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Background: Lead is an environmental health hazard that disproportionately impacts communities of color across the United States (U.S.). Recent incidents of widespread lead exposure have been linked to aging infrastructure, historical land use, and challenges in lead remediation.

Objective: To understand community-identified concerns, needs, and priorities related to lead exposure.

Methods: Four focus groups with a total of 73 community members, were conducted in Norristown, Pennsylvania, U.S. from Fall 2022 to Spring 2023. Using a community-based participatory research (CBPR) framework and a semi-structured interview guide, participants were asked questions regarding their perceived exposure to lead and current exposure prevention methods. Open coding was used to conduct a thematic analysis of the transcript data.

Results: Four themes were identified: (1) community reportesources of concern, including water, soil, and paint; (2) lack of information surrounding lead, particularly in Spanish; (3) systemic neglect, from workplaces, healthcare systems, and landlords; and (4) financial implications, from high costs and fear of displacement. Participants expressed a desire for lead testing of household water, paint, and soil, as well as personal blood lead level screening.

Conclusions & implications: : There was broad community support for a lead exposure risk assessment that investigated soil, tap water, and paint sources of lead, as well as the prevalence of elevated blood lead levels in adults and children. The study also highlighted the lack of information about lead exposure in non-English speaking communities, the need for providing language-appropriate information, and the necessity for multiple lead exposure assessment methods.

Supplementary information: The online version contains supplementary material available at 10.1007/s44155-025-00344-9.

Background: In Uganda, despite ongoing efforts to promote skilled birth attendance, many women in rural communities continue to deliver with Traditional Birth Attendants (TBAs). Understanding the reasons behind this preference and the nature of care provided by TBAs is critical for informing maternal health policy and community-level interventions.

Objective: To explore the experiences, perceptions, and underlying factors influencing the continued use of TBAs for childbirth among postpartum women in Mayuge District, Eastern Uganda.

Methods: A descriptive qualitative study was conducted in Mayuge District. In-depth interviews were held with 12 postpartum women who had delivered with TBAs within the past six months. Participants were purposively selected to capture variation in age, parity, and location. Data were collected using a semi-structured interview guide, audio-recorded, transcribed verbatim, and translated into English. Thematic analysis was conducted using both inductive and deductive coding in NVivo 13.

Results: Five overarching themes emerged: (1) Health System Barriers, including poor access to health facilities, transport challenges, and mistreatment by health workers; (2) Perceived Benefits of TBA Care, such as affordability, emotional support, privacy, and flexible payment options; (3) Traditional Practices and Beliefs, with participants emphasizing cultural alignment, spiritual care, and birth rituals provided by TBAs; (4) Health Risks and Limits of TBA Care, reflecting awareness of complications, delayed referrals, and lack of emergency support; and (5) Community Influence, where social norms, peer recommendations, and collective trust in TBAs shaped decision-making. A cross-cutting theme of husband and family involvement also significantly influenced birth location choices.

Conclusion: The continued reliance on TBAs is shaped by a complex interplay of structural barriers, cultural values, perceived advantages, and community dynamics. Interventions to improve maternal health in rural Uganda should address health system gaps, promote respectful and culturally sensitive facility-based care, and engage families and communities in birth preparedness efforts.

Background: Malaria in pregnancy remains a serious public health concern in sub-Saharan Africa. The household head as a primary decision-maker plays a major role in women's utilization of maternal health services. This study aimed to examine the trends, and the association between the sex of household head and the uptake of intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP) in six sub-Saharan African countries. The findings provide insight into the progress, status and gender-specific barriers to IPTp-SP uptake.

Methods: Secondary data from the most recent Malaria Indicator Surveys for the six countries were analysed. A total of 15,452 (weighted) women aged 15-49 years from the six countries were included in this study. Both descriptive and inferential statistics were computed, including a chi-square test and binary logistic regression.

Results: The pooled data showed that 77% of the participants took at least one dose of IPTp-SP and 37% took ≥ 3 doses. The trend analysis showed that the uptake of IPTp-SP has increased over time. Women with a female household head (AOR = 1.21, 95% CI 1.08-1.38) had higher odds of taking ≥ 3 doses of IPTp-SP compared to those with a male household head.

Conclusion: The findings suggest that promoting women's participation in decision-making and leadership at the household level may help increase the uptake of IPTp-SP in sub-Saharan Africa.

Introduction: Poor living conditions and poverty in urban slums mean that informal health providers (IHPs) often dominate health service provision in such settings. We explored the capacity of leaders within slums to contribute to linking IHPs to formal health providers (FHPs), for improved access to quality health services in slums.

Method: We purposively selected and interviewed 16 community leaders across 8 urban slums in Enugu and Anambra states in Southeast Nigeria. Transcribed interviews were then analyzed using thematic analysis aided by NVIVO.

Finding: Chairpersons and local vigilante security outfits were ubiquitous across urban slum communities- coordinating and influencing actors and health activities within settlements. Oversight functions and lived experiences meant leaders had a good insight into existing community dynamics. Slum leaders acknowledged the differential roles, as well as the strengths and weaknesses of FHPs and IHPs. Linkage establishment was considered potentially useful, and leaders were willing to assist, if the existing shortcomings in FHPs were addressed.

Conclusion: Despite being under-recognized, leaders in urban slums have the potential to help the realization of health goals given their grassroots influences. Leaders in urban have strategic positional knowledge and leverage that could catalyze the IHP-FHP linkage conversation and implementation towards improving access to quality healthcare services in slums.

The HIV incidence rate in Miami-Dade County is among the highest in the United States, with Latinx sexual and gender minority (SGM) groups experiencing a disproportionate burden. Despite extensive efforts by both private and public sectors to curb transmission and improve pre-exposure prophylaxis (PrEP) uptake, Latinx SGM groups continue to have high rates of HIV and low PrEP uptake compared to SGM groups overall. Using data collected from a biobehavioral study of the socio-structural factors affecting HIV susceptibility and PrEP uptake among Latinx SGM subgroups in Miami-Dade County, this paper shares lessons learned and provides concrete recommendations for tailoring survey research and biospecimen collection among a largely immigrant, socioeconomically disadvantaged community that is especially vulnerable to HIV. By drawing inferences from study data and contextualizing these with community partners, we learned: (1) Large parts of the target community may be unfamiliar with the underlying constructs captured in important HIV-related measures; (2) Cash incentives may shift motivation from intrinsic to extrinsic and lead to poorer data quality; (3) Deviations in Spanish go beyond vocabulary used in different Latin American countries, and more formal Spanish may relay concepts in unfamiliar ways that are unapproachable; and (4) community members may be unfamiliar with survey data collection processes and the protections in place to ensure confidentiality. These lessons and associated recommendations may help improve recruitment, study design, analysis, and community engagement in future studies, building trust and ultimately reducing the burden of HIV in these communities.

Purpose: The study examines the challenges of implementing nutritional programs to address severe acute malnutrition in children under five, a major cause of illness and death in Ethiopia. This paper examines why nutritional programs are ineffective in Eastern Ethiopia.

Methods: The research, conducted from April to June 2023 and from February to March 2024, included in-depth interviews, focus groups, and participant observations with mothers, healthcare workers, and traditional birth attendants. Thematic analysis was employed to identify key themes within the transcribed and coded data.

Results: Five themes representing challenges in implementing nutritional feeding programs to address severe acute malnutrition among children under five were identified in the interviews, focus group discussions and observations. These themes are: management steps for severe acute malnutrition; the role of grandmothers in severe acute malnutrition treatment; the 1000-day approach to tackle malnutrition at early stages; behavioural and knowledge-building focused intervention; and factors influencing the management of SAM among health workers. The feeding program is hindered by too high workloads of the healthcare workers, limited access to healthcare facilities, inconsistent availability of nutritional supplements, and inadequate support for malnutrition. Delayed health-seeking behaviours pose behavioural challenges.

Conclusions: The feeding program encounters challenges due to limited access to healthcare, inconsistent availability of nutritional supplements, inadequate support for malnutrition, and delayed health-seeking behaviour. Addressing malnutrition begins before a child's birth and requires a comprehensive and long-term strategy. Intergenerational caregiving and effective collaboration between communities and healthcare workers can offer valuable insights.

Background: Self-rated health (SRH) strongly predicts future mortality, even after controlling for various confounding factors. This study investigates two potential confounders of the SRH/mortality relationship-shared family background and genetics.

Methods: We analyze a dataset of several harmonized twin studies from the integrating genes and environment from multiple studies consortium. Utilizing a within-between twin methodology, we assess whether the SRH/mortality relationship can be explained by social and genetic inheritance.

Results: Our within-twin estimates are notably lower than the observational estimates, although the difference is statistically non-significant, indicating no substantial confounding from family background. Additionally, we find no significant interaction effects by zygosity, suggesting no confounding from shared genetic factors.

Conclusions: SRH has been shown to be robust to multiple sources of variation, including demographic sub-groups and contemporary controls for clinical assessments. This study reaffirms the resilience of the SRH/mortality relationship against confounding from shared family background and genetic factors.

Introduction: Fair work conditions are essential for promoting health among workers, communities, and society. Yet, historically farmworkers have been impacted by precarious and exploitative work conditions. Given the scarce research in Michigan with farmworkers, in 2019 we developed the Michigan Farmworker Project (MFP), guided by community-based participatory principles and in partnership with state and local organizations. This study assesses qualitative data collected from the first study of the MFP, specifically perceptions, knowledge, and experiences related to exploitative work and labor trafficking.

Method: We employed a framework analysis approach with 56 in-depth interviews with farmworkers (migrant, seasonal, H-2 A) and stakeholders from different service areas (social, educational, health care, legal and outreach) in Michigan.

Finding: Findings show the following emergent themes: (1) deceptive recruitment, (2) abuse of worker social vulnerability, (3) exploitative and hazardous work conditions, (4) coercion and threats, (5) wage theft, (6) document retention, (7) isolation and employer control, (8) confinement and physical and sexual violence, (9) experiences and perceptions of labor trafficking, and (10) fragmented systems and policy failures, underscoring the need for integrated federal, state and local regulatory responses to anti-trafficking efforts.

Conclusion: Exploitation of workers can be prevented by an independent regulatory body that enforces accountability and transparency from employers throughout the employment process. Federal and state level efforts on policies that promote decent and fair employment are sustainable development goals needed to address labor exploitation.

Supplementary information: The online version contains supplementary material available at 10.1007/s44155-025-00258-6.

Background: People with chronic illnesses such as Human Immunodeficiency Virus (HIV), hypertension, and Diabetes Mellitus (DM) are a priority for Coronavirus disease (COVID-19) vaccination due to elevated risk of severe disease. We explored the perspectives and experiences of COVID-19 vaccination among these priority populations in Southwestern and Southcentral Uganda.

Methods: Between January and April 2023, we conducted in-depth interviews with adult (≥18 years) persons living with HIV (PLWH), hypertension and/or DM (n = 30) and key informant interviews with healthcare providers and managers (n = 12) at Mbarara and Masaka Regional Referral Hospitals. We used the Behavioral and Social Drivers model to explore the factors that influenced COVID-19 vaccination. We coded the data using Dedoose software and analyzed them using thematic deductive analysis.

Results: Motivations to take the COVID-19 vaccine included fear of COVID-19, observing the effect of COVID-19 or the vaccine on others, vulnerability from underlying illnesses, family and social support, health worker recommendation, vaccine benefits and trust in the vaccine. Fear of side effects and vaccine interactions with antiretroviral, antihypertensive or antidiabetic medications, misinformation, rapid vaccine development and rollout, inadequate sensitization, and healthcare providers' hesitancy hindered uptake. Furthermore, health system challenges like stockouts and long queues hindered uptake or dose completion.

Conclusion: Fear of COVID-19, trust in the vaccine, family and social support facilitated COVID-19 vaccination uptake. Conversely, fear of side effects, vaccine and medication interaction, misinformation and inadequate sensitization hindered vaccine uptake. Effective communication strategies involving health workers and community leaders and sustained vaccine supply are crucial to improve COVID-19 vaccine uptake.

Supplementary information: The online version contains supplementary material available at 10.1007/s44155-025-00199-0.