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BACKGROUND: Substance use is a significant contributor to emergency department (ED) visits. Little is known about ED utilization patterns of individuals with substance related diagnosis (SRD). We used electronic health records (EHR) from a large healthcare system in California to examine ED healthcare utilization and socio-demographic characteristics of individuals with SRDs. METHODS: We used EHR data on all adult patients in our health system from April 2012 through September 2019 to conduct adjusted logistic regression models to determine socio-demographic correlates of SRDs (e.g., use, misuse, dependence) and associations between having an SRD and receiving emergency care. RESULTS: Among the sample (n = 342,651), the majority were female (55.08 %), Non-Hispanic White (58.10 %), with mean age of 48.26 (SD = 18.10), and there were 18,015 (5.26 %) individuals with an SRD. Patients with an alcohol-related diagnosis had the highest odds of visiting the ED (aOR = 3.75), followed by those with opioid (aOR = 3.57) and stimulant-related diagnoses (aOR = 3.48). Individuals with an SRD were more likely to identify as male, Black/African American, Hispanic/Latinx, have no health insurance, and have a serious mental illness. In the adjusted model, those with an SRD were significantly more likely to have ever received emergency care (aOR 3.72 [95 % CI 3.62-3.84]) than those without an SRD. DISCUSSION: Our study found an association between having an SRD and utilizing emergency health services. Demographic characteristics suggest disparities exist for those with SRDs around gender, race/ethnicity, insurance status, and mental health. These data can help with screening and targeted responses to prevent or provide emergency care.

BACKGROUND: Middle age is increasingly acknowledged as a critical window for prevention of Alzheimers disease and related dementia (ADRD) since research has shown that AD develops in the course of 20-30 years (1) but we know very little about middle-aged individuals perspectives on ADRD. Knowledge gaps are particularly large for Latinas living in regions typically underrepresented in ADRD research, such as rural and/or agricultural regions. This is important given that over the next 40 years Latinos are projected to have the largest increase in ADRD cases in the U.S. Therefore, this study aims to assess knowledge, perceptions, and feelings associated with ADRD among a sample of middle-age, Spanish-speaking Latina women. METHOD: Using qualitative methods involving semi-structured interviews, we examined knowledge, perceptions, and feelings associated with ADRD among a subsample of the Center for Health Assessment of Mothers and Children of Salinas (CHAMACOS) study. Participants are Latina women residing in an underserved agricultural community entering mid-life (mean = 46.5 years old). Interviews were conducted with 20 women and data was analyzed with inductive thematic content analysis. RESULTS: We identified themes regarding perceptions, knowledge, and feelings. First, participants perceive ADRD as involving (1) Loss of memory, (2) Getting lost; (3) Losing the person they once were. With regard to knowledge about ADRD, participants reported: (1) Some knowledge about protective and risk factors for ADRD, (2) No awareness of the links between cardiovascular risk factors and ADRD; (3) A desire to learn prevention methods alongside signs and symptoms of ADRD. Themes related to feelings about ADRD were: (1) Fear of developing ADRD and not being aware of reality or who they are; (2) Worry about losing relationships with loved ones and caretaking if diagnosed with ADRD; (3) Sadness about forgetting ones family and depending on others if diagnosed with ADRD. CONCLUSION: The knowledge gaps and negative feelings associated with ADRD highlighted in this study underscore the need for ADRD interventions to include CVD prevention, particularly for mid-life Latino populations residing in rural regions.

Background: Despite robust evidence demonstrating sociodemographic characteristics may underly some of the disparities in physical activity observed among children and adolescents, the often-overlooked nexus of potential interactions between these characteristics warrants further exploration. This study explored the intersectionality of gender, race/ethnicity, parental education, and household income in relation to device-measured physical activity volume and intensity in a nationally representative sample of US children and adolescents. Methods: Cross-sectional data from 3 cycles of the US National Health and Nutrition Survey (2011–2012; 2012 National Youth Fitness Survey; and 2013–2014) were used. A total of 6116 participants (49% female) between 3 and 17 years of age wore an accelerometer on their nondominant wrist for 7 days. Monitor-independent movement summary units were used to represent physical activity volume and intensity. A Social Jeopardy Index was created to represent increasing levels of intersecting social disadvantages based on combinations of gender, race/ethnicity, parental education, and household income-to-poverty ratio tertiles. Generalized linear regression models were computed. Results: The results showed social disadvantages become increasingly evident among children and adolescents during the most intense 60 minutes of daily physical activity (B = −48.69 [9.94] SE, P <.001), but disparities in total volume were not observed (B = 34.01 [44.96] SE, P =.45). Conclusions: Findings suggest that patterns of physical activity behavior may differ based on intersecting sociodemographic characteristics—more socially disadvantaged children and adolescents appear to accumulate activity at lighter intensities. Collecting contextual information about device-measured physical activity represents an important next step for gaining insight into these sociodemographic differences. [ABSTRACT FROM AUTHOR]

ObjectivesIncreasingly diverse caregiver populations have prompted studies examining culture and caregiver outcomes. Still, little is known about the influence of sociocultural factors and how they interact with caregiving context variables to influence psychological health. We explored the role of caregiving and acculturation factors on psychological distress among a diverse sample of adults.DesignSecondary data analysis of the California Health Interview Survey (CHIS).ParticipantsThe 2009 CHIS surveyed 47,613 adults representative of the population of California. This study included Latino and Asian American Pacific Islander (AAPI) caregivers and non-caregivers (n = 13,161).MeasurementsMultivariate weighted regression analyses examined caregiver status and acculturation variables (generational status, language of interview, and English language proficiency) and their associations with psychological distress (Kessler-6 scale). Covariates included caregiving context (e.g., support and neighborhood factors) and demographic variables.ResultsFirst generation caregivers had more distress than first-generation non-caregivers (β=0.92, 95% CI: (0.18, 1.65)); the difference in distress between caregivers and non-caregivers was smaller in the third than first generation (β=-1.21, 95% CI: (-2.24, -0.17)). Among those who did not interview in English (β=1.17, 95% CI: (0.13, 2.22)) and with low English proficiency (β=2.60, 95% CI: (1.21, 3.98)), caregivers reported more distress than non-caregivers.ConclusionsNon-caregivers exhibited the "healthy immigrant effect," where less acculturated individuals reported less distress. In contrast, caregivers who were less acculturated reported more distress.

OBJECTIVES: Research on links between social, geographic, and cultural determinants of health has been thwarted by inadequate measures of culture. The purpose of this study was to improve the measurement of community culture, defined as shared patterns of attitudes and behaviors among people within a neighborhood that distinguish it from others, and to examine dimensions of culture, independent of socioeconomic and demographic factors, and their relationships with health. STUDY DESIGN: A survey research design with correlational analyses was used. METHODS: A survey packet including the Community Culture Survey - Revised (CCS-R), demographic, health, and other individual-level measures was administered through convenience sampling across the United States (US) and to a sample in Thailand from 2016 to 2018. US county-level variables were obtained from zip codes. RESULTS: 1930 participants from 49 US states (n = 1592) and Thailand (n = 338) completed all CCS-R items, from which 12 subscales were derived: Social Support & Connectedness, Responsibility for Self & Others, Family Ties & Duties, Social Distress, Urban Diversity, Discontinuity, Church-Engaged, External Resource-Seeking, Locally Owned Business-Active, Power Deference, Next Generation Focus, and Self-Reliance. Neighborhood culture subscale scores varied more by geography than by participants demographics. All subscales predicted one or more health indicator, and some of these relationships were significant after adjusting for participant age and county-level socioeconomic variables. Most of the significant differences on subscales by race/ethnicity were no longer significant after adjusting for participants age and county-level socioeconomic variables. Most rural/urban and regional differences in culture within the US persisted after these adjustments. Based on correlational analyses, Social Support & Connectedness and Responsibility for Self & Others were the best predictors of participants overall health and quality of life, and Responsibility for Self & Others was the best predictor (inversely) of the CDCs measures of social vulnerability. CONCLUSIONS: Neighborhood culture is measurable, multi-dimensional, distinct from race/ethnicity, and related to health even after controlling for age and socioeconomic factors. The CCS-R is useful for advancing research and practice addressing the complex interactions between individuals, their neighborhood communities, and health outcomes.

Background: It is well established that emergency department (ED) crowding leads to worse health outcomes. Although various patient surveys provide information about reasons to visit EDs, less is known in terms of beliefs about EDs among the general population. This study examines public beliefs regarding accessibility and quality of EDs and their associations with social characteristics (gender, age, education, immigration background) as well as knowledge about emergency care services and health literacy.Methods: We conducted a cross-sectional study based on a random sample of 2,404 adults living in Hamburg, Germany, in winter 2021/2022. We developed eight statements regarding accessibility andquality of EDs leading to two scales (Cronbach’s α accessibility = 0.76 and quality of care = 0.75). Descriptive statistics of the eight items are shown and linear regression were conducted to determine associations of the two scales with social characteristics as well as knowledge about emergency care services and health literacy (HLS-EU-Q6).Results: Nearly 44% of the respondents agreed that “you can always go to an ED, if you do not get a short-term appointment with a general practitioner or specialist.” And 38% agreed with the statement, “If you do not have the time during normal practice hours due to your work, you can always go to an ED.” In terms of quality, 38% believed that doctors in EDs are more competent than doctors in general practice, and 25% believed that doctors in EDs are more competent than doctors in specialized practices. In the fully adjusted model, public beliefs about emergency care accessibility and quality of EDs were significantly associated with all social characteristics and knowledge of emergency care options with the strongest associations between knowledge and accessibility (β = −0.17; P < 0.001) and between education and quality (β = −0.23; P < 0.001).Conclusion: We found endorsement of public beliefs about accessibility and quality of EDs that can lead to inappropriate utilization. Our results also suggest that knowledge of different emergency services plays an important role. Therefore, after system-related reorganizations of emergency care, information campaigns about such services tailored to socially deprived populations may help alleviate the issue of crowding.

BACKGROUND AND HYPOTHESIS: Serious mental illness (SMI) may compromise diabetes self-management. This study assessed the association between SMI and glycemic control, and explored sociodemographic predictors and geographic clustering of this outcome among patients with and without SMI. STUDY DESIGN: We used electronic health record data for adult primary care patients with diabetes from 2 San Francisco health care delivery systems. The primary outcome was poor glycemic control (hemoglobin A1c >9.0%), which was modeled on SMI diagnosis status and sociodemographics. Geospatial analyses examined hotspots of poor glycemic control and neighborhood characteristics. STUDY RESULTS: The study included 11 694 participants with diabetes, 21% with comorbid SMI, of whom 22% had a schizophrenia spectrum or bipolar disorder. Median age was 62 years; 52% were female and 79% were Asian, Black, or Hispanic. In adjusted models, having schizophrenia spectrum disorder or bipolar disorder was associated with greater risk for poor glycemic control (vs participants without SMI, adjusted relative risk [aRR] = 1.24; 95% confidence interval, 1.02, 1.49), but having broadly defined SMI was not. People with and without SMI had similar sociodemographic correlates of poor glycemic control including younger versus older age, Hispanic versus non-Hispanic White race/ethnicity, and English versus Chinese language preference. Hotspots for poor glycemic control were found in neighborhoods with more lower-income, Hispanic, and Black residents. CONCLUSIONS: Poor diabetes control was significantly related to having a schizophrenia spectrum or bipolar disorder, and to sociodemographic factors and neighborhood. Community-based mental health clinics in hotspots could be targets for implementation of diabetes management services.

Food insecurity is a prevalent social determinant of health for people living with HIV and is associated with suboptimal treatment outcomes. While clinic-based efforts to address food insecurity have increased over the past decade, few studies have explored the perspectives of paitents and caregivers managing chronic illnesses such as HIV. Caregiver insights are particularly critical in pediatric HIV care, where caregivers often play a central role in screening and referral processes. This study examined the experiences of adolescents and young adults living with HIV and caregivers of children with HIV, to inform screening and referral practices within a pediatric palliative care clinic in Atlanta, GA. We conducted audio-recorded, in-depth interviews (n = 14) and focus groupswith 10 patients and caregivers living with food insecurity. Thematic analysis, guided by our interview topics, revealed five key themes: (1) trust in providers, (2) coping by "making it work", (3) barriers to healthy eating, (4) challenges to medication adherence, and (5) recommendations for cross-sector resource connection. Our findings underscore the need for partnerships between clinics and community-based organizations, bolstered by structural and systems-level interventions and policies, to promote food security and well-being for pediatric patients in complex care settings. [ABSTRACT FROM AUTHOR]

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Background and objective: The COVID-19 pandemic substantially impacted mental health globally, leading to increased levels of anxiety and fear. Although it is well known that socioeconomic factors and ethnicity play a role in mental health outcomes, the intersectional effects of these determinants during the pandemic are unclear, especially among adolescents. Thus, this study sought to explore the relationship between socioeconomic factors, ethnicity, and two mental health parameters—fear of COVID-19 (FCV) and generalized anxiety disorder (GAD)—among high school students in California, United States. Methods: A cross-sectional analysis was performed with 990 high school-aged participants from the San Joaquin Valley and Santa Clara County, California, recruited via convenience/snowball sampling using an online questionnaire from 15 June to 14 August 2022. The Fear of Coronavirus Scale (FCV-19S) and Generalized Anxiety Disorder-7 (GAD-7) were used to measure fear and anxiety, respectively. Results: The results reveal significant associations between ethnicity, socioeconomic status (i.e., family income), and FCV-19S and GAD-7 scores. Severe GAD and FCV were reported in 9.8% (n = 97) and 8.38% (n = 83) of participants. Black participants reported significantly higher levels of FCV (F = 6.867, p < 0.001) and generalized anxiety (F = 17.066, <0.001) than their counterparts Additionally, girls exhibited higher anxiety scores (t = 2.960, p = 0.003, CI = 0.23–1.15) and fear scores (t = 3.619, p = 0.001, CI = 0.40–1.37) than boys. Furthermore, fear and anxiety scores exhibited a strong positive correlation (r = 0.702, p < 0.001). Conclusion: This study suggests that gender, ethnicity, and socioeconomic factors are significantly linked to higher levels of FCV and GAD in teenagers during the pandemic. These findings underscore the importance of considering social determinants of mental health when addressing the psychological impact of COVID-19 on teenagers, particularly for vulnerable populations. [ABSTRACT FROM AUTHOR]

Background: The deteriorating mental health of children and young people in the United Kingdom poses a challenge that services and policy makers have found difficult to tackle. Kailo responds to this issue with a community-based participatory and systemically informed strategy, perceiving mental health and well-being as a dynamic state shaped by the interplay of broader health determinants. The initiative works to explore, define and implement locally relevant solutions to challenges shaping the mental health and well-being of young people. Kailo unfolds in three stages within each locale. These stages encompass: "early discovery", "deeper discovery and co-design" and "implementation". This document delves into the participatory group model building and design protocol occurring in the "deeper discovery and co-design" stage of the project. Methods: Participatory methods, such as group model building, are effective in articulating and building consensus on complex issues like the social determinants of adolescent mental health. This paper describes the protocol for application of group model building within the Kailo design process to develop causal loop diagrams and pinpoint leverage points for improving adolescent mental health. It also suggests a method for considering modifications to delivery within a unique project context and in alignment with participants' needs. This paper sets out to define the approach and clarify the objectives these engagements aim to fulfil. The method adapts existing group model building (GMB) protocols for use in a community setting. The engagements will involve groups of local young people and existing community members. To assess the success of the session's implementation post-delivery, the study utilizes existing frameworks for fidelity evaluations, which define a core and flex model. Discussion: The method described enables an integration of diverse local understandings of complex processes which provides a platform for creating co-designed interventions. This protocol can be used to further strengthen research and design through incorporating complexity and participation into the formulation of contextually relevant policies and practices. The strengths and limitations of the approach are discussed. [ABSTRACT FROM AUTHOR]

Background: Timely rehabilitative care is vital for functional recovery after stroke. Social determinants may influence access to and use of post-stroke care but have been inadequately explored. The study examined the relationship between the Social Vulnerability Index (SVI) and community-based rehabilitation utilization. Methods: We included 6,843 adults (51.6% female; 75.1% White; mean age 70.1) discharged home after a stroke enrolled in the COMprehensive Post-Acute Stroke Services study, a pragmatic trial conducted in 40 North Carolina hospitals from 2016–2019. Rehabilitation utilization was sourced from administrative claims. Geocoded addresses were linked to 2018 Census tract SVI. Associations between SVI and 90-day rehabilitation use, adjusted for patient's clinical and socio-economic characteristics, were obtained from generalized estimating equations. We also examined the associations of SVI with therapy setting, types of therapy, intensity of visits, and time to first visit. Results: Thirty-five percent of patients had at least one physical (PT) or occupational therapy (OT) visit within 90 days, ranging from 32.4%-38.7% across SVI quintiles. In adjusted analysis, there was no dose-reponse relationship between higher summary SVI, nor most of its sub-domains, and 90-day rehabilitation use. Greater vulnerability in household composition and disability was modestly associated with -0.4% (95% CI -4.1% to 3.4%) to -4.3% (95% CI -0.8% to -7.7%) lower rehabilitation use across SVI quartiles. Greater summary and subdomain SVI was associated with higher odds of receiving therapy in the home versus outpatient clinic (OR = 1.88, 1.58 to 2.17 for Q5 vs Q1 summary SVI) and receiving both PT and OT versus a single-type therapy (1.72, 1.48 to 1.97 for Q5 vs. Q1 summary SVI). No differences were observed for therapy intensity or time to therapy. Conclusion: Use of rehabilitation care was low, and largely similar across levels of SVI and most of its subdomains. Individuals residing in areas of high SVI were more likely to receive therapy in the home and to receive dual therapy, possibly reflecting greater need among these individuals. Future studies should evaluate potential mechanisms for these findings and further identify both patient and community factors that may inform strategies to improve rehabilitation use. Clinical Trial Number: https://www.clinicaltrials.gov/ NCT02588664 [registration date: 2015–10-23]. [ABSTRACT FROM AUTHOR]

Institutional diet recommendations suggest making changes to food habits to promote a healthier and more sustainable diet. Part of these recommendations is a reduction in meat consumption. But this conflicts with omnivorous diet models such as that found in Spain. This study investigates changes in the consumption of meat and vegetables in Spain through the use of logistic regressions and data from the Household Budget Survey (Encuesta de Presupuestos Familiares) (2006 to 2022) and the European Health Interview Survey (EHIS) in Spain (2014-2020). The results do not show the emergence of a new vegetable-based diet model. Meat consumption is linked to social groups with high occupational and educational status prevails, contrary to what has been found in other countries. Some resistance to a model change was observed. [ABSTRACT FROM AUTHOR]

The article investigates the social determinants of health affecting pediatric asthma patients in central Florida, particularly those with comorbid conditions such as allergic rhinitis and eczema. Through an electronic survey distributed to parents of affected children, significant insights were gained into the prevalence of social determinants of health disparity, with a focus on parental employment status and housing instability. The study underscores the critical role of social factors in pediatric respiratory conditions and emphasizes the need for targeted interventions to address these determinants and improve health outcomes. Objectives: Despite advances in therapies and educational initiatives, pediatric allergy disorders, including asthma, allergic rhinitis, and eczema, continue to pose substantial health challenges. Understanding the social determinants of health (SDoH) linked with these conditions is a critical area of research due to their multifactorial nature. This study aimed to assess the SDoH influencing pediatric allergy disorders in central Florida, specifically examining four groups of children: with asthma only, with eczema only, with both asthma and eczema, and a control group without these conditions. Methods: An electronic survey was distributed to parents of children diagnosed as having asthma, eczema, or both, who received evaluations at Nemours Children's Health in Orlando, Florida. The patients were categorized into four groups: asthma only, eczema only, co-occurring asthma and eczema, and a control group. A subgroup consisted of patients with asthma and allergic rhinitis. Results: The survey revealed a significant prevalence of SDoH disparities, with 61.2% of respondents reporting at least one factor. A notable distinction emerged in parental employment status (P < 0.001). In the group of patients with allergic rhinitis, housing instability was an important factor. Conclusions: Investigating the central Florida pediatric population provided crucial insights into the social determinants affecting pediatric allergy disorders. The study highlighted significant health disparities, particularly in parental employment status and housing instability, underscoring the critical role of social factors in these conditions. These findings emphasize the need for targeted interventions addressing social determinants to improve health outcomes for children with allergy disorders. [ABSTRACT FROM AUTHOR]

Objectives: There is a knowledge gap on resilience and its impact on mental health of Africans who survive a stroke. We describe the trajectory of psychological resilience and its association with depression and quality of life (QoL) across the first poststroke year in Nigeria. Method: Prospective observational study of 150 survivors of a first ever stroke. Resilience was ascertained at 3 time-points prospectively over 12 months using the 25-items Resilience Scale (RS). Depression and QoL were also assessed at baseline and follow-up, respectively using the centre for epidemiologic studies depression scale (CES-D 10) and health related quality of life in stroke patients (HRQOLISP-26). Associations were investigated using regression models and presented as adjusted odds ratios (OR) and Wald test coefficients within 95% confidence intervals (CI). Results: Resilience improved across time points of measurement (p < 0.001). In multivariate logistic regression analyses adjusted for the effect of age, education, alcohol use, and hypertension, higher resilience was associated with male sex (OR = 5.3, 95% CI= 1.7, 17.2), younger age (OR = 4.8, 95% CI = 1.5,15.7), and baseline hypertension (OR= 0.2, 95% CI ≤ 0.1,0.8). In similarly adjusted mixed effect linear regression analyses, higher resilience was associated with improvement in depression (months 12= −4.2, 95% CI= −5.6, −2.8) and quality of life (months twelve = 5.2, 95% CI = 2.2, 8.2) overtime. Conclusion: Resilience, which was associated with better mental health and wellbeing of stroke survivors, was less likely with hypertension. Results suggest an important role for control of vascular risk factors as part of resilience interventions to promote poststroke recovery. [ABSTRACT FROM AUTHOR]

Little is known about the relationships between demographic and economic social determinants of health and the probability of contracting COVID-19 in American Indian and Alaska Native (AI/AN) peoples. In addition, we do not know if and how tribal payments, unique to AI/AN peoples, are associated with the probability of contracting COVID-19. We surveyed 767 AI/AN patients of five geographically disparate health organizations that primarily served AI/AN peoples in urban settings between January and May of 2021. We used univariate modified Poisson regressions to estimate the influence of age, gender, household composition, education, household income, and tribal payments on risk of contracting COVID-19, with results presented as both risk and risk difference. Fifteen percent of the sample contracted COVID-19, and individuals who lived in households with two or more generations had an 11-percentage point elevated risk of contracting COVID-19 compared to those who lived alone. Twenty-seven percent of participants received tribal payments; receipt was associated with seven percentage points (change from 18% probability to 11% probability) lower risk of contracting COVID-19. Our findings showed interventions specifically designed to reduce the spread of COVID-19 in multigenerational households, and regular tribal payments may help improve health outcomes in urban AI/AN populations. [ABSTRACT FROM AUTHOR]

The caste system and resulting social exclusion are important social determinants of health inequity in India. This article critically analyzes the influence of the caste system on health inequity in India, starting with a historical perspective and moving to the current status. The article argues that the caste system has deprived Dalits and tribal people in India of achieving health equity. The programs to promote health are often disease-specific and not culturally informed, leading to poor attention at the policy level to the intersecting disadvantages that make Dalits and tribal communities vulnerable, resulting in poor health. The authors suggest strengthening and promoting primary care, improving health access for Dalit and tribal populations, and the need for pivotal changes in the medical education system, shifting the emphasis from specialized care to training family physicians to be oriented toward community health needs, keeping health equity in perspective. [ABSTRACT FROM AUTHOR]

Background: Mental illnesses contribute to a significant burden of disease in low- and middle- income countries (LMICs). Understanding risk factors for poor mental health is essential to reducing the burden, and for preventative measures to be implemented. The role of socioeconomic position (SEP) in poorer mental health is well established in high income countries, but less is known in LMICs. This study aimed to identify and synthesise epidemiological evidence for the associations between SEP and depression and suicidal ideation in LMICs in Southeast Asia, and to describe the strength and direction of any associations identified. Methods: This systematic review identified evidence by searching four databases in February 2023 (Medline, Embase, PsycInfo and Web of Science), grey literature and reference searching of included papers. Papers were included if they were based in a Southeast Asian LMIC general or hospital populations (= 16 years of age) and explored at least one measure of SEP in association with depression or suicidal ideation. Study quality was assessed using the Joanna Briggs Institute tool. A meta-analysis and narrative synthesis were performed. Results: Fifty-nine papers from six out of nine Southeast Asian LMICs were identified, with education the most commonly examined measure of SEP. Several papers explored more than one measure of SEP. Around half of the papers were rated as higher quality. Meta-analyses of education (OR: 1.87, 95% CI: 1.49-2.35) and working status (OR: 1.30, 95% CI: 0.99-1.71) provided evidence of lower levels of education and not being employed being associated with higher odds of depression. Consistent associations between lower SEP and higher odds of depression were also found for financial difficulty and subjective economic status. Three papers used suicidal ideation as their outcome, and there was some evidence of an association with lower SEP and higher ideation. Conclusions: Evidence indicates that lower SEP is associated with higher likelihood of depression, whereas for suicidal ideation, the evidence available is insufficient to reach a conclusion. The lack of longitudinal studies prevents the temporal nature of these associations being established. Systematic review registration: PROSPERO: CRD42023410444. [ABSTRACT FROM AUTHOR]

People surviving cancer represent a particularly vulnerable population who are at a higher risk for food insecurity (FI) due to the adverse short- and long-term effects of cancer treatment. This analysis examines the influence of the COVID-19 pandemic on the prevalence of FI among cancer survivors across New York State (NYS). Data from the 2019 and 2021 NYS Behavioral Risk Factor Surveillance System (BRFSS) were used to estimate the prevalence of FI. Multivariable logistic regression was used to explore socioeconomic determinants of FI. Among cancer survivors, FI varied geographically with a higher prevalence in New York City compared to the rest of the state (ROS) prior to (25.3% vs. 13.8%; p =.0025) and during the pandemic (27.35% vs. 18.52%; p = 0.0206). In the adjusted logistic regression model, pre-pandemic FI was associated with non-White race (OR 2.30 [CI 1.16–4.56]), household income <$15,000 (OR 22.67 [CI 6.39–80.43]) or $15,000 to less than <$25,000 (OR 22.99 [CI 6.85–77.12]), and more co-morbidities (OR 1.39 [CI 1.09–1.77]). During the pandemic, the association of FI with non-White race (OR 1.76 [CI 0.98–3.16]) was attenuated but remained significant for low household income and more co-morbidities. FI was newly associated with being out of work for less than one year (OR 6.36 [CI 1.80–22.54] and having one (OR 4.42 [CI 1.77–11.07]) or two or more children in the household (OR 4.54 [CI 1.78–11.63]). Our findings highlight geographic inequities and key determinants of FI among cancer survivors that are amendable to correction by public health and social policies, for which several were momentarily implemented during the pandemic. [ABSTRACT FROM AUTHOR]

This study examined social determinants associated with Korean American immigrant women's mammography use in Korea after immigration to the United States. Data from a cross-sectional survey were obtained from 187 women in Los Angeles County, California. More than one-quarter (28.3%) of the respondents reported returning to Korea for a mammogram after immigrating to the United States. Multivariable logistic regression revealed that compared to those who had their first mammogram in Korea, Korean American immigrant women who had their first mammogram in the United States were less likely to return to Korea for subsequent screenings (AOR = 0.02, 95% CI: <0.001, 0.05); also, those who had employer-based health insurance in the United States were less likely to get a mammogram in Korea after immigration (AOR = 0.01, 95% CI: <0.01, 0.18). Findings suggest that women familiar with the Korean healthcare system and who are uninsured or have inconsistent healthcare coverage in the United States may seek care in Korea. To promote adherence to breast cancer screening guidelines among Korean American immigrant women residing in the United States, greater access to free or low-cost screening services and breast cancer screening education is warranted to reduce the risk of later stage breast cancer detection resulting from medical tourism. [ABSTRACT FROM AUTHOR]

There is a developing body of research indicating that individual and population-based mental health is affected by a range of 'social determinants'. Discrimination, poverty, inadequate access to housing and education as well as exposure to violence, conflict and disaster have all been associated with poor mental health and mental illness. International human rights treaties identify many of the social determinants of mental health as matters of human rights. However, limited attention has been paid to the connection between social determinants and the right to enjoyment of the highest attainable standard of mental health. This paper explores the potential for incorporating elements of both social determinants and human rights approaches to provide a new framework for mental health research, policy and practice. While acknowledging potential challenges, it identifies advantages to collaborating across disciplinary boundaries. The social determinants approach provides a foundation for understanding the interconnectedness of rights and draws attention to individual and collective needs, while a human rights approach can help identify the measures that are required to secure the social determinants of good mental health and wellbeing. [ABSTRACT FROM AUTHOR]

In aggregate, Asian patients have a higher incidence and mortality from gastric cancer (GC) than Non-Hispanic White (NHW) patients. However, there is a lack of data regarding outcomes among Asian-American subpopulations with GC. The National Cancer Database was used to identify patients with GC between 2004 and 2020. Asian patients were disaggregated by region, with a further subanalysis of Eastern Asians. Outcomes of interest included the initial localized/regional presentation versus metastatic disease and cancer care measures including undergoing surgical excision or resection for stages I-III, receiving guideline-concordant care, receiving delayed treatment (> 90 days for any treatment type), and overall survival. Outcomes were adjusted for patient/disease characteristics, treatment, and zip-code socioeconomic factors using logistic regression. Among 182,811 patients with GC, 7.2% (n = 13,051) were classified as Asian. More than one-half of the Asian cohort was categorized as East Asian (n = 6,762, 50.1%), with Chinese patients compromising 44.0% (n = 2972) of this subcohort. East Asian patients had greater odds of presenting with nonmetastatic disease (odds ratio [OR] 1.59; P < 0.001), undergoing a curative-intent resection (OR 1.52; P < 0.001), and receiving guideline-concordant care (OR 1.26; P < 0.001) compared to NHW patients. Asians from outside of East, Southeast, and South Asia had increased odds of delayed treatment (OR 1.29, P = 0.024). Asians, in aggregate and by each subpopulation, had a lower mortality risk than NHW patients (P < 0.001). Asian patients with GC have improved outcomes in aggregate compared to NHW patients, largely driven by the East Asian subpopulation. All Asian subpopulations demonstrated improved survival in comparison with NHW patients. [ABSTRACT FROM AUTHOR]

The persisting life‐expectancy 'gap' between First Nations and non‐First Nations Australians is fundamentally driven by the social determinants of health. These include income and social protection, access to adequate housing and food security, among others. These factors are particularly prominent in Central Australia. Inadequate housing has led to some of the highest rates of Streptococcus pyogenes infection in the world, which in turn drives an extremely high prevalence of rheumatic heart disease. Food insecurity and inadequate social protection manifesting as energy insecurity result in inadequate nutrition and have resulted in a huge burden of diabetes in Central Australia. These factors, combined with social exclusion, racism and the pervasive effect of colonisation, also drive a high rate of alcohol misuse. Only by prioritising equity in these 'social determinants' and emphasising the importance of First Nations leadership in formulating and implementing solutions will health inequity be addressed. [ABSTRACT FROM AUTHOR]

Purpose: Patients and healthcare professionals overestimate the risks of using antidepressants during pregnancy. According to current literature, approximately half of people stop taking an anti-depressant medication when they become pregnant. Discontinuing antidepressants during pregnancy increases risks of postnatal relapses. Factors like socioeconomic status, education, and planned pregnancies play a role in the decision to continue antidepressant medication, which can worsen disparities in maternal and child health. Our aim was to identify the sociodemographic factors associated with antidepressant continuation after awareness of pregnancy. Methods: We used representative data from the Adolescent Brain Cognitive Development (ABCD) study that captures maternal medication during pregnancy. We identified women who used antidepressants before awareness of their pregnancy. We calculated crude and adjusted associations between sociodemographic factors and continuation of antidepressant medication during pregnancy. Our model included age, education, ethnicity, first language, household income, living with a partner, having planned the pregnancy, pregnancy duration and smoking during pregnancy. Results: In total, 199 women continued antidepressants and 100 discontinued. The logistic regressions resulted in only one significant factor: first language. Native English speakers were more likely to continue medication than other mothers (adjusted OR = 14.94, 95% CI = [2.40; 291.45], p =.015). Conclusions: Language differences were associated with continuation of antidepressants. Non-native English speakers were more likely to discontinue antidepressants, which may lead to health inequities. This finding should be taken into account to reinforce information about the limited risks of antidepressants among people with non-English speaking backgrounds in the USA. [ABSTRACT FROM AUTHOR]

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Healthy aging is a vital process that encompasses developing and maintaining functional ability to ensure wellbeing in older age. Social factors, including social relationships, support, engagement, and socioeconomic status, significantly influence successful aging outcomes. The UN Decade of Healthy Ageing, from 2021 to 2030, aims to transform societal perceptions of aging, create age-friendly environments, and provide integrated healthcare services to enhance the lives of older individuals globally. Demographic shifts towards aging populations pose challenges such as labour shortages and increased healthcare costs but also present opportunities to harness the potential of older societies through work incentives and community engagement. Social determinants, including economic stability, education, and cultural influences, play crucial roles in shaping healthy aging outcomes. Intergenerational relationships, social participation, and volunteerism are key components in promoting well-being in older adults. Psychological and physical well-being are intertwined, with social connections playing a significant role in enhancing overall health outcomes. Policy implications, technological innovations, and social integration strategies are essential for promoting healthy aging and ensuring the quality of life for older individuals. [ABSTRACT FROM AUTHOR]

Background Good subjective wellbeing (SWB) is a key societal aspiration. The study of SWB determinants is of increasing interest. The present study aimed to examine national inequalities in SWB, and trends in these inequalities, for England across five demographic (sex and age) and socio-economic (educational level, household income and living alone) characteristics. Method The relative index of inequalities (RII) and slope index of inequalities (SII) were calculated from repeated cross-sectional data from the Health Survey for England from 2010 to 2019 (excluding 2017 and 2018 as our outcome variable was not collected in these years), in a total of 90 236 participants aged 16+. SWB was assessed using the Warwick-Edinburgh Mental Well-being Scale (WEMWBS), treated as a dichotomous variable with high and low levels of SWB > 40 and ≤ 40, respectively. Results There were significant inequalities in SWB by income (RII from 1.086 to 1.116), educational level (RII from 0.893 to 0.941) and between people living alone or not (RII from 0.908 to 0.937). The RII and SII trends were not statistically significant. Conclusions Higher socio-economic status could play a protective role for SWB, and people in the most deprived socio-economic positions may be at higher risk for low SWB. These associations have remained stable over time. [ABSTRACT FROM AUTHOR]

Background/Objectives: During the pre-conceptional period, addressing social determinants of health (SDOH) is essential for reducing maternal health disparities, particularly among disadvantaged groups. Key SDOH factors such as income, education, and healthcare access significantly influence maternal and infant outcomes, increasing risks like miscarriage, preterm birth, and pregnancy complications. Here, we aimed to explore maternal and neonatal characteristics according to socio-economic status. Thus, we identified clusters of pregnant women with similar social and behavioral characteristics and explored their variability in terms of neonatal outcomes. Methods: Data from 1512 pregnant women in the "MAMI-MED" cohort at ARNAS Garibaldi Nesima in Catania were analyzed. A two-step cluster analysis grouped the women based on education level, employment status, pre-pregnancy nutritional status, and Mediterranean diet score (MDS). Results: Two clusters of pregnant women were identified. Cluster 1 (n = 739) consisted of women with lower educational attainment who were unemployed, overweight and/or obese, and had a lower mean MDS. Instead, cluster 2 (n = 773) was mostly characterized by women with a medium–high level of education who were employed, had normal weight, and had a higher average MDS. Women in cluster 1 had significantly higher proportions of preterm births (p = 0.004), low-birth weight newborns (p = 0.002), and large-for-gestational-age newborns. Differences in gestational week (p < 0.001), birth weight (p < 0.001), and newborn length (p = 0.004) were also noted between the two clusters. Conclusions: Cluster analysis can help identify high-risk groups who may benefit from personalized public health interventions. Our results highlight the need to examine the complex interactions between socio-demographic, behavioral, and genetic factors that contribute to maternal–infant health. [ABSTRACT FROM AUTHOR]

BackgroundUnderinsured patients with advanced head and neck cancer experience worse outcomes compared to their well-insured peers.MethodsRetrospective logistic regression analysis testing associations between demographic, geospatial, transportation, disease, and treatment factors in 50 government insured or uninsured patients receiving curative-intent, multidisciplinary cancer care.ResultsForty percent of patients missed at least one treatment or surveillance appointment within the first year. Thirty-two percent reported using public transportation; 42% relied on caregivers. Patients who used public transportation were 3.3 and 4.6 times more likely to miss treatment (p = 0.001) and surveillance (p = 0.014) visits, respectively. The median one-way travel duration for such routes was 52 minutes (range: 16–232 minutes) and included 0.7 miles of walking. Physical distance to care was not associated with transportation type, missed appointments, or disease recurrence.ConclusionsUnderserved, underinsured patient populations face significant logistical challenges with transportation, which may be mitigated by alternative models of care delivery, such as multidisciplinary clinics.

BackgroundThe Family Income-to-Poverty-Ratio (FIPR) is a recognized indicator of socioeconomic status, and influences a wide range of health and behavioral outcomes. Yet, marginalized and racialized groups, particularly Black individuals, may not reap comparable health benefits from their socioeconomic advancements as their non-Hispanic, White counterparts. This discrepancy is indicative of a phenomenon known as the minorities' diminished returns.AimsThis study investigates the differential impact of the FIPR on depression, obesity, tobacco use, and e-cigarette use between Black and White adults.MethodsUsing data from the 2022 National Health Interview Survey (NHIS), which included 21,354 non-Hispanic adults from both White and Black racial groups, this research employed structural equation modeling to assess the relationship between the FIPR and health outcomes, including depression, obesity, and e-cigarette use.ResultsThe analysis identified significant interactions between FIPR and race across all the examined outcomes. Contrary to expectations, the findings suggest that the protective effects of higher income levels on health and healthy behaviors are less pronounced for Black individuals compared to White individuals.ConclusionThe study underscores the substantial societal and environmental barriers that hinder Black families and individuals from converting their FIPR and socioeconomic resources into concrete health benefits, such as an enhanced mental and physical well-being. To redress these racial health disparities, targeted interventions are crucial, particularly those that focus on bridging the employment and marriage rate gaps caused by educational disparities among Black communities. A comprehensive approach that extends beyond simple access to education is imperative to eliminate the societal obstacles that limit the socioeconomic benefits for Black populations.

This article examines psychological distress and diagnosed mood and anxiety disorders in Pacific adults, comparing against non-Māori non-Pacific (nMnP) adults, and between Pacific subgroups. A sample of adults aged 15 years and over was pooled from five consecutive New Zealand Health Survey years spanning 2014/15–2018/19. Prevalence estimates of psychological distress and doctor-diagnosed mood and/or anxiety disorders were calculated for Pacific and nMnP adults, and Pacific subgroups defined by two sociodemographic factors: multiple ethnic affiliation (‘multi-ethnicity’) and years since migration to Aotearoa New Zealand. Risk ratios for comparative analyses were generated using log-binomial regression modelling. Mental health inequities were evident in Pacific adults (n = 4,335) as they were more likely than nMnP (n = 50,397) to experience psychological distress, but less likely to have ever had a diagnosed mood and/or anxiety disorder. Within-Pacific differences were also visible, with higher rates of diagnosed mood and/or anxiety disorders seen in both multi-ethnic and New Zealand-born Pacific adults, and lower rates in Pacific migrants. Living for a longer time in Aotearoa New Zealand appeared to be associated with an increased risk of diagnosed mood and anxiety disorders.

Introduction: HIV and AIDS are known to have become an emergency problem around the world, where infection transmission, morbidity rates, and mortality rates are still high. The existence of the HIV/AIDS epidemic is one of the scary scourges among the community because of its unexpected transmission by HIV due to human behaviour. Objective: This study aims to analyze social determinants with quality of life in people with HIV/AIDS in the Voluntary Counseling and Testing Clinic. Methods: This study is an analytical study using a cross-sectional study research design. The population in this study is all HIV/AIDS patients domiciled in Kendari City. The number of samples was 177 respondents which was determined by simple random sampling. Data analysis uses the chi-square test and the multiple logistics test. Result: The results of the study showed that there was a stigma relationship with Odhiv's quality of life at the VCT Clinic of Kendari City Hospital (p = 0.000) and there was a relationship between social support and Odhiv's quality of life at the VCT Clinic of Kendari City Hospital (p = 0.000). The variable that has the greatest influence on the quality of life of ODHIV is the social support variable with an OR of 0.353. Conclusion: The variable that has the greatest influence on the quality of life of People with HIV/AIDS (ODHIV) is social support. Social support has proven to be a very significant factor in improving the quality of life of people living with HIV. Individuals with strong social support, whether from family, friends, or the community, tend to have a better quality of life than those who receive less social support. Social support plays a role in helping people with HIV cope with stigma, reduce psychological pressure, and provide a sense of security and comfort that can have a positive impact on their physical and mental well-being.

Background: Influences on physical activity and sedentary behavior may differ for migrants moving from their country of origin to a new country. This study aimed to explore the range of contextual factors that influence physical activity and sedentary behavior among Indian migrants, making comparisons with India. Methods: Semistructured interviews were conducted with 21 Indian migrants (10 men and 11 women) aged between 18 and 65 years living in Melbourne, Australia. Data were analyzed thematically, coded inductively, and managed with NVivo. Results: Participants perceived a lack of social connection as a key barrier to physical activity participation. Group-based physical activity fostered social connections. Cultural associations were sites to engage in cultural physical activity and integrate with other Indians. Australia's physical contexts (eg, availability of facilities and built environment) facilitated physical activity behavior. Workplace environments (eg, the nature of the job) prompted sedentary behavior. Other contextual shifts with migration related to activities of daily living (eg, shifts in transport [walking] behavior in India to a greater reliance on cars in Australia) and migrant-friendly health communication (messaging from Australian health/allied health practitioners). Conclusions: Sociocultural contexts remain key influences on migrant physical activity participation. Prioritizing integrated approaches and engaging insider codesign are important in tailoring and promoting migrant physical activity and limiting sedentary behavior. [ABSTRACT FROM AUTHOR]

Vector-borne diseases exert immense health burdens worldwide. Malaria alone causes over 200 million cases and 600,000 deaths annually. Transmission involves complex drivers requiring examination beyond entomological factors. A systematic literature search across databases identified relevant studies on vector-borne disease determinants published in the last two decades, with priority given to rigorous designs like longitudinal analyses, reviews, and meta-analyses from diverse epidemic regions, allowing narrative synthesis of key determinants, relationships, and gaps. This narrative review synthesizes evidence on social, behavioral, and environmental determinants of major vector-borne disease risks over the past decade. Lower education, poverty, unplanned urbanization, gender inequities, inadequate water and waste management, climate variations, and land-use changes stood out as key determinants. However, significant knowledge gaps remain around quantifying precise threshold effects and impacts of tailored interventions across contexts. A social-ecological perspective recognizing interdependencies between determinants should frame integrated control programs. Multicomponent strategies addressing environmental modifications, protective measures, behavioral motivators, and infrastructure alongside governance and community engagement require implementation research and impact evaluation. Overall, this review highlights priority areas for advancing evidence-based vector control through contextualized, determinant-targeted policies and interventions. Further research incorporating modeling, trials, and cost-effectiveness analyses is critical to validate approaches that address influential drivers, leverage motivators, and reduce the global burden.

Abstract Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder with a global prevalence and presentation that varies widely and is influenced by both intrinsic and extrinsic factors. While research into disease heterogeneity and burden has traditionally focused on biological and genetic differences (i.e., intrinsic factors), emerging evidence suggests that social determinants of health (SDOH) and structural determinants of health (StDOH) (i.e., extrinsic factors) play a pivotal role in the disparities observed in HS. This narrative review consolidates insights on the influence of SDOH and StDOH on HS incidence, severity, and health disparities. We highlight the importance of SDOH, including economic stability, education quality and access, healthcare quality and access, neighbourhood environment, and social/community context in shaping HS outcomes. Furthermore, we emphasize the overarching role of StDOH, including government processes, economic policies, social/public policies, and cultural and societal values in determining health outcomes. Addressing these determinants is crucial for devising effective interventions and enhancing patient outcomes. Future research should focus on a holistic understanding of HS, moving beyond a purely biological perspective to consider the intricate interplay of social and structural determinants.

This study aims to evaluate the association between social determinants, environmental exposure metrics, and the risk of asthma emergency department (ED) visits in the New York State (NYS) Medicaid population using small-area analysis. Traffic densities for each census tract in NYS were calculated using the length of road segments within each tract and total area of the tract to produce a measure of average number of vehicles per square meter per day. Data on social determinants of health including internal and external environments and other demographic factors were obtained from various sources. Poisson regression analyses were conducted to identify significant factors associated with asthma ED visits in Medicaid claim and encounter data for years 2005–2015. High traffic density in NYS excluding New York City (NYC) correlated with increased risk of asthma ED visits (RR 1.69; 95% CI: 1.42, 2.00), mitigated by adjusting for environmental and social determinants (RR 1.00; 95% CI: 0.85, 1.19). Similar trends were observed in NYC only (RR 1.19; 95% CI: 1.00, 1.41), with the adjusted risk remaining elevated (RR 1.14; 95% CI: 0.98, 1.33) albeit not statistically significant. Living in census tracts with high concentrated disadvantage index, high proportions of minorities, and less green space predicted higher asthma ED visits. We mapped predicted rates and model residuals to identify areas of high risk. Our results support previous findings that environmental and social risk factors in poor and urban areas contribute to asthma exacerbations in the NYS Medicaid population, even if they may not necessarily contribute to its development.

The digital economy transformation has a significant impact on the public health system, opening up new opportunities to improve the quality of and access to healthcare services. The introduction of digital technologies, such as electronic medical records, telemedicine, remote patient monitoring systems, etc. can enhance healthcare delivery and accelerate the data exchange between medical institutions. Digital transformation reduces inequalities in access to healthcare services, especially for remote and underserved communities. The social determinants of public health are changing under influence of the digital economy transformation. New social determinants include access to digital technologies, digital literacy, digital inequality, opportunities to use telemedicine and online health services, etc. Access to information technology and the Internet is becoming an important factor in ensuring equal access to healthcare services. Digital tools overcome social inequalities by providing opportunities to receive medical care regardless of residence or social status. Digital transformation creates new opportunities and challenges, e. g. a need to increase the digital literacy of population, to ensure equal access to digital services (including vulnerable groups). Digital literacy is one of the main requirements for development of public health within economy digitalization. Lack of digital skills or access to technology can become a barrier to receiving medical care, improving health literacy, and preventing possible diseases. The digital literacy development is an important step towards ensuring equity and accessibility of healthcare services in the digital economy. The paper tests the hypothesis about the impact of new digital social determinants on public health by building and studying an econometric model. To build a multivariate regression model, we used statistical data for 29 European countries in 2021. The indicator of public health is Healthy life expectancy based on self-perceived health. The following indicators of digital determinants were selected: Households – level of Internet access; Individuals using the Internet to find information about goods and services; Individuals using the Internet to seek health-related information; Individuals who have basic or above basic overall digital skills by sex; Individuals using the Internet to participate in social networks; Individuals who have never used the Internet; Individuals regularly using the Internet. The construction of a multiple multivariate regression was implemented via the MS Excel software. The modeling results showed that such factors as Individuals using the Internet to find information about goods and services, Individuals using the Internet to seek health-related information, and Individuals who have basic or above basic general digital skills by sex have a statistically significant impact on public health indicators. This confirms the important role of digital determinants in the public health development and the need to integrate digital technologies into the healthcare sector to increase its efficiency and accessibility.

Objectives: This study used multilevel social determinants of health (SDoH) models to determine how SDoH influence different sexes of patients diagnosed with HPV-positive oropharyngeal squamous cell cancers (OPSCC) across the US. Methods: This was a retrospective cohort study assessing HPV-confirmed patients with oropharyngeal squamous cell cancers from 2010 to 2018 using census-level Yost Index socioeconomic status (SES) score and rurality–urbanicity measures alongside individual-level race–ethnicity while stratifying by biological sex. Age-adjusted multivariate regressions were performed for survival, treatment receipt, and delay of treatment initiation (of 3+ months). Results: Across 14,076 OPSCC-HPV-positive patients, delay of treatment uniquely featured positive predictors for males of black race–ethnicity (OR, 2.07; 95% CI, 1.68–2.54) and poor Yost SES (1.43; 1.24–1.65). Five-year all-cause mortality uniquely showed positive predictors of females of black race–ethnicity (2.74; 1.84–4.71) and of males with poor Yost SES (1.98; 1.79–2.19). Three-year all-cause mortality shared positive predictors across sexes but were exacerbated in females of black race–ethnicity (2.50; 1.82–3.44) compared to males (2.23; 1.91–2.60); this was reversed for poor Yost SES (male, 1.92, 1.76–2.10; female, 1.60, 1.32–1.95). Surgery showed negative predictors of black race–ethnicity that displayed worsened effects in females (0.60, 0.44–0.79) versus males (0.75, 0.66–0.86). First-line radiation receipt uniquely featured negative predictors for males of black race–ethnicity (0.73; 0.62–0.86) with poor Yost SES (0.74; 0.68–0.82). Conclusions: Comprehensive models of multilevel SDoH displayed exacerbated disparity effects of community-level SES in males and black race–ethnicity among female HPV-positive OPSCC patients. These objective comparisons of specific SDoH factors inform providers and policy direction on how to strategically target the most pertinent SDoH factors affecting a rapidly growing cancer population. [ABSTRACT FROM AUTHOR]

Background: There has been substantial progress made across multiple disciplines to emphasize the importance of perinatal mental health both for parents and offspring. This focuses on what has been termed the 'First 1000 Days' from conception to the child's second birthday. We argue that our understanding of this issue can go further to create an intergenerational approach to mental health. Despite the existence of theoretical frameworks and practical approaches to implementation, there are gaps in the understanding of perinatal and intergenerational mental health including which psychological mechanisms are implicated in the transmission of risk and resilience within the perinatal period; and how to leverage these into treatment approaches. Aims and Methods: In this paper, we explore the potential for mentalization as a candidate psychological approach to intergenerational mental health. Results: We contextualize this issue in terms of the points of contact between mentalization and broader theoretical models such as the social determinants of health and the Developmental Origins of Health and Disease (DoHaD) model. Further, we provide an overview of the existing evidence base for the relevance of mentalization to perinatal mental health. Discussion: Finally, we sketch out an outline model for integrating mentalization into perinatal and intergenerational mental health, highlighting several areas of opportunity to develop research and practice from diverse geographies and demographics. Here, we suggest that integration of mentalization with other conceptual frameworks such as DoHaD can mutually enrich the understanding of each model, pointing the way towards more effective early and preventative interventions. [ABSTRACT FROM AUTHOR]

Historically marginalized communities are disproportionately affected by cardiometabolic diseases yet are underrepresented in clinical trials that investigate needed interventions. This review investigates the barriers to equitable inclusion in clinical trials, identifying opportunities for improvement at the institutional, trial, community, and individual level. It proposes a social determinants-based approach that serves as a toolkit to target these barriers using structural, economic, community, healthcare access, and technology solutions, supporting constructive improvement in the clinical trial recruitment process. [ABSTRACT FROM AUTHOR]