Mothers’ characteristics influence children’s health and development. We conducted a cross-sectional study to assess the influence of mothers’ education level, employment status, and exposure to domestic violence on diarrhea among children under 5 years old using secondary data from 2010, 2015, and 2020 Rwanda Demographic Health Surveys. We used stratified descriptive statistics, pairwise comparisons, and logistic regression designs to assess (a) the prevalence of mothers per education level, employment status, and exposure to domestic violence; (b) their variation over time; and (c) their influence on diarrhea among children under 5 years old between 2010 and 2020 in Rwanda. According to the study findings, there was a decrease in the prevalence of lower levels of education among mothers and cases of mothers acknowledging having no decision on their own earnings, but there was no variation in the prevalence of cases acknowledging wife beating and no decision on own healthcare between 2010–2020. Children whose mothers have (a) no education; (b) primary education; and (c) secondary education were 3.3 times, 2.8 times, and 2.4 times more likely to have diarrhea, respectively, compared to those whose mothers have higher education. Children whose mothers acknowledge (a) no decision of their earnings; (b) no decision on their healthcare; and (c) wife beating were 1.3 times, 1.2 times, and 1.4 times more likely to have diarrhea than those whose mothers do not acknowledge any form of domestic violence respectively. The study findings suggest community stakeholders combine efforts to integrate related community-based control interventions through (a) consistent use of socioecological models and frameworks of effective implementation; and (b) valorization of community-based institutions and resources to address diarrhea risk factors, including domestic violence against mothers towards significant reduction of diarrhea among children under 5 years old in Rwanda.
The HIV/AIDS health communication approach in sub-Saharan Africa has often overlooked sociocultural specificities. The current approach follows a generalist notion that does not consider the specific contextual domains accordingly. Similarly, the cultural appropriateness of HIV/AIDS health communication among the Borana pastoral community in Ethiopia is not clear. In this study, we aimed to explore whether HIV/AIDS communication among the Borana pastoral community was tailored to the cultural contexts of the community. A qualitative case study was used to unpack the cultural communication contexts for HIV/AIDS. We collected data using three methods, namely, in-depth interviews, focus group discussions, and document analysis of Ethiopia’s HIV/AIDS policy. Health behavioral theories formed the foundation of this study. HIV/AIDS health communication was not properly tailored to the Borana folk culture, symbols, artifacts, and Indigenous institutions; the communication approach was top-down, expert-based, persuasive, urban-centered, and individual-behavioral-change oriented, overlooking deep-rooted sociocultural and environmental contexts. There is, therefore, a need to tailor HIV/AIDS health communication to the cultural contexts of the Borana pastoral community.
Unraveling provider-level sexual health stigma requires building an understanding of contributing factors, such as provider knowledge, values, beliefs, medical training, and other intrapersonal or interpersonal factors that may influence its manifestation at the clinic level during patient–provider interactions. Healthcare provider stigma has not been sufficiently understood or explained using classic psychological theories, such as Cognitive Dissonance Theory (CDT) or Social Cognitive Theory (SCT). We build a theory-based understanding of sexual health-provider stigma by proposing modifications to the SCT to develop the Modified SCT (M-SCT) model, where cognitive dissonance is hypothesized to influence the personal/cognitive and behavioral factors of the M-SCT. Employing a phenomenological study design, we administered a semistructured interview guide, which included two vignettes, to 10 sexual healthcare providers. We conducted an interpretive phenomenological analysis, in which initial codes were organized into overarching themes and then categorized according to constructs of the M-SCT. Results revealed themes within the behavioral and social/environmental factors of the M-SCT and several social, cultural, and political factors that intersect among all three factors of the SCT as part of overall reciprocal determinism. Key themes highlighted factors that contribute to patient–provider stigma: provider cultural humility and ability to tolerate imperfection; using affirmative language; the impact of patient internalized shame/stigma; patient past experiences with other providers; paternalism in medicine; and clinical practices, culture, and values. While these theoretical frameworks helped illuminate these themes, additional research is needed to explore how provider cognition is shaped by factors not assessed at the intrapersonal and interpersonal levels.
The purpose of this study was to compare mental health diagnoses in a sample of youth with autism spectrum disorder (ASD) and youth without ASD (non-ASD) admitted to inpatient hospitals across the United States. We hypothesized that autistic youth would have a greater proportion of co-occurring psychiatric diagnoses compared to their typically developing peers. To do this, we conducted a cross-sectional analysis of the Healthcare Cost and Utilization Project (HCUP) 2019 Kids’ Inpatient Database (KID). We compared the proportions of co-occurring psychiatric diagnoses between autistic and typically developing youth. Compared to 21% of non-ASD admissions, 36% of the ASD admissions were for a primary mental health condition. Overall, youth with ASD were significantly more likely to have a co-occurring mental health diagnosis (p < .01, V = 0.08), a diagnosis of unspecified mood disorder (p < .01, V = 0.08), a disruptive and conduct disorder (p < .01, V = 0.10), bipolar disorder (p < .01, V = 0.04), an anxiety disorder (p < .01, V = 0.04), and a psychotic disorder (p < .01, V = 0.04). We observed no significant differences for major depressive disorder (p > .05). These results add to the growing evidence suggesting increased risk for psychopathology and psychiatric hospitalization in autistic youth. This finding may reflect unmet mental healthcare needs for autistic youth at lower levels of care. Research addressing autistic healthcare needs, such as the relationship between care outcomes and provider knowledge, is necessary to improve mental health outcomes in autistic children.
Access to culturally appropriate cancer health education (CACHE), such as cancer information in languages other than English, that considers a group’s cultural beliefs, traditions, values, and practices, is increasingly recognized as a global health communication priority. CACHE is essential for reducing healthcare disparities and improving service accessibility among African immigrants, a rapidly growing demographic in the United States. This study explored the perceptions and experiences of Kenyan immigrants in Washington State regarding CACHE. We used a qualitative descriptive design, with a purposive sample of ten participants from the Kenyan immigrant community in Washington State. The Andersen Behavioral Model of Healthcare Utilization and the Social Determinants of Health (SDOH) framework guided the study in examining factors influencing CACHE access and utilization. Data collection involved a demographic questionnaire and semi-structured interviews, identifying emergent themes through direct content and domain analysis. Findings highlighted the impact of cultural beliefs, language barriers, and limited health literacy on cancer education access. Participants emphasized the importance of culturally appropriate preventive education and culturally competent care in improving understanding of cancer symptoms and treatment options. These findings lay the groundwork for interventions that would address the specific cancer needs of Kenyan immigrants while also promoting equitable access to CACHE.
Despite the known benefits of physical activity (PA), more than half of U.S. adults do not meet the American College of Sports Medicine’s PA recommendations for health, often resulting in negative health outcomes. Developing programming that increases motivation for PA participation is critical for healthcare professionals to combat physical inactivity. Previous research has demonstrated that framing disease-based PA charity fundraising events as “helping a cause” improved motivation for PA due to the individual’s emotional connection to the cause. There is currently no congruent research on motivation for participation in cause-based charity events. Behavioral economics theory posits that cognitive, emotional, and social factors lead to decisions that deviate from rational choice and may help explain increased motivation for participation in PA-based charity events of all types. Therefore, the purpose of this pilot research was to examine a cause-based PA charity event using the lens of behavioral economics to understand an individual’s motivation for participation. We collected data from 44 participants during an in-person, 1-mile charity walking event that raised funds and awareness about domestic violence. Results indicated a correlation between motivation to participate and making a difference for the cause (r = .413, p < .05); additionally, more than half of the participants reported raising money/awareness about domestic violence as the most important reason they participated (n = 23, 52.3%). These results suggest that cause-based charity events elicit emotional connections that positively influence motivation for PA and, therefore, may be beneficial as a strategy for promoting long-term PA participation. Future research on PA programming and behavior change should explore using both cause-based and disease-based charity events that are meaningful to the individual to increase PA motivation and facilitate PA participation.
Diabetes mellitus (DM) is a significant public health concern globally and in Owerri, southeast Nigeria. The deleterious effects of diabetes have been linked to poor glycemic control. According to the International Diabetes Federation, poor glycemic control is reflected in glycosylated hemoglobin (HbA1c) levels > 7.0%, which are associated with substantial morbidity and mortality. Studies have shown a dramatic rise in diabetic complications in Nigeria, particularly in Owerri. However, evidence is lacking regarding the specific risk factors associated with poor glycemic control among DM patients in Owerri. This study assessed the predictors of poor glycemic control in a hospital setting in Owerri. For the study, we recruited a cross-section of 160 type 2 diabetic patients attending the diabetes clinic at the Federal Medical Center in Owerri. Independent variables were age, sex, medication adherence, education, body mass index, and blood pressure, while the dependent variable was glycemic control measured using HbA1c. The prevalence of poor glycemic control in the participants was 76.9%. Age (p = 0.019) and medication adherence (p = 0.015) were predictors of glycemic control in the subjects. Younger age (< 60 years) and poor medication adherence had increased odds of 1.1 and 23 for poor glycemic control, respectively. This finding has the potential to promote positive social change through a focus on the younger age group and patients with poor medication adherence as an approach to improve glycemic control.
The Art and Science of Social Connection by Kasley Killam presents a case for better understanding individual health by ensuring that the social aspect is considered as a significant component of health in addition to the physical and mental aspects. Killam states that social health consists of an individual’s sense of belonging, the strength of relationships, and meaningful connections. By drawing from years of evidence building, Killam argues that social health is fundamental for one to truly flourish and prosper in their life as people who have stronger social health are shown to have higher quality of life, emotional resilience, and longevity. The Art and Science of Connection is an award-winning, 288-page book that takes the reader through not only understanding social health but also learning how to apply a framework that offers practical strategies to strengthen one’s own social health. As part of discussing key concepts, Killam, an internationally recognized expert in social health, redefines what it means to be healthy, offers a critical lens in examining the types of relationships people may have, including how each type may affect social health differently, argues for making social health a priority by being consistent in strengthening social muscles, and unveils ways that individuals can flourish together by joining a growing movement in social health. The aim of this review was to spotlight Killam’s book as a thoughtful approach for thinking about ways through which everyone can reach optimal health by connecting with others and strengthening their relationships.
Despite efforts to curtail tuberculosis (TB) in Nigeria, the country has not yet attained the global target. This study explored the dynamics of access to information about TB control and prevention among nomadic Fulani and their host communities. We used a mixed-methods approach and multistage sampling technique to recruit 812 respondents for the survey, and we conducted 18 in-depth interviews across six local government areas. The results indicated generally low access to TB information and services, with only 2% of nomadic Fulani engaging in TB prevention activities compared to 6.7% of host community members. Yoruba respondents had significantly higher odds of relying on television (odds ratio [OR] = 1.763, p = 0.003) and health workers (OR = 0.643, p = 0.036) for TB information. Marital status influenced access, with married individuals more likely to rely on billboards (OR = 15.290, p < 0.05) but less likely to participate in free counseling (b = –16.256, p < 0.05). Ethnicity significantly impacted reliance on sources such as religious leaders (p = 0.049) and television (p = 0.020). Qualitative analysis highlighted additional barriers for nomadic Fulani, such as distrust of health workers and geographic isolation, limiting their access to TB education and services. Furthermore, nomadic Fulani reported lower access to free TB counseling (15.9%), education (14.5%), and medicine (5.5%). Equitable access to TB control information and services remains unmet, with nomadic Fulani disproportionately underserved. Therefore, we recommend culturally sensitive, community-based interventions. These include leveraging trusted religious leaders, recruiting community health volunteers, and employing targeted media campaigns. Addressing sociocultural barriers holistically will enhance TB control efforts and health outcomes for nomadic Fulani and host communities in Nigeria.
We investigated how disability status, types, sociodemographic indicators, and reasons for not receiving vaccinations influenced COVID-19 vaccination rates among individuals with disabilities in the United States. Despite efforts, vaccination disparities persisted, necessitating a nuanced understanding of the barriers to vaccination. Using intersectionality theory and the social determinants of health framework, we examined the impact of marginalized identities and structural inequalities. Key questions included the association between disability status and vaccination uptake, differences among disability types moderated by sociodemographic factors, and the interaction between disability status and reasons for not vaccinating. We used Household Pulse Survey data from the U.S. Census Bureau (December 7, 2022–September 4, 2023) and logistic regression analyses to assess these relationships. Findings revealed that while disability status and sociodemographic variables alone did not significantly predict vaccination uptake, disability type was crucial, indicating the need for targeted interventions. These results support inclusive public health policies that address specific barriers faced by individuals with disabilities and promote equitable healthcare services and vaccination programs. Understanding the interplay among disability status, sociodemographic factors, and vaccination behavior may result in targeted strategies to ensure no population segment is left behind, fostering positive social change toward a more inclusive and equitable society.
Regretted sexual behaviors and alcohol use often occur in tandem for college students; however, few studies have examined their interrelationships or the variance across gender. This study tested gender differences in how regretting a consensual sexual experience is related to college students’ alcohol use. One hundred and forty first-year students (63% women, 69% Hispanic) surveyed in 2018 and 2019 reported their sexual behavior and alcohol use (following the Rutgers Alcohol Problem Index [RAPI]). Twenty-one percent of men and 16% of women reported a regretted sexual encounter. Interaction effects from regression models revealed that men with sexual regret had a significantly higher RAPI score than women with sexual regret. Our results challenge broader gender assumptions about regret for sexual encounters. Problematic alcohol use should be widely investigated to include consensual sexual activity that may later be regretted, with specific concern for men’s sexual activity.
Throughout history, research has depicted the notion that African Americans do not make use of mental health treatment, even when their mental health status may deem it clinically necessary. One of the most prevalent deterrents to African Americans seeking treatment is the mistrust of the medical system. In the African American community, medical mistrust has a longstanding history that stems from the discrimination, racism, lack of representation in the field, and medical mistreatment that African Americans received as test subjects by the medical community over time. Various instances, throughout history, of African Americans being unjustly treated— for the sake of progressing modern medicine—have been well documented. These occurrences fostered a feeling of medical mistrust in the African American community and, potentially, serve as a barrier to African Americans seeking mental health treatment despite exhibiting a need for it.
We used secondary data from the Rwanda Demographic and Health Surveys of 2010, 2015, and 2020 to assess the spatial-temporal variation of diarrhea among children under 5 years old between the years 2010 and 2020 in Rwanda. Stratified descriptive statistics, pairwise comparisons, and logistic regression designs were used for data analysis in SPSS. A statistically significant variation of diarrhea among children under 5 years old was observed across districts, regions, and urban–rural areas but not at the national level between 2010–2020. Some districts of the Western region, including Nyabihu (OR = 2.5), Ngororero (OR = 2.3), and Karongi (OR = 1.8); the Northern region, including Gicumbi (OR = 2.0) and Musanze (OR = 1.7); and the Southern region, including Nyamagabe (OR = 1.8), Nyanza (OR = 1.7), and Nyaruguru (OR = 2.4) were at higher risk of diarrhea in 2020 compared to Nyarugenge district. The Western region (OR = 1.7) was consistently at higher risk of diarrhea among children under 5 years old between 2010–2020 compared to Kigali City. The prevalence of diarrhea was consistently higher in rural areas (OR = 1.3) compared to urban areas. The spatial variation of diarrhea and its stagnant reduction with time may be due to uneven spatial distribution of diarrhea risk factors, lack of adapted diarrhea control interventions, and/or irregularities in the design and implementation of existing diarrhea control interventions. Area-specific, tailored diarrhea control interventions and their effective implementation are required to ensure a significant reduction of diarrhea among children under 5 years old over time across districts in Rwanda.
Suicide is the leading cause of death in prisons and custodial settings globally. International studies have consistently shown that prisoners and detainees are at a higher risk of suicide compared to the general population. Despite Bangladesh having a large prison population, there is no scholarly work on suicide within these settings. Against this backdrop, this study explored online newspaper content analysis capturing the characteristics of prison and custodial suicide in Bangladesh from 2014–2024. A total of 20 suicide cases were identified during this period. The data were arranged based on year-wise trends, age, sex, type of custody, nature of criminality, methods, and causes of suicide. Of these cases, 65% occurred in judicial custody (prisons and jails), while the remaining 35% occurred in police custody. All victims were male, and predominantly (65%) aged between 20 and 35. Hanging emerged as the most common method of suicide, accounting for 90% of all suicide deaths. Fears of punishment, frustration, and mental health problems were presumed to be potential causes of suicide, although in most cases the exact reasons remained unknown. Given that suicide is a preventable issue in prisons and custodial settings, it is imperative for Bangladesh to develop effective prevention strategies. Such strategies should be informed by empirical evidence and aligned with international institutional guidelines and global best practices.
Childhood obesity is a major health issue globally. The prevalence rate remains high in Ohio, with associated complications among affected children and adolescents. The current study examined the association among obesity risk knowledge, risk perception, feeding behavior, and child weight outcome while controlling for race, gender, income, and education. We collected quantitative data through an online survey of parents in Northwest Ohio (n = 71) using the obesity risk knowledge scale and factors from the Child Feeding Questionnaire. We analyzed data using multiple linear regression. The primary outcome measures were feeding behavior and child weight status. Parental obesity risk knowledge, risk perception, or concern about child weight was significantly associated with feeding behavior [F (6, 64) = 4.459, p < .001] and child weight outcome [F (6, 64) = 3.351, p = .006]. Risk perception significantly predicted parental feeding behavior of pressure to eat and food restriction, while the association among parental obesity risk knowledge, risk perception, and child weight status was modified by parental gender. The findings of the study suggest that parents’ perceptions or concerns about their child’s weight and their gender have a greater influence on their feeding intentions, behavior, and child weight than knowledge of obesity risk. Thus, interventions for childhood obesity could focus on addressing the parents’ risk perception and gender-tailored education to improve their feeding intentions, feeding behavior, and weight outcomes in children.
Support groups can provide members with space to discuss life issues, foster a sense of community, and promote connections with others. For people living with HIV, support groups can improve knowledge and awareness of tools and resources for HIV management, reduce stigma, improve social competence, and overall health. Studies that have connected empowerment and support group structures in populations with HIV have found promising results; however, a dearth of research demonstrates how applying theoretical frameworks can improve understanding of factors that increase empowerment among support group participants. The purpose of this phenomenological study was to apply the Psychological Empowerment Theory among seven HIV support group members to understand: (1) individual beliefs about how their HIV diagnosis affected day-to-day life, (2) efforts that the individual makes to maintain “control” of their life to proactively manage their diagnosis, and (3) their sociopolitical environment, such as their self-assessment of resources and available supports to manage their HIV diagnosis as well as level of involvement in community activities and organizations. Data were analyzed using an interpretive phenomenological analysis approach through which seven themes were identified: fostered relationships within the group, positive self-perception, increased perceived control, safe and secure environment, increased knowledge and social learning, group validated benefits through positive experience, and intention for longer-term commitment to the group. Findings contribute to the positive impact of HIV support groups in enhancing empowerment among its members, especially the critical role that both individual and interpersonal factors play in achieving improved health-related outcomes.
From the 1950s through 2024, transracial adoptions—particularly of Korean and Chinese children—have been increasingly prevalent in Western societies. While these adoptions provided children with opportunities to grow up in loving and supportive families, they also introduced unique challenges related to identity, cultural integration, and self-esteem. This basic qualitative study aimed to explore the lived experiences of Chinese and Korean transracial adoptees (TRAs) within their adoptive families, in their interactions with counseling, and their perceptions of the effectiveness of counseling interventions. The study was grounded in Relational-Cultural Theory (RCT) and the Openness to Communication framework to examine the experiences of 19 Chinese and Korean TRAs. Data were collected through qualitative surveys and analyzed through a modified version of Braun and Clark’s thematic coding to identify and interpret broad insights from recurring patterns and themes from the participants. The emerging themes reflected participants’ lived experiences, including their engagement with counseling during childhood and adulthood. Findings underscored the need for specialized therapeutic approaches that address the racial and cultural identity development of TRAs adopted into Caucasian families. By recognizing the significance of these factors and implementing culturally responsive counseling practices, mental health professionals can play a crucial role in fostering the psychological and emotional well-being of TRAs.
Our goal in this study was to examine the effect of a social cognitive intervention aimed at improving appropriate antibiotic use self-efficacy (AAUSE). The intervention incorporated several aspects of self-efficacy theory, including mastery, vicarious learning, and verbal persuasion. To test the effectiveness of the intervention, we used two comparison conditions—reading a pamphlet focused on antibiotic resistance (ABR) or one focused on general health (diet, physical activity, sleep). A total of 226 undergraduate students completed the study, which involved completing a series of questions/questionnaires at time 1 (preintervention), engaging in the intervention (or reading a pamphlet), and then completing the time 2 (postintervention) questions/questionnaires. Changes in AAUSE and other dependent variables (antibiotic-resistance knowledge, concern about antibiotic resistance, interest in minimizing antibiotic use) were observed from preintervention to postintervention in the intervention group and the ABR pamphlet group. At time 2 (postintervention), compared with both comparison groups, participants who took part in the social cognitive intervention had higher overall AAUSE, AAUSE specific to avoiding antibiotics for viruses, and self-perceived knowledge. Our results indicate that social cognitive strategies might be particularly beneficial in promoting AAUSE and related antibiotic-resistance preventive attitudes and behaviors.
The affect heuristic suggests that emotional responses significantly influence perceptions of risk and benefit. We extend this model to test how recalling ostracism affects these perceptions across financial, health, and social domains, and test how time pressure moderates these effects. Participants were randomly assigned to one of two conditions: recalling either a time they were ostracized (ostracism condition) or included (inclusion condition), followed by evaluating risk and benefit scenarios under time pressure or no time pressure. While a growing body of evidence has linked ostracism to increases in risky decision-making, we found that recalling ostracism led to domain-specific, bi-directional changes in risk and benefit perception. Ostracized individuals perceived lower risk in financial and health domains but higher risk in social contexts. Time pressure further intensified these effects, strengthening the inverse relationship between risk and benefit perceptions. Under time pressure, ostracized participants reported greater perceived benefits of financial risks and lower perceived benefits of social risks. These findings support the hypothesis that ostracism shapes risk and benefit perceptions in a domain-specific way, with time pressure amplifying these effects through heightened affective responses.
