The negative impact of ambient air pollution on movement behaviours in the global south is a significant concern. Yet, evidence about this complex relationship is limited. This study assessed how precautions taken to prevent ambient air pollution exposure are associated with sedentary behaviour among children and youth in India. Participants aged 5-17 years (N = 986) from 41 schools in 28 urban and rural areas across India completed online surveys to provide information on movement behaviours, including precautions taken to avoid exposure to air pollution, perception of built environment, and sedentary behaviour. Multivariate gamma regression models were developed, adjusting for sociodemographic variables with sedentary behaviour as the primary criterion variable. Apart from an overall sample model, six segregated models were built to understand age, gender, and geographical variations. Children and youth who reported taking precautions to prevent ambient air pollution exposure were associated with significantly higher daily minutes of sedentary behaviour in both the overall sample (β = 0.085, 95 % CI = 0.001, 0.169) and the 13 to 17 age group (β = 0.110, 95 % CI = 0.007, 0.227). However, being able to access outdoor physical activity facilities before or after school was associated with lower sedentary behaviour in the following models: overall, rural, 5 to 12 and 13 to 17 age groups, and boys and girls. To our knowledge, this is the first study to depict a potential paradoxical relationship between precautions taken to avoid exposure to ambient air pollution and higher sedentary behaviour among children and youth in India i.e., a health-preserving behaviour is perpetuating another chronic disease risk factor.

Efficiency-oriented healthcare reforms have led to the closure of obstetric units in several European countries, particularly affecting rural areas that are experiencing depopulation and a decreased birthrate. Using Bourdieu's field theory, this qualitative study aimed to explore how women's economic, cultural, and social capital affects their coping at different stages of maternity. The study was based on 20 semi-structured interviews with women in rural Estonian areas where obstetric units have been closed or face imminent closure because of the low number of deliveries. The findings suggest that the utilisation and interplay of these types of capital are shaped by the geographical context, digital opportunities, and the framework of biomedicalization. From pregnancy through childbirth to the postpartum stage, the importance of economic capital increased because the women were obliged to plan their travel to doctors and hospitals more carefully. The women's cultural and social capital, in the form of information retrieved from the Internet and the availability of family support, was closely associated with their travel decisions. Structural limitations and poor collaboration between healthcare providers and social services hindered capital interplay across fields, especially during the postpartum period. This focus on rural women's lived experiences of coping with maternity care complements previous quantitative studies that have highlighted the health risks associated with the closure of obstetric units in rural hospitals. Our findings suggest that the effect is not overwhelmingly negative, although we observed greater risk for some individuals and varying capabilities in coping with maternity care challenges.

Growing male anabolic steroid use is often framed as symptomatic of a post-industrial masculinity crisis, but little quantitative evidence exists for this account. We examine whether steroid use is associated with geographic exposure to industrial decline, namely historical coal mining, and whether any association is mediated by masculine norms.

Built environmental determinants can drive lifestyle behaviors and potentially reduce chronic disease prevalence. Few studies exist that have examined the association of obesogenic environment exposures with cardiovascular disease (CVD) outcomes. We aim to specifically examine the association between neighborhood walkability, food environment and CVD. Data from 6117 Dutch participants of The Maastricht Study, between the ages of 40 and 75 years in the Netherlands were examined. Home addresses were linked to geographic information systems data from the Geoscience and Health Cohort Consortium to create neighborhood exposures of walkability and food environment. Perceived walkability was obtained from the Abbreviated Neighborhood Environment Walkability Scale. An 11-year incidence of CVD was defined by self-reported non-fatal or fatal event (as registered by Statistics Netherlands). Cox regression models examined the association of environment exposures with incident CVD adjusted for demographic and socioeconomic variables. There was lower incidence of CVD using the perceived walkability questionnaire in those living in the most walkable neighborhood (Quartile 4 HR: .77; 95% CI = .62, .97) but not using the objective walkability index (Quartile 4 HR: 1.10; 95% CI = .89, 1.38). There was no association between the food environment and incident CVD (Quartile 4 HR: .82; 95% CI = .65, 1.04). The discordant findings between walkability measures suggest integrating residential feedback and accounting for lived experiences should be prioritized by policymakers when designing equitable neighborhoods to prevent CVD.

International migration is contributing to changes in the sociocultural and the economic landscapes of many cities in the world. As part of the changes in cities, we are witnessing an increased use of community gardens as spaces for wellbeing restoration, for social connection, and for addressing the challenge of food insecurity, particularly cultural food insecurity. Cultural food security is one major under-recognized issue, yet is pivotal to address given its role in positively supporting immigrants' settlement and health. However, there is lack of comprehensive evidence of how neighborhoods are changing to accommodate these initiatives and meet the cultural food needs of diverse communities. Our scoping review explored evidence from existing literature on how neighborhoods are changing to accommodate community gardens (CG) as a novel means to address cultural food insecurity among immigrant communities and support place-making and resettlement. Our literature search identified several areas of transformations including the different kinds of community gardens that have emerged, the associated physical, social, cultural, environmental, economic, and policy changes that have been reported in other countries in the Global North. The review also identified multifold benefits of CG in this regard, including benefits to health and wellbeing - the physical (i.e. nutrition and physical activity), mental (e.g., a place for healing for immigrants fleeing war-torn countries, domestic violence, trauma; fostering a connection to the land in new environments via place-making), and social (e.g., fostering community connections and cultural knowledge exchange). Despite the known benefits of community gardens to immigrants' health and wellbeing, there remains a lack of comprehensive evidence in Canada on how neighborhoods are changing to accommodate these initiatives and meet the cultural food needs of diverse communities. Such studies will serve as sources of evidence for novel ideas to address the cultural food needs and food insecurity of immigrant communities, which is becoming a growing public health concern.

This study examined variation in county-level cardiovascular disease (CVD) death rates among adults aged 35-64 years using four measures of rural-urban status: Urban Influence Codes, Rural-Urban Continuum Codes (RUCC), National Center for Health Statistics Urban-Rural Classification Scheme, and Core-Based Statistical Areas. We estimated 2021 CVD death rates and used Poisson regression models to calculate rate ratios (RR) for full and dichotomized rural-urban measures. All measures identified the largest RR in the middle of the rural-urban spectrum. RUCC demonstrated patterns by population size and adjacency. RR magnitude varied across dichotomization methods. These findings demonstrate complexity underlying rural-urban differences and can guide public health practice.

Studying and defining social contextual disadvantage in community-living older persons is vitally important, yet no composite indices of social disadvantage have been developed and validated specifically for the geriatric population. The current study aims to create two novel composite indices representing state- and county-level social contextual disadvantage in older (≥65 years) persons in the United States (US), and to evaluate whether disparities in mortality exist between index-defined disadvantaged and non-disadvantaged groups. Publicly-available state- and county-level (2006-2014) contextual factors from all 50 US states and 3132 counties were used to create indices of social contextual disadvantage. Associations of disadvantage-status with mortality (2010-2019) were assessed by negative binomial models. We found mortality rates were significantly higher in index-defined disadvantaged states/counties compared with non-disadvantaged ones for 2010-2015 and 2014-2019. For both periods, compared with non-disadvantaged states, the disadvantaged states had at least 11% increased mortality risk. At the county-level, the disadvantaged counties had an approximately 10% increased mortality risk. The findings suggest that the two indices of state- and county-level contextual disadvantage in older persons may serve as useful tools for identifying place-based disadvantaged populations of older Americans and as multidimensional factors driving mortality disparities. State- and county-level social contextual disadvantage should be considered when formulating public health policies and interventions aimed at reducing health disparities.

Aircraft noise is an important source of environmental pollution and a burden on public health. We examined the association between three different area-level deprivation measures (Carstairs index 2011 only; yearly avoidable mortality rates 2014-2018 and yearly fuel poverty rates 2014-2018) and daily aircraft noise metrics (Lday, Leve, Lnight, and LAeq24) around London Heathrow Airport. Analyses were conducted for 2014-18 for ∼155,000 postcodes using a Random-Effects model with an autoregressive term for the temporal variability of daily noise. We found that the relationship between aircraft noise and deprivation was complex, varying by the measure of deprivation and aircraft noise metric. We observed gradient relationships between avoidable death rates and aircraft noise exposure for all noise metrics. For Carstairs index, a measure of area-based material deprivation, the least deprived quintile exhibited the lowest night-time noise levels, but no gradients were observed for this or other noise metrics. Similarly, we did not see clear patterns of association between fuel poverty and aircraft noise. When stratifying the data by % non-White population, the conclusions for avoidable death rates and fuel poverty remained similar, but an association of Carstairs index with noise metrics was seen in the two tertiles with the highest % non-white population. Our strengths include our large dataset with high temporal and spatial resolution, as well as use of multiple deprivation measures and daily noise metrics over five years, that can capture dynamic changes in noise exposure related to changes in flight paths and weather conditions. Limitations include that we looked at 2014-18 and noise levels have been changing over time due to action plans to reduce exposure, and activity changes due to the pandemic and post-pandemic periods. Heathrow Airport is sited near wealthy and densely inhabited communities so may not be representative of all airports.

Health inequity represents a significant social injustice with major policy implications. This study examines the role of neighborhood intergenerational mobility (IM)-defined as the extent to which children within a specific neighborhood can achieve better socioeconomic outcomes than their parents-in shaping population health, addressing widening health inequalities. We propose that neighborhood IM is positively associated with population health, moderated by spatial dependency and heterogeneity. Analyzing over 69,000 census tracts in the contiguous United States using spatially-lagged X models, we find that neighborhood IM is positively associated with health status. The positive relationship weakens in neighborhoods surrounded by neighborhoods with higher levels of IM and strengthens in neighborhoods surrounded by neighborhoods with lower levels of IM. It also weakens in more advantaged environments-characterized by higher socioeconomic indicators, better built environment features, and more favorable natural environment conditions-and strengthens in less advantaged environments with poorer socioeconomic, built, and natural conditions. Our findings underscore the critical role of neighborhood context and heterogeneity in shaping the effects of social determinants on health, suggesting that policymakers should prioritize resources for disadvantaged neighborhoods with lower IM, particularly those surrounded by similarly low-IM areas, to mitigate health disparities more effectively. Our study provides new insights into the role of neighborhood IM in population health and demonstrates the value of geographic approaches for understanding and mitigating health disparities.

Urban greenspaces are considered an important health asset associated with improved population health and well-being. However, inequalities in access to and use of the outdoors continue to exist, particularly among low-income and minority ethnic populations. Following a socio-ecological approach, this study aimed to investigate the individual, interpersonal, and environmental factors that influence the use of greenspaces among an ethnically diverse community in the UK and explore strategies to increase use. A mixed-methods cross-sectional community survey was conducted between March and June 2022 with residents of two ethnically diverse towns situated in Southeast England, UK. Data were collected on factors that influence greenspace use alongside demographic information on age, ethnicity, and social deprivation. An open-ended question explored respondents' views on strategies to increase engagement with greenspaces. The survey was completed by 906 participants aged between 16 and 94 (60.7% female; 94.5% non-white British). The findings revealed that age, gender, perceived importance of using greenspaces, awareness of greenspaces, and the natural environment were all significant predictors of greenspace use. Qualitative evidence supported these findings and provided useful strategies for increasing access. The findings have provided an increased understanding of the factors that influence greenspace use and suggest that to improve access. There is a clear need to improve the quality of the available green spaces, making them safe and visually appealing to the local communities they serve. Increasing awareness and providing more opportunities for social and intergenerational interaction were also considered important strategies for increasing use.

In the US, racial/ethnic health disparities are undeniable. These disparities partially stem from residing in low socioeconomic neighborhoods, a circumstance to which racial/ethnic minorities are disproportionately exposed. Associations between socioeconomic status (SES) and health may have some underlying molecular mechanisms reflected in the epigenome. Yet, a growing body of research suggests that neighborhood characteristics are not experienced the same way for individuals from differing racial/ethnic backgrounds. The present study evaluated associations between area-based SES and epigenetic age as assessed by the Horvath, Hannum, PhenoAge, and GrimAge epigenetic clocks in a national sample of older non-Hispanic White, non-Hispanic Black, and Hispanic participants. The present study used epigenetic age data from 3790 participants in the 2016 wave of the Health and Retirement Study and census tract SES data from the 2012-2016 American Community Survey. Four epigenetic clocks were regressed on area-based SES, adjusting for age, sex, and educational attainment. Although area-based SES was not significantly associated with Horvath or Hannum clocks, living in lower SES census tracts was associated with older PhenoAge and GrimAge. After considering smoking status, however, only the association with GrimAge remained. Investigating interactions with race/ethnicity suggested that area-based SES was more strongly associated with accelerated Hannum, PhenoAge, and GrimAge among non-Hispanic White participants than for other racial/ethnic groups. These racial/ethnic differences were completely reduced, however, in models that included smoking status. The present results illuminated racially/ethnically distinct patterns of biological (epigenetic aging) and behavioral (smoking) risk for poor health, and suggested that ameliorating low area-based SES may be beneficial for racially/ethnically diverse populations.

While the antioxidative potential of certain vitamins and minerals in cardio-protection has garnered increasing interest, their ability to attenuate associations between air pollution exposure and cardiometabolic diseases (CMDs) remains unexplored. This study examined the associations of air pollution (particulate matter including ultrafine particles (UFP), and nitrogen oxides, including NO and NO) and six dietary antioxidants with incident non-fatal CMDs in 30,519 EPIC-NL study participants. Data on CMD incidence (total cardiovascular disease (CVD), acute myocardial infarction (AMI), coronary heart disease (CHD) and heart failure (HF)) and Type 2 Diabetes Mellitus (T2DM) diagnoses were obtained from medical registries. Annual average ambient concentrations of air pollutants at the participants' baseline residential addresses were predicted using land use regression models. Dietary intake of antioxidants was assessed via a food frequency questionnaire. Multivariable Cox regression models were used to explore associations. Exposures to NO and UFP were associated with elevated HF risk (Hazard Ratio (HR) (95 % CI): 1.24 (1.00, 1.54) and 1.69 (1.04, 2.76), respectively). Higher beta-carotene intake was associated with reduced risk of total CVD and CHD incidence (HR (95 % CI): 0.94 (0.89, 0.99) and 0.92 (0.84, 0.99), respectively), whereas, in general, antioxidant intake was positively associated with incident T2DM. Interaction analyses indicated some variability in CMD risk by antioxidant intake, but none of these interactions remained significant after correcting for multiple comparisons. These findings indicate that the associations of air pollution with incident CMD do not differ by dietary antioxidant intake.

Menstruation has received growing attention in public health research, particularly among adolescents in schools. However, fewer studies have engaged adult men. This secondary analysis (1) assessed alignment between men's perceptions of women's menstruation practices and women's actual practices; 2) examined associations between men's demographic characteristics and their perception of menstruation-related communication norms, and 3) assessed if men's perceptions of these norms are associated with their support of menstruating women or girls in their household. Cross-sectional data were collected via household survey from men (n = 344) and women (n = 297) in Kampala, Uganda in 2022. Outcomes were two norms questions on the appropriateness of discussing menstruation in public and in front of men. We used a combination of Poisson and Firth's regressions. Presence of a menstruator in the household was positively associated with men's perception that it is acceptable to discuss menstruation in front of men (PR: 1.37; 95% CI: 1.07, 1.76; p < 0.01) or in public (PR: 1.12, 95% CI: 1.12, 2.46; p < 0.01). Supportive norms were associated with supportive behaviors; men who agreed that women may discuss menstruation in public and in front of men were more likely to report a willingness to talk to women about menstruation-related problems (PR = 1.75, 95% CI: 1.38, 2.22; p < 0.001). Our findings support the need for norms change to reduce stigma around discussing menstruation. Programs aiming to improve menstrual health should consider men's knowledge of menstruation, their role in the household environment around menstruation, and how norms may contribute to how they support menstruators in their households.

Noise is a major global environmental issue that raises concerns about both mental and physical health. However, few studies have investigated the mediating role of emotions in the pathways linking noise exposure to health outcomes. Additionally, many studies have overlooked the varying effects of noise across different activity contexts. Most importantly, previous research has predominantly relied on correlational analysis, offering limited evidence of causality. In this study, we utilize real-time data from an environmental health survey of 800 residents in Hong Kong collected between 2021 and 2023 and apply a neural network-based Double Machine Learning model to estimate the pathways through which noise influences emotional states and health outcomes. Our findings reveal that (1) noise during travel significantly heightens real-time annoyance, while noise at home primarily increases real-time stress; (2) annoyance strongly contributes to headaches, whereas stress predominantly leads to insomnia and fatigue; and (3) noise at home directly triggers insomnia and fatigue, whereas noise during travel not only directly causes insomnia and headache but also indirectly exacerbates insomnia, fatigue, and headache through heightened annoyance. In contrast, noise in the workplace and outdoors has a limited impact on insomnia, fatigue, and headaches. This study provides valuable insights into the pathways through which noise influences negative emotional states and, subsequently, health outcomes, offering a methodological framework for unraveling the "black box" of environmental health relationships.

Renters generally experience higher psychological distress than homeowners, which may be partially due to financial strain and difficulties to cover the costs of living. Whether interventions targeting financial strain will reduce the mental health disparities between renters and homeowners needs further investigation.

Palestinian youth in the West Bank, occupied Palestinian territory (oPt) live in proximity to various forms of Israeli occupation infrastructure, such as checkpoints, road obstructions, a separation barrier, and Israeli settlements. We investigated the effect of proximity to such infrastructure on youth mental health and health risk behaviors by linking geospatial data on the locations of occupation infrastructure to geocoded survey data collected from a representative sample of Palestinian youth living in the West Bank. We estimated the relationship of youth mental health and proximity to each type of occupation infrastructure with controls for exposure to conflict-related violence and a range of demographic factors. We found that youth mental health is strongly negatively impacted by proximity to manned checkpoints (for males and females) and proximity to settlements (for females), and these impacts appear to be direct rather than mediated by conflict-related trauma exposure. The results indicate the importance of environmental aspects of the conflict for youth mental health, in addition to conflict-related violence itself.

Public toilets are an important resource for securing gender equitable access to public space, but they are neglected across global contexts. This qualitative study explored the status, opportunities and challenges to creating menstrual friendly public toilets (MFPTs) in six cities: Barcelona, Kampala, Manila, New York City, Osaka, and Rio de Janeiro.

The blood pressure control status and its influencing factors in elderly patients with essential hypertension are complex. Existing studies often overlook spatial differences or utilize coarse spatial scales, which limits the understanding of the fine patterns of spatial heterogeneity and the design and implementation of further prevention and control policies.

This study explored linkages between natural resources and determinants of fertility decisions in Greenland. Interviews were conducted with 26 policymakers and key stakeholders in two communities about climate adaptation, hunting and fishing, economic development, and fertility and reproductive health. Participants link fertility outcomes to disparate community socioeconomic circumstances that affect individual access to education and financial mobility. Workforce and education challenges in Greenland limit ability to expand culturally grounded reproductive healthcare. Coordinating healthcare, education, and housing policy may improve material resources to support fertility decisions in Greenland. We contextualize drivers of fertility decisions within Greenland's climate adaptation policy options.

Understanding the role of place in connection to Indigenous youth participation in nature-based traditional and spiritual activities (NBTSA) is of primary concern as exposure to both nature and culture collectively contribute to overall health and wellbeing. From oppressive historical Indian policies to contemporary barriers by way of climate change and increased use of technology, Indigenous youth continue to face risk of detaching from nature and losing pieces of their cultural identity. Qualitative and quantitative features of place in predicting NBTSA participation among Indigenous youth are not well understood and may offer key insights that connect youth to land, water and their cultures. Moreover, application of the Indigenous Traditional Ecological Knowledge (ITEK) theoretical model to inform the social sciences has largely been absent. In this study, we sought to investigate the role of place measured by residing in a sovereign Tribal or First Nation (qualitative) and increased presence of greenspace (quantitative) exposure on participation in NBTSAs among Indigenous youth. Our findings demonstrate that although increasing residential exposure to greenspace had a positive association, residing in a Tribal Nation was a stronger predictor for NBTSA participation. Applying an Indigenous methodology to research with Indigenous populations and communities allows us to move beyond general notions of what (e.g., greenspace) promotes human-nature interaction and, instead, identify place-based determinants. Namely, the ITEK framework guided our rationale to include Tribal Nations in our study. Sovereign Nations connect youth to traditional knowledge holders that share Indigenous knowledges and practices of the land and water through story and experiential learning. Significance. This study is one of the first to measure both qualitative and quantitative features of place that influence human-nature interaction among youth that collectively identify as Indigenous. Our research found that residing in a sovereign Tribal Nation is a stronger predictor than increasing exposure to greenspace for participating in land- and water-based traditional and spiritual practices providing evidence and public health implications for Indigenous determinants to health and wellbeing.

Lasting results of federal government influence for housing on-reserve include challenges with housing quantity and quality. Some First Nations communities face distressing housing shortages and household crowding. This study used a cross-sectional survey and the Canadian National Occupancy Standard definition of crowding to explore how household crowding affects health of people living on-reserve. and. First Nations Peoples from two reserve communities in Saskatchewan participated, a total of 831 individuals 18 years and older from 379 households. Household crowding and reports of respiratory diseases were high. The household crowding measure was significantly associated with chronic bronchitis. A culturally appropriate lens and more context are needed to understand household crowding on-reserve.