Low Awareness Research Articles

Circular Economy in Morocco: Status and Perspectives and Policy Implications for Vietnam

This paper explores the current status of the circular economy (CE) in Morocco, its potential future directions, and policy implications for Vietnam. The concept of CE, which promotes sustainable resource use, waste reduction, and regeneration, is increasingly gaining global traction. Morocco, having made significant progress in sectors such as waste management, agriculture, renewable energy, and water resource management, serves as a valuable case study. Key initiatives like the National Solid Waste Management Program (PNDM) and the "Green Morocco Plan" highlight Morocco’s successful integration of CE principles. Despite challenges such as financial constraints and low public awareness, Morocco's transition to a circular economy presents numerous opportunities, including job creation and innovation. For Vietnam, which faces growing environmental and resource pressures, Morocco’s experience offers critical insights. By adopting CE principles in waste management, agriculture, renewable energy, and water management, Vietnam can move toward more sustainable development. The paper suggests specific policy recommendations, including fostering public-private partnerships, enhancing regulatory frameworks, and promoting green financing. The lessons drawn from Morocco’s journey can help Vietnam align its growth with environmental sustainability, positioning both countries as leaders in the global shift towards a circular economy.

Environmental Impact of Waste Produced in Street Markets: A Study on Challenges and Opportunities in Serra Da Ibiapaba, Ceará

Objective: The objective of the article is to analyze the environmental impact of vegetable waste produced in street markets in the Serra da Ibiapaba region, Ceará, Brazil, and propose solutions to the identified impacts in order to achieve the Sustainable Development Goals. Method: This is a qualitative and quantitative research study that uses field data collection, the Leopold matrix for environmental impact assessment, and descriptive analysis to evaluate the current state of waste management practices in the region. Results and Discussion: The results indicate that inadequate waste management practices lead to environmental pollution, including the presence of insects and leachate in urban areas. The study identifies common problems related to waste management and low environmental awareness among vendors and public authorities. Originality/Value: The Serra da Ibiapaba region is an important agricultural area in Brazil, and the inadequate disposal of vegetable waste in street markets poses relevant environmental challenges for society. This research is relevant because it addresses a gap in the literature regarding the environmental impacts of street market waste in a region that is significant both environmentally and economically, offering practical solutions aligned with the Sustainable Development Goals.

Building and Sustaining Public Trust in Health Data Sharing for Musculoskeletal Research: Semistructured Interview and Focus Group Study.

Although many people are supportive of their deidentified health care data being used for research, concerns about privacy, safety, and security of health care data remain. There is low awareness about how data are used for research and related governance. Transparency about how health data are used for research is crucial for building public trust. One proposed solution is to ensure that affected communities are notified, particularly marginalized communities where there has previously been a lack of engagement and mistrust. This study aims to explore patient and public perspectives on the use of deidentified data from electronic health records for musculoskeletal research and to explore ways to build and sustain public trust in health data sharing for a research program (known as "the Data Jigsaw") piloting new ways of using and analyzing electronic health data. Views and perspectives about how best to engage with local communities informed the development of a public notification campaign about the research. Qualitative methods data were generated from 20 semistructured interviews and 8 focus groups, comprising 48 participants in total with musculoskeletal conditions or symptoms, including 3 carers. A presentation about the use of health data for research and examples from the specific research projects within the program were used to trigger discussion. We worked in partnership with a patient and public involvement group throughout the research and cofacilitated wider community engagement. Respondents were supportive of their health care data being shared for research purposes, but there was low awareness about how electronic health records are used for research. Security and governance concerns about data sharing were noted, including collaborations with external companies and accessing social care records. Project examples from the Data Jigsaw program were viewed positively after respondents knew more about how their data were being used to improve patient care. A range of different methods to build and sustain trust were deemed necessary by participants. Information was requested about: data management; individuals with access to the data (including any collaboration with external companies); the National Health Service's national data opt-out; and research outcomes. It was considered important to enable in-person dialogue with affected communities in addition to other forms of information. The findings have emphasized the need for transparency and awareness about health data sharing for research, and the value of tailoring this to reflect current and local research where residents might feel more invested in the focus of research and the use of local records. Thus, the provision for targeted information within affected communities with accessible messages and community-based dialogue could help to build and sustain public trust. These findings can also be extrapolated to other conditions beyond musculoskeletal conditions, making the findings relevant to a much wider community.

Identifying Motivators, Facilitators, and Barriers to Engagement and Retention in Anal Cancer Screening Among Men and Women with HIV in One Ryan White HIV/AIDS Clinic.

Anal squamous cell carcinoma disproportionally affects people with HIV (PWH); however, engagement in anal cancer screening is low in many settings. This study was conducted to assess knowledge and perceptions of anal cancer screening to identify factors in the engagement and retention in prevention services among PWH. Semistructured interviews were conducted among adult PWH eligible for anal cancer screening in our Ryan White HIV/AIDS Program clinic. Descriptive statistics were tabulated; thematic analyses were performed to identify emerging motivators, facilitators, and barriers. Among 26 PWH, 9 had not been screened, 8 had undergone Papanicolaou (Pap) testing alone, and 9 had undergone anoscopy. The median age of the cohort was 55.2 years; 54% identified as men who have sex with men, and 54% identified as Black. In the unscreened cohort, participants were motivated by investing in their health and positive attitudes toward cancer prevention however were deterred by a lack of referral and low awareness about screening. Among those who had Pap testing, trust in healthcare providers and abnormal testing results were motivators to engagement, whereas lack of perceived risk of anal cancer and worry about pain of an anoscopy were prominent barriers. Among those who had anoscopy, perceived risk, positive experience with the procedure, and use of anxiolytics prior to anoscopy were motivators, whereas anxiety around a new cancer diagnosis and negative experience with anoscopy were barriers. Clinics seeking to build or strengthen their anal cancer screening programs can address the barriers described in this study to promote access to anal cancer screening among PWH.

“I think they only study seawater”: Oceanography classroom career panel as a tool to promote geoscience career awareness

The utilization of a professional geoscience career panel as a curricular classroom activity can be essential for promoting career awareness. By interacting with professionals, students can be exposed to diverse geoscientific careers, helping them understand various professional paths and the real-world applications of their studies. Using social constructivism and critical reflection theories of learning, we designed and implemented a two-day career panel attended by ten ocean scientists in an undergraduate oceanography course for majors and non-majors. We used a qualitative, quasi-experimental design involving pre-and-post reflection data collected from the treatment group (n = 22) and control group (n = 19), and five post-treatment interviews to evaluate the effectiveness of the career panel on students’ ocean science career awareness. While the pre-reflections revealed that students in both the treatment and control groups had low awareness and knowledge about ocean science careers and practice, students in the treatment group showed improved awareness about ocean science careers and disciplines, processes of ocean science work, and the social and cultural impact of ocean science work after attending the career panel. Students in the treatment group also showed increased interest in ocean science and geosciences in general. Results indicate classroom career panel that include personal narratives, discussions, and students’ critical reflections can be effective tools to promote career awareness and interest in the geosciences. We provide implications for geoscience education such as supplementing classroom career panel with hands-on activities (e.g., job simulations), advanced organizers (e.g., worksite visits), and experiential learning opportunities (e.g., internships) as instructional tools to promote students’ career awareness.

Gender equality in family relations: legal aspects of protecting the rights of women and men in marriage

Gender equality in family legal relations is one of the main foundations of modern legal and social development. The article is devoted to the systematic analysis of the principle of gender equality in family relations as one of the fundamental tasks of the state and society. This study acquires special importance in the context of global political processes, international obligations of Ukraine and its European choice. The theoretical and practical importance of this issue is decisive for legal principles and the development of national society. Implementation of the principles of gender equality in family relations is important not only from the point of view of justice, but also for ensuring the harmonious development of society in general. The article examines the concept of gender equality in detail and determines its impact on the realization of property rights of participants in family relationships. On the basis of an in-depth analysis of scientific provisions, the legal nature of economic relations of spouses and their importance in the science of family law have been clarified. It is emphasized that family legislation reflects the concept of gender, taking into account all aspects of gender issues. Its purpose is to strengthen the principles of egalitarian democracy in the family, to ensure equal opportunities for the realization of constitutional rights, freedoms and duties of both an individual and a citizen. Legal awareness is defined as the basis of the mechanism for ensuring gender equality in Ukraine. The importance of gender equality for achieving stability and harmony in the family and society in general is emphasized. It has been established that there are problems of low legal awareness of citizens in general and specific problems of gender inequality in the country. It has been studied that gender equality in family relations is becoming more and more relevant and necessary in modern society. The meaning of gender equality as equal recognition of rights and opportunities for men and women in all aspects of family life is considered. Through the analysis of the legal aspects of the protection of the rights of women and men in marriage, highlighting the practical aspects of the realization of these rights and the analysis of socio-cultural influences, the formation and application of gender equality in modern family relations has been studied. It was noted that achieving gender equality in family relationships is a complex process that includes both legal and socio-cultural aspects. In particular, this issue is closely related to the fight against gender stereotypes, which can still affect attitudes towards the roles of men and women in the family. Therefore, the effective provision of gender equality in family legal relations requires not only the improvement of legislation, but also a change in public consciousness.

Analyzing Changes in Attitudes and Behaviors towards Seasonal Influenza Vaccination in Spain’s Adult Population over Three Seasons

Background/Objectives: The experience of the COVID-19 pandemic has turned the spotlight on the importance of public health measures and disease prevention. Despite this, the acceptance of influenza vaccination has remained low in most countries (and far from the 75% target set by the World Health Organization). The objective of this study has been to investigate how attitudes and behaviors regarding influenza vaccination in the Spanish adult population have changed over the last three years (from 2021 to 2024) in order to analyze trends in influenza vaccination. Methods: To this end, a cross-sectional study was conducted through 2206 telephone interviews, and the results were compared with those obtained in previous campaigns. Results: The findings indicate a significant decline in overall vaccination intent. Healthcare professionals remain the most influential factor in encouraging vaccination, yet there is a notable increase in the lack of vaccine recommendations, contributing to the decision not to vaccinate. This study also reveals low awareness of the influenza vaccine campaign, emphasizing the need for improved public health communication. Conclusions: To counteract these trends, this study recommends intensifying awareness campaigns, strengthening the role of healthcare providers in vaccine advocacy, and tailoring communication strategies. These efforts are crucial to enhancing vaccination coverage and protecting vulnerable populations against influenza.

MODELING HYPERTENSION DISEASE RISK IN INDONESIA USING MULTIVARIATE ADAPTIVE REGRESSION SPLINE AND BINARY LOGISTIC REGRESSION APPROACHES

In the pursuit of the Sustainable Development Goals (SDGs), health-related challenges, especially hypertension, remain a significant global issue. The third goal of the SDGs aims to improve the quality of life and well-being of all individuals, but hypertension is a serious problem that can hinder these goals. Often referred to as the "silent killer" by the World Health Organization (WHO), hypertension is exacerbated by low awareness. Globally, more than 1.28 billion adults suffer from hypertension, with most cases in lower to middle-income countries, including Indonesia. Indonesia has an alarming rate of hypertension incidence, ranking fifth highest in the world. Riset Kesehatan Dasar (Riskesdas) 2023 and the Indonesia Family Life Survey (IFLS) are critical for understanding hypertension risk factors in Indonesia. The IFLS data, obtained from www.rand.org, includes observations from October 2014 to April 2015, totalling 85 observations. Despite being over 10 years old, this dataset was selected because it remains the most recent comprehensive data available from RAND, representing 83% of the Indonesian population. The IFLS is conducted every 7-8 years, with the next wave of data expected soon. Most studies on hypertension globally and in Indonesia use parametric regression methods. However, a research gap exists as no studies have used Multivariate Adaptive Regression Splines (MARS) on IFLS data to analyze hypertension risk factors. This study addresses this gap by comparing binary logit regression and MARS. The analysis shows the Apparent Error Rate (APPER) for MARS is 84.706%, while for binary logistic regression it is 80%, indicating MARS is better at classifying hypertension data in Indonesia. Using MARS offers a novel approach to understanding hypertension risk factors in Indonesia. Despite the data's age, it remains relevant as primary causes and risk factors for hypertension have not changed, making the findings valuable for current health policy and strategies.

Conjoint Analysis to Measure Millennial Generation's Preferences on the Role of Technology in the Existence of Mitra Batik Cooperatives in Tasikmalaya

As a people's economic movement founded on the concept of kinship, a cooperative is a corporate company made up of individuals or cooperative legal entities that engage in cooperatively-based activities. In the city of Tasikmalaya alone there are 603 ooperatives with an active level of 44%. Mitra batik cooperative is one of the oldest consumer cooperatives in Tasikmalaya. In an effort to develop cooperatives, mitra batik cooperatives are faced with a situation where they still have various obstacles for their development, one of which is the low interest and awareness of the community members to participate in cooperatives. In an effort to increase the number of cooperative members, the authors intend to conduct research on the preferences of Tasikmalaya people, especially millennial generation to participate in maintaining the existence of mitra batik cooperatives. The method used is conjoint analysis. According to the research results, millennials consider technology the most significant aspect in preserving mitra batik cooperatives in Tasikmalaya. In the digital age, technology is a crucial element. Millennials like technology's ease. The millennial generation must develop technology to preserve mitra batik cooperatives in Tasikmalaya. Due to the fast expansion of banking, particularly in technology, cooperatives must keep up with technology.

Knowledge and Attitudes Regarding the Inappropriate Use of Proton Pump Inhibitors Among Students of Umm Al-Qura University in Saudi Arabia: A Cross-Sectional Study.

Background Proton pump inhibitors (PPIs) are commonly prescribed to manage various upper gastrointestinal conditions such as dyspepsia, gastroesophageal reflux disease (GERD), and peptic ulcer disease. However, concerns are increasing regarding their excessive and inappropriate use, particularly in cases where there is no clear medical indication. Inappropriate use can lead to unnecessary side effects and complications, emphasizing the need for better awareness of appropriate PPI use. Objectives This study aimed to assess the knowledge and attitudes of Umm Al-Qura University (UQU) students in Makkah, Saudi Arabia, regarding the inappropriate use of PPIs, highlighting the necessity of targeted educational interventions to improve awareness and promote safe PPI practices. Methods A cross-sectional online survey was conducted among 534 UQU students, aged 18-30, from both health-related and non-health-related majors. Participants were selected through convenience sampling, with the questionnaire distributed via Google Forms across various channels. Data were prepared using Microsoft Excel and analyzed with IBM SPSS Statistics for Windows, V. 25.0 (IBM Corp., Armonk, NY, USA). Results The survey revealed a significant lack of awareness about the potential side effects of PPIs, with 48.1% of participants (n=247) exhibiting low awareness, 30.9% (n=165) demonstrating high awareness, and 21% (n=112) showing moderate understanding. A chi-squared test confirmed that this awareness distribution significantly differed from what was expected, χ²(2, n=534)=60.48, p<0.001. In terms of behavior, 70.4% of participants adhered to good practices regarding PPI use, following appropriate guidelines such as using PPIs only when prescribed, following the correct dosage, and avoiding self-medication. Additionally, 21.3% (n=114) displayed moderate behavior, and 8.2% demonstrated poor behavior by engaging in practices such as using PPIs without medical supervision or not adhering to the recommended dosage and duration. A chi-squared test indicated significant differences in the behavior distribution, χ²(2, n=534)=344.14, p<0.001. Conclusion While most respondents displayed good behavior regarding PPI usage, there remains a significant gap in knowledge and attitudes. Addressing these gaps through targeted educational interventions, such as workshops, e-learning modules, and awareness campaigns, could promote the safe and effective use of PPIs among students in Saudi Arabia. The next steps would involve implementing these programs in collaboration with healthcare professionals and university departments, with effectiveness measured through follow-up surveys, behavior assessments, and analysis of PPI usage trends over time.

Knowledge and Practices Regarding Prevention of Central Venous Catheter Removal-Associated Air Embolism: A Survey of Nonintensive Care Unit Medical and Nursing Staff.

Air embolism is a potentially serious complication of central venous catheter (CVC) use. While CVC insertion is usually performed by a trained specialist, extraction is frequently the responsibility of junior staff members. This complication can be easily prevented by following several simple measures described in common guidelines. We conducted a single-center survey to assess knowledge and practices concerning the prevention of air embolism associated with CVC removal among healthcare workers from nonintensive care units. The correct answers to the questionnaire were determined according to best-practice recommendations for CVC removal. Based on a comparison of the total sum of correct answers between the categories of groups, factors that predicted the level of knowledge were identified using an independent sample t test. Of the 156 respondents, one-third were unfamiliar with air embolism as a complication of CVC extraction. Almost 80% were unaware of the existence of a CVC removal protocol. Almost half of respondents did not follow guidelines regarding patient position when removing a CVC, 72% did not ask the patient to perform the Valsalva maneuver during the procedure, and 54% did not ask the patient to remain supine after the procedure. Adherence to the protocol was correlated with professional experience, with a lower level among those with experience of less than 1 year and, particularly, among interns. Our survey revealed inappropriately low awareness of CVC removal-associated air embolism risk and low familiarity with CVC removal best-practice recommendations among nonintensive care unit healthcare workers. Staff members with experience of less than 1 year, including interns, were found to have a lower level of knowledge. These findings emphasize the importance of development and distribution an internal hospital protocol and the integration of educational intervention into a preliminary internship program.

Environmental Perception as a Strategic Factor in Legal Compliance Auditing: Challenges and Opportunities

Legal compliance auditing consists of the systematic analysis of processes, products, and activities within an organization, with the aim of verifying whether they are in accordance with environmental standards established by laws, regulations, and other requirements. In this context, environmental awareness in companies is an increasingly relevant topic in discussions about sustainability, corporate social responsibility, and environmental management. Environmental awareness can be understood as the way an organization identifies, interprets, and responds to environmental issues arising in its operational context. Companies, especially those operating in sectors that utilize natural resources or have significant environmental impacts, need to integrate environmental awareness into their daily activities. The objective of this paper is to analyze how environmental awareness influences the effectiveness of legal compliance audits, highlighting its importance in promoting sustainability and ensuring adherence to environmental regulations. Companies with a well-developed environmental awareness tend to adopt a more proactive approach to their environmental responsibilities, going beyond mere legal compliance. On the other hand, low environmental awareness within the organization can lead to neglecting environmental issues, resulting in less effective audits.

How Effective Are Work-Life Balance Policies? The Importance of Inclusion

In this manuscript we review research on the effectiveness of work-life balance (WLB) policies in improving employee and organizational outcomes. We find that while WLB policies are often implemented with good intentions, their effects are generally small or inconsistent. We identify eight barriers to policy inclusivity that we theorize are linked to reduced effectiveness—a narrow definition of family, focusing on work-family rather than work-nonwork balance, low policy awareness, the practical constraints of access, overlooking vulnerable workers, the nature of the job, supervisor attitudes and behaviors, and unsupportive organizational cultures—and make recommendations for addressing these barriers. We also highlight the importance of considering individual differences and cultural contexts when implementing WLB policies. We conclude by proposing future research directions, such as examining coworker support and the impact of national culture on policy effectiveness.

Changing Our Food Habits One Bite at a Time: Exploring Young Flexitarians in a Country with a High Meat Intake.

Flexitarian diets have gained attention for their potential positive impact on human health and greenhouse gas emissions reduction. However, a critical question remains: Can the segment of flexitarians significantly contribute to necessary changes in our current unsustainable food systems? Our study addresses this gap by examining meat consumption habits among young adults (n = 1023) in a country with traditionally high meat intake. Furthermore, we focus on a subset of flexitarians (n = 286). Our findings reveal two distinct groups of flexitarians: ethical (n1 = 140) and utilitarian (n2 = 148). Utilitarian flexitarians exhibit a stronger preference for meat (t(284)= -15.180, p < 0.001), greater food neophobia (t(284) = -4.785, p < 0.001), and lower environmental awareness (t(284) = 7.486, p < 0.001) compared to Ethical flexitarians. The Ethical group, predominantly female (χ2(1) = 13.366, p < 0.001), demonstrates higher life satisfaction (t(284) = 5.485, p < 0.001), better health perceptions (t(284) = 5.127, p < 0.001), and stronger beliefs in reducing meat consumption (t(284) = -8.968, p < 0.001). Additionally, Ethical flexitarians hold more positive views on plant-based meat, perceiving it as healthier (t(284) = 4.326, p < 0.001) and more ethical (t(284) = 4.942, p < 0.001), and show a greater willingness to adopt it (t(284) = 7.623, p < 0.001). While both groups possess similar knowledge and willingness regarding cultured meat and insects, Ethical flexitarians view cultured meat more favourably (t(250.976) = 2.964, p = 0.003). Our study provides insights into the evolving trends of flexitarianism within Central and Eastern European countries, where research on meat consumption and flexitarianism is scarce. These insights hold value for promoting behaviour change toward reduced meat consumption for both health and environmental reasons. Additionally, they offer guidance to the food industry, including producers, sellers, and providers of meals in educational and employment facilities.

Patient selection for left ventricular assist device implantation. The main problems

To analyze the experience of Chazov National Medical Research Center of Cardiology in patient selection for left ventricular assist device (LVAD) implantation. 901 patients, whose documents were sent to Chazov National Medical Research Center of Cardiology from regional medical and prophylactic institutions, were screened as selection for LVAD implantation. Firstly, all patients underwent transthoracic echocardiography performed according to the extended protocol with a comprehensive assessment of the left and right ventricle size and function. Patients who underwent the screening procedure underwent further examination including both laboratory and instrumental diagnostic methods. In addition, the polyclinic database of patients diagnosed with chronic heart failure (CHF) and dilated cardiomyopathy was also analyzed. Among 901 screened patients 7.9% were suitable candidates for LVAD implantation and only 23 (2.6%) patients underwent surgery. Among those not eligible for surgery: 208 (29%) patients were not on optimal medical therapy, 15% of patients had indications for other surgical treatment of CHF, 12% of patients had severe right ventricular failure, 9.8% had severe comorbidities, 6.8% of patients refused surgery. The main problems of selection for LVAD implantation were: low awareness of doctors about the introduction of new treatment methods, poor quality of transthoracic echocardiography, a large percentage of patients not receiving basic therapy for CHF, untimely referral of patients for other types of surgical treatment.

Upaya Meningkatkan Kepedulian Masyarakat Dalam Pembayaran Pajak Bumi dan Bangunan

Land and Building Tax (PBB) is one of the revenues for local governments which is very important for funding infrastructure development, health services, education and other public services. PBB has a very significant role in community compliance and awareness in paying PBB in various regions is still said to be low. This is usually caused by several factors such as a lack of socialization, minimal transparency in the use of PBB funds, and low public awareness of the use of PBB payments, which is the main cause of low taxpayer compliance. The aim of this research is to identify strategies to be implemented to increase public awareness and compliance in paying PBB. This research uses a qualitative approach using observation and documentation methods. This research shows that the results show that by having regular outreach campaigns or outreach, utilizing information technology in the payment process, as well as developing a compensation and public quality improvement system funded by PPB, it will be an effective step to increase public compliance in paying taxes. Apart from that, involving several community leaders and non-governmental organizations in tax awareness outreach or education is also able to strengthen community responsibility and participation in regional development. By implementing existing strategies, it is hoped that we will be able to overcome problems such as low awareness and low community compliance in PBB payments, which will then be able to support the sustainability of the ability to achieve goals in implementing regional development programs

Basketball self-evaluation matrix: discrepancy between self-confidence and decision-making performance on psychological profiling of players.

In basketball training, self-evaluation plays a crucial role in the decision-making and execution of movements of players. The self-evaluation of players is influenced by their perception of own basketball ability and self-confidence state. This study aimed to explore potential discrepancies between self-confidence levels of players and their decision-making performance, while also characterizing different types of players. Data was collected from 20 youth basketball players who participated in a decision-making video task and a self-confidence assessment. Based on data from their self-confidence and decision-making awareness assessment, the K-means cluster analysis was used to categorize the players into different groups. Then, ANOVA and post hoc Scheffe test were conducted to compare these clusters. The cluster analysis identified four distinct profiles of players and the results of the ANOVA and post hoc Scheffe tests revealed significant differences between the four clusters. The "High Self-confidence & Low Decision-making Awareness" players might display an overconfident mindset, while the "High Self-confidence & High Decision-making Awareness" players potentially demonstrated the better performance and maintained a consistent and confident attitude. The "Low Self-confidence & High Decision-making Awareness" players appeared to lack confidence and needed to foster greater faith in their abilities. Finally, the "Low Self-confidence & Low Decision-making Awareness" players required a long-term and comprehensive training program to improve their skills. These preliminary findings informed the development of a self-evaluation matrix, designed to help coaches better understand player profiles and design tailored interventions. Moreover, this study contributes on sport calibration and enhances understanding of the behavioral and psychological states of players.

Environment-related health risks, knowledge and awareness among people in precarious milieus: secondary data analysis from the German "Environmental Awareness Study".

Precarious milieus more frequently suffer from environmental risks and show lower environmental awareness and behavior than other milieus in the German population. This study investigates the factors that influence environmental awareness in precarious milieus and the roles of environmental knowledge and the perception of environment-related health burdens. A quantitative secondary data analysis of the German Environmental Awareness Study 2018 (N = 2017) was used to analyze the perception of environmental health burdens, environmental knowledge, and environmental awareness between precarious milieus (n = 190) and seven other milieus. One-way analysis of variance (ANOVA) and Bonferroni post hoc tests were used for this purpose. More in-depth analyses of the precarious milieus were carried out using multiple regression analyses. There were significant differences in the perceptions of environmental health burdens affected by rail-traffic noise and neighborhood noise. Furthermore, environmental knowledge in precarious milieus was significantly lower than in five out of the seven other milieus (all p < 0.001) and was significantly associated with environmental cognition and gender. Precarious milieus had higher environmental affect than established milieus but less than that of critical-creative milieus and young idealists (all p < 0.001). Environmental cognition and environmental behavior were significantly associated with environmental affect. Environmental cognition was significantly higher in precarious milieus than in established milieus and among young pragmatists but was lower than in critical-creative milieus and among young idealists (all p < 0.001). Environmental affect, environmental knowledge, and gender were significantly associated with environmental cognition. In precarious milieus, environmental behavior was significantly lower than in traditional milieus and critical-creative milieus and among young idealists (all p < 0.001) and was significantly associated with environmental affect. The differences in the perception of environmental health burdens, environmental knowledge, and environmental awareness among precarious milieus indicate that there is a need for specific education and support structures for these population groups. Further research is needed to determine what other factors within the precarious milieus influence environmental knowledge and awareness, as well as the skills needed to understand environmental information, which are included in the framework of environmental (health) literacy.

Influence of Health-Seeking Behavior on Treatment Initiation of Cancer Patients at a Tertiary Care Hospital in Varanasi

Abstract Background: Cancer is one of the leading causes of death worldwide, and in order to prevent it, it is vital to understand cancer patients’ health-seeking behavior that contributes to patient delays in receiving cancer treatment globally; however, no similar studies have been conducted in India. Therefore, this study made an effort to know health-seeking behavior among delayed cancer patients receiving treatment at a tertiary care hospital, Varanasi. Methods: A cross-sectional study was conducted at the Department of Surgical Oncology OPD, Sir Sunder Lal Hospital, IMS, BHU, Varanasi. Randomly selected 440 registered patients were interviewed with the help of semi-structured questionnaire. Binary logistic regression analysis and 2-test were used in this study. Results: Out of total 440 patients included in this study, 207 (47.05%) were males and 233 (52.95%) were females. The majority (59.32%) of patients were more than 45 years of age group. Most (80%) of the patients had delay in cancer treatment of more than 60 days from onset of symptoms. Only 29.55% of patients were aware of any symptoms of Cancer. Those patients who were doing self-medication (P=0.03) and did not attend any cancer screening program (P=0.04) showed a statistically significant association with delayed initiation of treatment. Patients referred from another centre (P = 0.03) also show a significant association with delayed treatment initiation. Cancer patients who visited the screening program (AOR= 0.22, P=0.003) were significantly associated with a lower likelihood of delayed treatment initiation. Conclusion: The study showed that 80% of patients were delayed in seeking treatment for Cancer and highly influenced by low awareness, self-medication and visiting multiple health centres for diagnosis and treatment. Therefore, there is a strong need to address the reasons for the delay in seeking treatment.

A Study of digital literacy among the marginalizes in Thailand: Issues, challenges for implementation and the way forward

The concerns about digital literacy in Thailand especially relevant to fake news, disinformation, and misinformation keep increasing and creating a multifaceted challenges to various sectors of Thai society i.e. financial, commercial, politics, society, and health-related. Among the areas identified include digital contents creation, dissemination, and social media enabling various information with complex challenges such as the proliferation of fake news, disinformation, and misinformation affected more kinds of negative effects currently. This study employs mixed-research method quantitative (survey questionnaire) and qualitative (Focus group discussion, observation, interview) data collection and analysis. A total of 315 samples and key informants were involved as well as grouped under 5 categories: marginal youths, elderly, community leaders, teachers, also government workers focusing on digital literacy knowledge and skills relevant to fake news. It also highlights the relevant contexts i.e. regulatory frameworks and mechanisms driven by key agencies in Thailand. Two main results were revealed that reflected the objectives of the study accordingly: The first objective is (1) overview of digital literacy and how to achieve it. The findings summarized from survey questionnaire include 1.1) even regulations exist found inadequate enforcement and low public awareness call for more effective and collaborative communication from all partners starting from the government agencies; 1.2) urgent need for public awareness communication campaigns emphasizing all the marginalized groups. Youths expressed in the interviews about their contribution to help reduce all kinds of fake news; 1.3) support more friendly ICT context provision such as availability, affordability, accessibility, usability, and useful information. The second objective is (2) mechanism for digital skills empowerment. The feedback from key informants include: 2.1) strengthening digital literacy skills among all marginalized groups to be a smart citizen then can help protecting themselves, their families and their communities; 2.2) all agencies from policy to local i.e. community leaders, educational institutions, private sectors, social media companies, civil society, and others must synergized more contributions; 2.3) educational institutions must design digital literacy academy with digital new-skills for the marginalizes, ensuring them for their safety and future job demands; 2.4) private sectors should support and co-designing digital products and services that address all current needs; 2.5) local government, and all partners should take an active collaboration and enforcement. The study concluded with implications and suggestions for future research in line with SDGs.