{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T01:26:46Z","timestamp":1781227606697,"version":"3.54.1"},"reference-count":51,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T00:00:00Z","timestamp":1764115200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The growing use of disinfectants has raised ecological concerns regarding disinfectants as emerging environmental contaminants. Given the similarities in environmental fate and discharge behavior between pharmaceuticals and disinfectants, ecopharmacovigilance (EPV) as a framework emphasizing eco-directed pharmaceutical use and disposal was previously proposed as a potential strategy to mitigate environmental emissions of disinfectants. This study investigated the likelihood of spillover between eco-directed pharmaceutical disposal and pro-environmental disinfectant use across knowledge, attitude, and practice (KAP) dimensions, and examine whether perceived similarity between pharmaceuticals and disinfectants mediated these spillover effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using a sample of 1,002 Chinese residents, questionnaire-based KAP survey data were analyzed using regression analysis for spillover effect test. A bias-corrected non-parametric percentile Bootstrap test was employed to examine mediation effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A one-unit increase in eco-directed pharmaceutical disposal improved the residents\u2019 pro-environmental disinfectant use by 0.648, 0.782, and 0.791\u202funits in KAP dimensions (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.000), respectively, under the control of covariates. Similarity recognition exerted a significant mediating effect on the relationship between eco-directed pharmaceutical disposal and pro-environmental disinfectant use, with the effect size values of 0.168 (95% confidence interval [CI]: 0.130, 0.206), 0.107 (95% CI: 0.072, 0.142), and 0.079 (95% CI: 0.029, 0.128) across KAP dimensions, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Eco-directed pharmaceutical disposal might positively spill over to pro-environmental disinfectant use partially through indirect path of the perceived similarity, which further supports the feasibility of adopting EPV, a framework originally designed for pharmaceutical environmental risk management, for the remediation of disinfectant emerging contaminants.<\/jats:p>\n                  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