Objectives. To evaluate change in past-year sexual harassment from 2018 to 2024. Methods. #MeToo surveys assessed past-year sexual harassment with US adults (n = 5293) recruited via phone and online in 2018 and 2024. Logistic regression analysis estimated the odds of reporting past-year sexual harassment in 2024 relative to 2018, adjusting for sociodemographics. Results. Reported past-year sexual harassment doubled, from 10.7% in 2018 to 24.3% in 2024 (men: 6.7% to 15.2%; women: 14.3% to 31.8%; P < .001). The odds of reporting past-year sexual harassment were nearly 3 times higher in 2024 than in 2018 (adjusted odds ratio = 2.80; 95% confidence interval = 2.35, 3.33). Conclusions. Reported past-year sexual harassment in the United States increased from 2018 to 2024, indicating either an increase in sexual harassment or an increase in disclosure rates after the #MeToo movement. Although prior evidence indicates that awareness and policy protections for workplace harassment have improved since the #MeToo movement, this has not led to declines in sexual harassment. Future policies should expand protection from sexual harassment to include public and online spaces and support stronger accountability structures. (Am J Public Health. Published online ahead of print July 23, 2026:e1-e5. https://doi.org/10.2105/AJPH.2026.308577).

Background While India is making notable strides in women's financial inclusion, closing remaining gaps is hampered by a lack of granular data at the sub-state level. This study uses model-based small-area estimation techniques, linking data of National Family Health Survey 2015-16 and 2019-21, respectively, with the 2011 Indian Census data to generate district-level estimates of three components of women's financial inclusion: women's bank/savings account ownership, their knowledge and use of microcredit programmes in 640 districts of India in 2015-16 and 2019-21.Results Model-based estimates reveal considerable intra- and inter-state variations in all indicators. In NFHS-5, estimates of bank/savings account ownership varied from 56.1% in Kiphire district of Nagaland to 95.4% in Perambalur district of Tamil Nadu. Knowledge of microcredit programmes varied from 11.8% in Lawngtlai district of Mizoram to a maximum of 84.9% in Thiruvarur district of Tamil Nadu. The use of microcredit programmes was more limited (7.7%). Substantial within state clustering was present in all the three components. Districts with lower prevalences in NFHS-4 registered higher increase between NFHS-4 and NFHS-5 in women's bank/savings account ownership and their knowledge of microcredit programmes.Conclusions Present study reveals considerable intra-state variations in both rates of financial inclusion and changes in financial inclusion levels over time. Our approach provides a new tool for policy makers to identify and close remaining gaps in women's financial inclusion.

Deaths of despair (DoD; i.e., suicide, drug overdoses, and alcohol-related deaths) have drastically increased among non-Hispanic Whites since 1999. Beyond the established honor-suicide association, there are several reasons to suspect that U.S. honor cultures also exhibit higher DoD rates given similarities in the socioecological factors underlying both outcomes and that substance use increases risk for suicide. We examined this possibility at both the state and individual levels. Using two indices of honor culture, Study 1 examined statewide differences in DoD rates among non-Hispanic Whites and non-Whites between 1999-2019 by age group and sex. Among non-Hispanic Whites, we found honor- (v. dignity-) oriented states exhibited significantly higher overall DoD rates, suicide rates, drug overdose rates (only among females), and alcohol-related death rates, and that rates typically peaked in middle-age. The collective pattern of evidence indicated that honor culture is not related to DoD among non-Whites. Using a large sample of non-Hispanic Whites (paralleling the target population from Study 1), Study 2 (N = 1686) examined associations between individual-level endorsement of gendered honor norms and thoughts and behaviors that might precipitate despair-related deaths. Results indicated that honor endorsement significantly predicted suicidal ideation, but not binge drinking or illicit drug use. However, the effect of honor endorsement on these latter two outcomes was significant among men but not women. Collectively, this work extends prior research on the honor-suicide association by showing that the cultural ideology of honor affects a wider range of death outcomes. We discuss theoretical, health, and policy implications.

BackgroundStress and financial concerns due to the COVID-19 pandemic are well documented, with mixed evidence regarding their relationship with substance use. This mixed-methods study describes the prevalence of pandemic-related stress and financial worry, and their association with changes in substance use among people with HIV with a history of injection drug use in Russia.MethodsWe conducted a secondary analysis of survey and qualitative data collected from two trials between May 2020 and July 2021. We used multivariable logistic regression to assess associations between pandemic-related stress and financial worry, and reported changes in illicit opioids (primary), cigarettes (secondary), and alcohol (exploratory) use. The outcome was defined as any change (increase, decrease, or stopping) in substance use. A thematic analysis of semi-structured interviews explored experiences of stress and substance use during the pandemic.Results and conclusionsAmong 132 survey participants, 52% reported high pandemic financial worry and 31% reported high pandemic stress. Overall, 22% reported changes in opioid use (20% decrease, 2% increase), 21% in cigarette smoking (18% decrease, 3% increase), and 15% in alcohol use (9% decrease, 6% increase). High stress was associated with reporting any change in opioid use due to the pandemic (AOR 2.98; 95%CI: 1.20, 7.40; p = 0.02). Financial worry showed a similar but imprecise association (AOR 2.45; 95%CI: 0.96, 6.21; p = 0.06). No associations were observed for cigarette or alcohol use. Qualitative findings indicated that pandemic-related stressors and disruptions in drug access may have been linked to substance use patterns for some participants, although changes in use were not a dominant theme. Most participants did not report changes in substance use; among those who did, changes were primarily decreases. Pandemic-related stress was associated with opioid use change, though direction varied. These findings suggest that stress-related responses are context-specific and may not uniformly lead to increased substance use among PWH.

Social norms define what is acceptable and appropriate for women and men, boys and girls, in a given group or society. Restrictive social norms around women and men's roles and responsibilities have proven harmful for both women and men, particularly in adolescence and young adulthood, and are associated with increased risk of violence. In global settings, measurement of social norms tends to rely on proxy measures capturing attitudes, beliefs, and perspectives. Measurement of social norms on women's and men's roles and responsibilities is particularly limited among adolescents and young adults, a formative age period where sanctions for non-adherence to norms can be heavy. We used data from the nationally representative 2022 Eswatini Violence Against Children and Youth Survey (VACS) to test the psychometric properties of a novel set of social norms survey items among male and female youth aged 13-24 (n = 7,709). Items were largely derived from prior scales and adapted by social norms experts to ensure that they were salient to the lives of adolescents in low-income settings. The items captured norms about women and men's, boys' and girls' education, domestic labor, household decision-making, work, marriage and violence, with the community as the reference group. We conducted exploratory (EFA) and confirmatory factor analysis (CFA) on 16 norms survey items using split-random half samples. We identified a single-factor, four-item scale as the best-fitting solution (EFA: RMSEA = 0.060, CFI = 0.974, TLI = 0.923, SRMR = 0.076; CFA: RMSEA = 0.063, CFI = 0.972; TLI = 0.915; SRMR = 0.048). The scale captured norms in communities on domestic labor for youth and household-decision making by adults. We assessed measurement invariance by age and sex of this final one-factor, four-item solution. We observed latent mean differences by sex in baseline (β = 0.309, p < 0.001) and final DIF-adjusted (β = 0.299, p < 0.001) models. In addition, females and males varied in their propensity to endorse two of the scale items (Item 5: β = 0.225 p < 0.001; Item 6: β = -0.212, p < 0.001). We assessed correlation between the final DIF-adjusted community norms measure and two attitude scales: attitudes toward IPV (r = 0.363, p < 0.001) and attitudes toward women and men's relations (r = 0.087, p = 0.018). The measure demonstrated adequate reliability and convergent validity. The analysis resulted in a promising single factor, four-item social norms scale, which meets requirements of a brief, theory-based measure and is feasible to incorporate into national and cross-national surveys. Future work is needed to validate the scale in other settings.

This study seeks to provide current evidence on the role of political ideology on shaping retrospective reporting of sexual violence (SV) in the United States. We used cross-sectional, nationally representative data from the online 2024 #MeToo Survey among U.S. adults (N = 3,350). We found that liberal women were more likely and conservative women and gender diverse adults were less likely to report lifetime SV, relative to moderates. Effects for past 12 months SV were not observed. This nationally representative evidence suggests that lifetime SV experiences and reporting may differ based on political ideology among U.S. women and gender diverse adults.

BACKGROUND:Youth participatory action research (YPAR) centers the living experiences of youth, integrating them into health research processes to produce actionable findings. Our study has built a YPAR project that engages queer, trans, and non-monogamous young women and non-binary youth aged 19 to 29 years in British Columbia, Canada to explore perceptions of measures of gender equity in relationships. OBJECTIVES:We share an assessment of how our YPAR approach impacted youth study members. METHODS:Youth were engaged through May 2022 and March 2023. Three youth research associates (core members of the research team) completed a qualitative reflection on their participation. Ten youth advisory committee (YAC) members (advisors on study processes/analysis during bi-monthly meetings) completed a mixed-methods questionnaire following five committee meetings assessing whether they felt heard, valued, and prepared to participate. RESULTS:Youth research associates reported feeling valued and supported through training, data collection, and analysis. They identified the importance of ongoing training as their roles evolved. YAC members felt well prepared for their role and described meetings as a safe and productive place for dialogue. Meetings were considered too short and infrequent, highlighting the limits budget and pace of data collection placed on engagement. YAC members' reasons for participating included gaining research experience, honoraria, curiosity about the research topic, and community building. CONCLUSIONS:This assessment offers insight into successful implementation of a YPAR approach with queer, trans, and/or non-monogamous young women and non-binary youth, providing a roadmap for health researchers to build projects wherein a diversity of youth feel valued and supported.

Abstract Background Firearm violence is a leading cause of injury and death in the United States. Understanding how exposure to firearm violence shapes attitudes and behaviors related to firearms is critical for informing prevention and intervention strategies. This study examined associations between recent and lifetime firearm violence exposure and attitudes toward firearms for safety, as well as recent firearm acquisition. We hypothesized that recent and direct firearm violence exposure would be associated with increased firearm acquisition, whereas direct exposure recently and across the lifetime would be associated with more positive attitudes toward firearm ownership for protection. Methods A cross-sectional study was conducted using data from the 2023 Violence Experiences (VEX) surveys, state-representative, population-based online surveys of adults 18 and older in California (CA) and Louisiana (LA). Data was combined from both states (n = 4492). Exposure variables included recent (past 12 months) and lifetime direct firearm violence exposure. Outcomes included attitudes toward having a firearm in the home for safety and past-year firearm acquisition. Poisson regressions with robust standard errors were utilized to examine the associations between violence exposure and attitudes toward firearms, and multinomial regressions to examine the association between violence exposure and firearm acquisition. Results Respondents from LA reported higher lifetime exposure to violence, more positive attitudes toward having a firearm for safety, and greater recent firearm acquisition. Lifetime firearm violence exposure was associated with increased odds of positive attitudes regarding firearms for safety (APR 1.46, 95% CI 1.22–1.74), while recent exposure was associated with increased odds of firearm acquisition in the past year (ARR 4.15, 95% CI 2.36–7.28). Individuals with lifetime exposure had 1.50 the odds of reporting recent firearm acquisition compared to those with no lifetime exposure (95% CI 1.11, 2.03). Similar trends were found for state-specific analyses related to attitudes and acquisition. Conclusions Findings suggest that prior direct exposure to firearm violence may be associated with both attitudes toward firearms and decisions to acquire them. Future research should explore how state-level policies may mitigate these effects and identify strategies to support individuals who acquire firearms for protection following exposure to violence.

There is limited data on forced marriages in the context of India. This study involved validation of new measures of women’s marital choice in terms of partner selection and timing of marriage as indicators of women’s marital agency in rural India. We conducted a cross-sectional analysis of survey data from N = 1192 married women aged 18–30 who participated in the Counseling Husbands and wives to Achieve Reproductive health and Marital equity (CHARM2) trial in rural Maharashtra, India. We included two novel items on women’s decision-making regarding who the married and when they married. We evaluated the construct validity of these measures by testing their associations with other traditionally gender normative practices related to marriage including girl child marriage, purdah, and dowry using Fisher’s exact test. We then conducted crude and adjusted regression models to determine associations between our marital choice variables and indicators of current marital agency, specifically recent intimate partner violence, marital quality, and contraceptive self-efficacy. 15.5

To assess associations between recent intimate partner violence (IPV) (victimization and perpetration) on firearm ownership and recent firearm purchase. Analysis of statewide online surveys on violence conducted in 2023 in California and Louisiana, respectively. We examine whether past year IPV was associated with firearm ownership using regression models adjusting for sociodemographic covariates and mental health. Survey participants were adults from California (N = 3,560), with data collected between March and May 2023 and Louisiana (N = 1,081), collected between May and June 2023. In fully adjusted models, IPV victimization was associated with three times higher odds of current firearm ownership (AOR 2.93, 95

As the global community looks beyond the 2030 Sustainable Development Goals agenda, there is a critical opportunity to refine and elevate indicators focused on sexual and reproductive health and rights (SRHR) and to shift nations away from fertility and contraceptive targets. This commentary presents four key frameworks-drawn from a panel at an International Union for the Scientific Study of Population (IUSSP) meeting focused on SRHR measurements-that offer distinct yet complementary lenses for understanding and measuring reproductive choice and agency. These include the EMERGE Empowerment Framework (focused on measurement and evaluation), Patient-Centered Care (focused on clinical practice), the Human Rights Framework (focused on policy), and Reproductive Justice (focused on social change). While not an exhaustive list, these frameworks reflect a diversity of disciplinary perspectives and emphasize the importance of grounding reproductive health indicators in concepts of choice and agency. The empowerment framework centers on individual decision-making and collective action, while person-centered and rights-based approaches evaluate how health systems and policies support or constrain that agency. Reproductive justice expands the lens further, highlighting how structural inequalities shape differential access and outcomes across race, class, and other social determinants of health. Together, these frameworks underscore the need for multilevel, intersectional indicators or reproductive agency-spanning individuals, health systems, communities, and policies-to effectively guide and evaluate the impact of reproductive health programs and policies at scale.

Background:Effective family planning interventions may have inadvertent effects on births of girls given son preference in India. We conducted 36 and 48-month follow-ups to our CHARM2 family planning study to determine long-term intervention effects on births and sex of children. Methods:Our non-blinded two-armed cluster RCT randomized young married couples (N = 1201 couples) from 20 geographic clusters (60-61 couples per cluster) into either the CHARM2 intervention or control (referral to local care) condition. CHARM2 offers 5-session gender-synchronized family planning and gender equity counseling delivered by trained local medical providers. Data were collected at baseline in September 2018-June 2019 and then follow-ups at 9, 18, 36 and 48 months, up to September 2023. We retained 88 %-91 % of women across follow-ups with no difference in retention by treatment group. We used adjusted mixed-effects logistic regression models examining sex composition of births at each follow-up and over the total 48-month follow-up to assess differences in all births of boys and girls by treatment group. We adjusted for treatment condition, cluster, and relevant demographics in adjusted models. Results:We saw no treatment effects on total births or boy births, but lower likelihood of a girl birth was seen at 9-month follow-up and for the total 48-month follow-up period. We found at 9-month follow-up a girl birth was less likely for intervention compared with control participants (7.1 % vs. 10.3 %, respectively, p = 0.06), and the male to female sex ratio of births born between baseline and 9-month follow-up was also significantly higher for intervention vs. comparison participants (1.50 [95 % CI 1.00-2.26] vs. 0.83 [95 % CI 0.56-1.21], p = 0.04). We conducted a sensitivity analysis to determine treatment effects on boy births and girl births over the 48-month follow-up and again found no effects on boy births, but a significantly lower likelihood of a girl birth for the intervention group (22 % vs 29 %, p = 0.03). Conclusion:The CHARM2 family planning intervention, previously demonstrating significant effects on contraceptive use and women's reproductive agency in rural India, resulted in lower likelihood of girl births over time, suggesting that family planning programs can contribute to sex ratio imbalances if broader social changes eliminating son preference and improving value of a girl child do not occur. Funding:National Institutes of Health, Grant R01HD084453 Bill and Melinda Gates Foundation. INV002967. The funders had no role in the design and conduct of the study, collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. [ClinicalTrials.gov Identifier: NCT03514914.].

OBJECTIVE:To assess sex differences in the belief that abortion access is important for women's health. STUDY DESIGN:A 2024 survey asked N = 3348 U.S. adults their agreement with this belief. Adjusted multinomial regression analyses were conducted. RESULTS:Most (58.3%), and a higher proportion of females than males, agreed with the statement. Subgroup analysis of sex by political leanings showed that observed sex differences in this belief holds for moderates with a trend seen for liberals and conservatives. CONCLUSION:While most people agree with the statement, females across political leanings are more likely to endorse this belief compared to males. IMPLICATIONS:The paper contributes to the discourse on abortion access as a health issue in the United States. We find that over half of U.S. participants agreed that abortion access is important for women's health, and females from across political parties were more likely than males to endorse this statement.

Research investigating association between patriarchy and demographic behavior is limited in India. The only study on this subject utilized 1981 Indian Census data to examine associations between patriarchy and fertility. We examined the association of patriarchy, measured using India Patriarchy Index (IPI), with total fertility rate (TFR) and excess female child mortality in India. Additionally, we examined independent associations of the 5 dimensions included in the IPI with the two outcomes. We used univariate and bivariate Local Indicators of Spatial Autocorrelation, multivariable ordinary least squares and spatial error- regressions to examine the associations. Spatial heterogeneity beyond the north-south divide was evident in the spatial association of IPI with TFR and excess female child mortality. Results show positive association of IPI with TFR and excess female child mortality. While son preference and socio-economic domination were positively associated with TFR, domination of men over women and son preference were positively associated with excess female child mortality. This study is the first of its kind to examine the association of a novel measure of patriarchy with TFR and excess female child mortality. As patriarchy is deep-rooted in Indian society, a great deal of effort is needed to shift these traditionally held social norms and practices.

BACKGROUND:Extreme temperatures are increasing in frequency and severity, posing growing risks to maternal and child health through adverse pregnancy and birth outcomes. This challenge is especially pronounced in countries like India, that lack adequate protections against climate-related health risks. While socio-economic and accessibility barriers already limit healthcare utilization during pregnancy, climatic factors such as extreme temperatures can create additional obstacles to accessing these essential services, thereby influencing pregnancy and birth outcomes both directly and indirectly. METHODS:We conducted a cross-sectional analysis using data from the National Family Health Survey (NFHS-5), a nationally representative survey for India. We examined recent healthcare utilization reported by women in their fifth month of pregnancy or later (N = 10,606). Temperature exposure was measured using daily Wet Bulb Globe Temperature (WBGT), Heat Index, and Dry Bulb Temperature (DBT) matched to respondents' geo-coded residential clusters. We calculated the number of days during the study period when temperature values exceeded or fell below extreme temperature thresholds. Generalized mixed-effects models with Inverse Propensity of Treatment Weighting (IPTW) examined associations between extreme temperature and no healthcare contact, with effect modification tested across socioeconomic variables. FINDINGS:Extreme heat exposure significantly increased the likelihood of healthcare non-utilization among pregnant women, with the strongest associations observed for WBGT and Heat Index measures. An additional 10-days of exposure above the 90th percentile WBGT threshold increased the risk of no healthcare contact by 11 %, with similar patterns across the 85th and 95th percentiles. Heat Index showed consistent positive associations across all thresholds (8-11 % increases), while DBT trends were positive but not statistically significant. For extreme cold exposure, temperature indicators showed some association with healthcare non-utilization, though results were not consistent across exposure definitions. We did not find evidence of effect measure modification across socioeconomic groups, with only a few isolated exposure definitions showing significant difference between subgroups.

Importance:Although research has documented links between climate factors and violence, evidence specific to domestic violence (DV) remains limited, particularly in climate-vulnerable urban areas. Objective:To analyze the association between extreme heat events and DV-related calls to law enforcement in New Orleans, Louisiana, between 2011 and 2021. Design, Setting, and Participants:This cross-sectional study used a spatially weighted time-stratified case-crossover design analyzing DV-related call data between January 1, 2011, and December 31, 2021, from the New Orleans Police Department. Statistical analysis was conducted from March to May 2024. Exposures:Daily mean Universal Thermal Climate Index (UTCI) data were used to define 6 extreme heat definitions based on thresholds (30 °C and 90th percentile) and durations (1, 3, or 5 consecutive days). Additional thresholds were considered in sensitivity analyses. Main Outcomes and Measures:The primary outcome was DV-related calls made. Calls were aggregated to zip code days, and conditional logistic regression weighted by cases per zip code day was used to evaluate the association between extreme heat and DV calls. Attributable fractions and attributable numbers of DV calls due to extreme heat exposure were calculated. Results:Of the 150 523 DV-related calls during the study period, 69.6% were classified as domestic disturbances, and 22.4% were classified as simple battery. Consistent positive associations were found between extreme heat and DV-related calls; for example, the likelihood of a DV-related call increased by 4% (odds ratio, 1.04; 95% CI, 1.02-1.07) when the mean UTCI was above 30 °C. Stronger associations were seen during prolonged exposure to extreme heat; when the mean UTCI exceeded the 90th percentile for 5 consecutive days, the likelihood of a DV-related call increased by 7% (odds ratio, 1.07; 95% CI, 1.03-1.12). Eliminating such heat wave events would most likely prevent approximately 245.0 DV-related calls (95% CI, 105.1-370.9) during the study period. Conclusions and Relevance:In this cross-sectional study of the association between extreme heat and DV-related calls in New Orleans, DV-related calls were associated with extreme heat events, with the strongest associations observed during prolonged heat waves. These findings highlight the need to integrate climate adaptation with violence prevention strategies during such extreme heat events.