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Background Climate change poses a global health risk through consequences such as sea level rise, wildfires, and increased air pollution. Children born today and in the future may be disproportionately affected by climate change. As a result, many young adults are rethinking having children. The impacts of the climate crisis on the decision-making of parents is an understudied area of research. This study aims to be one of the first to explore how climate change impacts the pregnancy intentions of young women in Canada and their perspectives towards childbearing. Methods We conducted auto-photography and qualitative interviews. Participants were recruited using social media, and were aged 18–25, nulliparous, assigned female at birth, and were either current or previous residents of British Columbia, Canada. We asked participants to take photos that responded to the question, “Show us how climate change impacts your decision to have a family,” then complete a virtual, one-on-one interview during which photo-elicitation was employed to guide conversation about participants’ decision-making related to childbearing and climate change. We subjected all transcribed interviews to qualitative thematic analysis. Results We conducted in-depth interviews with seven participants who discussed a total of 33 photographs. Analysis of participants’ interviews and photographs identified themes of eco-anxiety, hesitancy towards having children, sense of loss, and a desire for systemic change. Participants experienced anxiety, grief, and loss when faced with thoughts of change associated with their environments. Climate change impacted all but two participants’ childbearing decision making, which was found to be interrelated with social-environmental factors, such as cost of living. Conclusion We aimed to identify the ways in which climate change may impact youth decisions to have a family. Further research on this topic is needed to understand the prevalence of this phenomenon, and to build such considerations into climate action policy and family planning tools used among young people.

Background With complex changes in the global climate, it is critical to understand how ambient temperature affects health, especially in China. We aimed to assess the effects of temperature on daily mortality, including total non-accidental, cardiovascular disease (CVD), respiratory disease, cerebrovascular disease, and ischemic heart disease (IHD) mortality between 2016 and 2020 in Chengdu, China. Methods We obtained daily temperature and mortality data for the period 2016–2020. A Poisson regression model combined with a distributed-lag nonlinear model was used to examine the association between temperature and daily mortality. We investigated the effects of individual characteristics by sex, age, education level, and marital status. Results We found significant non-linear effects of temperature on total non-accidental, CVD, respiratory, cerebrovascular, and IHD mortality. Heat effects were immediate and lasted for 0–3 days, whereas cold effects persisted for 7–10 days. The relative risks associated with extreme high temperatures (99th percentile of temperature, 28 °C) over lags of 0–3 days were 1.22 (95% confidence interval [CI]: 1.17, 1.28) for total non-accidental mortality, 1.40 (95% CI: 1.30, 1.50) for CVD morality, 1.34 (95% CI: 1.24, 1.46) for respiratory morality, 1.33 (95% CI: 1.20, 1.47) for cerebrovascular mortality, and 1.38 (95% CI: 1.20, 1.58) for IHD mortality. The relative risks associated with extreme cold temperature (1st percentile of temperature, 3.0 °C) over lags of 0–14 days were 1.32 (95% CI: 1.19, 1.46) for total mortality, 1.45 (95% CI: 1.24, 1.68) for CVD morality, 1.28 (95% CI: 1.09, 1.50) for respiratory morality, 1.36 (95% CI: 1.09, 1.70) for cerebrovascular mortality, and 1.26 (95% CI: 0.95, 1.68) for IHD morality. We found that hot and cold affects were greater in those over 85 years of age, and that women, individuals with low education levels, and those who were widowed, divorced, or never married, were more vulnerable. Conclusions This study showed that exposure to hot and cold temperatures in Chengdu was associated with increased mortality, with people over 85 years old, women, those with low education levels, and unmarried individuals being more affected by hot and cold temperatures.

Background Residents of informal settlements in Sub-Sahara Africa (SSA) are vulnerable to the health impacts of climate change. Little is known about the knowledge, attitudes and practices (KAP) of inhabitants of informal settlements in SSA regarding climate change and its health impacts. The aim of this study was to investigate how inhabitants of an informal settlement in SSA experience climate change and its health impacts and assess related knowledge, attitudes and practices. The study was conducted in Mukuru informal settlement in Nairobi City County, Kenya. Methods A cross-sectional study was conducted in September 2021 using a structured, semi-closed KAP questionnaire. Inclusion criteria were ≥ 18 years of age and living in one of the three main sections in Mukuru: Kwa Njenga, Kwa Reuben or Viwandani. By spinning a pen at the geographic centre of each section, a random direction was selected. Then, in every second household one individual was interviewed, creating a representative mix of ages and genders of the local community. To assess participant characteristics associated with climate change knowledge multivariable logistic regression was used. Thematic content analysis was performed for qualitative responses. Results Out of 402 study participants, 76.4% ( n  = 307) had heard of climate change before the interview, 90.8% ( n  = 365) reported that climate change was affecting their community, and 92.6% ( n  = 372) were concerned with the health-related impact of climate change. Having lived in Mukuru for more than 10 years and living in a dwelling close to the riverside were factors significantly associated with having heard of climate change before (aOR 3.1, 95%CI 1.7 – 5.8 and aOR 2.6, 95%CI 1.1 – 6.1, respectively) and experiencing a climate change related impact on the community (aOR 10.7, 95%CI 4.0 – 28.4 and aOR 7.7; 95%CI 1.7 – 34.0, respectively). Chronic respiratory conditions, vector-borne diseases, including infectious diarrhoea, malnutrition and cardiovascular diseases were identified by respondents as climate related health risks. Conclusions Most respondents were knowledgeable about climate change and were experiencing its (health-related) impact on their community. This study provides insights which may prove useful for policy makers, intervention planners and researchers to work on locally adapted mitigation and adaption strategies.

Background The current understanding of climate anxiety among adolescents is sparse. This study identifies the characteristics of adolescents living in Quebec (Canada) who experience impairments induced by climate anxiety, who have feelings of self-efficacy and who adopt pro-environment behaviors. It also characterizes the association between climate anxiety, feelings of self-efficacy, and environmental actions. Methods We used a cross-sectional design to analyze data from the COMPASS study on adolescent health. Participants ( n  = 45 362) from 113 schools in Quebec (Canada) answered questions about climate anxiety, self-efficacy, behavioral engagement, and several indicators of well-being. Data were analyzed using ordered logistic regressions adjusted for potential confounders (age, gender, school type, material deprivation, etc.). Results 9% of adolescents reported that thinking about climate change made it difficult to sleep at least sometimes. 6% of adolescents reported that thinking about climate change interfered with their ability to get work or assignments done at least sometimes. Only 34% believed they could do something to address the problem, and 43% tried to reduce their behaviors that contribute to climate change at least sometimes. Adolescents who were boys or who were less anxious experienced less impairment and were less involved in the fight against climate change. Adolescents from less affluent families experienced more difficulty sleeping and interference with work but were not more engaged. Those with stronger school connectedness experienced less impairment and were more often involved in the fight against climate change. Adolescents who felt they could do something about climate change were more likely to try to reduce behaviors that contribute to climate change. Conclusion The findings are useful to identify and support vulnerable groups that are more likely to experience impairment due to climate anxiety. The feeling of climate self-efficacy was not well developed among some groups of adolescents. Improving adolescents’ beliefs in their capacity to help address climate change may be a key strategy to promote pro-environmental actions. As the threat of climate change increases, it will be important to follow the evolution of climate anxiety and engagement among adolescents.

Background There is a paucity of resources focusing on the climate change experience of readymade garment (RMG) workers in developing countries such as Bangladesh. Therefore, this mixed method approach aims to understand the distinctive types of climate change experiences from a health and occupational perspective, along with the consequences of these changes among RMG workers in Bangladesh. Methods The study was conducted from January 2022 and February 2022 where the quantitative data were collected from 200 RMG workers in 10 randomly selected garments and two focus group discussions took place with 20 conveniently selected RMG workers. The key informants were relevant stakeholders in the industry. Quantitative findings were reported using descriptive methods and qualitative findings were analysed using a content analysis approach. Result A total of 200 RMG workers were included in the study of which the majority belonged to the age group of 26–30 years (44%), were male (55%), worked in a compliant factory (70%), and were machine operators (79%). Half of the respondents experienced damage from natural disasters (51%), but only approximately 37% received humanitarian help. Migration and urbanisation were among the aftermath of the damage caused by e natural disasters, and 42% were forced to shift their homes due to natural disasters. Competition in the job market increased, and the owners had the opportunity to take on employees at a reduced salary. The respondents flagged climate change as a major contributor to their disease patterns. More than three-quarters of the respondents became sick because of increased heat while working; however, only half received any treatment. Conclusion Employee participation in hazard recognition, employer preparedness, prevention through design, research, surveillance, and upholding workplace ethics and standards can be the answers to climate change problems for readymade garment workers.

Background An important consequence of climate change for urban health is heat-related mortality. Vulnerable groups, especially elderly, will be the most affected. A solution put forward in many reports and policy documents is the introduction or expansion of urban green spaces. While they have a proven effect in decreasing the ambient temperature and reducing heat related mortality, the causal pathways are far from clear. Moreover, results vary for different contexts, population types and characteristics of green spaces as they are ‘complex systems thrusted into complex systems’. To our knowledge, there is no systematic synthesis of the literature that examines the mechanisms by which and the circumstances under which green spaces work to decrease heat-related mortality for elderly. Methods We performed a realist synthesis– a theory-driven review method– to develop a complexity- and context-sensitive program theory. As a first step, a causal loop diagram was constructed which describes the possible pathways through which urban green spaces influence heat-related mortality in elderly. In a second step, one of the pathways - how they may lead to a reduction of heat-related mortality by increasing social capital - was further explored for underlying mechanisms, the context in which they work and the differentiated patterns of outcomes they generate. Literature was searched for evidence supporting or contradicting the initial programme theory, resulting in a refined theory. Results Results show how urban green space can impact on heat-related mortality in elderly by its influence on their exposure to outdoor and indoor heat, by improving their resilience as well as by affecting their access to treatment. Urban green spaces and their interactions with social capital affect the access to health information, social support, and the capacity for effective lobbying. Several mechanisms help to explain these observed demi-regularities, among others perceived behavioural control, perceived usefulness, receptiveness, ontological security, and self-interest. If and how they are triggered depends on the characteristics of the urban green space, the population, and other contextual factors. Conclusion Looking into the impact of urban green spaces on heat-related mortality in elderly, researchers and policy makers should take interest in the role of social capital.

Background Influenza epidemics pose a threat to human health. It has been reported that meteorological factors (MFs) are associated with influenza. This study aimed to explore the similarities and differences between the influences of more comprehensive MFs on influenza in cities with different economic, geographical and climatic characteristics in Fujian Province. Then, the information was used to predict the daily number of cases of influenza in various cities based on MFs to provide bases for early warning systems and outbreak prevention. Method Distributed lag nonlinear models (DLNMs) were used to analyse the influence of MFs on influenza in different regions of Fujian Province from 2010 to 2021. Long short-term memory (LSTM) was used to train and model daily cases of influenza in 2010–2018, 2010–2019, and 2010–2020 based on meteorological daily values. Daily cases of influenza in 2019, 2020 and 2021 were predicted. The root mean squared error (RMSE), mean absolute error (MAE), mean absolute percentage error (MAPE) and symmetric mean absolute percentage error (SMAPE) were used to quantify the accuracy of model predictions. Results The cumulative effect of low and high values of air pressure (PRS), air temperature (TEM), air temperature difference (TEMD) and sunshine duration (SSD) on the risk of influenza was obvious. Low (< 979 hPa), medium (983 to 987 hPa) and high (> 112 hPa) PRS were associated with a higher risk of influenza in women, children aged 0 to 12 years, and rural populations. Low (< 9 °C) and high (> 23 °C) TEM were risk factors for influenza in four cities. Wind speed (WIN) had a more significant effect on the risk of influenza in the ≥ 60-year-old group. Low (< 40%) and high (> 80%) relative humidity (RHU) in Fuzhou and Xiamen had a significant effect on influenza. When PRS was between 1005–1015 hPa, RHU > 60%, PRE was low, TEM was between 10–20 °C, and WIN was low, the interaction between different MFs and influenza was most obvious. The RMSE, MAE, MAPE, and SMAPE evaluation indices of the predictions in 2019, 2020 and 2021 were low, and the prediction accuracy was high. Conclusion All eight MFs studied had an impact on influenza in four cities, but there were similarities and differences. The LSTM model, combined with these eight MFs, was highly accurate in predicting the daily cases of influenza. These MFs and prediction models could be incorporated into the influenza early warning and prediction system of each city and used as a reference to formulate prevention strategies for relevant departments.

Background Although studies have indicated that extreme temperature is strongly associated with respiratory diseases, there is a dearth of studies focused on children, especially in China. We aimed to explore the association between extreme temperature and children’s outpatient visits for respiratory diseases and seasonal modification effects in Harbin, China. Methods A distributed lag nonlinear model (DLNM) was used to explore the effect of extreme temperature on daily outpatient visits for respiratory diseases among children, as well as lag effects and seasonal modification effects. Results Extremely low temperatures were defined as the 1st percentile and 2.5th percentile of temperature. Extremely high temperatures were defined as the 97.5th percentile and 99th percentile of temperature. At extremely high temperatures, both 26 °C (97.5th) and 27 °C (99th) showed adverse effects at lag 0–6 days, with relative risks (RRs) of 1.34 [95% confidence interval (CI): 1.21–1.48] and 1.38 (95% CI: 1.24–1.53), respectively. However, at extremely low temperatures, both − 26 °C (1st) and − 23 °C (2.5th) showed protective effects on children’s outpatient visits for respiratory diseases at lag 0–10 days, with RRs of 0.86 (95% CI: 0.76–0.97) and 0.85 (95% CI: 0.75–0.95), respectively. We also found seasonal modification effects, with the association being stronger in the warm season than in the cold season at extremely high temperatures. Conclusions Our study indicated that extremely hot temperatures increase the risk of children’s outpatient visits for respiratory diseases. Efforts to reduce the exposure of children to extremely high temperatures could potentially alleviate the burden of pediatric respiratory diseases, especially during the warm season.

Background Cardiovascular diseases (CVDs), the leading cause of death worldwide, are sensitive to temperature. In light of the reported climate change trends, it is important to understand the burden of CVDs attributable to temperature, both hot and cold. The association between CVDs and temperature is region-specific, with relatively few studies focusing on low-and middle-income countries. This study investigates this association in Puducherry, a district in southern India lying on the Bay of Bengal, for the first time. Methods Using in-hospital CVD mortality data and climate data from the Indian Meteorological Department, we analyzed the association between apparent temperature (T app ) and in-hospital CVD mortalities in Puducherry between 2011 and 2020. We used a case-crossover model with a binomial likelihood distribution combined with a distributed lag non-linear model to capture the delayed and non-linear trends over a 21-day lag period to identify the optimal temperature range for Puducherry. The results are expressed as the fraction of CVD mortalities attributable to heat and cold, defined relative to the optimal temperature. We also performed stratified analyses to explore the associations between T app and age-and-sex, grouped and considered together, and different types of CVDs. Sensitivity analyses were performed, including using a quasi-Poisson time-series approach. Results We found that the optimal temperature range for Puducherry is between 30°C and 36°C with respect to CVDs. Both cold and hot non-optimal T app were associated with an increased risk of overall in-hospital CVD mortalities, resulting in a U-shaped association curve. Cumulatively, up to 17% of the CVD deaths could be attributable to non-optimal temperatures, with a slightly higher burden attributable to heat (9.1%) than cold (8.3%). We also found that males were more vulnerable to colder temperature; females above 60 years were more vulnerable to heat while females below 60 years were affected by both heat and cold. Mortality with cerebrovascular accidents was associated more with heat compared to cold, while ischemic heart diseases did not seem to be affected by temperature. Conclusion Both heat and cold contribute to the burden of CVDs attributable to non-optimal temperatures in the tropical Puducherry. Our study also identified the age-and-sex and CVD type differences in temperature attributable CVD mortalities. Further studies from India could identify regional associations, inform our understanding of the health implications of climate change in India and enhance the development of regional and contextual climate-health action-plans.

Background Recently, attention has focused on the impact of global climate change on infectious diseases. Storm flooding is an extreme weather phenomenon that not only impacts the health of the environment but also worsens the spread of pathogens. This poses a significant challenge to public health security. However, there is still a lack of research on how different levels of storm flooding affect susceptible enteric infectious diseases over time. Methods Data on enteric infectious diseases, storm flooding events, and meteorology were collected for Changsha, Hunan Province, between 2016 and 2020. The Wilcoxon Rank Sum Test was used to identify the enteric infectious diseases that are susceptible to storm flooding. Then, the lagged effects of different levels of storm flooding on susceptible enteric infectious diseases were analyzed using a distributed lag nonlinear model. Results There were eleven storm flooding events in Changsha from 2016 to 2020, concentrated in June and July. 37,882 cases of enteric infectious diseases were reported. During non-flooding days, the daily incidence rates of typhoid/paratyphoid and bacillary dysentery were 0.3/100,000 and 0.1/100,000, respectively. During flooding days, the corresponding rates increased to 2.0/100,000 and 0.8/100,000, respectively. The incidence rates of both diseases showed statistically significant differences between non-flooding and flooding days. Correlation analysis shows that the best lags for typhoid/paratyphoid and bacillary dysentery relative to storm flooding events may be 1 and 3 days. The results of the distributed lag nonlinear model showed that typhoid/paratyphoid had the highest cumulative RR values of 2.86 (95% CI: 1.71–4.76) and 8.16 (95% CI: 2.93–22.67) after 4 days of general flooding and heavy flooding, respectively; and bacillary dysentery had the highest cumulative RR values of 1.82 (95% CI: 1.40–2.35) and 3.31 (95% CI: 1.97–5.55) after 5 days of general flooding and heavy flooding, respectively. Conclusions Typhoid/paratyphoid and bacillary dysentery are sensitive enteric infectious diseases related to storm flooding in Changsha. There is a lagging effect of storm flooding on the onset of typhoid/paratyphoid and bacillary dysentery, with the best lagging periods being days 1 and 3, respectively. The cumulative risk of typhoid/paratyphoid and bacillary dysentery was highest at 4/5 days lag, respectively. The higher of storm flooding, the higher the risk of disease, which suggests that the authorities should take appropriate preventive and control measures before and after storm flooding.