Outdoor air pollutants may reduce TNF-α and IL-8 expression, weakening host defense against Mycobacterium tuberculosis infection and increasing PTB risk. These findings highlight potential immunological pathways linking air pollution to PTB pathogenesis.

Higher EC skin test thresholds enhance positive predictive value but reduce sensitivity, underscoring the need for improved biomarkers or risk prediction models to refine TB prediction accuracy.

This study identifies actionable gaps in TB preparedness among Chinese medical freshmen, advocating for curriculum-integrated education to address knowledge deficiencies and peer-led anti-stigma initiatives. The strong preference for institutionally vetted information underscores universities’ pivotal role in health communication. Prioritizing IMB-based interventions could enhance both personal prevention practices and future professional competency, directly supporting China’s national TB control agenda.