association between individual forms of social capital and the well-being of the elderly ‘left-behind’ parents and to determine if there is a gender difference within the possible relationship. Methods This study applied the first wave of the Longitudinal Ageing Study in India (LASI, 2017-18) data. In this study, the respondents were 4,736 older parents ‘left-behind’ by their migrant adult sons. We employed descriptive statistics and bivariate analysis to assess the study sample’s characteristics. The proportion test was performed to examine if there was a significant gender difference among older adults regarding depression, ADL, and IADL impairments. In addition, binary logistic regression was utilized to investigate the associations between social capital and elderly parents’ health outcomes. Results This study found a significant gender difference in depression (male: 8.26%; female:11.32%; P < 0.001), ADL (male:20.23%; female:25.75%; P = 0.032), and IADL (male: 33.97% female: 54.13%; P < 0.001) limitations. Elderly parents who did not participate in any social activity had a higher odd of ADL (aOR: 2.44; 95%CI: 1.882–3.171; P = < 0.001) and IADL (aOR: 1.22; 95%CI: 1.034–1.766 ; P = < 0.001) limitations. Networking with friends through phone/email conversations has a substantial impact on lowering depression in older parents. Older adults with good personal social capital were less likely to have depression, ADL, and IADL limitations. Conclusion Personal social capital is closely associated with the well-being of left-behind older parents. More efforts should be in place to increase the stock of social capital in this group with focused gender disparity.
  • Health insurance coverage and poverty status of postpartum women in the United States in 2019: an ACS-PUMS population-based cross-sectional study

    Bojung Seo; Jack Edward Turman; Hongmei Nan (BMC, 2023-11-01)
    Abstract Background A quarter of United States (US) postpartum women still report unmet health care needs and health care unaffordability. We aimed to study associations between receipt of health insurance coverage and poverty status/receipt of government financial support and determine coverage gaps overall and by social factors among US postpartum women in poverty. Methods This study design is a cross-sectional study using secondary data. We included women who gave birth within the last 12 months from 2019 American Community Survey Public Use Microdata Sample. Poverty was defined as having an income-to-poverty ratio of less than 100%. We explored Medicaid/government medical assistance gaps among women in poverty. To examine the associations between Medicaid/government medical assistance (exposures) and poverty/government financial support (outcomes), we used age-, race-, and multivariable-adjusted logistic regression models. We also evaluated the associations of state, race, citizenship status, or language other than English spoken at home (exposures) with receipt of Medicaid/government medical assistance (outcomes) among women in poverty through multivariable-adjusted logistic regression. Results It was notable that 35.6% of US postpartum women in poverty did not have Medicaid/government medical assistance and only a small proportion received public assistance income (9.8%)/supplementary security income (3.1%). Women with Medicaid/government medical assistance, compared with those without the coverage, had statistically significantly higher odds of poverty [adjusted odds ratio (aOR): 3.15, 95% confidence interval (95% CI): 2.85–3.48], having public assistance income (aOR: 24.52 [95% CI: 17.31–34.73]), or having supplementary security income (aOR: 4.22 [95% CI: 2.81–6.36]). Also, among postpartum women in poverty, women in states that had not expanded Medicaid, those of Asian or other race, non-US citizens, and those speaking another language had statistically significantly higher odds of not receiving Medicaid/government medical assistance [aORs (95% CIs): 2.93 (2.55–3.37); 1.30 (1.04–1.63); 3.65 (3.05–4.38); and 2.08 (1.86–2.32), respectively]. Conclusions Our results showed that the receipt of Medicaid/government medical assistance is significantly associated with poverty and having government financial support. However, postpartum women in poverty still had Medicaid/government medical assistance gaps, especially those who lived in states that had not expanded Medicaid, those of Asian or other races, non-US citizens, and other language speakers.
  • Gender and sexual identity-based inequalities in adolescent wellbeing: findings from the #BeeWell Study

    Jose Marquez; Neil Humphrey; Louise Black; Megan Cutts; Devi Khanna (BMC, 2023-11-01)
    Abstract Background Gender and sexual minority adolescents experience greater symptoms of psychological distress than their peers, but little is known about broader aspects of their wellbeing. This study examines wellbeing inequalities relating to gender and sexual identity among adolescents from Greater Manchester in the United Kingdom. Method 37,978 adolescents (aged 12–15, attending 165 secondary schools) completed surveys of life satisfaction, positive and negative affect (hedonic framework); autonomy, self-esteem, optimism, and positive relationships (eudaimonic framework); and, symptoms of distress and mental wellbeing (complete state framework). Structural correlated factors models were used to assess gender and sexual identity wellbeing inequalities. Results The magnitude of wellbeing inequalities pertaining to gender and sexual identity were routinely substantially greater than those concerning other characteristics (e.g., socio-economic disadvantage). Gender identity wellbeing inequalities followed a consistent pattern, with the largest disparities evident between gender diverse adolescents and boys. Sexual identity wellbeing inequalities also followed a consistent pattern, with the largest disparities evident between sexual minority youth (both gay/lesbian and bi/pansexual) and their heterosexual peers. Finally, variation was evident across wellbeing domains. For example, observed gender identity (boys vs. girls) and sexual identity (heterosexual vs. sexual minority) disparities were substantially greater for symptoms of distress than for mental wellbeing in the complete state model. Conclusions LGBTQ + adolescents experience lower wellbeing than their peers, and this is evident across a range of wellbeing domains. Accordingly, there is an urgent need for the prioritisation of improved prevention and intervention efforts that can better meet the needs of gender diverse and sexual minority youth, and future research should be conducted to improve understanding of the mechanisms underpinning the wellbeing inequalities observed.
  • Estimating the effect of timing of earned income tax credit refunds on perinatal outcomes: a quasi-experimental study of California births

    Deborah Karasek; Akansha Batra; Rebecca J. Baer; Brittany D. Chambers Butcher; Sky Feuer; Jonathan D. Fuchs; Miriam Kuppermann; Anu Manchikanti Gomez; Aric A. Prather; Matt Pantell (BMC, 2023-11-01)
    Abstract Background The largest poverty alleviation program in the US is the earned income tax credit (EITC), providing $60 billion to over 25 million families annually. While research has shown positive impacts of EITC receipt in pregnancy, there is little evidence on whether the timing of receipt may lead to differences in pregnancy outcomes. We used a quasi-experimental difference-in-differences design, taking advantage of EITC tax disbursement each spring to examine whether trimester of receipt was associated with perinatal outcomes. Methods We conducted a difference-in-differences analysis of California linked birth certificate and hospital discharge records. The sample was drawn from the linked CA birth certificate and discharge records from 2007–2012 (N = 2,740,707). To predict eligibility, we created a probabilistic algorithm in the Panel Study of Income Dynamics and applied it to the CA data. Primary outcome measures included preterm birth, small-for-gestational age (SGA), gestational diabetes, and gestational hypertension/preeclampsia. Results Eligibility for EITC receipt during the third trimester was associated with a lower risk of preterm birth compared with preconception. Eligibility for receipt in the preconception period resulted in improved gestational hypertension and SGA. Conclusion This analysis offers a novel method to impute EITC eligibility using a probabilistic algorithm in a data set with richer sociodemographic information relative to the clinical and administrative data sets from which outcomes are drawn. These results could be used to determine the optimal intervention time point for future income supplementation policies. Future work should examine frequent income supplementation such as the minimum wage or basic income programs.
  • The influence of home isolation during COVID-19 on the physical fitness development of college students: a study utilizing repeated measures analysis of variance

    Chang Jie; Sun Xugui; Zhang Min; Zhu Ergang; Wang Hongwu; Sun Jun (BMC, 2023-11-01)
    Abstract Background Research on the impact of COVID-19-induced home isolation on the physical fitness of college students is limited. This study aims to compare and analyze the physical fitness test scores of college students in two groups: those who experienced home isolation and those who did not, over three consecutive years after enrolment, to investigate the effects of home isolation on the physical fitness development of Chinese college students. Methods This comparative study included two longitudinal surveys conducted among medical college students. The participants were divided into an experimental group and a control group. The physical fitness indicators measured included body mass index (BMI), vital capacity (VC), 50-metre run, sit-and-reach, standing long jump, 1000/800-metre runs (males/females), pull-ups (males) and sit-ups (females). Repeated measures analysis of variance (ANOVA) was employed, and the Greenhouse-Geisser correction was applied when Mauchly’s assumption of sphericity was violated. Pairwise comparisons were conducted using the Bonferroni method. Results A total of 6580 students participated in the study, with 3360 students (1490 males, 1870 females) enrolled in 2019 as the experimental group and 3220 students (1326 males, 1894 females) enrolled in 2017 as the control group. All participants completed the physical fitness tests for three consecutive years. The results showed that the experimental group exhibited decreased performance in the 1000-metre and 800-metre runs, and improved performance in the sit-and-reach test. After the end of home isolation, there was an improvement in the performance of the 1000-metre run and 800-metre run, while no significant differences were observed in the trends of the other tested indicators. Conclusion The findings of this study indicate that the home isolation environment during COVID-19 had a significant impact on the physical fitness of college students, specifically in terms of endurance and flexibility qualities, as well as male BMI. To better prepare for future public health emergencies and mitigate the effects of isolation, teaching students endurance exercises that can be performed at home should be prioritized. Furthermore, physical education programs should be improved to enhance student flexibility.
  • Evaluation of the Acute flaccid paralysis surveillance indicators in Zambia from 2015–2021: a retrospective analysis

    Barnabas Bessing; Edward A. Dagoe; Deborah Tembo; Alice Mwangombe; Muzala K. Kanyanga; Fadinding Manneh; Belem B. Matapo; Patricia M. Bobo; Musole Chipoya; Victor A. Eboh (BMC, 2023-11-01)
    Abstract Background The resurgence of poliovirus infection in previously polio free regions and countries calls for renewed commitment to the global polio eradication efforts including strengthening of Acute Flaccid Paralysis (AFP) surveillance systems. Zambia is one of the countries substantially at risk for the importation of poliovirus infection from neighbouring countries including Malawi, Mozambique, and Democratic Republic of the Congo (DRC). This study describes a seven-year AFP surveillance, assesses the surveillance indicators, and highlights areas for improvement. Methods We conducted retrospective analysis of the routinely collected AFP surveillance data from January 2015 to December 2022. The AFP surveillance indicators performance was assessed using the World Health Organisation’s recommended minimum AFP surveillance indicators performance. Results Cumulatively, a total of 1715 AFP cases were reported over the study period. More than half, 891 (52%) of reported cases were aged < 5 years with 917 (53.5%) of males. More than half, 1186 (69.2%) had fever at onset, 718 (41.9%) had asymmetric paralysis and 1164 (67.9%) had their paralysis progressed within 3 days of onset. The non-polio AFP rate ranges from 3.4 to 6.4 per 100,000 children < 15 years old and stool adequacy ranging from 70.9% to 90.2% indicating sensitive surveillance with late detection of cases. The percentage of cases with early stool collection, timely transportation was above the World Health Organisation (WHO) minimum of 80% but with declining proportion of stools arriving in the laboratory in optimal condition. Completeness of 60-days follow-up evaluation was suboptimal ranging from 0.9% to 28.2%. Conclusion The AFP surveillance system in Zambia is doing well. However, additional efforts are needed to improve early detection of cases; stool sample collection, transportation and monitoring to ensure arrival in good condition in the laboratory; and improve 60-days follow-up evaluation for evidenced-based classification of inadequate AFP cases and proper care.
  • Global, regional and national burden of male infertility in 204 countries and territories between 1990 and 2019: an analysis of global burden of disease study

    Baoyi Huang; Zhaojun Wang; Yanxiang Kong; Mengqi Jin; Lin Ma (BMC, 2023-11-01)
    Abstract Background Many countries and regions have experienced male fertility problems due to various influencing factors, especially in less developed countries. Unlike female infertility, male infertility receives insufficient attention. Understanding the changing patterns of male infertility in the world, different regions and different countries is crucial for assessing the global male fertility and reproductive health. Methods We obtained data on prevalence, years of life lived with disability (YLD), age-standardized rates of prevalence (ASPR) and age-standardized YLD rate (ASYR) from the Global Burden of Disease Study 2019. We analyzed the burden of male infertility at all levels, including global, regional, national, age stratification and Socio-demographic Index (SDI). Results In 2019, the global prevalence of male infertility was estimated to be 56,530.4 thousand (95% UI: 31,861.5–90,211.7), reflecting a substantial 76.9% increase since 1990. Furthermore, the global ASPR stood at 1,402.98 (95% UI: 792.24–2,242.45) per 100,000 population in 2019, representing a 19% increase compared to 1990. The regions with the highest ASPR and ASYR for male infertility in 2019 were Western Sub-Saharan Africa, Eastern Europe, and East Asia. Notably, the prevalence and YLD related to male infertility peaked in the 30–34 year age group worldwide. Additionally, the burden of male infertility in the High-middle SDI and Middle SDI regions exceeded the global average in terms of both ASPR and ASYR. Conclusion The global burden of male infertility has exhibited a steady increase from 1990 to 2019, as evidenced by the rising trends in ASPR and ASYR, particularly in the High-middle and Middle SDI regions. Notably, the burden of male infertility in these regions far exceeds the global average. Additionally, since 2010, there has been a notable upward trend in the burden of male infertility in Low and Middle-low SDI regions. Given these findings, it is imperative to prioritize efforts aimed at improving male fertility and reproductive health.
  • What works in interventions targeting loneliness: a systematic review of intervention characteristics

    N. Morrish; S. Choudhury; A. Medina-Lara (BMC, 2023-11-01)
    Abstract Background Loneliness has been linked to negative health and economic outcomes across the life course. Health effects span both physical and mental health outcomes, including negative health behaviours, lower well-being, and increased mortality. Loneliness is however preventable with effective intervention. This systematic review aims to identify what has worked in interventions for loneliness to guide the development of future interventions. Methods Eight electronic databases (Medline, Embase, PsycINFO, Social Policy and Practice, Social Sciences Citation Index, Epistemonikos, CINAHL, Cochrane Library) were systematically searched from inception to February 2022 using terms for intervention and loneliness to identify relevant interventions in the general population. No restrictions on age, socio-economic status, or geographic location were imposed. Studies were to measure loneliness as the primary outcome through a validated scale or single-item question. Case studies were excluded. Additional studies were identified through citation chasing. Extracted data included study and intervention characteristics, and intervention effectiveness for cross-study comparison. Critical appraisal was conducted using the Joanna Briggs Institute and Critical Appraisal Skills Programme tools before the studies were summarised in a narrative synthesis. Results Searches identified 4,734 hits, from which 22 studies were included in this review. Of these studies, 14 were effective in reducing loneliness. Additionally, five studies presented unclear findings, and three concluded no decrease in loneliness. Interventions varied between group vs. individual format, online vs. in person delivery, and regarding both intervention duration and individual session length. Furthermore, this review highlighted five key areas when considering designing an intervention for loneliness: use of between session interaction, inclusion of clear learning mechanisms, role of active participation, number of opportunities for group or facilitator interaction, and variation in teaching and learning styles. Conclusions Group sessions seem preferred to individual formats, and interaction through active participation and group or facilitator contact appear beneficial, however studies also recognised the importance of a person-tailored approach to delivery. Studies suggest there is no ‘quick fix’ to loneliness, but that learnt practices, behaviours, and community connection should be built into one’s lifestyle to achieve sustained intervention effectiveness. Future interventions should consider longer follow-up periods, male and populations with lower educational levels.
  • Introduction and acceptability of the Surveillance Outbreak Response Management and Analysis System (SORMAS) during the COVID-19 pandemic in Côte d’Ivoire

    Tanja Barth-Jaeggi; Clarisse A. Houngbedji; Marta S. Palmeirim; Daouda Coulibaly; Aboubakar Krouman; Cordula Ressing; Kaspar Wyss (BMC, 2023-11-01)
    Abstract Background The Surveillance Outbreak Response Management and Analysis System (SORMAS) has been implemented for various infectious diseases since 2015. 2020, at the beginning of the COVID-19 pandemic, SORMAS was adapted to SARS-CoV2. Methods We assessed the acceptability and usability of SORMAS and accompanied its implementation in two pilot regions of Côte d’Ivoire (Abidjan 2 and Gbêkê) from July/August 2021 to March 2022. We conducted 136 semi-structured interviews to cover knowledge on COVID-19, information on conventional surveillance systems for disease monitoring including COVID-19, acceptability of SORMAS, and impact of SORMAS on epidemic preparedness and surveillance. Scores before and 6–8 months after implementation were compared. Results SORMAS was implemented in two pilot regions in Côte d’Ivoire. The conventional software for the surveillance of the COVID-19 pandemic by the company MAGPI was maintained in parallel; the additional time needs to enter and manage the data in SORMAS were the main concern. SORMAS acceptance and satisfaction scores were high after the user training, which was prior to implementation, and after 6–8 months of use. The ability of SORMAS to improve COVID-19 preparedness and early detection of cases and contacts was widely acknowledged. To keep the understanding and skills of users up-to-date, regular refresher trainings were requested. The expectation to be able to make decisions based on data produced by SORMAS was high at baseline and the perceived experience after several months of use of the software was very positive. Unfortunately, the link with the laboratories could not be established in the pilot regions, but it is an existing feature of SORMAS that many users were asking for. Following the positive experience using SORMAS for COVID-19, the pilot regions expanded its use for monitoring and management of measles, yellow fever, meningitis, and cholera. Conclusion SORMAS was very well accepted by users and decision makers in the two pilot regions of Côte d’Ivoire and its ability to improve epidemic preparedness and surveillance was acknowledged. If the hurdles of maintenance (tablets, server, and maintaining user skills) are handled sustainably, it can serve as a valid tool to identify, surveil and manage future outbreaks of various infectious diseases in Côte d’Ivoire.
  • Risk perceptions of COVID-19, vocational identity, and employment aspirations of Chinese aviation students: a structural equation modeling approach

    Hongyao Qin; Yong Tang (BMC, 2023-11-01)
    Abstract Background The COVID-19 pandemic has wreaked havoc on the aviation and education sectors in China. This study examined the relationships between risk perceptions of the pandemic, vocational identity, and employment aspirations of Chinese aviation students. Methods The study used a convenience sampling approach to collect data (n = 276 respondents) from August 2 to 8, 2022. An online survey was sent via WeChat and QQ to Chinese students majoring in aviation service management who were under lockdown at six Chinese schools. Results In spite of the strong support for the stringent COVID policies and full awareness of infection risk and protective measures, respondents were worried about the current unstable situation and felt fear for its severity and long-lasting symptoms. The casual path from career commitment to employment aspiration was supported, but high risk perceptions of the pandemic failed to have any psychological effect on the two constructs of vocational identity and employment aspirations. Conclusions The findings not only demonstrate the power of career commitment on employment aspirations but also reveal that a relatively high self-assessment of career proficiency may not necessarily lead to a clear career aspiration, possibly due to poor risk communication and insufficient career planning guidance. Thus, Chinese aviation students should improve their career proficiency and commitment, broaden their career options and adaptability, and have a clear career plan, in order to be well prepared for the fierce job market that will face the next wave of the ongoing pandemic.
  • Secular trends in the incidence of major depressive disorder and dysthymia in China from 1990 to 2019

    Ming Li; Wenlong Gao; Yuqi Zhang; Qiuxia Luo; Yuanyuan Xiang; Kai Bao; Noha Zaki (BMC, 2023-11-01)
    Abstract Background Depression is increasingly recognized as a worldwide serious, public health concern. A better understanding of depression is important for advancing its management and learning the difference between major depressive disorder (MDD) and dysthymia. Our aim is to conduct a concurrent analysis of the trends of both MDD and dysthymia in China. Methods The data on depression from 1990 to 2019 were collected from the Global Burden of Disease Study 2019 (GBD 2019). To determine the average annual percent changes (AAPC) and relative risks (RRs), joinpoint regression and the age-period-cohort models were employed, respectively. Results The incidence number of MDD and dysthymia continuously increased in China from 1990 to 2019, however, the age-standardized rates (ASR) had a decreasing trend in both men and women. The results from joinpoint regression showed that a declining trend was presented in young people (< 50 years) but an increased trend in the elderly (≥ 50 years) both in men and women, during 1990–2019. Age is the most influential factor for MDD and dysthymia. Age RRs for MDD incidence had an overall increasing trend with age. Period RR in MDD presented a U-shaped pattern, while Cohort RRs presented an inverted U-shaped pattern. On the other hand, RRs in dysthymia for period and cohort effects had no statistical significance, only the age effect presented an inverted U-shaped pattern. Conclusions The disparities in trends observed between MDD and dysthymia during the period of 1990–2019 indicated the significance of distinguishing between these two disorders. The age, period and cohort effects all had a greater impact on MDD than on dysthymia, and age effects presented different influential patterns in these two. To alleviate the burden of depressive disorders in China, proactive measures need to be implemented, with particular attention to the elderly population.
  • Health effects and externalities of the popularization of sanitary toilets: evidence from Rural China

    Yingwen Gu; Wanli Zhou; Tan Zheng; Fang Huang (BMC, 2023-11-01)
    Abstract Background This study aimed to assess the impact of the increased prevalence of sanitary toilets in rural areas on the health of rural residents, and whether the popularity thereof has a positive externality. This study investigates whether the broader use of sanitary toilets has had a positive effect on the health of people who do not have access to them. Methods Data from the China Family Panel Studies from 2012 to 2014 and a two-way fixed effect model were used to investigate the relationship between the prevalence of village sanitary toilets and the health of rural residents of all ages. Results The results showed that: (1) the increase in the prevalence of sanitary toilets in villages is conducive to improving the health level of rural residents; (2) the widespread adoption of sanitary toilets in rural areas has improved the health of not only residents with access to these toilets but also residents without access; (3) the health of children is more sensitive to improvements in sanitary conditions of toilets; and (4) there are significant regional differences in the impact of the popularity of sanitary toilets on the health of rural residents. Conclusions This study found that the popularity of sanitary toilets has externalities, improving not only the health of residents who use them but also the health of other residents. This study enriches the literature in the field of health effects of sanitation improvement, while providing a reference for developing countries to further enhance the living environment in rural areas. In the future, the popularization of sanitary toilets should be vigorously promoted to reduce the incidence of diseases.
  • Work, travel, or leisure: comparing domain-specific physical activity patterns based on rural–urban location in Canada

    Chelsea Pelletier; Nicole White; Annie Duchesne; Larine Sluggett (BMC, 2023-11-01)
    Abstract Background Physical activity occurs across various domains including leisure/recreation, for transportation, or for work or household reasons. Rural and urban active living environments are characterized by different opportunities for physical activity within each domain which may translate into different patterns of behavior. The aim of this study was to compare rural–urban differences in physical activity across different domains, and explore interactions between sociodemographic factors, physical activity domains, and rurality. Methods We used self-reported data collected across three physical activity domains (active transportation, recreation, occupational/household) and relevant sociodemographic variables from the Canadian Community Health Survey. Adjusting for sociodemographic factors, we did two separate cross-sectional analyses: 1) binary logistic regression to determine the odds of reporting any activity in each domain, and 2) ordinary least squares regression using the sub-samples reporting > 0 min per week of activity to compare how much activity was reported in each domain. Results Our final survey weighted sample of Canadian adults (mean age 47.4 years) was n = 25,669,018 (unweighted n = 47,266). Rural residents were less likely to report any active transportation (OR = 0.59, 95% CI [0.51, 0.67], p < .0001). For recreational physical activity, rural males had lower odds (OR = 0.75, 95% CI [0.67, 0.83], p < .0001) and rural females had higher odds (OR = 1.19, 95% CI [1.08, 1.30], p = .0002) of reporting any participation compared to urban residents. Rural males (OR = 1.90, 95% CI [1.74, 2.07], p < .0001) and females (OR = 1.33, 95% CI [1.21, 1.46], p < .0001) had higher odds of reporting any occupational or household physical activity. Conclusions Urban residents tend to participate in more active transportation, while rural residents participate in more occupational or household physical activity. Location-based differences in physical activity are best understood by examining multiple domains and must include appropriate sociodemographic interactions, such as income and sex/gender.
  • Socioeconomic inequality in teenage pregnancy in Papua New Guinea: a decomposition analysis

    Hao Li; Yiran Pu; Zhen Li; Ziyang Jin; Yi Jiang (BMC, 2023-11-01)
    Abstract Background Teenage pregnancy is a global public health issue, and it poses a serious threat to the health and socioeconomic status of mothers and their newborn children. Although Papua New Guinea has recorded one of the highest teenage pregnancy rates among Asia-Pacific countries, few studies have conducted research on the related inequality in the country. Therefore, this study aimed to assess socioeconomic inequality in teenage pregnancy and its contributing factors in Papua New Guinea. Methods Data for this cross-sectional study were obtained from the 2016–2018 Papua New Guinea Demographic and Health Survey. The analytical sample consisted of 2,864 girls aged 15–19 years. We employed Erreygers normalized concentration index (ECI) and concentration curves to measure and depict socioeconomic inequality in teenage pregnancy. Decomposition analysis was likewise performed to identify the contributions of determinants to the observed inequality. Results Weighted ECI for teenage pregnancy was − 0.0582 (P < 0.001), thereby indicating that teenage pregnancy in Papua New Guinea is disproportionately concentrated among poor girls. Decomposition analysis suggested that education level (65.2%), wealth index (55.2%), early sexual debut (25.1%), region (8.5%), and sex of household head (4.1%) are the main determinants explaining the pro-poor socioeconomic inequality in teenage pregnancy. Conclusions A pro-poor socioeconomic inequality of teenage pregnancy was present in Papua New Guinea. This inequality may be alleviated by such interventions as ensuring that teenage girls receive education; implementing poverty alleviation projects, eliminating child, early, and forced marriages; strengthening promotion for household head to support teenagers in accessing sexual and reproductive health education; improving geographical accessibility to health facilities on contraceptive services, and taking necessary precautions and responses to sexual misconduct.
  • A comparative analysis of road and vehicle qualities as factors of road traffic carnage in Nigeria

    Onyenekenwa Cyprian Eneh; Andy Okosun; Idu R Egbenta; Nicholas I Obi; Martin C Oloto; Obinna Ubani; Chinemelum A Eneh; Cosmas I Eneonwo (BMC, 2023-11-01)
    Abstract Background and objective Carnage on roads is a growing concern in Nigeria. Over 27 persons, equivalent to more than 4 families, die daily from road traffic crashes. Two direct factors of a road crash are road quality and vehicle quality. To interrogate and compare both factors to road traffic accidents, the longitudinal study regressed secondary data on death tolls against road quality and vehicle quality. Materials and methods Data on the estimated number of vehicles imported into Nigeria (1992–2021) served as the indicator of vehicle quality on Nigerian roads. The longitudinal study regressed secondary data on death tolls (2013–2019) against road quality (2006–2019) and vehicle quality (1992–2021). Results Results showed that road quality is degenerating as well as vehicle quality in Nigeria, resulting in increase in the number of road traffic crashes and the attendant death tolls. For every 1% decrease in road quality, death tolls from road traffic crashes in Nigeria increased by 0.00642% at 5% significance, and for every decrease in vehicle quality, death tolls from road traffic crashes in Nigeria increased by 0.327% at 5% significance. Conclusion The study recommended increased advocacy on the sanctity of life and the need for all tiers of government to prioritize policy and implementation of improving the road quality and vehicle quality to reduce road traffic crashes and save lives on Nigerian roads.
  • Body Mass Index Asian populations category and stroke and heart disease in the adult population: a longitudinal study of the Indonesia Family Life Survey (IFLS) 2007 and 2014

    Kamaluddin Latief; Dieta Nurrika; Min-Kuang Tsai; Wayne Gao (BMC, 2023-11-01)
    Abstract Background A substantially elevated Body Mass Index (BMI) is one of the largest global modifiable risk factors for stroke and heart diseases. Most studies classify BMI according to the WHO BMI cut-off point in stroke and heart disease studies. However, there is a limited understanding of the association between the BMI cut-off point in the Asian population category and stroke and heart disease. This study aimed to investigate the incidence rate ratio of stroke and heart disease by BMI categories for the Asian population. Methods A 7-year prospective longitudinal study (2007–2014) was conducted on 6,688 adult Indonesian individuals (≥ 35 years) residing across 13 different provinces in Indonesia during the survey periods. Data on BMI were collected in 2007. Information on stroke and heart disease was obtained in both 2007 and in 2014. A multivariate-adjusted Poisson regression model was used to estimate the incidence rate ratio (IRR) and 95% confidence intervals (CIs) of either stroke or heart disease or both stroke and heart disease by BMI. Results Among the 6,688 eligible participants, 334 (5%) were judged as stroke and heart disease in 2014. The IRR (95% CI) of stroke and heart disease for participants with obesity was 2.57 (1.64–4.04) compared with those within normal weight. This incidence rate ratio was more pronounced among middle-aged adults (< 55 years) rather than the older adults (≥55 years).The IRR of stroke and heart disease among obese middle-aged adults was 4.18 (95% CI 2.10–8.31). Conclusions An association was observed between obesity and the risk of stroke and heart disease, especially in middle-aged adults. These findings suggest that lowering BMI through the adoption of healthy dietary habits and increasing physical activity, particularly among middle-aged adults with high education, occupational employment, and residence in either urban or rural areas, may be beneficial for preventing stroke and heart disease.
  • The effectiveness of a telephone smoking cessation program in mental health clinic patients by level of mental well-being and functioning: a secondary data analysis of a randomized clinical trial

    Sarah Swong; Andrew Nicholson; David Smelson; Erin S. Rogers; Omar El-Shahawy; Scott E. Sherman (BMC, 2023-11-01)
    Abstract Background Few studies have examined the effectiveness of telephone smoking cessation interventions by severity of behavioral health symptoms. Using data from a telephone counseling study, we examined whether abstinence rates varied by level of behavioral health symptoms. Methods The parent study recruited adults who smoke cigarettes (N = 577) referred by mental health providers at six Veterans Health Administration facilities. Participants were randomized to specialized telephone counseling (intervention) or state Quitline referral (control). Participants completed assessments at baseline and 6 months, including the BASIS-24, a self-report measure of behavioral health symptoms and functioning. We used the BASIS-24 median to dichotomize participants as having high or low scores. The primary outcome was 30-day self-reported abstinence at 6 months. We compared groups on outcomes by logistic regression and performed an interaction effect analysis between treatment assignment and groups. Results At baseline, those with high behavioral health symptoms scores reported heavier nicotine dependence and more sedative and/or antidepressant use, compared to participants with low behavioral health symptoms. At 6 months, participants with low behavioral health symptoms scores in the intervention reported higher rates of 30-day abstinence compared to those in the control arm (26% vs 13%, OR = 2.3, 95% CI = 1.8, 2.9). People with high behavioral health symptoms scores reported no difference in 30-day abstinence between the treatment assignments at 6 months (12% vs. 13%, OR = 1.1, 95% CI = 0.6, 2.0). Conclusions Only participants with low behavioral health symptoms scores reported higher abstinence rates in the intervention compared to the state Quitline. Future research can examine alternative approaches for people with worse mental well-being and functioning. Trial registration The parent study is registered at NCT00724308.

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