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Despite the growing evidence on the influence of neighborhood safety on physical activity, few studies have specifically focused on preschool-aged children and differentiated the various domains of neighborhood safety. This study investigates the relationship between parental perceptions of neighborhood safety and preschool children's time spent outdoors and explores potential sex differences in this relationship. This study analyzed nationally representative data from 1656 Korean children (848 boys and 808 girls) aged 3, 5, 6 years collected over the course of three waves of the Panel Study on Korean Children (PSKC). Outdoor playtime was measured by maternal reports of the time their children spent playing outdoors on a typical weekday. Parental perceptions of neighborhood safety were assessed using two items that inquired about neighborhood safety in terms of crime and accidents, respectively. Fixed effects estimates revealed that parental perceptions of social safety were associated with an increase in children's outdoor physical activity (b = 3.778, p < 0.05), whereas perceptions of physical safety were not. Sex-stratified models showed that the association between parental perceptions of social safety and children's outdoor play was driven largely by boys (b = 8.498, p < 0.001), with no association observed for girls. The findings of this study underscore the importance of addressing the social safety of neighborhood environments to promote outdoor play in preschool children. Moreover, sex differences should be considered when developing interventions aimed at increasing physical activity among young children. • Parental perceptions of neighborhood safety predicted preschool children's outdoor play. • Parental perceptions of social safety were more salient than those of physical safety. • Parental perceptions of social safety were only associated with outdoor play among boys. • Efforts to provide socially safe neighborhoods are needed to promote preschool children's outdoor play. [ABSTRACT FROM AUTHOR]

We examine new doctors' and nurses' experiences of transitioning from training to practising as health professionals, drawing on the concept of liminality. Liminality is a stage of 'in-betweenness', involving uncertainty and ambiguity as people leave one social context and reintegrate into a new one. Surprisingly little research has explored new health professionals' experiences of liminality during role and career transitions, particularly in precarious and resource-constrained settings. Drawing on 146 qualitative interviews and seven focus groups, involving 121 new graduate medical doctors and nurses transitioning through internship training in Kenya, we describe three aspects of liminality. First, liminal professional practice , where interns realise that best practices learned during medical and nursing schools are often impossible to implement in resource constrained health care settings; instead they learn workarounds and practical norms. Second, liminal relational identities , where interns leave behind being students and adopt the identities and responsibilities of qualified professionals within pre-existing professional hierarchies of status and expertise. We explain how these new doctors and graduate nurses negotiate their liminal status, including in relation to more experienced but less qualified professional colleagues. We also discuss how interns cope with liminality due to disappointing and inadequate supervision and role modelling from senior colleagues but then find peer support and their place within their own professions. Finally, we discuss how new doctors and nurses come to terms with the precarity of working in resource constrained health systems, abandon expectations of secure, permanent employment and careers, and accept the realities of liminal professional careers. We explain how all three forms of liminality influence professionals' developing practices, identities, and careers. We call for further studies with a specific liminality lens to explore this critical period in health workers' careers, to inform policy and practice responding to global transformations in healthcare professions and practice. • We describe three dimensions of liminal experience among doctor and nurse interns. • Liminal professional practice, in response to professional training - reality gaps. • Negotiation with others and construction of liminal relational identities. • Liminal career prospects, realising careers they expected are unlikely to happen. [ABSTRACT FROM AUTHOR]

The label "deaths of despair" for rising US mortality related to drugs/alcohol/suicide seems to implicate emotional distress as the cause. However, a Durkheimian approach would argue that underlying structural factors shape individuals' behavior and emotions. Despite a growing literature on deaths of despair, no study has directly compared the effects of distress and structural factors on deaths of despair versus other causes of mortality. Using data from the Midlife in the United States study with approximately 26 years of mortality follow-up, we evaluated whether psychological or economic distress, employment status, and social integration were more strongly associated with drug/alcohol/suicide mortality than with other causes. Cox hazard models, adjusted for potential confounders, showed little evidence that psychological or economic distress were more strongly associated with mortality related to drugs/alcohol/suicide than mortality from other causes. While distress measures were modestly, but significantly associated with these deaths, the associations were similar in magnitude for many other types of mortality. In contrast, detachment from the labor force and lower social integration were both strongly associated with drug/alcohol/suicide mortality, more than for many other types of mortality. Differences in the estimated percentage dying of despair between age 25 and 65 were larger for employment status (2.0% for individuals who were neither employed nor retired versus only 0.6% for currently employed) and for social integration (1.9% for low versus 0.7% for high integration) than for negative affect (1.2% for high versus 0.8% for no negative affect). Most of the association between distress and drug/alcohol/suicide mortality appeared to result from confounding with structural factors and with pre-existing health conditions that may influence both the perception of distress and mortality risk. While deaths of despair result from self-destructive behavior, our results suggest that structural factors may be more important determinants than subjective distress. • Psychological and economic distress were modestly linked with deaths of despair. • Those measures had associations of similar magnitude with other types of mortality. • Employment and social integration were strongly associated with deaths of despair. • In the US, those associations were stronger than for many other types of mortality. • Structural factors may be more important determinants than subjective distress. [ABSTRACT FROM AUTHOR]

Structural barriers, which impede access to healthcare, are often seen as tangible expressions of structural racism. Those who experience more structural barriers to healthcare access are likely to experience poor health. Expanding on this notion, our research integrated the Internalized Racism Framework (James, 2022) with the Structural Vulnerability Framework (Bourgois et al., 2017; Metzl and Hansen, 2014) to explore how encountering barriers to healthcare access influences healthcare seeking attitudes across four health domains: mental, medical, dental, and vision. Our study included a sample of 780 Black American adults (average age = 37.68) who were recruited to participate in an anonymous web-based cross-sectional survey. Our findings revealed that internalized racism explained the direct effect of healthcare access structural barriers on healthcare attitudes in the mental, medical, and vision health domains, but not in the dental health domain. Specifically, the experience of more structural barriers in accessing healthcare (mental, medical, and vision) correlated with heightened internalized racism, which, in turn, was associated with more negative attitudes towards seeking (mental, medical, and vision) healthcare. Notably, our results also showed variations in the frequency and types of structural barriers encountered across the four health domains, along with differences in participants' positive healthcare seeking attitudes. Our findings underscore an urgent need for targeted interventions addressing both structural and internalized racism. Removing healthcare access barriers is crucial for fostering equitable healthcare access for Black Americans. Future research should explore additional factors influencing healthcare seeking attitudes, as well as strategies that mitigate the negative effects of racism on said attitudes. • Experiencing more healthcare barriers is associated with internalized racism. • Internalized racism is associated with more negative health seeking attitudes. • Dental healthcare access barriers are related to dental health seeking attitudes. • Medical healthcare access barriers are related to medical health seeking attitudes. [ABSTRACT FROM AUTHOR]

Since the 2011 Fukushima nuclear power plant accident, multiple social network disruptions have been reported among the community in Fukushima, while posttraumatic stress symptoms among the residents have persisted. In this study, we aimed to explore the influence of time and social networks on the recovery of posttraumatic stress symptoms based on longitudinal data from community residents in Fukushima, following up five to ten years after the nuclear power plant accident. We conducted five questionnaire surveys quasi-annually, the targets of which were randomly sampled 4900 non-evacuee community residents. In this study, the data of 1809 respondents who participated in at least one survey were used (36.9% of the initial target). Setting posttraumatic stress symptoms as the outcome, we examined the interaction between time and social network size using a mixed model, adjusting for sociodemographic characteristics and disaster-related events. Their interaction was statistically significant, and the posttraumatic stress symptoms of those with small social networks persisted, while those with larger social networks recovered. Maintaining and promoting social networks may contribute to mental health recovery after a nuclear disaster. • Posttraumatic stress symptoms remained 10 years after the Fukushima nuclear disaster. • Posttraumatic stress symptoms persisted among those with small social networks. • Posttraumatic stress symptoms decreased among those with not-small social networks. [ABSTRACT FROM AUTHOR]

This paper investigates how healthcare professionals experience digital platforms in their work practices and how these relationships enable forms of emotional labour and contribute to shaping their emotional health. Methodologically, the contribution draws on audio-diaries kept by 15 healthcare professionals and a final semi-structured interview conducted with the same informants. The research material was analysed using open and axial coding techniques, in a grounded theory fashion. Findings provides meaningful insights to the literature on the emotional labour of healthcare professionals, as well as to studies on digital health and labour. Specifically, we show that participants associate different and even contrasting reflections and emotional states with their relationships with digital platforms. Thus, there is not exclusively one trajectory that can explain the implications of media uses, as different and potentially conflicting emotions coexist within the same experience. Given this scenario, we argue that it can be fruitful to use the lens of 'ambiguity' to scrutinise the ambivalences and tensions characterising platform experiences, and how emotional labour in healthcare intertwines with technological developments. Moreover, we advocate for the development of critical digital literacy skills among healthcare professionals. • We contribute to literature on digital health and emotional labour. • We show the emotional ambivalences in healthcare professionals' platform experiences. • We argue for the merits of using the concept of 'ambiguity'. • We advocate for critical digital literacy among healthcare professionals. [ABSTRACT FROM AUTHOR]

When it comes to health-related information-seeking behavior, online communities play a key role for some groups, such as parents. With a case study of online communities in a loosely organized vaccination system, that of Austria, we study how parents make use of a prominent online forum (parents.at) in their vaccination trajectories and situate this analysis in its socio-political context. Based on inductive qualitative analysis of relevant threads (n = 27), we find that parents use forums in three ways: First, the forum serves as a platform through which parents seek orientation in a loosely organized and fragmented vaccination system. Second, the forum offers space for sharing, collecting, and evaluating different forms of expertise. In doing so, parents carve out a space in which they can comfortably put lay expertise and credentialed expertise on a par, particularly in their advice to peers. Third, and on that basis, parents use the forum for deliberating on future or past vaccination-related decisions. In doing so, they frequently draw on idiosyncratic notions of individual risks and benefits. These three practices enable parents to accumulate and share what we label navigational capital. We conclude that parents resort to online spaces both out of a subjective need and, for some, as a result of a dysfunction of the national childhood vaccination program which offers little orientation for parents. • Online forums are important for parents' vaccination trajectories in systems that offer little guidance or orientation. • Online forums facilitate sharing and accumulating navigational capital. • Parent use online forums to address questions that seem too conflictual in face to face encounters with health care providers. • Parents use online forums for sharing, collecting, and evaluating lay and credentialied expertise. • Peer to peer advice could be beneficial towards vaccine acceptance. [ABSTRACT FROM AUTHOR]

Young people who attend intensive alcohol and other drug (AoD) treatment commonly do so more than once. This paper aims to understand precipitators, enablers and barriers to young people's re-engagement in programs. Data come from a longitudinal qualitative study involving three waves of interviews with Australian young people recruited while attending intensive AoD programs (n = 38 at wave 1). We found that young people's ambitions for what they might achieve with a new stay and capacity to benefit from programs, evolved. Skills learnt in earlier stays or changed life circumstances often helped them achieve better outcomes subsequently. Ongoing contact with an AoD worker was the most important enabler to service re-engagement. Across the span of a year, we saw most young people in our study sample develop a stronger sense of wellbeing and control over substance use. While researchers tend to focus on evaluating outcomes associated with single stays at specific programs, young people think about their trajectories towards managing substance use and their lives as occurring more holistically, supported by engagements with a range of services. We argue that the notion of incremental treatment is useful in depicting the synergistic effects of service engagement over time. • Young people affected by substance use often attend many programs. • Participants who returned to services reported new goals and changed circumstances. • AoD treatment effects build as young people learn and engage with services. • The medical term 'incremental treatment' is useful in depicting this. • Outcomes should be measured through service system engagement over time. [ABSTRACT FROM AUTHOR]

to assess the feasibility of a new stated preference approach, the multiple bounded dichotomous choice (MBDC), designed to generate value sets for preference-based measurement of health-related quality of life. MBDC and standard gamble (SG) tasks were completed to derive SF-6Dv2 value sets from a sample of the general population in Quebec, Canada. Participants were randomized between the two approaches: 6 health states were evaluated in SG and 11 health states in MBDC. Several models were used to estimate data in each approach, and the preferred models were chosen by using mean absolute error (MAE), logical consistency of parameters, and significance levels. Results of MBDC were compared with SG in terms of acceptability (self-reported difficulty and quality levels in answering, and completion time), consistency (monotonicity of model coefficients), accuracy (standard errors), dimensions coefficient magnitude, correlation between the value sets estimated, and the range of estimated values. The intra-class correlation coefficient (ICC) was computed to assess value sets' consistency. Out of 655 individuals who completed MBDC tasks and 828 who completed SG tasks, a total of 585 participants for MBDC and 714 for SG tasks were included for analysis. The preferred models for both approaches were GLS Tobit. No significant difference was observed in self-reported difficulties and qualities in answers among approaches, but MBDC had less excluded participants and was less prone to report difficulties in answering. Additionally, completion time in the MBDC group was significantly lower (99.80 vs 68.12 s). Most standard errors in the MBDC were lower than those in SG, and the number of non-significant parameters was also lower. The range of utility values generated by MBDC tended to be wider (−0.372 to 1) than those generated by the SG (−0.137 to 1) and the number of worse-than-dead states in MBDC (0.91%) was higher than for SG (0.08%). The Pain dimension was identified as the most significant, while the Vitality dimension showed the lowest significant decrement. Both approaches exhibited a tendency to overestimate severe health state values and underestimate better health state values. The correlation and ICC between the two value sets were 0.937 and 0.983, respectively. Based on empirical evidence, it can be inferred that the MBDC method is not only feasible but also holds the potential to generate meaningful and well-informed preference data from respondents. This approach can be used to derive a value set for preference-based instrument. • First study to use the MBDC approach to generate health utilities. • MBDC approach is compared to the standard gamble (SG) approach. • MBDC is feasible and generates meaningful and well-informed preference data. [ABSTRACT FROM AUTHOR]

Although precarious employment (PE) has emerged as a growing public health concern, research on older adults is scarce. This study explored the associations between PE and the onset of depressive symptoms and problematic alcohol use among middle-aged and older workers. A total of 2536 Korean waged workers aged ≥45 years contributed 8486 observations from 2006 to 2022. PE was defined as a multidimensional construct that includes employment insecurity, income inadequacy, and a lack of worker rights and protection. Depressive symptoms and problematic alcohol use were assessed using the Center for Epidemiological Studies Depression Scale and the CAGE questionnaire. Generalized estimating equations were employed to determine the association of PE with depressive symptoms and problematic alcohol use after the two-year follow-up. Risk ratios (RR) and 95% confidence intervals (CI) were estimated. Women, individuals with older age and low educational background, and blue-collar workers were more likely to belong to the high PE group. For individual indicators of PE, daily employment (RR: 1.26, 95% CI: 1.05–1.53), the lowest wage quartile (RR: 1.32, 95% CI: 1.01–1.72), and lack of trade union (RR: 1.55, 95% CI: 1.10–2.17) were positively associated with depressive symptom onset in the follow-up. Compared with the group with the lowest overall PE, the group with the highest PE exhibited increased risks of experiencing the onset of depressive symptoms (RR: 1.62, 95% CI: 1.27–2.08) and problematic alcohol use (RR: 2.45, 95% CI: 1.16–5.17) in the follow-up. This study suggests that PE is a major social determinant of older workers' mental health. • This study explored the associations between precarious employment (PE), depressive symptoms, and problematic alcohol use. • Temporary employment, low wages, and lack of trade unions were positively associated with the depressive symptom onset. • High overall PE is associated with the onset of depressive symptoms and problematic alcohol use at the two-year follow-up. • PE is a significant social determinant of mental health among older workers. [ABSTRACT FROM AUTHOR]

Catastrophic out-of-pocket health expenditure (CHE) remain high in Sub-Saharan Africa and may not conform to the sporadic random pattern of acute illnesses that shapes insurance arrangements intended to avoid the risk of financial loss. The persistency of CHE remains a largely unexplored issue due to the lack of relevant methods and scarcity of panel data. This paper addresses the first shortcoming by presenting three different approaches to incorporating the timeframes into the analysis, considering dynamics between two periods, average over time and the recurrence of CHE incidence. Through the application of the complementary approaches, we identify (i) those at risk of persistent CHE in the short-term; (ii) those facing transient versus persistent CHE in the long-term; and (iii) those facing multiple CHE spells. The methods are applied to different definitions of CHE using panel data from three sub-Saharan countries: Malawi (3 waves: 2010, 2013, and 2016) with 4983 observations; Tanzania (3 waves: 2008, 2010, and 2012) with 8715 observations; and Uganda (5 waves: 2009, 2010, 2011, 2013, and 2015) with 6475 observations. All datasets are balanced panels. Additionally, we employ empirical strategies to identify the underlying factors contributing to these persistent and relatively high OOP. Across the three countries, we find that at least 27% of the people facing CHE in one period, because they spent more than 5% of their household budget on health out-of-pocket, will face it again in the next period. The lower-bound risk for those spending more than 10% of their household budget is 9% and for those spending more than 25% of their household capacity to pay is 13%. Between 11% and 45% of the population incurred CHE at least twice during the observation period when using the 5% budget definition of CHE. The double recurrence rate ranges between 7% and 13% when using the 25% capacity-to-pay definition and between 3% and 20% when using the 10% budgetshare definition. Between 22% and 32% of the population experienced chronic CHE at the 5% of the budgetshare definition (6%–10% at the 10% of the budgetshare definition of CHE; 2%–11% at 25% of capacity-to-pay). Our panel regression analysis consistently highlights the susceptibility of certain groups to face persistence CHE, notably those residing in rural areas, individuals with lower levels of education, the elderly, and those who have undergone hospitalizations. • We propose to assess persistent catastrophic health expenses via risk exposure, average changes and recurrence. • At least 27% facing catastrophic health expenses in Malawi, Uganda, and Tanzania will face it again. • Elderly, female heads, and health shocks increase catastrophic health expense persistence. • Longitudinal insights identify enduring financial vulnerabilities due to out-of-pocket health spending. [ABSTRACT FROM AUTHOR]

This study tries to understand the power of knowledge within collaborative care networks to provide insights for designing successful collaboration within care networks by combining intersectionality and epistemic (in)justice. Becoming an informal carer for someone with an acquired brain injury (ABI) causes a dramatic disruption of daily life. Collaboration between professionals and carers with a migration background may result in unjust and unfair situations within care networks. Carer experiences are shaped by aspects of diversity which are subject to power structures and processes of social (in)justice in care networks. In this study, intersectionality was used to both generate complex in-depth insights into the different active layers of carer experiences and focus on within-group differences. Intersectionality was combined with the theoretical concept of epistemic (in)justice to unravel underlying dynamics in collaborative care networks contributing to the understanding that carers with a migration background are often not seen as 'knowers of reality.' This qualitative study conducted in the Netherlands between 2019 and 2022 incorporated three informal group conversations (N = 32), semi-structured interviews (N = 21), and three dialogue sessions (N = 7) with carers caring for someone with an ABI. A critical friend and a community of practice, with carers, professionals, and care recipients (N = 8), contributed to the analysis. Three interrelated themes were identified as constituting different layers of the carer experience: (a) I need to keep going , focusing on carers' personal experiences and how experiences were related to carers social positioning; (b) the struggle of caring together , showing how expectations of family members towards carers added to carer burden; and (c) trust is a balancing act , centering on how support from professionals shaped carers' experiences, in which trusting professionals' support proved challenging for carers, and how this trust was influenced by contextual factors at organizational and policy levels. Overall, the need for diversity-responsive policies within care organizations is apparent. Carers with a migration background need to feel heard so they can meaningfully tailor care to meet recipients' needs. • This study used an approach combining intersectionality and epistemic (in)justice. • Generating theoretical and practical insight in lived experiences of migrant carers. • Carers face racialization and silencing, impacting their health and wellbeing. • Care organizations should put diversity-response policies into practice. • Dialogue to address discrimination in care networks should be emphasized. [ABSTRACT FROM AUTHOR]

Antimicrobial resistances (AMR) present a particularly challenging cross-sectoral policy problem, affecting human and animal health as well as the environment. Compared to the actual problem pressure, the public awareness for AMR is comparatively low and the issue has not been high on the political agenda in most. Given the rising problem pressure, we aim to find out as to what degree and under which conditions political parties bring AMR on the political agenda. By means of multilevel logit regressions based on 173 electoral manifestos in 30 European countries from 2015 to 2020, we explore the conditions that explain whether AMR are taken up in manifestos. The empirical findings indicate firstly that AMR are only addressed by political parties in Northern and Western Europe, in no case in Eastern, and only in one case in Southern Europe, though resistant bacteria are more widely spread in the latter. Secondly, Green parties are those who are most likely to address the AMR challenge. Thirdly, vote share is positively associated with AMR agenda-setting, while EU membership is insignificant and the national average on antibiotics consumption is negatively related to AMR agenda-setting. Finally, AMR are surprisingly mainly perceived as a problem of the agricultural policy subsystem despite its cross-sectoral policy character. The study makes theoretical and empirical contributions: regarding theory, the article shows that typical variables that are used for agenda-setting are less explanatory for complex intersectoral policies. This is also accompanied by the empirical contribution: since problem awareness and complexity of policy problems are correlated, AMR are reduced to an agricultural issue and as such, it is taken over by political parties that have expertise on agricultural-environmental topics. • Antimicrobial resistances (AMR) are a challenging cross-sectoral policy problem. • Public awareness for AMR is low and the issue is not high on the political agenda. • AMR are only addressed by political parties in Northern and Western Europe. • Green parties are most likely to address the AMR challenge. • AMR are mainly perceived as a problem of the agricultural policy subsystem. [ABSTRACT FROM AUTHOR]

Aligning culture to be similar across work units is a common organizational tactic, but its appropriateness for the multidisciplinary context of healthcare is far from certain. Variation in perceptions of culture across large health systems may serve a functional purpose in delivering high quality care and ameliorating job stress; however, past research in healthcare has focused on culture as the average set of values and norms (i.e., cultural content) rather than on (dis)agreement about values and norms among organizational members (i.e., cultural structure). This survey-based study examines both cultural content (averages among individuals) and structure (distances between individuals) in departments of a large U.S. healthcare organization (total sample = 26,314 workers, response rate = 84%). We used linear models to associate four commonly used culture measures with outcome measures (perceived care quality, intent to stay, and manageable job stress). We found substantial heterogeneity in perceptions for multiple culture types. We found curvilinear relationships between heterogeneity for all culture types and outcomes, suggesting that heterogeneity promotes positive outcomes up to a certain point after which the positive effect declines. For research, our findings point to the importance of studying culture in healthcare with greater focus on heterogeneity; for practice, this study highlights how culturally-focused efforts to improve care quality and worker experience in healthcare should be more precise about balancing cultural alignment and heterogeneity. [ABSTRACT FROM AUTHOR]

The ethical effect of aesthetics is underexplored in literatures on healthcare, especially reproductive services. Healthcare aesthetics play a particular role in influencing patient choice, and in so doing, mediates who is – and is not – welcomed into certain medical spaces. This is particularly pertinent in the context of assisted reproductive clinics, which are often seeking competitive advantage in a market where patients purportedly have a choice amongst providers, and where providers have the capital to invest in clinic design and social media presence to attract patients. Interrogating aesthetic and spatial dimensions of reproductive clinics is especially critical in uncovering gendered, class, and racial assumptions of reproductive futures. As such, ethical inquiry would benefit from examining the aesthetic qualities of ART and its implications on the reproduction of commercialized, gendered, and racialized health settings. In this paper, we draw on reflections made by participants about aesthetics during qualitative interviews on commercial influences on ART services. We expand on these initial reflections by engaging with feminist literature on the image in reproductive ethics and broader scholarship regarding health environments. In doing so, we examine the normative assumptions and effects held within clinic aesthetics to discuss the construction and influence of 'pink' reproductive spaces. • Commercial ART clinics adopt 'pink aesthetics' of female empowerment and choice. • Aesthetics can trouble patriarchal medicine but commodify feminist justice. • Social media and advertising are critical to cultivating gendered aesthetics. • Pink aesthetics reinforces personal responsibility over reproductive futures. • The pink aesthetic constitutes reproductive imaginaries and subjectivities. [ABSTRACT FROM AUTHOR]

Contamination in U.S. public drinking water systems (PWS) is estimated to cause millions of illnesses and billions of dollars in medical expenditures annually. Few prior studies have explored intervention strategies, including environmental enforcement, to reduce estimated health-related exposure disparities (exposure disparity) in PWS, which are driven partially by socioeconomic status (SES), racism, and PWS characteristics. This study used a longitudinal measurement method to estimate the annual health-related exposure level (health level) of each PWS in Michigan, based on data from the Enforcement and Compliance Online (ECHO) and U.S. Census Bureau databases. Using a decomposition model with four strategies, we analyzed how eliminating disparities in SES, proportion minority, environmental enforcement, and PWS characteristics across communities would affect adjusted exposure disparities. This study found that adjusted race- and poverty-based exposure disparities have existed since the 1980s but might have decreased in the last one or two decades. PWS characteristics strongly impacted the crude and adjusted exposure disparity. Environmental enforcement, although less effective in minority-concentrated communities, reduced the adjusted race-based exposure disparity by 10%–20% in the 1980s, 8% in the 1990s, and 0.012% in the 2010s. Equalizing the poverty rate distribution reduced the adjusted race-based exposure disparity by 0.72% in the 1980s and 6.8% in the 2010s. However, equalizing racial and ethnic composition distribution increased the adjusted poverty-based exposure disparity in the 2000s. These findings indicate that economically disadvantaged or minority-concentrated communities in Michigan disproportionately suffer from poorer PWS quality. Enhanced environmental enforcement, increased household income, PWS investment, and other actions are needed to address these exposure disparities effectively. • Crude and adjusted exposure disparities decreased in the 2000s and 2010s. • PWS characteristics strongly affected both crude and adjusted exposure disparities. • Environmental enforcement moderately reduced adjusted race-based exposure disparities (0.01%–20%). • Equalizing the poverty rate distribution quickly and slightly reduced adjusted race-based exposure disparities (0.72%–6.8%). [ABSTRACT FROM AUTHOR]

The purpose of this systematic review was to synthesize the components of interventions that are aimed at reducing stigma among adults living with chronic non-communicable diseases (NCDs). A secondary objective was to assess the effectiveness of interventions in reducing health-related stigma. A search was conducted on OVID MEDLINE, OVID APA PsycINFO, EBSCO CINAHL Complete, Web of Science, and Cochrane Central in July 2023 for articles that report the development and/or testing of health-related stigma-reduction interventions among adults with NCDs. The quality of included studies was assessed using the Joanna Briggs Institute critical appraisal checklists. Intervention components were narratively synthesized. The DerSimonian-Laird random effect model was used to pool standardized mean differences across studies. Nineteen articles were included in the review. Interventions addressed individual level (intrapersonal and interpersonal) and structural level stigmas. Components of intrapersonal interventions included cognitive exercises, stress reduction, promoting self-efficacy, developing communication skills, and listening to other patients' stories. Contact-based interventions were used in many interpersonal interventions. Structural interventions included mass media campaigns and training for healthcare professionals. Pooled intervention effects indicated a significant reduction in stigma levels post-intervention for both persons with NCD (Hedge's g = −1.13; 95% CI: 1.66, −0.60, I 2 = 85%, N = 6 studies) and those without (Hedge's g = −2.45, 95% −4.84, −0.06; I 2 = 97%, N = 2 studies). Interventions to address NCD stigma, although multifaceted, are often not multilevel. Future studies are needed to design and test multilevel NCD stigma-reduction interventions. • Interventions to reduce non-communicable disease stigma have focused on cancers. • Interventions often target intrapersonal stigmas, and few addressed structural stigmas. • Existing interventions demonstrate some preliminary evidence of effectiveness. • However, higher quality studies are required to evaluate medium- and long-term impact of interventions. [ABSTRACT FROM AUTHOR]

This longitudinal quasi-experimental study examines the relationship between social class, subjective health, motivation to return to work (RTW) following medical rehabilitation, and participation in aftercare interventions, utilizing the Social Cognitive Theory of Social Class. To do so, a prospective multicentric study was conducted. The analysis was based on data from N = 1044 orthopedic rehabilitation patients in three clinics in Germany. Latent growth curve models, fixed-effect linear regression models, and multilevel binomial logistic regression were employed for data analysis. As hypothesized, the findings demonstrate that lower social class is associated with poorer subjective health, while higher social class is linked to increased solipsistic motives, characterized by pursuing personal goals in the context of RTW. Conversely, individuals from lower social classes exhibit contextualist motives, which indicate a focus on social and environmental threats influencing their motivation to RTW. Surprisingly, social class does not significantly impact participation in aftercare interventions, probably due to low variance and potentially the successful inclusion within the German healthcare system. These findings emphasize the importance of considering diverse motivation profiles derived from the Social Cognitive Theory of Social Class. The study contributes to our understanding of the social determinants of health and has implications for reducing health disparities by highlighting the motivational aspects, including solipsistic and contextualist motives, associated with social class. • Social class shapes subjective health trajectories in orthopedic rehabilitation patients. • Individuals from lower social classes initially exhibit lower subjective health. • Rehabilitation may equalize health improvements across social classes. • Solipsistic and contextualist return-to-work motives may vary based on social class. • No class differences in participation in aftercare programs were observed. [ABSTRACT FROM AUTHOR]

Hundreds of state-level abortion restrictions were implemented in the US between 2010 and 2020. Medication abortion was being widely adopted during this same period. Understanding the impact of health policies and political climate will improve the delivery of and access to reproductive healthcare in a period of rapid change. To measure the association between state abortion hostility and mifepristone and procedural abortion rates, we conducted a state-level repeated cross-sectional study using 2010–2020 employer-sponsored insurance claims data from Merative MarketScan. The exposure of interest was a 13-point state-level abortion hostility score based on the presence of policies which either reduce or protect access to abortion. Outcomes of interest were annual mifepristone and procedural abortion claims per 100,000 enrollees. We used a linear mixed model adjusting for urbanicity, age group, and year. We assessed whether temporal trends in abortion claims were modified by state abortion hostility by interacting year with two measurements of abortion hostility: baseline score in 2010 and change from baseline score. We found that median state-level mifepristone claims increased from 20 to 37 per 100,000 included enrollees; meanwhile, median procedural abortions claims decreased from 69 to 20 per 100. For mifepristone, every unit increase in a state's baseline abortion hostility score was associated with 7.5 (CI, −12 to −3.6) fewer mifepristone claims per 100,000 in 2010. For states with baseline hostility and change scores of zero, we did not observe a significant time trend over the 11 year study period. For every unit increase in baseline hostility, the time trend changed by 0.5 fewer claims (CI, −0.8 to −0.2) per 100,000 per year. States with higher baseline abortion hostility had fewer overall abortions, less uptake of mifepristone abortions, and slower decline in procedural abortions between 2010 and 2020. Changes in hostility from new restrictions during this time period did not significantly impact claims. Advocates for abortion access must simultaneously attend to individual abortion policies and the overall political climate. Updated research on the relationship between political climate and the evolving clinical landscape of abortion care is needed to inform this work. • From 2010 to 2020, hundreds of abortion restrictions were passed in the US. • For commercially insured patients during this period, mifepristone claims increased and procedural abortions decreased. • More restrictive states had smaller increases in mifepristone and slower declines in procedural abortions. • Mifepristone replaced procedural abortions only in more abortion-friendly states. [ABSTRACT FROM AUTHOR]

Gender-affirming healthcare can carry significant benefits for trans people. However, there are substantial geographical inequalities in the provision of and access to trans-specific healthcare across Europe. Comparative healthcare systems research has typically focused on universal services, neglecting provision which serves specific groups within populations (e.g., trans people). This study aimed to develop a comparative typology of trans-specific healthcare systems across 28 European countries (the EU 27 plus the UK), and to examine country-level correlates which may influence or be influenced by these systems. Using hierarchical and k-means cluster analysis, countries were classified into four types based on measures of trans-specific healthcare provision, regulation and access. Possible country-level correlates (including socio-political climate, medical outcomes, and the general healthcare system) were investigated. The cluster analysis identified four clusters of trans-specific healthcare systems in Europe, characterized as: 1) Centralized conservative (highly centralized, extensive range of treatments, few trans-specific government policies); 2) Centralized reformist (highly centralized, extensive range of treatments, multiple trans-specific government policies); 3) Decentralized marketized (highly decentralized, moderate range of treatments, few trans-specific government policies); 4) Underdeveloped (highly decentralized, limited range of treatments, few or no trans-specific government policies). We found statistically significant differences between the clusters in rates of: public support for trans people; gender identity concealment; treatment access; overall health expenditure; gender inequality. The study develops a novel typology of trans-specific healthcare systems in Europe. It also identifies a range of potential drivers and outcomes of geographical divergences and inequalities in trans-specific healthcare provision. Building on this typology, future comparative research should aim to link the structure of healthcare systems to outcomes for trans people. Comparative healthcare systems research must account for the distinctive forms taken by services and systems that provide healthcare to specific groups within populations. • Develops a novel typology of trans-specific healthcare systems in Europe. • Conceptualizes four distinct types of trans-specific healthcare systems. • Investigates potential drivers and outcomes of inequalities between systems. [ABSTRACT FROM AUTHOR]

Alcohol is recognized as a driver of intimate partner violence (IPV) perpetration and experience, but relatively little research has focused on the role of couples' drinking patterns, nor pathways between alcohol and violence. We draw on data collected among young (18–30 year old) people living in informal settlements who self-selected to enroll in an intervention trial to reduce IPV in Durban, South Africa to understand these dynamics. Between September 2015 and September 2016 quantitative data were collected from women, who reported on their own experiences of IPV and alcohol use, as well as their partner's own alcohol use. To contextualise and interpret the quantitative results, we use qualitative data from women and men (who were not in relationships with one another) to understand potential pathways through which alcohol use may shape conflict in relationships. All forms of IPV (physical and/or sexual, emotional and economic) were more common among women where either, they alone had problematic drinking levels, their partner was frequently drunk but they did not have problematic alcohol use, or they had problematic alcohol use and their partner was drunk frequently. Qualitative data suggested women and men in relationships rarely drank together. Three potential ways in which alcohol use increased conflict and IPV: disinhibition, with women and men more likely to get into arguments and speak 'badly' to one another; the impact of men's drinking on relationships, including economic provision and providing emotional support; and, the close association between alcohol consumption and infidelity, with women's public drinking being particularly stigmatized and male partner's seeing this as a challenge to their authority and control. Interventions addressing the alcohol-IPV nexus need to also address male patriarchal control and alcohol's close association with infidelity and the impact on finances, as well as reducing alcohol use. • Alcohol and IPV are intertwined, but the pathways are poorly understood. • Qualitatively, young women in informal settlements describe three pathways. • Alcohol leads to disinhibition and arguments. • Men's drinking is seen to divert money and time from relationships causing conflict. • Men seek to control women's public drinking as it shows loss of male authority. [ABSTRACT FROM AUTHOR]

Arts and cultural engagement has the potential to reduce social deficits such as loneliness and social isolation. However, as most evidence is from Western countries, less is known whether the protective association of engagement with social deficits can also be seen in different cultural settings such as Asia. We explored the associations of arts and cultural engagement, focusing on engagement continuity and type, with loneliness and social isolation among older adults in Japan, one of the fastest-ageing countries. This three-year longitudinal study involved 4,383 individuals (mean age = 74.3 years; 51.3% women) from the Japan Gerontological Evaluative Study 2019; 2022 waves. To assess engagement continuity, respondents were categorised into four groups: none, decreasing, increasing and sustained engagement. A latent class analysis identified four classes of engagement type: low, receptive, creative and diverse engagement. Loneliness and social isolation were measured using the University of California Los Angeles (UCLA) 3-Item Loneliness Scale (range: 3–9) and the Social Isolation Index (range: 0–5), respectively. We applied ordinary least squares regressions to investigate the associations between engagement and the outcomes. Regarding engagement continuity, those who increased or sustained their engagement across waves reported lower loneliness compared with those who did not engage (increased: coef. = −0.22, 95% confidential interval [CI] = −0.41, −0.04; sustained: coef. = −0.26, 95% CI = −0.36, −0.16). Individuals who sustained their engagement also reported lower social isolation (coef. = −0.18, 95% CI = −0.27, −0.09). Regarding engagement type, engaging in diverse activities was associated with lower loneliness compared to low engagement (coef. = −0.34, 95% CI = −0.59, −0.10), while creative and diverse engagement were associated with lower social isolation (creative: coef. = −0.13, 95% CI = −0.22, −0.04; diverse: coef. = −0.33, 95% CI = −0.54, −0.12). These findings suggest that offering a diversity of creative arts and cultural activities and supporting sustainable engagement of older adults may help alleviate their social deficits. • Arts and cultural engagement may reduce social deficits (loneliness and isolation). • This study focused on engagement continuity and type among older adults in Japan. • Increasing and sustained engagement showed lower social deficits three years later. • Diverse and creative engagement indicated lower levels of subsequent social deficits. • Sustained offering of diverse creative arts and cultural activities may mitigate social deficits. [ABSTRACT FROM AUTHOR]

On November 4, 2008, Barack Obama was elected the first Black President of the United States. His campaign and electoral win served as a symbol of hope for a more just future, fostering an "Obama effect" that appears associated with improved well-being among non-Hispanic (NH) Black communities. Situating the Obama election within the symbolic empowerment framework, we consider the potentially protective role of the Obama election on NH Black fetal death, an important but understudied measure of perinatal health that has stark racial disparities. Using restricted-use natality files from the National Center for Health Statistics, we proxy fetal death using the male twin rate (number of twins per 1000 male live births). Male twins have a relatively high risk of in utero selection that is sensitive to maternal and environmental stressors, making the twin rate an important marker of fetal death. We then estimate interrupted time-series models to assess the relation between the Obama election and male twin rates among NH Black births across monthly conception cohorts (February 2003–October 2008). Greater-than-expected male twin rates signal less susceptibility to fetal loss. Results indicate a 4.5% higher male twin rate among all NH Black cohorts exposed in utero to the Obama election, after accounting for historical and NH white trends (p < 0.005). The greater-than-expected rates concentrated among births conceived in the months preceding Obama's nomination at the Democratic National Convention and Obama's presidential win. These results suggest a salutary perinatal response to election events that likely reduced NH Black fetal loss. They also indicate the possibility that sociopolitical shifts can mitigate persisting NH Black-NH white disparities in perinatal health. • Greater-than-expected male twin rates signal reduced susceptibility to fetal loss. • Black male twin rates increased for cohorts in utero during Obama's 2008 election. • Increases were greatest for births conceived months prior to primary, election wins. • Symbolic sociopolitical shifts may mitigate persisting perinatal health disparities. [ABSTRACT FROM AUTHOR]

This national US study determined the causal impact of shared decision making (SDM) on pain outcomes, including any overall pain and the subcategories of any acute pain and any chronic pain. We additionally examined whether the causal impact of SDM on overall pain is moderated by gender, race-ethnicity, clinician-patient racial-ethnic concordance, and clinician-patient gender concordance. We used national US data from the 2003–2017 Medical Expenditure Panel Survey, which were externally valid to the US national non-institutionalized population, employed a standard measure of shared decision making, and applied an internally-valid two-stage least squares approach that used the peer SDM behavior of similar clinicians as an instrument. The instrument was sufficiently strong and statistically uncorrelated with patient characteristics. We found a large impact of SDM on both female and male chronic pain outcomes, where the effect for females was approximately 50% larger than for males, with a 10 percentage point increase in SDM quality resulted fewer females experiencing chronic pain that interfered with everyday activities (−24.8 percentage points; 95% confidence interval [CI]: 43.3, −6.4) than males (−16.5 percentage points; 95% CI: 32.9, −1.0). We estimated that a 10 percentage point national increase in the SDM index would thus result in 10.1 million fewer females and 5.7 million fewer males in the US experiencing chronic pain that interfered with their daily activities. Policy implications include both increasing the quality of SDM for all patients and educating male patients on the value of SDM. • Shared decision-making (SDM) results in chronic pain elimination for some patients. • SDM impacts chronic pain outcomes in 50% more females than males. • Higher quality SDM would eliminate chronic pain for 15.8 million people. • Instrumental variables were used to determine causal effects using national data. [ABSTRACT FROM AUTHOR]

War and military metaphors have long been used in clinical medicine to describe medicine's collective fight against disease. However, recently resistor trainees have used similar language to describe their acts of professional resistance against social harm and injustice. To understand the contours of this war, this study analyzes the metaphoric language these trainees use to describe their acts of resistance. We recruited 18 resisting trainees using our personal and professional networks and snowball sampling. Participants were interviewed from July 2022–February 2023. Using methodological bricolage, we analyzed the data using Wickens' analytical approach, which draws on constant comparative analysis and discursive textual analysis. Data were analyzed in three phases that included a consult with a military historian, isolation of metaphoric language, and a textual analysis using context clues from participants' descriptions of their acts of professional resistance. Resisting trainees used metaphorical language to signal an insurgency to topple power. These trainees referenced two conflicts: the mistreatment of patients and the mistreatment of trainees. Enemies were conceptualized as anyone who actively protects institutions and the traditions of medicine, such as leaders of medical schools and hospitals, and physicians trained in a more traditional system. Trainees conceptualized the primary battlefield as medicine's process of socialization that integrates trainees into a profession, and accepts mistreatment as the norm. Weapons included LCME site visits and sympathetic faculty members. Whereas metaphorical language around war and the military was previously the purview of physicians, resistor trainees have adopted war metaphors for their own purposes. They do not use these metaphors accidently; they are meant to signal their intentions to restructure medical education. Leaders must begin working with trainees in sincere partnership to create widespread change. • Resisting medical trainees are engaged in acts of professional resistance to transform medical education and practice. • Resisting medical trainees are using metaphors of war and military to communicate their intentions. • Collectively, resistor trainees are engaged in an insurgency/social movement to overturn those in power. [ABSTRACT FROM AUTHOR]

Valuing child health necessitates normative methodological decisions on whose preferences should be elicited and who should be imagined as experiencing impaired health. Formal guidance is limited and expert consensus unclear. This study sought to establish the degree of consensus among expert stakeholders on normative issues of who to ask and who should be imagined when valuing child health (7–17 years) to inform UK health technology assessment. Sixty-two experts (n = 47 in Round 2) from 18 countries participated in a modified, two-round online Delphi survey (Round 1: May-June 2023; Round 2: September-October 2023). Participants were expert stakeholders in child health valuation, including academics (n = 38); industry/consultancy representatives (including the charity/not-for-profit sector; n = 13); and UK policy/government representatives (n = 11). The Delphi survey was modified between rounds and consisted of 9-point Likert, categorical, multiple-choice, and free-text questions on normative issues in valuing child health. Responses were analysed descriptively and thematically. An a priori criterion of ≥75% agreement was established for formal consensus, while areas approaching consensus (≥70% agreement) and without consensus were identified as a future research primer. Consensus was observed that older adolescents (aged 16–17 years) and adults (18+ years) should be asked to value child health states. There was consensus that the former should think about themselves when valuing the health states and the latter should imagine a child of some form (e.g., imagining themselves as a child or another hypothetical child). However, no consensus was evident on what form this should take. Several other methodological issues also reached consensus. These findings are largely consistent with recent views elicited qualitatively from members of the public and other stakeholders on normative issues in valuing child health. The results mean that, contrary to what has been done in previous child health valuation studies, efforts should be made to involve both older adolescents (16+ years) and adults in child health valuation. • No established consensus on normative approaches to value child health. • Opinions of international experts elicited using online Delphi survey methodology. • Consensus that adults and older adolescents (16+) should value child health states. • Consensus that adults should think about a child and adolescents about themselves. • Lack of consensus in several methodological issues, including which child perspective. [ABSTRACT FROM AUTHOR]

Socioeconomic inequalities in cognitive impairment may partly act through structural brain damage and reduced connectivity. This study investigated the extent to which the association of early-life socioeconomic position (SEP) with later-life cognitive functioning is mediated by later-life SEP, and whether the associations of SEP with later-life cognitive functioning can be explained by structural brain damage and connectivity. We used cross-sectional data from the Dutch population-based Maastricht Study (n = 4,839; mean age 59.2 ± 8.7 years, 49.8% women). Early-life SEP was assessed by self-reported poverty during childhood and parental education. Later-life SEP included education, occupation, and current household income. Participants underwent cognitive testing and 3-T magnetic resonance imaging to measure volumes of white matter hyperintensities, grey matter, white matter, cerebrospinal fluid, and structural connectivity. Multiple linear regression analyses tested the associations between SEP, markers of structural brain damage and connectivity, and cognitive functioning. Mediation was tested using structural equation modeling. Although there were direct associations between both indicators of SEP and later-life cognitive functioning, a large part of the association between early-life SEP and later-life cognitive functioning was explained by later-life SEP (72.2%). The extent to which structural brain damage or connectivity acted as mediators between SEP and cognitive functioning was small (up to 5.9%). We observed substantial SEP differences in later-life cognitive functioning. Associations of structural brain damage and connectivity with cognitive functioning were relatively small, and only marginally explained the SEP gradients in cognitive functioning. • Early-life socioeconomic position (SEP) was associated with later-life cognition. • Later-life SEP was associated with later-life cognition. • Later-life SEP mediated 72.2% of the association of early-life SEP with cognition. • Mediation by structural brain damage or connectivity was small (up to 5.9%). [ABSTRACT FROM AUTHOR]

This study uses the bioecological model of human development and person-centered methods to describe the underlying patterns of risk and their association with bullying perpetration and victimization among U.S. children. Using the National Survey of Children's Health, this study (n = 7319) explored the underlying patterns of risks across six domains (i.e., individual, family, school, neighborhood, economic, and socio-cultural) associated with bullying perpetration and victimization among U.S. elementary school children. Latent Class Analysis uncovered four patterns of risks. The low risks group (72.4%) showed the lowest rates of bullying perpetration (24.6%) and victimization (57.2%). The individual and environmental risks group (15.3%) presented moderate levels of bullying perpetration (31.8%) and victimization (67.1%). The family risks group (8.3%) showed moderate levels of bullying perpetration (35.9%) and victimization (66.0%). High risks group (4.0%) presented exceptionally high rates of bullying perpetration (59.1%) and victimization (87.3%). Results suggest rates of bullying perpetration and victimization differed across the four patterns of risks. Understanding the sources of risk may be critical to alleviate bullying perpetration and victimization among children. Findings suggest that child bullying should be approached with customized treatment considering their pattern of risk exposure. • Four underlying risk patterns associated with bullying perpetration and victimization. • Bullying rates among U.S. children were 29% for perpetration and 61% for victimization. • Customized anti-bullying treatments should consider a child's risk pattern. [ABSTRACT FROM AUTHOR]

People in the North of England live shorter, less healthy lives than those in the South. Despite the significance of this 'North South health divide', regional health inequalities in England are under-researched qualitatively. Existing literature on geographical inequalities in health is largely confined to the neighbourhood level, is quantitative, and consists of very little lay knowledge. The current study is the first to examine lay perspectives of health inequalities on a regional level: exploring how people living in two urban areas of the North and South of England experience and perceive the North South health divide – including its causes and solutions. Using three focus group discussions with a total of 34 participants, and conducting participatory analysis, we identified three key themes: 'inequalities of power', 'lack of control over lived environment' and 'communities under strain'. Findings align with existing research on lay perspectives of health inequalities at the neighbourhood level – identifying a network of material-structural and psychosocial factors. Participants across both regions discussed political and economic structures as central to understanding regional health inequalities, supporting calls to adopt a political economy approach in understanding health and place. Deindustrialisation, unemployment, loss of community facilities, and disengagement from politics were more present in Northern narratives than Southern. Findings add important 'social meaning' to emerging research on the North South health divide, reinforcing the urgency of public health professionals' recommendations for fair redistribution of power, wealth and resources to reduce regional health inequalities. In the context of government policy which diverges from public health evidence, this study sparks questions of how health inequalities research can intersect with wider social and political movements organising for systemic change. • Explores how people living in the North and South understand England's 'health divide'. • Political and economic factors discussed as central to regional health inequalities. • Supports arguments to 'scale up' analysis of health-place relationships. • Considers implications for policy addressing the North South health divide. • Sparks questions around role of health inequalities research in political action. [ABSTRACT FROM AUTHOR]

There is a lack of knowledge about the health consequences of politically initiated forced permanent rehousing (FPR) of residents in social housing areas. This study investigates if FPR is associated with the contact frequency with general practitioner (GP) and the proportion of residents who use antidepressants. The study included 432 rehoused residents matched 1:2 with remaining residents and residents from a comparable neighbouring area without exposure to rehousing. For GP contact frequency, we conducted a difference-in-difference analysis while the proportion of residents who used antidepressants was investigated through descriptive statistics. We found high GP contact frequency in the three groups, but no significant differences. Further, we found a low proportion of residents who used antidepressants in all groups, but a small increase from baseline to follow-up. Our results thus suggest that FPR neither affected the rehoused residents' GP contact frequency nor the proportion who used antidepressants. • Forced permanent rehousing did not affect general practitioner contact frequency. • High general practitioner contact frequency was found among all residents. • Rehoused residents had no considerable increase in the proportion who used antidepressants. • Residents were not more likely to initiate or continue to use antidepressants after rehousing. [ABSTRACT FROM AUTHOR]

Research points to the existence of racial bias and beliefs among healthcare staff but does not explicate accounts of racialization in healthcare and the day-to-day utterances that have racializing effects excluding minoritized users' right to care. This study understands racism as structural and embedded in societies and institutions, including healthcare, as well as in interactions and talk. Through excavating accounts of healthcare staff's talk that devalues minoritized users, this study posits talk as reflective and constitutive of the dominant structure of racism within which it is situated. Drawing on qualitative interviews with 58 staff in Sweden, the study delineates three categories through which racialized talk differentiates between minoritized and majoritized users. These are: Characterizing minoritized users as 'bad' users, Characterizing minoritized users' health complaints as unworthy and finally, Devaluing minoritized users as justification for suboptimal and differential care. Healthcare staff accounts show that continuous racialization of minoritized users maintains existing power-relations representing Western users as civilized and non-Western users as uncivilized and problematic. Through reiteration, these practices of exclusion become invisible, normalized, and assume the status quo. It is imperative to address racialization as it has implications for the core ethics of healthcare. • This article examines healthcare staff's racialized talk. • Racialized talk characterizes minoritized users as 'bad' and uncivilized users. • Minoritized users' health complaints are viewed as unworthy of care. • Racialized talk is further used to justify suboptimal and differential care. [ABSTRACT FROM AUTHOR]

Social scientists have given relatively scant attention to the association between attractiveness and longevity. But attractiveness may convey underlying health, and it systematically structures critical social stratification processes. We evaluated these issues using the Wisconsin Longitudinal Study (WLS, N = 8386), a survey of Wisconsin high school graduates from 1957 which provided large samples of women and men observed until their death (or through their early 80s). In doing so, we utilized a meticulously constructed measure of facial attractiveness based on the independent ratings of high-school yearbook photographs. We used linked death information from the National Death Index-plus through 2022 and Cox proportional hazard models as well as standard life-table techniques. We found that the least attractive rated sextile of the sample had significantly higher hazards of mortality (HR: 1.168, p < 0.01) compared to the middle rated four sextiles of attractiveness. This finding remained robust to the inclusion of covariates describing high-school achievement, intelligence, family background, earnings as adults, as well as mental and physical health in middle adulthood. We also found that different specifications of the attractiveness measure consistently indicated no significant differences in the mortality hazard between highly attractive and average-looking people. Using life-table techniques, we next illustrated that among women in the least attractive sextile, at age 20 their life expectancy was nearly 2 years less than others'; among men in the least attractive sextile, it was nearly 1 year less at age 20. • Little is known about the association between facial attractiveness and longevity. • We analyze how attractiveness based on yearbook pictures is linked to longevity. • We find that the least attractive 1/6th had a significantly Higher Hazard of mortality. • The least attractive 1/6th of women lived almost 2 years less than others at 20. • The least attractive 1/6th of men lived almost 1 years less than others at 20. [ABSTRACT FROM AUTHOR]

Using cross-sectional data from a representative sample of the French population (the 2008 Disability Health survey), this paper examines whether the SF-6D, a widely used preference-based measure of health-related quality of life in economic evaluations, fully captures the variation in subjective well-being (SWB) due to chronic illnesses. We conduct a mediation analysis to disentangle the direct and indirect, through the SF-6D, effects of various chronic conditions on SWB (happiness). Our results show that the SF-6D reflects changes in happiness due to most illnesses except mental illness. Changes in SWB mediated by the SF-6D account for 74% of the total effect. The variation unexplained by the SF-6D is significant and increases substantially in the presence of multimorbidity when a chronic illness is combined with anxiety or depression. Overall, our results suggest that the SF-6D incompletely captures the subjective experience of chronically ill patients, especially those with comorbid conditions. • 74% of the effect of chronic illness on happiness is captured by the SF-6D. • The SF-6D does not fully capture the effect of mental illness on happiness. • The effect not captured by the SF-6D increases significantly with multimorbidity. [ABSTRACT FROM AUTHOR]

Nongovernmental migrant shelters in Mexico play a key role in documenting the factors that shape forced migration from Central America. Existing intake protocols in shelters are largely oriented to humanitarian legal frameworks that determine eligibility for international protection based on interpersonal violence and political persecution. This qualitative study calls attention to how existing humanitarian logics may obscure climate- and health-related disruptions as drivers of forced migration from Central America in the context of everyday humanitarian practice. In May 2022 we compared migrant's responses (n = 40) to a standardized intake protocol at a nongovernmental humanitarian migrant shelter in Mexico with responses to semi-structured interviews that focused on migrants' perceptions of climate change and health as drivers of forced displacement. We found that slow- and rapid-onset climatic disruptions; illness and disease; and various forms of violence and repression are often interrelated drivers of forced displacement. Comparing intake protocols and in-depth interview responses, we found that climate- and health-related drivers of forced displacement are rarely documented. These findings speak to the importance of critically examining everyday humanitarian practices in the context of ongoing advocacy that calls for climate-related disruptions to be integrated into existing humanitarian protection frameworks. • Climate-health risks contribute to forced displacement from Central America • Central Americans often access humanitarian migrant shelters while crossing Mexico. • Climate-health risks as migration drivers are rarely documented in shelters. • Shelters mediate how climate-health risks are made known, obscured, and governed. [ABSTRACT FROM AUTHOR]

This study investigates the impact of gender discrimination in the labor market on suicidal ideation among Korean women, taking into consideration women's multiple social locations and their discriminatory experiences across various aspects of employment. Analysis using waves 4 to 8 data of the Korean Longitudinal Survey of Women and Family, with response rates ranging from 68.3% to 78.2%, indicates that gender discrimination in hiring, dismissal, promotion, job allocation, training, wage, and sexual harassment is strongly associated with suicidal thoughts among women. This relationship remains significant even after controlling for stress, depression, and other forms of discrimination. Subgroup analysis further highlights that women with lower income levels are particularly susceptible to the adverse effects of gender discrimination. The findings underscore the importance of policy intervention to mitigate labor market discrimination against women as a crucial step in preventing suicides among Korean women. • Gender discrimination in the labor market is significantly associated with suicidal ideation among Korean women. • The impact of discrimination remains substantively significant even after controlling stress, depression, and prior suicidal ideation. • The analysis takes women's different social locations and discrimination in multiple settings into account. • Women with lower income levels are particularly susceptible to the adverse effects of gender discrimination. • Policy intervention to reduce labor market discrimination against women is essential to prevent the suicide of Korean women. [ABSTRACT FROM AUTHOR]

Trust remains a critical concept in healthcare provision, but little is known about the ability of health policy and interventions to stimulate more trusting relationships between communities and the health system. The CONNECT (Community Network Engagement for Essential Healthcare and COVID-19 Responses Through Trust) Initiative in Lao PDR provided an opportunity to assess the community-level impact of a trust-building community engagement approach. A mixed-method process evaluation was implemented from 10/2022–12/2023 among 14 diverse case study communities in four provinces across Lao PDR. Data collection involved two rounds of census surveys (3161 observations incl. panel data from 618 individuals) including an 8-item trust scale, 50 semi-structured interviews with villagers, and 50 contextualizing key informant interviews. The two data collection rounds were implemented before and three months after village-based CONNECT activities and helped discern impacts among activity participants, indirectly exposed villagers, and unexposed villagers in a difference-in-difference analysis. Stakeholders attested strong support for the CONNECT Initiative although community-level retention of trust-related themes from the activities was limited. Quantitative data nevertheless showed that, at endline, the 8-item trust index (from [–8 to +8]) increased by 0.95 points from 4.44 to 5.39 and all trust indicators were universally higher. Difference-in-difference analysis showed that villagers exposed to the CONNECT activities had a 1.02-index-point higher trust index compared to unexposed villagers. Trust impacts improved gradually over time and were relatively more pronounced among men and ethnic minority groups. The CONNECT Initiative had considerable direct and systemic effects on community members' trust in their local health centers in the short term, which arose from strong stakeholder mobilization and gradual institutional learning. Relational community engagement approaches have the potential to create important synergies in health policy and broader cross-sectorial strategies, but also require contextual grounding to identify locally relevant dimensions of trust. • Community engagement holds promise for building trust in healthcare • Study provides short-term mixed-method evaluation evidence from rural Lao PDR • Trust improved strongly and consistently across all dimensions • Systemic and direct impacts underline success of relational community engagement • Trust-building approaches require strong stakeholder support and local grounding [ABSTRACT FROM AUTHOR]

This cross-sectional study examined the associations between sociodemographic characteristics, BMI, and body image constructs (body satisfaction and weight bias internalization; WBI) and explicit weight bias. A near-representative sample of 995 English-speaking Canadian adults (52% Female) completed a survey which assessed explicit weight bias (Anti-Fat Attitudes questionnaire), body satisfaction (Body Shape Satisfaction Scale), WBI (Modified Weight Bias Internalization Scale), and self-reported height and weight. Multiple linear regression analyses were run. Results showed that the variable that explained the most variance in explicit weight bias was WBI, followed by BMI. Higher levels of WBI and a lower BMI were both significantly associated with greater explicit weight bias. Male sex was associated with both disliking people with obesity and thinking obesity is attributable to lack of willpower, whereas female sex was associated with worrying about weight gain. The current findings emphasize the importance of future research efforts aimed at preventing or mitigating WBI to reduce negative attitudes about people with obesity. • Weight bias internalization is important in explaining explicit weight bias. • Lower BMI is associated with greater explicit weight bias. • Male sex is associated with greater negative attitudes towards people with obesity. • Self-stigma explains more of explicit weight bias than BMI, education, and income. [ABSTRACT FROM AUTHOR]

Racial and gender differences in the effects of discrimination on health are well-established. The evidence has derived largely from studies of older adults, with less attention paid to younger adults. The current study takes an intersectional approach to address this gap. Using nationally representative, longitudinal data from the 2017 and 2019 Panel Study of Income Dynamics Transitioning to Adulthood Supplement (PSID-TAS), we assess the effects of everyday discrimination on psychological distress among Black and White young adults aged 18–28 (n = 3894). We examine cumulative discrimination and individual items of the cumulative measure based on the Everyday Discrimination Scale. The analysis reveals that perceived discrimination is positively associated with psychological distress for each race-gender group. However, the magnitude of the association varied by group and dimension of discrimination. Black men and women reported more frequent experiences of each type of discrimination than their White counterparts. The positive association between discrimination and distress, however, was lower for Black men and women relative to White men— suggesting that White men may be more sensitive to and/or less resilient against the effects of perceived discrimination. In contrast, associations for White women did not differ significantly from those of White men. Our findings demonstrate that the health-harming effects of discrimination on psychological distress begin early in the life course and suggest that resilience-based coping mechanisms found in older samples of Black adults may also exist for younger adults. • Negative effects of discrimination on mental health for young adults are understudied. • Health-harming effects of discrimination for young adults vary by race and gender. • Perceived discrimination increased psychological distress for all race-gender groups. • However, the rate of increase was lower for Black men and women than White men. • Resilient coping found among older Black adults may also exist in young adulthood. [ABSTRACT FROM AUTHOR]

The study aimed to explore the meaning for adolescents of living with a parent with amyotrophic lateral sclerosis (ALS). The design is qualitative. Interviews were conducted between December 2020 and April 2022 with 11 adolescents (8-25 y), living in households with a parent with ALS in Sweden. The analysis was phenomenologically hermeneutical. The adolescents were in a difficult and exposed situation, especially if the parent had a severe disability and assistant care providers were in the home. Witnessing the gradual loss of the parent in an indefinite battle against time, while still needing them, elicited grief-filled and hard-to-manage emotions. Everyday life was turned upside down, resulting in greater responsibility for the adolescents, not only in helping with household chores and assisting the ill parent, but also in emotionally protecting both parents. It forced the adolescents to mature faster and put their own life on hold, triggering experiences of being limited. This, together with changing family roles yet being more attached to home, reinforced the imbalance in the adolescents' lives. The interpreted whole of the adolescents' narratives revealed that living with a parent with ALS meant a challenging and grieving transition during an already transition-filled adolescence, which left the adolescents struggling to keep a foothold on a life torn apart. The unbalanced life situation may hinder the adolescents' identity formation and emancipation, which are developmentally important for managing a healthy and independent adulthood. The results emphasize the importance of early targeted support to reach this vulnerable group in order to secure their health. • Living with a parent with amyotrophic lateral sclerosis (ALS) was challenging. • The adolescents' lives were turned upside down, bringing increased responsibility. • They were forced to mature faster while becoming more attached to home. • This unbalanced life situation may disturb the identity formation and emancipation. • Early, targeted support is crucial to secure this vulnerable group's health. [ABSTRACT FROM AUTHOR]

Across two studies, using five samples (N = 1,850), we examined whether health information avoidance—the deliberate decision to remain ignorant of available but unwanted personal health information—serves a defensive purpose and is interchangeable with other defensive strategies. We tested this idea by examining the relationship between health information avoidance—both as a dispositional tendency and deliberate decision—and feedback derogation. In Study 1, we experimentally demonstrated that a situation known to reduce defensiveness—self-uncertainty—decreased both proactive avoidance and reactive defensiveness relative to a control group. Study 2 demonstrated, across four samples, that people with a greater defensive orientation toward personal health information were more likely to derogate health information. These results are consistent with the idea that feedback derogation replaced the decision to avoid feedback. Together, results suggest that health information avoidance is likely part of a broader self-protective system and is replaceable with other motivated self-protection strategies. • Are health information avoidance and derogation linked by defensive motivation? • Decreasing the decision to avoid does not necessarily increase acceptance. • Interventions must enervate defensive motivation more broadly to prevent rejection. [ABSTRACT FROM AUTHOR]

Children with experience of maltreatment, abuse or neglect have higher prevalence of poor mental health. In the United Kingdom, child protection services identify children at risk of significant harm on the Child Protection Register (CPR) and intervene to reduce risk. Prevalence and incidence of mental health service use among this population of children are not well understood. We analysed records from one Scottish Local Authority's CPR, linked to electronic health records for all children in the broader health board region aged 0–17 years. We described mental health service use among children with a CPR registration using measures of mental health prescribing and referrals to child and adolescent mental health services (CAMHS). We calculated age- and sex-specific incidence rates for comparison with the general population. Between 2012 and 2022, we found 1498 children with a CPR registration, with 69% successfully linked to their health records. 20% were registered before birth and median age at registration was 3 years. Incidence rates in all measures of mental health service use were higher in children with a CPR record across all ages (at outcome) and genders compared to the general population. The largest absolute difference was for boys aged 5–9 with a CPR record, who had 31.8 additional mental health prescriptions per 1000 person-years compared to the general population (50.4 vs. 18.6 prescriptions per 1000 person-years, IRR: 2.7). Girls aged 0–4 years with a CPR registration had the largest relative difference, with a rate of CAMHS referral 5.4 times higher than the general population (12.3 vs. 2.3 per 1000 person-years). Our reproducible record linkage of the CPR to health records reveals an increased risk of mental health service use during childhood. Our findings have relevance to public mental health surveillance, service prioritisation and wider policy aiming to reduce childhood exposure to risk of harm. • The first record linkage of a UK child protection register to electronic mental health records. • Children at risk of serious harm have up to 5 times the rate of mental health service use. • Increased risk is observed for both sexes and at each age group up to 17 years. [ABSTRACT FROM AUTHOR]

Irregular legal status is a recognized health risk factor in the context of migration. However, undocumented migrants are rarely included in health surveys and register studies. Adverse perinatal outcomes are especially important because they have long-term consequences and societal risk factors are modifiable. In this study, we compare perinatal outcomes in undocumented migrants to foreign-born and Norwegian-born residents, using a population-based register. We included women 18–49 years old giving birth to singletons as registered in the Medical Birth Registry of Norway from 1999 to 2020. Women were categorized as 'undocumented migrants' (without an identity number), 'documented migrants' (with an identity number and born abroad), and 'non-migrants' (with an identity number and born in Norway). The main outcome was perinatal mortality, i.e., death of a foetus ≥ gestational week 22, or neonate up to seven days after birth. We used log-binominal regression to estimate the association between legal status and perinatal mortality, adjusting for several maternal pre-gestational and gestational factors. Direct standardization was used to adjust for maternal region of origin. Regional Ethical Committee (REK South East, case number 68329). We retrieved information on 5856 undocumented migrant women who gave birth during the study period representing 0.5% of the 1 247 537 births in Norway. Undocumented migrants had a relative risk of 6.17 (95% confidence interval 5.29 ̶7.20) of perinatal mortality compared to non-migrants and a relative risk of 4.17 (95% confidence interval 3.51 ̶4.93) compared to documented migrants. Adjusting for maternal region of origin attenuated the results slightly. Being undocumented is strongly associated with perinatal mortality in the offspring. Disparities were not explained by maternal origin or maternal health factors, indicating that social determinants of health through delays in receiving adequate care and factors negatively influencing gestational length may be of importance. • Undocumented migrants had six times the risk of perinatal mortality to non-migrants. • Undocumented migrants had four times the risk compared to documented migrants. • Disparities were not explained by maternal origin or maternal health factors. • Gestational length could only partially explain the excess perinatal mortality risk. • Delays in receiving adequate care may have a role explaining the disparities. [ABSTRACT FROM AUTHOR]

15–20% of identified pregnancies result in miscarriage, which may lead to persistent symptoms of psychological morbidities in some women. Healthcare satisfaction is among the factors believed to influence such negative psychological responses. Here, we present the results of a study conducted in Portugal that analyzes the relationship between healthcare satisfaction, information and support provision and perinatal grief symptoms. In a cross-sectional study, symptoms of perinatal grief, degree of satisfaction with healthcare received, and information and support provision data were collected through an online survey aimed at women in Portugal who suffered a miscarriage. 873 were considered eligible. Correlations were performed between perinatal grief scores and healthcare satisfaction rates. Finally, the proportions of information and support received were compared after distributing the sample in groups according to their perinatal grief levels. Healthcare satisfaction correlated significantly with perinatal grief scores, the latter increasing as satisfaction levels decreased. 61.1% of our sample received information about the physical consequences of miscarriage and showed a significantly lower rate of above-threshold perinatal grief symptoms in this group. 18.2% received information about its mental health consequences, with no significant differences in above-threshold symptom rates. 11.7% were offered or recommended mental health support, but no significant differences in above-threshold symptom rates were found. Healthcare satisfaction and information on after-miscarriage physical changes correlated significantly with reduced perinatal grief rates after miscarriage. However, any effects of mental health information and psychological support provision need further studies. Training for healthcare providers dealing with pregnancy loss, implementing national guidelines that include follow-up on the parents' physical and psychological health, and including a specialized area in medical structures are advised. • Miscarriage affects 15–20% of identified pregnancies. • Perinatal grief levels correlate significantly with healthcare satisfaction. • The effect of psychological information and support provision needs further studies. • Specialized areas, training, and national guidelines are recommended. [ABSTRACT FROM AUTHOR]

Previous work has shown socioenvironmental factors can influence firearm injury. Milwaukee County, Wisconsin is a diverse midwestern county with historic disinvestment in marginalized communities yielding stark segregation along racial and ethnic lines. It is also one of the many U.S. counties burdened by surging firearm injuries. The differences among communities within Milwaukee County provides a unique opportunity to explore the intersection of socioenvironmental factors that may affect clinical outcomes and geospatial patterns of firearm injury. The trauma registry from the regional adult level 1 trauma center was queried for patients who sustained a firearm-related injury from 2015 to 2022 (N = 2402). The Social Vulnerability Index (SVI) ranking was derived using patient residence addresses to evaluate its association with traumatic injury clinical outcomes (i.e., in-hospital mortality, length of hospital stay, ICU or ventilator treatment, or injury severity score) and risk screening results for alcohol use disorder (AUD), posttraumatic stress disorder (PTSD), and depression. We evaluated hotspots of firearm injury density over time for patient residences and injury locations and distances between locations. A spatially lagged regression model tested the association between firearm injury density and SVI domains, alcohol outlet types, and park coverage. Most firearm injury patients were younger, male, racial or ethnic minorities from disadvantaged neighborhoods (SVI total; M = 0.86, SD = 0.15). SVI was not associated with any clinical outcomes. Of those screened, 12.9% screened positive for AUD and 44.5% screened at risk for PTSD, depression, or both. Hotspot analysis indicated consistent concentrations of firearm injury density. There were no differences in clinical outcomes between those injured inside or outside the home. Census tracts with lower socioeconomic status, greater off-premises and lower on-premises alcohol outlet density were associated with greater firearm injury density. In Milwaukee County, firearm injury patients are injured in and often return to the same disadvantaged neighborhoods that may hamper recovery. Results replicate and expand previous work and implicate specific socioenvironmental factors for intervention and prevention of firearm injury. • Highlights (3–5 points: maximum 85 characters, including spaces, per bullet point). • 80% of a Milwaukee firearm injury sample live in disadvantaged neighborhoods. • Neighborhood disadvantage was not related to hospital outcomes, possibly due to skew. • Socioeconomic status and alcohol outlet density related to firearm injury density. • Consistent hotspots show need to consider community context within recovery. [ABSTRACT FROM AUTHOR]

Our objective was to determine whether social media influences vaccination through informational and normative influences among Democrats and Republicans. We use a probability-based longitudinal study of Americans (N = 1768) collected between December 2022 and September 2023 to examine the prospective associations between social media use and vaccination as well as informational and normative influence as mediating processes. Greater social media use correlates with more frequent vaccination (cross-lagged coefficients: COVID-19 = 0.113, p < 0.001; influenza = 0.123, p < 0.001). The underlying processes, however, vary between Democrats and Republicans. Democrats who use social media more are more likely to vaccinate because they encounter information about new pathogens. In contrast, Republicans who use social media more are more likely to vaccinate because they think that people who are important to them receive the recommended vaccines. Our findings underscore the potential for social media campaigns to promote vaccination, among both Democrats and Republicans by paying attention to the specific processes in each audience. • Greater social media use correlates with more frequent vaccination. • The underlying processes, however, vary between Democrats and Republicans. • Our findings underscore the positive potential for social media campaigns. [ABSTRACT FROM AUTHOR]

Understanding factors influencing the transition from non-use to tobacco and nicotine product initiation among adolescents is crucial for designing and implementing effective preventive strategies. This study explores transition patterns among 13–15-year-old adolescents in lower secondary school, focusing on the transition from non-use to tobacco and nicotine product initiation and the influence of individual, social, risk behavioral, and mental health factors on this transition. Based on data from a Danish smoking prevention trial between 2017 and 2019, this study employed questionnaire surveys at three time points: baseline (start of seventh grade, n = 1,990, response rate = 86.3%), eight-month follow-up (end of seventh grade, n = 1,666, response rate = 74,8%), and 20-month follow-up (end of eighth grade, n = 1,149, response rate = 70,6%). Tobacco and nicotine use indicators included current and lifetime use of cigarettes and lifetime use of e-cigarettes, smokeless tobacco, and hookah. A latent transition analysis was applied to identify longitudinal transition patterns across waves and to explore predictors of these patterns. Three user classes emerged across all waves: none-use, lifetime e-cigarette and cigarette use, and poly-tobacco use. While the most prevalent class was the non-user class (71%–86%), the proportion of the lifetime e-cigarette and cigarette class increased over time (from 12% to 17%). Similarly, the poly-tobacco user class increased from 2% to 12%. The probability of transitioning from non-use to lifetime e-cigarette and cigarette use increased from 0.5% at baseline to 12% by the second follow-up, while the probability of transitioning from lifetime e-cigarette and cigarette use remained stable over time (12%–15%). Across all waves, elevated risk behavior predicted this transition. For instance, binge-drinking (OR = 3.76, 95% CI: 1.51–9.34), susceptibility to smoking (OR = 7.63, 95% CI: 3.68–16.83), and truancy (OR = 7.00, 95% CI: 1.98–24.59) influenced the transition from non-use at baseline to lifetime e-cigarette and cigarette use at first follow-up. Additionally, boys, adolescents with low socioeconomic status, low life satisfaction, and those with smoking friends or parents were more likely to transition from non-use to lifetime e-cigarette and cigarette use. This study demonstrates that sociodemographic, social risk, behavioral, and mental health factors impact the transition from non-use to lifetime e-cigarette and cigarette use. The findings provide valuable insights for developing targeted preventive strategies focusing on these influencing factors. • Three tobacco and nicotine use classes emerged among 13-15 year-old adolescents. • Over time, non-use to lifetime cigarette and e-cigarette transition probability rose from 0.5% to 12%. • Sociodemographic, risk behaviour, social, and mental health factors influenced the transition. • Effective preventive strategies require consideration of multiple factors. • Implementing strategies before age 15 could impact tobacco use initiation. [ABSTRACT FROM AUTHOR]

Healthy ageing is a global priority. Polypharmacy (the use of 5+ medicines) amongst older people is increasing, with over one-third of adults in England, aged 80–89, prescribed at least eight medications. Although sometimes necessary, polypharmacy can be harmful; the risk of harm increases with age and number of medicines prescribed. Medication reviews are recommended as one way of reducing the potential harms of polypharmacy although evidence of clinically significant benefit of medication reviews as currently delivered is limited. What happens in medication reviews in practice is poorly understood. We used a linguistic ethnography approach to explore how medication reviews proceed and what is accomplished during these consultations. We studied 18 video-recorded medication review consultations from three general practices in England. The consultations involved patients aged 65 or older, prescribed 10+ medications ('higher risk' polypharmacy), and primary care clinicians (general practitioner or clinical pharmacist). Video-recordings were gathered as part of a wider ethnographic study investigating practices of polypharmacy in primary care between 2017 and 2021. We conducted microanalysis of consultation data, drawing on our ethnographic knowledge of the organisational, institutional and domestic contexts of polypharmacy to inform our interpretation of these interactions. Consultations were time-consuming and involved lengthy stretches of interactional trouble: non-understandings; misunderstandings; misalignments. These stretches revealed profound uncertainties as to the effectiveness of medicines in the context of multimorbidity and polypharmacy. These uncertainties seeped further into 'troubles talk' concerning patients' existential concerns relating to enduring illness, ageing and mortality. Although these existential concerns were partially articulated, clinicians and patients left such troubles talk unelaborated, unresolved and unfinished. Participants succeeded in smoothing over interactional difficulties and maintaining respectful relationships but often fell short of addressing problematic polypharmacy more directly. • Polypharmacy can present risks of harm, especially amongst older people. • Little is known about how polypharmacy is addressed in medication reviews. • Microanalysis of consultations reveals misunderstandings and 'troubles talk'. • Reaching agreement on which medicine is under review and what it is for is difficult. • Patients' existential concerns are witnessed but tend to remain unresolved. [ABSTRACT FROM AUTHOR]

As a complementary means to urban public transit systems, public bike-sharing provides a green and active mode of sustainable mobility, while reducing carbon-dioxide emissions and promoting health. There has been increasing interest in factors affecting bike-sharing usage, but little is known about the effect of ambient air pollution. To assess the short-term impact of daily exposure to multiple air pollutants (PM 2.5 , PM 10 , NO 2 , and O 3) on the public bike-sharing system (PBS) usage in Seoul, South Korea (2018–2021), we applied a quasi-Poisson generalized linear model combined with a distributed lag nonlinear model (DLNM). The model was adjusted for day of the week, holiday, temperature, relative humidity, and long-term trend. We also conducted stratification analyses to examine the potential effect modification by age group, seasonality, and COVID-19. We found that there was a negative association between daily ambient air pollution and the PBS usage level at a single lag day 1 (i.e. , air quality a day before the event) across all four pollutants. Our results suggest that days with high levels of air pollutants (at 95th percentile) are associated with a 0.91% (0.86% to 0.96%) for PM 2.5 , 0.89% (0.85% to 0.94%) for PM 10 , 0.87% (0.82% to 0.91%) for O 3 , and 0.92% (0.87% to 0.98%) for NO 2 , reduction in cycling behavior in the next day compared to days with low levels of pollutants (at 25th percentile). No evidence of effect modification was found by seasonality, age nor the COVID-19 pandemic for any of the four pollutants. Our findings suggest that high concentrations of ambient air pollution are associated with decreased rates of PBS usage on the subsequent day regardless of the type of air pollutant measured. • Ambient air pollution was negatively associated with public bike-sharing system usage. • Elevated levels of air pollutants impacted next day bike usage. • The impact of air pollution did not vary based on age, COVID-19, and seasonality. [ABSTRACT FROM AUTHOR]

This study addresses the challenge of low blood donation rates in developing countries by examining the effectiveness of a barrier-removal incentive—a one-day transportation voucher—to promote blood donation. Utilizing a longitudinal dataset of 23,750 donors from a Brazilian blood collection agency (BCA) collected between March 2018 and May 2020, we examine the short and long-term effects of this campaign on donation rates. Our results show that the incentive had a large positive influence on both donation attempts and successful donations on the day of the campaign. However, the short-term success of the intervention had an unintended consequence: the significant increase in prospective donors' waiting time at the BCA during the intervention day, which may help explain the negative impact on return rates in the 24-month follow-up. Despite these opposing outcomes, the net effect of the one-day blood donation incentive was still positive, offering valuable insights for BCAs aiming to enhance donor recruitment and retention strategies and emphasizing the need to balance immediate benefits with potential long-term impacts. • Transportation vouchers increase present blood donations by encouraging new donors. • The use of such vouchers does not pose additional risks to blood safety. • Increased wait times on the day of the campaign discourage subsequent donations. • Using transportation vouchers yields a positive net effect on blood donations. • Blood agencies should plan for demand surges to avoid upsetting donors. [ABSTRACT FROM AUTHOR]

This study examines the association between community incarceration rates, household incarceration, and the mental health of parents and children. Participant families had children ages 5–9 (n = 1307) from the African American, Latinx, Hmong, Somali/Ethiopian, Native American, and White communities in the Twin Cities, Minnesota. Linear mixed models were used to estimate associations between parent and child mental health, household incarceration exposure, and census tract race, ethnicity and gender-specific incarceration rates matched to the family's home address and race/ethnicity. Findings indicated that living in census tracts with elevated incarceration rates of men from your same racial or ethnic group was significantly associated with psychological distress in parents and externalizing behaviors in boys, regardless of household exposure to incarceration. The association between incarceration rates and externalizing behaviors was only observed among girls with exposure to household incarceration. Policies that deconstruct pervasive racism in penal systems are needed to improve population mental health. • Male incarceration rates are higher in indigenous and Black communities than in White communities. • Parents surrounded by high male incarceration rates had worse mental health. • Boys in communities with high male incarceration had more externalizing behaviors. • Girls exposed to both household and high community incarceration had more externalizing behaviors. [ABSTRACT FROM AUTHOR]