Catherine McLean Pirkle

Domestic violence (DV) is a public health issue with serious consequences for women’s physical and mental health. During pregnancy, it increases the risk of anxiety and depression and worsens quality of life. Additionally, the physiological changes during this period lead to postural adaptations that contribute to lower back and pelvic pain. These impacts can be even more intense in pregnant adolescents, who are more vulnerable to pre- and postnatal complications, including premature births. The aim of this study was to assess the association between painful symptomatology and DV in pregnant adolescents and adults. This is a cross-sectional observational study resulting from the AMOR project (Adolescence and Motherhood Research), with 41 adolescents and 45 adults during the third trimester of pregnancy. DV (Hurt Insult Threatened Scream scale) and painful symptomatology (the Pelvic Pain Assessment Questionnaire of the International Society of Pelvic Pain) were assessed through self-report. Chi-square and Fisher’s exact tests assessed the associations, considering p < .05. Violence perpetrated by a family member was reported by 33.7% of all the participants and was associated with pain when urinating ( p = .035) and pain when sitting ( p = .047). Intimate partner violence was reported by 23.3% of the sample and associated with pain during sexual intercourse ( p = .041). Reporting violence from any source was associated with pain during sexual intercourse ( p = .026) and pain when sitting ( p = .047). When considering the sample stratified by age, violence perpetrated by family members was higher among adolescents (46.3%) than adults (22.2%; p = .018), and the associations between the different types of DV and painful symptomatology remained significant only among adolescents. Pregnant adolescents are more likely to experience DV and should be identified and evaluated for pelvic pain. Targeted interventions and specialized care are essential to mitigate health risks and improve outcomes for this vulnerable population.

Background: Prospective studies of pregnant adolescents are essencial to effectively address this global health priority. They help answer vital questions about their health, but such studies are uncommon due to the difficulty in retaining adolescents. This paper describes the successes and challenges of the research strategies used to ensure sufficient recruitment and retention of pregnant adolescents in a longitudinal study about adolescent childbearing in an under-resourced setting. Methods: The Adolescence and Motherhood Research project was conducted in a rural region of Northeast Brazil in 2017-2019 and assessed 50 primigravids between 13-18 years (adolescents) and 50 primigravids between 23-28 years (young adults) during the first 16 weeks of pregnancy with two follow-ups (third trimester of pregnancy, and 4-6 weeks postpartum). Recruitment strategies involved engagement of health sector and community, as well as referrals from health care professionals and dissemination of the project in different locations. Retention strategies included maintaining contact with the participants between assessments and providing transportation for them to attend the follow-up procedures. Results: Recruitment took 10 months to complete. A total of 78% of the participants were recruited from the primary health care units, mainly after referral from a health care provider. Retention reached 95% of the sample throughout the study (90%: adolescents; 98%: adults). Conclusion: A combination of approaches is necessary to successfully recruit and retain youth in longitudinal studies and engaging local stakeholders may help to increase community-perceived legitimacy of the research. Working closely with front-line staff is essential when conducting research in rural low-income communities.

A strong and growing evidence base across multiple dimensions of health and wellness supports the value of physical activity with cultural or regional relevance, such as ethnic dance and traditional games. Greater inclusion of culturally and regionally relevant physical activity (CURE-PA) into health promotion is concordant with international public health goals, yet CURE-PAs have traditionally been underused in health and physical activity promotion especially at the population level. The specificity of deep community and cultural context of these activities, an important strength for public health promotion, can obscure communalities in approaches, synergies and outcomes across locations, programmes and populations. Following a narrative review method by a multinational expert team as preparation for the development of formal search protocols in this vast, multidisciplinary literature, this paper: (1) provides a preliminary assessment of the potential size and nature of relevant research, (2) develops a definition of CURE-PA and (3) delineates relevant characteristics supporting inclusion of CURE-PA in population level health promotion. Numerous articles and scientific disciplines with vital evidence on CURE-PA were identified, including nature and health, sport(s), dance, Indigenous health, physical literacy, sociology, political science, youth leadership development, resilience models, community design, ecology, leisure studies, cultural revitalisation and decolonialisation in sports. In formal searches, 100 000s of relevant articles would be found, highlighting the importance of clarifying CURE-PA boundaries, definitions and conceptual models in advance of formal search protocols. A synthesising literature about CURE-PA from a global health promotion perspective can guide future work and support engagement, planning, study, uptake, funding and implementation of CURE-PA in population-level public health. Greater inclusion of CURE-PA in health promotion can help to address physical inactivity as well as chronic disease, mental health concerns, loneliness and other global public health challenges, building from community strengths, preferences and knowledge systems.

Objective: Petroleum hydrocarbons are significant environmental health concerns globally, due to their extensive use and environmental release, including water contamination events such as the 2021 Red Hill jet fuel spill. Research on kerosene and kerosene-based jet fuels is limited, with prior reviews often focused on occupational and post-combustion exposures. No previous systematic review has focused specifically on pre-combustion exposures. Thus, we systematically reviewed evidence of human health impacts associated with these raw fuels across all exposure settings and population groups. Materials and methods: Search strategies and eligibility criteria were developed and executed following PRISMA reporting guidelines and informed by OHAT procedures for systematic reviews. PubMed and Web of Science databases were searched (2017–2024) for eligible literature. Data extraction, analyses, quality assessment and risk of bias appraisals were conducted. Four reviewers participated in these processes. Results: A total of 28 articles were included. Respiratory outcomes were frequently observed following acute kerosene ingestion, whereas neurological outcomes were common with chronic occupational, dermal and inhalation exposure to jet fuel. Evidence of gastrointestinal and dermal outcomes were also documented. Current literature did not allow outcomes with long latency to be assessed. Limited analytical studies and data heterogeneity challenge the ability to establish robust conclusions. Conclusion: Considering the global health implications of kerosene and kerosene-based jet fuel, and recent water contamination events, this review is novel and timely in its focus on unburned fuel. Current evidence on the human health consequences of these fuels is limited. We thus provide recommendations for future studies, including exposure assessment methods, study designs, and prioritization of underrepresented populations.

Introduction: Cardiovascular risk factors (CRFs), such as hypertension, diabetes, dyslipidemia, and smoking are associated with several adverse health outcomes among older people, such as poor physical function. Handgrip strength and gait speed are key measures of physical function that indicate general health status among older people. Nevertheless, it is unclear which factors have the greatest impact on these measures in older adults. In addition, gender differences in cardiovascular disease risk are observed, with older women with a history of diabetes, obesity, and hypertension being more prone to cardiovascular events than older men. This may be related to different patterns of cardiovascular aging, which may impact the physical function of older men and women differently over time. This article aims to describe the protocol for a systematic review to identify which CRFs are associated with measures of physical function (handgrip strength and gait speed) and whether this association varies by sex. Methods and analysis: A systematic search will be conducted in the PubMed, LILACS (Latin American and Caribbean Health Sciences Literature), Cochrane Library, Web of Science and Embase databases. The sorting and tracking of articles will be performed with the help of the Rayyan platform. Following the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P), the main reviewer will conduct the initial search and exclusion of duplicates, and two researchers will extract data from the selected articles independently and blindly, using an instrument built specifically for this research. Discrepancies will be solved by a third reviewer. Cross-sectional and/or longitudinal studies, involving community-dwelling older individuals and that have assessed the association between CRFs and measures of physical function (handgrip strength and/or gait speed) will be included. The methodological quality of the included studies will be assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. PROSPERO registration number: CRD420251167299.

Background : Culturally and regionally relevant physical activities (CRRPA) show promise for disease prevention and strengths-based public health promotion. Understanding engagement across the lifecourse can support effective public health policy, research, and practice. This study examined: (1) factors associated with lifetime CRRPA participation; (2) contexts of practice and the frequency and duration of engagement; and (3) lifetime participation in 4 CRRPA in Hawai‘i (Hula, outrigger canoe paddling, spearfishing, and surfing). Methods : A cross-sectional analysis was conducted among 1044 English-speaking adults in Hawai‘i. Native Hawaiians (NH) and residents of primarily rural islands (not O‘ahu) were oversampled for representation. Lifetime participation in each CRRPA was self-reported and dichotomized. Engagement was characterized by sociodemographic and health-related variables. Frequency, context, and duration were summarized for the total sample and for NH (n = 425). Engagement patterns over the lifecourse are also presented. Results : 69.3% of respondents reported lifetime engagement in at least one CRRPA: 44.9% engaged in Hula, 41.4% in surfing, 34.9% in spearfishing, and 33.9% in outrigger canoe paddling. Most respondents participated in multiple CRRPA; 12.4% engaged in all 4 at some point in their lives. Among NH, family-based participation was common, especially for spearfishing and surfing. The mean session duration for all activities was 2 hours or more, with more frequent engagement reported among NH. Engagement was highest during earlier life stages and declined with age. Trends varied notably by generation. Conclusions : Engagement in CRRPA is widespread across Hawai‘i, underscoring opportunities to advance strengths-based public health promotion, planning, and policy for health equity.

Introduction Culturally and regionally relevant physical activities (CRRPA) show promise for disease prevention and strengths-based public health promotion. Understanding engagement across the lifecourse can support effective public health policy, research, and practice. This study examined: (1) factors associated with CRRPA participation, including gender, race/ethnicity, and chronic disease; (2) contexts of practice, as well as the frequency and duration of engagement; and, (3) lifetime participation in four CRRPA in Hawai‘i (Hula, outrigger canoe paddling, spearfishing, and surfing). Methods A cross-sectional analysis was conducted among 1044 English-speaking adults in Hawaiʻi, recruited through an online panel or by random-digit dialing to complete a survey examining CRRPA engagement in the state. Native Hawaiians and residents of rural islands (excluding Oʻahu) were oversampled for representation. Lifetime participation in each CRRPA was self-reported and dichotomized. Engagement was characterized by sociodemographic and health-related variables. Frequency, context, and duration were summarized for the total sample and for Native Hawaiians (n = 425). Engagement patterns over the lifecourse are also presented. Results Overall, 69.3% of respondents reported lifetime participation in at least one CRRPA. In the full sample, 44.9% engaged in Hula, 41.4% in surfing, 34.9% in spearfishing, and 33.9% in outrigger canoe paddling. Among those reporting having engaged in at least one CRRPA (n = 724), percentages were 64.8% (hula), 59.7% (surfing), 49.7% (spearfishing), and 48.9% (paddling). Most participated in multiple CRRPA, and 12.4% engaged in all four at some point in their lives. Among Native Hawaiians, family-based participation was common, especially for spearfishing and surfing. The average session duration for all activities was two hours or more, with more frequent engagement reported among Native Hawaiians. Engagement was highest during earlier life stages and declined with age. Trends varied notably by generation, with younger generations engaging more than older ones. Lifetime patterns corresponded with important historical events that popularized activities such as Hula and surfing. Conclusions Engagement in CRRPA is widespread across Hawai‘i. Trends varied by demographic and generational factors, underscoring opportunities to advance strengths-based public health promotion, planning, and policy for health equity.

Outrigger canoe paddling (“paddling”) is a culturally and regionally relevant physical activity (PA) in Hawai‘i and the Pacific with potential for public health promotion and disease prevention, yet paddling remains understudied from a public health perspective. This study explored the meaning of paddling across levels of the social–ecological model (SEM) using qualitative methods. The study goal was to develop a research base and inform scholarship about participation in paddling for public health. A total of 1066 Hawai‘i residents (18 + years) completed an online or phone survey about culturally relevant PA. Among them, 362 self-identified as current or former paddlers and responded to the open-ended question: ‘What does outrigger canoe paddling mean to you?’. Qualitative analysis was conducted using a deductive–inductive approach. Findings revealed themes spanning an adapted SEM: (i) intrapersonal—fun, relaxation, PA; (ii) proximal connections—relationships with people past and present; (iii) distal connections—teams, canoe(s), and the ocean “humanized” as part of the community; (iv) environmental—immersion in the natural world; (v) macrosocial—culture, traditions, ancestral knowledge; and (vi) spiritual—life symbolism and spirituality. Many respondents reported multiple levels of the SEM in their responses, which can be seen in this illustrative quote, sharing that padding meant: ‘…physical health, emotional balance, spiritual connection with ocean and self, building trust and communication with a team.’ Paddling fosters health, well-being, and community across SEM levels, making it a strong candidate for PA interventions aligned with best-practice public health guidelines.

Spearfishing, a culturally relevant practice in many locations globally, may foster physical activity and enhance well-being by promoting social cohesion, food security, and nature connectedness, but is understudied in public health promotion and surveillance. This study measured the population-level prevalence of lifetime spearfishing engagement in Hawaiʻi and identified associated factors for public health promotion. The Hawaiian Islands present an ideal setting for such activities due to its central Pacific location and a diverse population with cultural ties to spearfishing. In 2019 and 2020, lifetime spearfishing engagement was added to the Hawai’i Behavioral Risk Factor Surveillance System (N = 12,737). Prevalence ratios (PR) and 95% confidence intervals (95%CI) were estimated for spearfishing “sometimes,” “often,” or “very often” during one’s lifetime, considering sociodemographic, health behavior, and health status variables. A quarter of respondents statewide reported engagement, with higher rates amongst men (41%), Native Hawaiians (43%), other Pacific Islanders (36%), American Indian or Alaskan Native (32%), and rural island residents of Lānaʻi (51%) and Molokaʻi (43%). All age groups reported similar lifetime engagement. After statistical adjustment, those with a high school diploma or less were significantly more likely to have engaged in spearfishing than those with higher education. Spearfishing engagement was also associated with a higher likelihood of meeting physical activity guidelines (PR 1.45 95%CI 1.29-1.63). There is widespread lifelong engagement in spearfishing in Hawaiʻi, especially among Indigenous and rural populations. Supporting culturally relevant activities, such as spearfishing, is a strength-based approach to health promotion with global relevance, including encouraging physical activity.

There is a substantial body of quality research on covid-19 and pregnancy,1 but as is broadly the case in public health,2 a primary focus has been on individual risk factors for adverse maternal and perinatal outcomes, rather than on the contribution of policies and norms on health outcomes. Engjom et al’s individual patient meta-analysis in BMJ Medicine (doi:10.1136/bmjmed-2023-000733) provides compelling evidence that national public health policies had a substantial role in women's risks of hospital admissions due to covid-19.3 Their work also highlights inadequate use of SARS-CoV-2 directed medical treatment for pregnant women with covid-19.3