This study examined the association between self-reported oral health - related food avoidance and household food insecurity among U.S. adults using National Health and Nutrition Examination Survey (NHANES) 2021-2023. Food insecurity was defined using the U.S. Food Security Survey Module. Survey-weighted logistic regression adjusted for sociodemographic characteristics, health insurance status, and access to care. Oral health - related food avoidance was associated with food insecurity (OR 2.46; 95% CI 1.81-3.34), with higher odds across increasing frequency. Findings were similar in sensitivity analyses and after adjustment for Supplemental Nutrition Assistance Program (SNAP). Findings indicate that oral health - related food avoidance was associated with household food insecurity.
Background Among US groups, Native Americans (NAs) have the highest rates of smoking and chronic pain. No study has examined whether smoking contributes to NA chronic pain disparities.Purpose We tested a biopsychosocial model linking smoking with chronic pain among NAs.Methods Social, psychological, and biological variables associated with chronic pain risk and smoking were assessed in healthy, pain-free NAs and non-Hispanic Whites (NHWs). Participants were followed for 5 years to assess who did (N = 49) and did not (N = 151) develop chronic pain (pain rated >= 3/10 on most days lasting >= 3 months).Results Native Americans had higher odds of smoking and developing chronic pain than NHWs, and smoking predicted chronic pain at 5 years (OR = 3.86, 95% CI, 1.59-9.35), even after controlling for age, sex, income, and education, but NA ethnicity did not confer greater chronic pain risk among those that smoke. A path analysis suggested that smoking contributed to the NA chronic pain disparity via 4 indirect paths. One linked NA ethnicity to chronic pain via smoking. Others suggested that the higher smoking rate in NAs was partially explained by interpersonal discrimination, and that cardiometabolic load (stress-related wear-and-tear on cardiovascular/metabolic systems) and impaired physiological pain inhibition (assessed by quantitative sensory testing) linked smoking to NA chronic pain.Conclusions Smoking fits within a biopsychosocial model of NA chronic pain risk. Discrimination is linked to higher rates of smoking among NAs; smoking is associated with the NA chronic pain disparity; and higher cardiometabolic load and impaired pain inhibition link smoking to NA pain disparities. Native Americans experience some of the highest rates of smoking and chronic pain in the United States, but the reasons for these disparities are not fully understood. This study followed healthy Native American and non-Hispanic White adults for 5 years to learn whether smoking contributes to the development of chronic pain, and what social, psychological, and biological factors might explain this link. We found that Native American participants were more likely to smoke and more likely to develop chronic pain. Smoking greatly increased the chances of developing chronic pain for everyone in the study. For Native Americans, higher smoking rates were partly explained by greater experiences of discrimination. Discrimination was also linked with stress-related wear-and-tear on the body and with disruptions in the body's natural ability to regulate pain. Our results suggest that discrimination may lead to smoking, which then increases physiological strain and weakens pain-regulating systems, raising the risk for chronic pain. These findings highlight that smoking cessation, culturally grounded support, and efforts to reduce discrimination are important strategies for preventing chronic pain and promoting health equity among Native Americans.
Background: Sequential physical activity interventions hold promise in developing effective interventions when adapted to participants' physical activity. Adaptive interventions can be further strengthened by understanding the moderators of their effects on physical activity outcomes. Purpose: To determine whether baseline personal characteristics moderated the impact of adaptive interventions on physical activity in the Working Women Walking trial. Methods: This study analyzed data from a sequential multiple assignment randomized trial (SMART) targeting 18- to 70-year-old women employed at an urban medical center who self-reported low physical activity (N = 301). Four adaptive interventions included combinations of Initial Treatments (Fitbit or Fitbit + Text Messages) and Augmented Treatments for nonresponders (Motivational Calls or Group Meetings). Personal characteristics, including demographics, health status, self-reported physical activity, and neighborhood walkability, were measured at baseline. Moderation of intervention effects was tested across ActiGraph-assessed physical activity at baseline, 9-10 weeks (end of Initial Phase), 35-36 weeks (end of Augmented Phase), and 49-50 weeks (end of Maintenance). Results: There was no evidence that personal characteristics moderated the differential impact of the Initial or Augmented Treatments on device-assessed steps or moderate-to-vigorous physical activity. Independent of the Initial Treatment, Black race, higher baseline body mass index, and higher baseline self-reported moderate-to-vigorous physical activity were associated with lower increases in physical activity (P < .05) during the Initial Phase. Lower neighborhood walkability was associated with relative decreases in physical activity during the Maintenance Phase. Conclusions: Although personal characteristics may have altered the degree to which participants increased their physical activity, they did not alter the differential impact of the adaptive interventions.
Background Firearm violence is a pressing public health crisis in the United States and disproportionately impacts sexual and gender minority (SGM) young adults of color who already face systemic inequities. Despite elevated risks of suicidality and violence victimization, firearm violence research rarely focuses on SGM populations.Purpose This study examined firearm experiences among SGM young adults of color in Detroit, MI, to inform trauma-informed care, firearm safety education, and inclusive prevention strategies.Methods Using a community-engaged convergent parallel mixed-methods design, we integrated survey data and in-depth qualitative interviews. Participants (N = 24; aged 18-29) were recruited through a community health center serving SGM young adults of color. Surveys assessed firearm behaviors, interpersonal and community exposures, and safety perceptions. Reflexive thematic analysis was applied to interview.Results Qualitative data revealed pervasive trauma linked to firearm violence, eroding mental health and feelings of safety. Transgender women in the sample described vulnerability to intimate partner firearm violence, while sexual minority cisgender men described violence in public spaces. Participants described firearms as both normalized and necessary for protection and noted a lack of culturally relevant firearm safety education. Quantitative findings from this small, purposive sample indicated that over half reported carrying or using a firearm (52.4%), two-thirds had been shot at (66.7%), and 42.9% experienced intimate partner firearm threats.Conclusions Findings highlight the urgency of integrating trauma-informed care into SGM health services, developing inclusive firearm safety initiatives, and reinstating sexual orientation and gender identity measures in surveillance systems to better track inequities and inform prevention policy. This study looked at experiences with firearm experiences among sexual and gender minority (SGM) young adults of color in Detroit, MI. SGM people include those who identify as lesbian, gay, bisexual, or transgender. Firearm research has largely excluded this population despite their elevated vulnerability to firearm exposure. Researchers interviewed and surveyed 24 SGM young adults of color through a Detroit community health center. Participants described high levels of exposure to firearm violence and lasting effects on their mental health and sense of safety. Transgender women described particular vulnerability to firearm threats from intimate partners. Participants expressed a strong desire for trauma-informed care and firearm safety education delivered through community organizations they already trusted. The findings highlight the importance of developing firearm violence prevention efforts in partnership with SGM young adults of color.
Background Both sleep and physical activity (PA) are essential for health. Previous studies found inconsistent effects of PA, including evening PA (EPA), on sleep.Purpose To examine the effects of PA and its timing on objectively and subjectively measured sleep in predominantly healthy, young adults.Methods In the Budapest Sleep, Experiences and Traits Study, a highly ecologically valid multiday observational study, 267 participants tracked their natural sleep and reported PA for at least 1 week, including mobile electroencephalography recordings. We estimated the effects of PA and its timing, quantifying it as the time elapsed between activity initiation and sleep onset.Results Our findings showed no substantial main effect of PA on sleep (all P >= .19). However, PA temporally close to sleep had a rapid eye movement (REM) sleep-suppressing effect: each additional hour between PA and sleep onset decreased REM latency by 1.8 minutes (B = -1.82, SE = 0.58, P = .002) and increased REM percentage by 0.30 percentage points (B = 0.30, SE = 0.11, P = .008), but no other timing effect was found. Results were robust across multiple analytical specifications.Conclusions Our results support neither a general sleep-promoting effect of PA nor a sleep-suppressing effect of EPA and suggest that for healthy young individuals, habitual, relatively low-intensity EPA is safe to perform and is a good alternative for those whose daily schedule permits no alternative timing, although the lack of detailed exercise intensity monitoring is a limitation of our study. General sleep hygiene advice is to avoid exercising in the evening, because it might worsen sleep quality. However, scientific evidence about the topic is mixed. We examined how physical activity and its timing relate to sleep quality in healthy young adults.Participants were monitored for multiple days in their homes. Physical activity was reported daily, and sleep was measured using a headband that records brain activity, allowing a detailed assessment of sleep structure. This approach allows us to study this relationship in participants' natural environment and provides more precise sleep measurements than movement-based trackers or self-reports used in previous studies.We found that daily physical activity had minimal effects on sleep quality or structure. Even when people reported evening physical activity, it was not associated with major sleep disruption. However, activity performed nearer to sleep onset was linked to a modest reduction in rapid eye movement sleep, a stage associated with dreaming. This is likely because this stage is particularly sensitive to the physiological effects of exercise.Based on these findings, evening physical activity is generally safe to perform. A limitation of our study is that it only investigated the effects of habitual exercise on healthy young adults.
Background Disordered eating during adolescence is common and can interrupt daily participation in family, peer, and school life. However, prior studies typically treat social relationships as precursors to disordered eating rather than as health outcomes that may deteriorate once symptoms appear. Purpose To test whether adolescents with disordered eating symptoms show poorer social health across multiple relational settings, and whether impairment is stronger for multi-symptom and more persistent symptoms and changes over time. Methods Data came from 11 868 adolescents in the Adolescent Brain Cognitive Development Study, followed annually across 5 years. Parents reported 5 eating disorder-related symptoms each year; variables were created for any symptom, >= 2 symptoms, and the proportion of study years with symptoms (chronicity). Social health was measured with parent-reported social withdrawal and adolescent-reported prosocial behavior, peer victimization, family conflict, and school functioning (school disengagement, school environment, and school involvement). Generalized estimating equations with year fixed effects estimated population-averaged associations. Results Across adolescence, 39.7% of adolescents were ever symptomatic (eg, binge eating, fear of gaining weight, or vomiting for weight control) and 7.0% had >= 2 symptoms. Any eating disorder symptom was associated with higher social withdrawal (beta = 0.26, q < .001), more peer victimization (beta s = 0.09-0.12, qs < .001), and greater family conflict (beta = 0.12, q < .001); school environment and involvement were modestly lower. Associations were substantially stronger for multi-symptom and more persistent symptoms, such that adolescents symptomatic across multiple years showed the largest deficits across all layers of social health. Symptom-by-year tests indicated the social withdrawal gap widened modestly over time. Conclusions Adolescent disordered eating symptoms were associated with poorer social health across family, peer, and school settings, particularly when symptoms are recurrent or multifaceted. These findings suggest that social participation warrants assessment alongside eating disorder screening in pediatric and school contexts.
Background Cognitive Behavioral Therapy (CBT) shows promise for addressing distress in cancer caregivers, though results are mixed. Traditional CBT may not fully address transdiagnostic processes underlying caregiver distress, such as attentional rigidity and perseverative thinking. Emotion Regulation Therapy (ERT), a contemporary CBT targeting these mechanisms, has promise for cancer caregivers (ERT-C). We compared ERT-C to caregiver-adapted CBT (CBT-C) on caregiver- and patient-reported outcomes.Methods We conducted a multisite RCT (ERT-C vs. CBT-C) with distressed caregivers of patients with any cancer type or stage. Caregivers completed measures of anxiety, depression, worry, rumination, burden, and quality of life (QOL) at baseline, post-treatment, and 3- and 6-months follow-up. Patients reported outcomes at baseline and 3 months. Linear mixed-effects models with multiple imputation were used to assess group differences.Results From March 2021 to April 2024, we randomized 253 caregivers, of whom 244 were analyzed (ERT-C = 124; CBT-C = 120), and enrolled 95 patients (ERT-C = 47; CBT-C = 48), of whom 87 were analyzed. From pre- to post-treatment and through 6 months follow-up, caregivers in ERT-C did not improve significantly more than in CBT-C. Although there were significant between-group differences in patient physical and mental health, these effects did not persist after multiplicity adjustment. However, caregivers overall demonstrated significant improvements over time in anxiety, depression, worry, and QOL, and patients demonstrated significant improvements in perceived stress and emergency room visits.Conclusions Although ERT-C was not superior to CBT-C, caregivers showed meaningful psychosocial improvements overall, and patients improved on 2 outcomes. Future work will examine whether the 2 treatments differentially engage putative mechanisms leading to the observed clinical findings.Clinical trial registration This trial is registered on ClinicalTrials.gov (identifier: NCT04802720). Cancer caregivers-the parents, partners, children, siblings, and friends of patients with cancer-shoulder significant responsibilities and are at risk for anxiety and depression. While Cognitive Behavioral Therapy (CBT) has the strongest evidence to address anxiety and depression across various clinical populations, mixed findings among cancer caregivers may reflect the limitations of traditional CBT to address the unique distress experienced by this vulnerable population. Our group developed Emotion-Regulation Therapy for Cancer Caregivers (ERT-C), a CBT-based approach that targets worry and rumination and which may offer a particular benefit for caregivers above traditional CBT. This study compared the relative efficacy of 8 sessions of ERT-C compared to 8 sessions of Cognitive Behavioral Therapy for Cancer Caregivers (CBT-C), delivered over telehealth to 253 distressed caregivers of patients with all sites and stages of cancer. Our hypothesis that ERT-C would outperform CBT-C was not supported; both groups showed significant improvements in anxiety, depression, worry, and quality of life. There were also significant improvements across both groups among the patients for whom enrolled caregivers provided care in perceived stress and emergency room visits. Our results highlight a critical lesson: For distressed caregivers of patients with cancer, engagement in any evidence-based CBT-informed intervention targeting caregiver-specific distress may be beneficial. For distressed caregivers of patients with cancer, engagement in any evidence-based CBT-informed intervention targeting caregiver-specific distress may be beneficial.
Background While evidence suggests psychosocial support benefits well-being, physical health, and weight management, the impact of psychosocial health within digital behavioral weight management programs (compared to traditional in-person models) remains underexplored. Purpose To evaluate the effectiveness of a digital commercial program (DCP) compared to standard nutrition guidance (SNG) on some weight-related psychosocial outcomes: weight-bias internalization (WBI), self-compassion, weight-related quality of life (WQOL), well-being, and body appreciation (BA). Methods A 6-month randomized controlled trial (NCT05648344) was conducted among 376 US adults living with overweight/obesity. n = 187 were randomized to a DCP (WeightWatchers (R)), and n = 189 received SNG. Intention-to-treat analyses using analysis of covariance (ANCOVA), adjusted for sex, age, race, ethnicity, education, body mass index (BMI), and baseline values, were completed to assess changes in outcomes. Results Mean +/- SD age was 47.7 +/- 12.2 years; 7.4% self-identified as Asian; 13.8% Black; 6.4% Other; 9.6% Hispanic; 20.7% male; 17.8% experienced food insecurity; BMI = 33.6 +/- 4.7 kg/m(2). At 6 months, DCP relative to SNG, participants lowered their WBI by a mean difference +/- SE of -0.3 +/- 0.1; and increased their self-compassion by 0.2 +/- 0.1; BA by 0.2 +/- 0.1; well-being by 6.4 +/- 1.7, and WQOL by 5.6 +/- 1.2, all P<.01. Conclusions Relative to SNG, participants in the DCP showed increased self-compassion, BA, well-being, and WQOL, and decreased WBI, highlighting that DCPs may deliver favorable changes in psychosocial outcomes. These findings should be interpreted with caution due to the short follow-up period and the question of whether the observed differences are clinically meaningful.
Background Digital interventions offer scalable solutions for program accessibility but face challenges with engagement and adherence. Hybrid delivery models integrating human support through coaching may enhance engagement outcomes, which can improve intervention or clinical outcomes.Purpose This study describes a structured, intervention-agnostic coaching model and associated training procedures designed to reinforce digital intervention content without requiring specialist expertise. It evaluates the feasibility, fidelity, and acceptability of the coaching model, including participant satisfaction.Methods Parents of toddlers born very preterm (n = 113) received digital parent training or health education paired with weekly coaching calls. Eleven coaches from diverse educational backgrounds completed a standardized training protocol. Feasibility was assessed via observations and coach self-report of adherence and competence. Acceptability was evaluated through parent satisfaction surveys. Descriptive analyses summarized fidelity, engagement, and program completion.Results Coaches demonstrated high adherence (M = 94.9%) and competence (M = 88.9%) across 266 observed calls, with minimal variance. Parent call engagement was rated high (M = 2.70; 3-point scale). Most parents (75%) attended >= 6 of 11 coaching calls, and 64% completed all 6 digital program modules. Satisfaction was strong, with 93.6% of parents reporting being satisfied or very satisfied, and over 70% felt connected to their coach. Calls were brief (M = 12.9 minutes), supporting feasibility for busy families.Conclusions An intervention-agnostic coaching model delivered by non-specialists was feasible and acceptable for parent participants. Development of a standardized coaching manual and testing across additional digital interventions are planned to enhance scalability and replication.Clinical trial identification number NCT05217615; ClinicalTrials.gov. Digital programs can help families learn effective strategies for managing behavior and supporting child development, but many people struggle to stay engaged without personal support. This study tested a new coaching approach designed to make digital interventions more effective and easier to complete. The coaching model uses short, structured phone calls to encourage program use and help participants apply what they learn. Coaches do not need to be mental health specialists; instead, they receive brief, standardized training focused on communication skills and reinforcing program content. Calls are practical, goal-oriented, and typically last about 13 minutes, making them easy to fit into busy schedules. Results showed that coaches followed the protocol closely and provided high-quality support, characterized by consistent adherence and competent use of coaching techniques. Parents reported high satisfaction with coaching and most completed the digital program. These findings suggest that structured coaching can improve engagement and outcomes for digital interventions without requiring highly trained professionals. This approach could make evidence-based programs more accessible and scalable across different settings. Next steps include creating a standardized coaching manual and testing this model with other digital interventions to ensure it works for a variety of programs and populations. Our study demonstrates that non-specialist coaches, using brief structured calls, consistently delivered high-fidelity parent support by adhering to a standardized protocol. This approach ensures reliable program delivery and scalability across digital interventions.
Background In the United States, underserved women face persistent healthcare disparities, making mammography screening and equity public health priorities.Purpose This retrospective observational study assessed how tailored messaging influenced mammogram scheduling and attendance, determined which message types were most effective, and explored differences across key demographic subgroups.Methods We employed Precision Nudging using reinforcement learning and behavioral science to tailor email messages informed by the Capability, Opportunity-Behavior (COM-B) model. Messages were sent to 156 954 women overdue for screening. Mammogram scheduling and attendance were documented via electronic health records. Analyses focused on the engaged patient population who opened at least one email (N = 106 616; 67.9%). Logistic regressions examined whether COM-B content in the first and last message predicted scheduling and attendance, testing interactions for age, race, income, insurance, and education.Results Among engaged patients, 23.7% scheduled and 20.3% attended a mammogram. Capability-focused messaging was generally associated with higher overall uptake, while opportunity messaging consistently predicted lower scheduling and attendance rates. Equity analyses revealed nuanced engagement patterns among underserved groups. Underrepresented racial/ethnic minority women had higher odds of completing screening than White women. Older age predicted lower attendance, with early messages addressing motivation predicting lower attendance than capability messages. Final intervention messages addressing motivation were more effective for low- and high-income women than middle-income women and more effective for women without private insurance.Conclusions These findings suggest that tailoring messages to patients' needs and context encourages mammogram uptake and may help reduce disparities in women's health. Tailored email messages were sent using artificial intelligence to encourage overdue women to schedule and complete recommended mammograms. The message type that was most helpful differed by age, race, income, insurance coverage, and education. Many women in the United States do not get mammograms on time, which can increase breast cancer risk. This study tested whether tailored email messages could help women schedule and attend recommended mammograms. Email messages reached more than 150,000 women overdue for a mammogram. Messages were designed to address specific barriers that each woman faced. For example, some messages focused on helping women understand why screening matters, while others helped women feel more confident about scheduling or attending their appointment. Artificial intelligence technology was used to tailor messages to each woman's situation. Among women who opened at least 1 email, almost 25% scheduled a mammogram and 20% completed a screening. Messages generally worked best when they helped women feel capable and informed, whereas messages targeting access or social support were often less effective. Messages that reduced fear and encouraged motivation were less helpful for older women, but more helpful for women with lower incomes and without private insurance. Simple, tailored messages can help women get screened for breast cancer. Designing outreach that reflects individual barriers, rather than using the same message for everyone, may better reach women who are overdue for care and close long-standing gaps in preventive screening.
Agricultural extension services play a critical role in improving farm productivity and ensuring sustainable rural livelihoods, yet their effectiveness is often limited by persistent resource constraints. This study investigates how such constraints influence the effectiveness of extension services in Juaben Municipality, Ghana. A qualitative descriptive exploratory design was employed, involving 14 smallholder farmers, two focus group discussions, and one key informant interview with an extension officer. Thematic analysis revealed that although farmers regard extension advice as valuable, its impact is weakened by delays in delivery and ineffective communication. Extension officers are perceived as committed, but their work is hindered.
This study examines wealth-based inequalities in undernutrition among socioeconomically marginalized Scheduled Caste/Scheduled Tribe (SC/ST) children across India and tracks regional changes from 2005-06 to 2019-21. Using three rounds of National Family Health Survey data and the Erreyger concentration index, it assesses inequality in the Composite Index of Anthropometric Failure (CIAF) at national and subnational levels. CIAF prevalence declined by nearly seven percentage points, yet over 60% of children in the poorest quintiles remained affected in 2019-21. Undernutrition remained strongly pro-poor across all regions, though inequality narrowed modestly after 2015. The findings highlight the need for equity-focused nutrition interventions among SC/ST communities.
This study explores barriers students face at private, urban, liberal arts universities when accessing food and other basic necessities. Students at three private universities were recruited (n = 1,034). Students received the 2022 Food Access Survey (FAS) distributed via e-mail link. Fifteen open-ended questions were analyzed using qualitative analysis. Four themes emerged: (a) Accessibility and Acceptability: ample and nutritious food; (b) Availability: time constraints influence food needs; (c) Affordability: financial resources for food and other basic necessities; and (d) Accommodation/Additional support: students identify opportunities for universities to address food access. Students shared numerous barriers that negatively affect their academics, health, and wellbeing. This study will help inform university administrators and policymakers about the acute food insecurity experienced by students at private colleges.
Food banks address food insecurity in the UK, yet donated food can be nutritionally unsatisfactory and of limited supply. This qualitative study explored barriers and motivations to donate through semi-structured interviews with 22 UK adults from diverse socioeconomic backgrounds, recruited through the University of Reading and social media. Thematic analysis revealed perceptions of food banks. Motivations included empathy, guilt and cues to action (e.g. observing a donation point). Barriers were structural (limited access); behavioral (forgetting); and emotional/cognitive (doubts about impact). Participants recommended increasing visibility, particularly pre-checkout supermarket prompts. Future research should test these strategies to improve donation quality and quantity.
This study examines the research published on school meal programs in T & uuml;rkiye through the lenses of Bronfenbrenner's socio-ecological model and Fraser's social justice framework. Following PRISMA 2020 guidelines, 21 studies published after 2000 were analyzed using the Mixed Methods Appraisal Tool. Findings reveal a fragmented research landscape dominated by individual-level nutrition education interventions, with limited attention to institutional, community, and policy dimensions. Persistent disparities between public and private schools, urban and rural areas, and socio-economic groups highlight significant distributive and recognitive justice gaps. While some interventions improve short-term nutritional knowledge, evidence on long-term outcomes and inter-ministerial coordination remains scarce.
