BACKGROUND AND OBJECTIVE:Bhutanese refugees in the United States face intersecting health disparities shaped by trauma, cultural disruption, and systemic barriers. Despite growing attention to refugee health, little is known about how this community defines and practices healthy living post-resettlement. This study explores Bhutanese refugees' lived experiences of health using participatory, culturally grounded methods. METHODS:Using photovoice within a community-based participatory research framework, 24 Bhutanese participants and 6 peer facilitators engaged in photodocumentation and community wellness workshops. Participants captured images related to healthy living and discussed their meanings in collective sessions. Thematic analysis of photonarratives was codeveloped with community members. RESULTS:Four themes emerged: (1) Land as memory and identity, where loss of agrarian life symbolized disconnection from health and culture; (2) Food as cultural survival, as traditional eating practices supported well-being and adaptation; (3) Health navigation in a system not built for us, showing how chronic illness and healthcare inaccessibility were mitigated by community-led support; and (4) Spiritual continuity as healing, where faith, ritual, and language sustained emotional and cultural resilience. CONCLUSION:Health among Bhutanese refugees is relational, culturally embedded, and shaped by collective resilience. Effective interventions must integrate cultural continuity, peer leadership, and place-based strategies.
Pathways Community Hub (PCH) is a model of care for pregnant mothers and infants designed to improve maternal and infant outcomes. This study examined the characteristics, service use, costs, and newborn outcomes of pregnant mothers who participated in a PCH in Texas from 2019 to 2022. PCH program data were linked to Medicaid claims data for mothers and their infants for analysis. Medicaid data were available for 90 mothers who completed the PCH program and 68 mothers who participated but did not complete the PCH program. The results found that compared with matched control groups, pregnant mothers who participated in the PCH incurred higher prenatal costs and delivery costs. Mothers who completed the PCH program had a significantly higher number of postpartum visits. However, mothers who completed the PCH were significantly more likely to have newborns with preterm births, low birth weight, and neonatal intensive care admissions than matched controls. Sensitivity analyses also found no significant differences in birth outcomes between PCH participants and matched controls. These findings suggest a limited impact of PCH on modifying maternal and newborn outcomes, but replication is needed.
BACKGROUND AND OBJECTIVES:Physical activity (PA) is important for overall well-being, but participation remains low in underserved Texas-Mexico border communities. This study, part of a local needs assessment, examined how motivational, physical, and environmental barriers relate to PA and sedentary behavior among adults in Brownsville, Texas. METHODS:A cross-sectional survey was administered to 144 adults in Brownsville, Texas. Participants completed the International Physical Activity Questionnaire-Short Form and rated 12 perceived barriers to PA across 3 domains: motivational, physical, and environmental. Multiple linear regression models examined associations between barriers and PA levels (moderate-to-vigorous PA [MVPA] and light PA [LPA]) and sedentary behavior (sitting time), adjusting for age, gender, and socioeconomic status. RESULTS:Difficulty initiating PA was significantly associated with lower MVPA (B = -462.46, P < .001). Feeling too tired after work (B = 137.28, P = .002) was associated with greater sitting time, whereas having a busy day (β = -152.54, P = .001) and limited recreational access were associated with less sitting time (β = -102.95, P = .04). No barriers were significantly associated with LPA. CONCLUSIONS:Findings highlight the need for multilevel interventions that address both psychological and contextual challenges to PA in border communities. Tailored strategies that enhance self-efficacy, reduce fatigue, and improve environmental safety may help reduce disparities in PA engagement and sedentary behavior.
BACKGROUND AND OBJECTIVES:As many rural hospitals continue to close their labor and delivery units and the gap between the demand for and supply of physicians practicing obstetrics continues to grow, this study seeks to understand the barriers and facilitators to delivering obstetric care in rural Wisconsin communities. METHODS:We conducted interviews with rural-based family medicine and OB-GYN physicians to glean their perspectives on challenges and opportunities that they face in the provision of high-quality obstetrical care and used thematic analysis techniques to generate results. RESULTS:We interviewed 21 physicians that currently practice or have practiced obstetrics in rural Wisconsin hospitals, consisting of 11 family medicine physicians and 10 OB-GYN physicians. Key themes emphasized 1) Patient Safety Programs and Training, 2) Staffing, and 3) Physician Involvement in Hospital Changes. CONCLUSIONS:Future considerations in rural obstetric care will involve hands-on education for obstetric teams, agreements with larger hospitals, and retention of a strong obstetric team committed to the community. Implementing training programs to supplement lower annual deliveries and creating a network of support among colleagues and health systems are imperative to sustain and build rural obstetric care.
BACKGROUND:Vicariously experienced racism-related stress is a key social determinant of child depression, yet national data on racial/ethnic and income disparities in this relationship are limited. OBJECTIVES:This study tested whether non-Hispanic Black (NHB) children and children from lower income households experience more frequent depression linked to parent-experienced racism-related stress than other groups. METHODS:In the 2023 National Health Interview Survey (NHIS), 1712 parents of children from minoritized racial/ethnic groups aged 5-17 years (weighted N = 37.7 million) reported their own experiences of racism-related stress and their child's depression. Multivariable ordinal weighted least squares regression assessed associations between parent-experienced racism-related stress and child depression, with moderation by income and race/ethnicity. RESULTS:Parent-experienced racism-related stress was significantly associated with more frequent child depression. This relationship was stronger among children from middle- and lowest-income households and among NHB children compared with Hispanic children. CONCLUSIONS:Children from lower income families and NHB children are more vulnerable to depression associated with parental racism-related stress. These findings highlight the need to consider both direct and vicarious racism-related stressors in child mental health research and interventions.
Background: Achieving environmental justice for children requires that their spaces promote health and well-being. In this study, we characterized the broader environmental context for family-based childcare (FCC) homes in Chicago, Illinois, to identify gaps in knowledge and directions for future work. Methods: Data on childcare providers were obtained from a state agency. Using public data sets, we characterized the physical, chemical, and built (PCB); nutritional; and social environments at the census tract level. We then described differences in neighborhood quality for census tracts containing only center-based care and those containing only FCC homes. Results: Indicators of PCB environments were similar for all census tracts. Census tracts containing FCC homes only had higher median percentages of residents with low food access and households receiving nutrition assistance relative to census tracts with center-based care only. Indicators of the social environment, including educational attainment and violent crime, were also less favorable for census tracts with FCC homes only relative to those with center-based care only. Conclusions: Our analysis highlighted differences in neighborhood quality for FCC homes, which are an important resource for low-income and racially marginalized families. Our work highlights the need to examine how structural racism contributes to the broader environmental context and children's health.
Youth gangs and gang involvement are commonly associated with delinquency and legal system contact, but relations to health have received less attention despite known population disparities. Clarifying how and why gang-involved youth are at greater risk for adverse health will help inform the development of a research and practice agenda to address population-level inequities. A scoping review of US-based studies was conducted to assess what is currently known about the relationship between youth gangs, gang involvement, and health. A descriptive summary and reflexive thematic analysis of 69 studies illustrated important features of the current research literature on this topic, including the theoretical importance of gangs as social and cultural contexts for health; the utility of ecological and developmental theories for understanding the gang-health link; and the importance of gender, family, and neighborhoods for shaping health experiences and outcomes of gang-involved youth. Our analysis also revealed key gaps in the current literature that should be addressed to ensure this area of research holds practical utility for reducing health inequities in the youth gang population. Directions for research to address identified gaps are discussed.
Background and objectives: Cultural competency and awareness are imperative to building trust and relationships between tribal members and non-native health care providers. The Chippewa Cree leaders in Northern Montana and Duke University School of Nursing (DUSON) collaborated to establish a service-learning opportunity focused on providing a children's summer day-camp, Camp Mi-yo-mah-chi-wi-n (“to be well ”). The purpose of this project was to assess cultural competency among graduate nursing students, identify evidence-based curriculums for future academic-community activities, and demonstrate a mutually agreed on mental health model for future camps. Methods: Eleven graduate nursing students and Chippewa Cree volunteers participated in a two-group, post-camp experience survey and key informant session at the conclusion of the initial youth camp. Results: The results indicated a positive and meaningful camp experience among all participants, indicating that the academic-community partnership should be cultivated and sustained. Graduate nursing student participants reported the need for enhanced cultural knowledge and understanding and a desire to ensure culturally competent care in collaboration with tribal volunteers. Conclusion: Service learning is an effective way to fortify academic-clinical partnerships that are mutually beneficial with inclusion of student preparation emphasizing knowledge, beliefs and cultural competency.
Background and Objectives: Regular medical checkups are essential for preventing and managing chronic diseases. However, significant disparities in the utilization of these checkups exist, particularly in the US–Mexico border communities. This study applies to Andersen's Behavioral Model of Health Service Use to explore the factors influencing regular medical checkups utilization among residents in Brownsville, Texas. Methods: A total of 144 adult participants from Brownsville, Texas, completed a bilingual (English/Spanish) survey from March to September 2024. The survey assessed demographic characteristics, health status, enabling resources (eg, income, insurance), and need factors (eg, mental health status, chronic conditions). Structural Equation Modeling was used to analyze the relationships between these factors and the likelihood of receiving regular medical checkups. Results: The study found significant positive associations between predisposing characteristics and regular medical checkups ( P < .001), and between enabling resources and regular checkups ( P < .001). However, need factors did not show a significant relationship with regular checkups. In addition, there was a negative interrelationship between predisposing characteristics and enabling resources ( P < .001), whereas there was a positive association between enabling resources and need factors ( P = .001). Conclusions: The findings highlight the importance of predisposing characteristics and enabling resources in influencing the utilization of regular medical checkups.
Background and objectives: This study explored the association between the social determinants of health (SDOH) and the likelihood of premature mortality and premature accidental mortality. Methods: Data from the National Longitudinal Survey of Adolescent to Adult Health (ADD Health) linked with records from the National Death Index (NDI) were used to classify deceased respondents by their cause of death. First, logistic regression examined the association between accidental death/premature mortality, individual characteristics, and SDOH. Second, a 2-stage model then analyzed the likelihood of having an accidental cause of death conditional on premature mortality. Results: Premature mortality odds were lower for female individuals (OR = 0.89), Black individuals (OR = 0.94), those who identify as Hispanic (OR = 0.56), college graduates (OR = 0.27), and married individuals (OR = 0.45). However, living in the South (OR = 1.19) and lower income (OR = 2.22) increased the odds. Accidental death odds were lower for female individuals (OR = 0.29), Black individuals (OR = 0.32), those who identify as Hispanic (OR = 0.87), and multiracial groups (OR = 0.06). College education (OR = 3.61) and lack of medical care (OR = 1.13) raised accidental death odds while marriage (OR = 0.20), lower income (OR = 0.12), and residing in the West or Midwest (OR = 0.13) decreased them. Conclusion: There was a significant association between the likelihood of accidental death and adverse SDOH, suggesting that they may serve as risk factors of premature accidental death.
Background and Objectives: Weight loss medication use has grown in popularity for adolescents and young adults, raising concerns about the implications of increased medicalization of weight reinforcing stigma toward those in larger bodies. Weight stigma is particularly salient for young people given their heightened risk of body dissatisfaction and disordered eating. Despite this concern, the relationship between weight loss medication use and stigma remains unexplored. Methods: The present study used a hybrid qualitative analysis to explore awareness and opinions of weight loss medications in a sample of 47 emerging adults. Results and Conclusion: Nearly half the sample ( n = 23) endorsed awareness of medications for weight loss. Among those aware, opinions toward their use were generally negative, particularly for use by adolescents. Preference was expressed for traditional weight loss methods (i.e., diet and exercise) and concerns about long-term risks of medication raised. Individuals with personal knowledge of others taking weight loss medications were more likely to have ambivalent or positive opinions on their use, suggesting that personal exposure may affect perception and stigma. It is possible that medicalization of weight status increases stigma by reinforcing beliefs that an individual's weight is a result of behavior and personal responsibility.
Latino/a migrant farmworker (LMFW) families travel frequently in search of seasonal farm work. This pattern of high mobility can compromise youth's sense of belonging and social connectedness which consequently can compromise their well-being. However, strengths-based health and wellness orientations such as being optimistic and holding a hopeful look toward the future may offset risks and improve youths' capacity to cope with frequent moves and adversity. This qualitative study thematically analyzed interview data from 24 LMFW youth aged 10-18. Findings revealed how LMFW youth conceptualize "home" and describe the toll that frequent moves can have on their wellbeing. Results also spotlighted how optimistic interpretations of migration can promote hope, future-oriented thinking, and a sense of purpose. These findings underscore the importance of strengths-based approaches and can inform programming aimed at promoting health and wellness among LMFW youth.
Hypertension disparities persist across communities, driven by interactions between social determinants of health (SDOH) and behavioral factors. This study examines geographic and demographic patterns of hypertension in Nashville, Tennessee, to assess how socioeconomic, environmental, and behavioral factors contribute to inequities in prevalence, treatment, and control. Granular ZIP code-level analyses highlight community-specific drivers and the need for policy reforms to advance health equity. Using 2022 data from the U.S. Census Bureau’s American Community Survey and CDC PLACES, we analyzed 199 Nashville ZIP codes. K-means clustering identified five population clusters. Lower-income clusters (e.g., Hardship Heartland: 37.2% hypertension prevalence; Urban Renters: 33.7%) exhibited elevated physical inactivity (30.9%), insufficient sleep (38.9%), smoking (22.6%), alongside limited healthcare access. Affluent clusters (Elite Enclaves: 30.8%) demonstrated better cardiovascular health. Non-Hispanic Black residents in urban cores faced disproportionately higher hypertension rates (35.4%) compared to non-Hispanic white residents in the same clusters (e.g., 43.8% white residents in Urban Renters). Structural inequities—poverty, housing instability, and unequal healthcare access—drive hypertension disparities. Multi-sector interventions targeting upstream SDOH (e.g., affordable housing, equitable healthcare, and community wellness programs) are critical to reduce cardiovascular risk. Policy reforms prioritizing place based strategies in high-burden communities could mitigate disparities and improve population health.
BACKGROUND AND OBJECTIVES:Diaper access affects child health and well-being; however, accessibility concerns have exponentially increased with 46% of families reporting diaper insecurity in 2023. This report examines the 1) reach of community-based diaper distribution events and 2) role of social drivers of health (SDOH) screening and implications in integrated primary care. METHODS:Diaper distribution event(s)' registration data (N = 6) were analyzed from July 2023 to July 2024. Mapping and statistical analyses were conducted, using ArcGIS Pro 3.2.1 and R. RESULTS:A total of 2793 children received diapers across 42 zip codes, and each child received 50 to 100 diapers per event. Most families spoke Spanish (54.5%), were enrolled in Women, Infants, and Children (71.28%) and Medicaid (53.46%), and identified as Hispanic (63.6%). Approximately one-third (33.6%) lived in areas with "low" educational opportunity. CONCLUSIONS:Findings suggest that broader SDOH screening is needed in primary care, as many families face unmet needs despite living in zip codes considered to have "moderate" socio-economic opportunity.
BACKGROUND:Achieving environmental justice for children requires that their spaces promote health and well-being. In this study, we characterized the broader environmental context for family-based childcare (FCC) homes in Chicago, Illinois, to identify gaps in knowledge and directions for future work. METHODS:Data on childcare providers were obtained from a state agency. Using public data sets, we characterized the physical, chemical, and built (PCB); nutritional; and social environments at the census tract level. We then described differences in neighborhood quality for census tracts containing only center-based care and those containing only FCC homes. RESULTS:Indicators of PCB environments were similar for all census tracts. Census tracts containing FCC homes only had higher median percentages of residents with low food access and households receiving nutrition assistance relative to census tracts with center-based care only. Indicators of the social environment, including educational attainment and violent crime, were also less favorable for census tracts with FCC homes only relative to those with center-based care only. CONCLUSIONS:Our analysis highlighted differences in neighborhood quality for FCC homes, which are an important resource for low-income and racially marginalized families. Our work highlights the need to examine how structural racism contributes to the broader environmental context and children's health.
BACKGROUND AND OBJECTIVES:Regular medical checkups are essential for preventing and managing chronic diseases. However, significant disparities in the utilization of these checkups exist, particularly in the US-Mexico border communities. This study applies to Andersen's Behavioral Model of Health Service Use to explore the factors influencing regular medical checkups utilization among residents in Brownsville, Texas. METHODS:A total of 144 adult participants from Brownsville, Texas, completed a bilingual (English/Spanish) survey from March to September 2024. The survey assessed demographic characteristics, health status, enabling resources (eg, income, insurance), and need factors (eg, mental health status, chronic conditions). Structural Equation Modeling was used to analyze the relationships between these factors and the likelihood of receiving regular medical checkups. RESULTS:The study found significant positive associations between predisposing characteristics and regular medical checkups ( P < .001), and between enabling resources and regular checkups ( P < .001). However, need factors did not show a significant relationship with regular checkups. In addition, there was a negative interrelationship between predisposing characteristics and enabling resources ( P < .001), whereas there was a positive association between enabling resources and need factors ( P = .001). CONCLUSIONS:The findings highlight the importance of predisposing characteristics and enabling resources in influencing the utilization of regular medical checkups.
BACKGROUND AND OBJECTIVES:Cultural competency and awareness are imperative to building trust and relationships between tribal members and non-native health care providers. The Chippewa Cree leaders in Northern Montana and Duke University School of Nursing (DUSON) collaborated to establish a service-learning opportunity focused on providing a children's summer day-camp, Camp Mi-yo-mah-chi-wi-n ("to be well "). The purpose of this project was to assess cultural competency among graduate nursing students, identify evidence-based curriculums for future academic-community activities, and demonstrate a mutually agreed on mental health model for future camps. METHODS:Eleven graduate nursing students and Chippewa Cree volunteers participated in a two-group, post-camp experience survey and key informant session at the conclusion of the initial youth camp. RESULTS:The results indicated a positive and meaningful camp experience among all participants, indicating that the academic-community partnership should be cultivated and sustained. Graduate nursing student participants reported the need for enhanced cultural knowledge and understanding and a desire to ensure culturally competent care in collaboration with tribal volunteers. CONCLUSION:Service learning is an effective way to fortify academic-clinical partnerships that are mutually beneficial with inclusion of student preparation emphasizing knowledge, beliefs and cultural competency.
BACKGROUND AND OBJECTIVES:Weight loss medication use has grown in popularity for adolescents and young adults, raising concerns about the implications of increased medicalization of weight reinforcing stigma toward those in larger bodies. Weight stigma is particularly salient for young people given their heightened risk of body dissatisfaction and disordered eating. Despite this concern, the relationship between weight loss medication use and stigma remains unexplored. METHODS:The present study used a hybrid qualitative analysis to explore awareness and opinions of weight loss medications in a sample of 47 emerging adults. RESULTS AND CONCLUSION:Nearly half the sample ( n = 23) endorsed awareness of medications for weight loss. Among those aware, opinions toward their use were generally negative, particularly for use by adolescents. Preference was expressed for traditional weight loss methods (i.e., diet and exercise) and concerns about long-term risks of medication raised. Individuals with personal knowledge of others taking weight loss medications were more likely to have ambivalent or positive opinions on their use, suggesting that personal exposure may affect perception and stigma. It is possible that medicalization of weight status increases stigma by reinforcing beliefs that an individual's weight is a result of behavior and personal responsibility.
BACKGROUND AND OBJECTIVES:This study explored the association between the social determinants of health (SDOH) and the likelihood of premature mortality and premature accidental mortality. METHODS:Data from the National Longitudinal Survey of Adolescent to Adult Health (ADD Health) linked with records from the National Death Index (NDI) were used to classify deceased respondents by their cause of death. First, logistic regression examined the association between accidental death/premature mortality, individual characteristics, and SDOH. Second, a 2-stage model then analyzed the likelihood of having an accidental cause of death conditional on premature mortality. RESULTS:Premature mortality odds were lower for female individuals (OR = 0.89), Black individuals (OR = 0.94), those who identify as Hispanic (OR = 0.56), college graduates (OR = 0.27), and married individuals (OR = 0.45). However, living in the South (OR = 1.19) and lower income (OR = 2.22) increased the odds. Accidental death odds were lower for female individuals (OR = 0.29), Black individuals (OR = 0.32), those who identify as Hispanic (OR = 0.87), and multiracial groups (OR = 0.06). College education (OR = 3.61) and lack of medical care (OR = 1.13) raised accidental death odds while marriage (OR = 0.20), lower income (OR = 0.12), and residing in the West or Midwest (OR = 0.13) decreased them. CONCLUSION:There was a significant association between the likelihood of accidental death and adverse SDOH, suggesting that they may serve as risk factors of premature accidental death.
Background: Understanding the relationship between social capital, mental health, and well-being is important for advancing health equity in rural communities. We examined 5 individual-level dimensions of social capital and their relationship with well-being and mental distress in rural Georgia. Methods: Mail-in population survey data were collected from 6 rural Georgia counties (n = 1374) from December 2018 to May 2019. We conducted bivariate and multivariable analyses, controlling for county. Results: Social capital was significantly associated with improved well-being and inversely associated with mental distress. Conclusion: Findings support research that strengthens social capital through trust-building, strengthening neighborhood ties, and offering civic engagement opportunities.
