PurposeKorean immigrant families are growing in the Southern United States (U.S), an area where culturally specific resources can be limited. Korean immigrant families encounter distress in navigating the American culture, but cultural stigma impedes discussion within the family. An evidence-based mental health awareness program called Youth Mental Health First Aid (YMHFA) exists to serve as gatekeeper training for lay adults to identify and support youth experiencing mental health challenges. This study aimed to evaluate the feasibility of a culturally adapted Korean-YMHFA (K-YMHFA) program among Korean immigrants in the Southern U.S.Materials and methodUsing a mixed methods approach, a quantitative survey was distributed before and after program completion (N = 24), and a follow-up interview following program completion was also completed (N = 12). Quantitative analysis conducted a paired sample t-test, qualitative analysis conducted directed content analysis, and mixed methods analysis developed joint displays.ResultsParticipant's mental health literacy, confidence and control in YMHFA skills, and positive attitude toward YMHFA skills significantly increased, and stigma decreased after the training. Participants also provided information on specific steps for increasing cultural relevancy and sustainability within the community. Overall, mixed methods analysis indicated that the program was feasible in the context of Korean immigrants in the Southern U.S.ConclusionDespite the growing Korean community, the Southern U.S. has limited Korean ethnic services. With the feasibility of K-YMHFA, advocacy in promoting K-YMHFA is needed to counteract the limited resources while serving as an early intervention for youth and families in distress.

Across the United States and worldwide, communities face significant health challenges, including rising rates of chronic conditions such as obesity, heart disease, and diabetes. Addressing these issues requires comprehensive public health strategies that prioritize the development of infrastructure to support healthier lifestyles. One promising strategy is to expand and enhance public green spaces like urban parks. While numerous studies have examined the relationship between green spaces and physical health, inconsistent findings reveal gaps in current understanding. This study explores the complex relationship between urban park size, neighborhood crime risk, and community physical health in Alabama. Data were collected for 989 urban parks across Alabama using the Trust for Public Land's ParkServe database and city Parks and Recreation Department websites. Park size was measured with geographic information systems data, and crime risk data, including violent and property crimes, were provided by the Environmental Systems Research Institute. Community physical health data were obtained from the PLACES database to assess the prevalence of poor physical health. Our analysis revealed a significant negative total effect (p < .001) and a significant negative direct effect (p < .01), indicating that larger urban park sizes were consistently associated with a reduced prevalence of poor physical health. Additionally, larger urban parks were significantly associated with reduced neighborhood crime risk, which, in turn, was significantly related to a lower prevalence of poor physical health in communities (p < .05). These findings offer important policy insights for future urban planning and public health efforts.

This study investigated the relationship between urban park size and community mental health, focusing on neighborhood crime risk as a mediator. Data were collected for 989 urban parks in Alabama, USA, from the Trust for Public Land's ParkServe database and relevant Alabama cities' Parks and Recreation Department websites. Park size was measured using Geographic Information Systems. The relative risks of various crime types, including violent and property crimes, were provided by the Environmental Systems Research Institute. Community mental health data from the PLACES database were used to evaluate the prevalence of poor mental health in different communities. Guided by the Stress Reduction Theory, we used mediation analysis to explore whether crime risk mediated the relationship between park size and mental health outcomes. Results indicated that the effect of larger park sizes on reducing poor mental health was fully mediated by the indirect pathway through reduced crime risk, though park sizes alone were not significantly directly associated with a lower prevalence of poor mental health. By allocating resources to create and maintain high-quality urban neighborhood parks, policymakers can foster safer environments that contribute to improved mental health across communities, and, ultimately, build essential infrastructure to support the public's mental well-being.

There is a paucity of research on pain and depression among older adults in rural communities. To address such a gap, this study examined the association between pain and depression among older rural-community-dwelling adults. Recruited from rural senior centers, 100 chronically ill older adults (age 55 or older) experiencing pain completed a cross-sectional survey. Data were collected on their level of depression (a five-item version of the Center for Epidemiologic Studies Depression scale), pain (the six-item Philadelphia Geriatric Center Pain scale), and sociodemographic factors. A multiple linear regression was conducted. With sociodemographic variables controlled, those reporting higher pain scores were significantly more likely to have higher depression scores (p < .05). Older participants had lower depression scores than younger participants (p < .05). In view of poorer health outcomes and limited health care access in rural areas, our findings warrant interventions to promote better access to pain management and mental health services for rural older adults.

BACKGROUND AND OBJECTIVES:Research on racial and gender disparities in end-of-life care quality has burgeoned over the past few decades, but few studies have incorporated the theory of intersectionality, which posits that membership in 2 or more vulnerable groups may result in increased hardships across the life span. As such, this study aimed to examine the intersectional effect of race and gender on the quality of care received at the end of life among older adults. RESEARCH DESIGN AND METHODS:Data were derived from the combined Round 3 to Round 10 of the National Health and Aging Trends Study. For multivariate analyses, 2 logistic regression models were run; Model 1 included the main effects of race and gender and Model 2 included an interaction term for race and gender. RESULTS:Results revealed that White men were the most likely to have excellent or good care at the end of life, followed by White women, Black men, and Black women, who were the least likely to have excellent or good care at the end of life. DISCUSSION AND IMPLICATIONS:These results point to a significant disadvantage for Black women, who had worse end-of-life care quality than their gender and racial peers. Practice interventions may include cultural humility training and a cultural match between patients and providers. From a policy standpoint, a universal health insurance plan would reduce the gap in end-of-life service access and quality for Black women, who are less likely to have supplemental health care coverage.

This study explored the link between park size and crime risk in Alabama, analyzing 564 parks across 73 cities with populations over 10,000. Park dimensions were measured using Google Earth Pro, and crime data, covering violent and property crimes, were sourced from Applied Geographic Solutions. Additional data on population density, mental health prevalence, social vulnerability, and alcohol expenditure (indicative of affluence) were obtained from the U.S. Census Bureau, CDC, and ESRI. A multiple regression analysis revealed a significant negative association between park size and crime risk, meaning that larger park sizes tended to have lower crime rates. Key covariates-mental health, social vulnerability, and alcohol spending- were also significantly related to crime rates. Our findings have policy implications for local governments and community organizations seeking to reduce crime rates.

Pain is one of the most common concerns among chronically ill older adults. However, access to pain management is not equitable among certain populations, including rural residents. This qualitative study explored rural older adults' experiences with pain and its treatment. Eighteen participants were recruited from rural counties of Alabama, who were age 60+, cognitively intact, community-dwelling, had one or more chronic/serious illnesses, and experienced pain. Open-ended questions were asked in individual interviews, and inductive, thematic analysis was used for data analysis. Findings revealed the impact of pain (physical limitations, psychological distress, and coping strategies), the impact of COVID-19 (physical/mental health and pain management), challenges in pain management in rural areas (lack of provider and healthcare resources, transportation-related issues, mistrust, and limited insurance coverage) and suggestions to address these challenges. Program and policy-level interventions are crucial in improving the resources and education/training needed for effective pain management for rural older adults.

To date, no studies have examined well-established associations between substance abuse, intimate partner violence, and an increased susceptibility to HIV (also known as the SAVA syndemic), among transitioning age youth in the U.S. juvenile legal system. This secondary data analysis addresses this gap using baseline and 7th wave data from the Pathways to Desistance study (N = 709). We examined the relationship between SAVA syndemic variables, mental health, and HIV testing, differentiated by gender, while controlling for neighborhood conditions, motivation to succeed, and sociodemographic variables among cisgender, youth involved in the juvenile legal system using cross-sectional logistic regression and path models. 50% endorsed intimate partner violence. In path analyses, among males and females, neighborhoods (beta = 0.18, p<.01) and illegal drug use (beta= -0.91, p<.05) had significant direct effects on testing. Findings underscore the need for gender-specific HIV prevention policies targeting transitioning youth in the juvenile legal system.

Abstract Over the past few decades, research on quality of life at the end of life has proliferated, with an increased focus on issues of diversity. However, few studies have considered the impact of multiple disadvantaged identities, including the combination of race and gender. This study assessed the intersectional impact of race and gender on four end-of-life outcomes: pain, anxiety/depression, patient autonomy, and overall care quality. Data were derived from the combined 2012 to 2020 last-month-of-life interviews conducted by the National Health and Aging Trends, which is an annual longitudinal panel survey of Medicare beneficiaries aged 65 and older. Multivariate logistic regression models were used to test the association between the race/gender intersection and each of the four outcomes. Results showed that Black women were the most likely to be in pain, most likely to have a lack of autonomy in decision-making, and the least likely to have excellent or good care at the end of life. White women were the most likely to have had anxiety/depression, followed by Black women, Black men, and then White men. Across all four outcomes, White men were the most likely to have had favorable outcomes, confirming the theory of intersectionality. These results point to a significant disparity in quality end-of-life care for Black women, who have double-jeopardy as a result of their membership in two vulnerable groups. Thus, there is increased need for practice, policy, and research interventions to attain equitable end-of-life care for all individuals.

Introduction: Although transportation use and related barriers in rural areas are substantially related to individual mental health outcomes, the relationship among depressive symptoms, perceived transportation barriers, and household transportation use remains underexplored. This study aimed to investigate possible factors associated with household transportation use and examined whether perceived transportation barriers moderate the relationship between depressive symptoms and household transportation use among residents in the southeastern U.S. rural areas after controlling for covariates.Methods: In this cross-sectional study, a convenience sample of 191 Black/African American adults (18-84 years old) were recruited from four communities in the Alabama Black Belt areas. A multiple linear regression was performed using the PROCESS macro in SPSS. Results: Our regression model found that depressive symptoms and perceived transportation barriers interacted with one another to be related to the use of household transportation (p < .05). Amongst people who faced transportation barriers, the higher the depressive symptoms, the more likely they were to use household transportation. Health insurance and income were also significantly associated with household transportation use (p < .05).Conclusions: Our finding posited that people with depressive symptoms who experience transportation barriers need more personal mobility over other modes. Such needs should be considered when developing better policies/interventions for transportation assistance, particularly for those living in rural areas.

Abstract Proper pain management is essential to quality of life. Due to the risks of harmful drug interactions, there has been an increasing effort to reduce medication that may be harmful or ineffective (i.e., deprescribing) and to promote non-medication based (i.e., non-pharmacological) strategies in pain management. The purpose of this qualitative study is to understand the views of deprescribing and non-pharmacological methods in pain management among community-dwelling older adults with multiple chronic health conditions. Eligibility criteria included: 65+, Alabama resident living outside of nursing homes, cognitively intact, have two or more chronic health conditions and chronic pain, and take medications for their health conditions including pain medications. Participants were recruited through the Area Agency on Aging across the state of Alabama as well as other community venues serving older adults. Individual, open-ended interviews were conducted by phone to explore their concerns about medications, their views of deprescribing and using non-pharmacological pain management as well as their needs in doing so. Thematic analysis of the interview data revealed various barriers and needs: concerns about various side effects while also worrying about missing out benefits from the medications if reduced or stopped, uncertainty or skepticism toward non-pharmacological pain treatment, lacking financial and logistical access to non-pharmacological options, and lack of knowledge about available non-pharmacological options and their benefits. These findings have implications for future education and advocacy efforts to promote older adults’ knowledge and self-efficacy so that they can consider deprescribing and non-pharmacological methods in managing their pain.

Prior research reported lower engagement in end-of-life discussions and planning among Korean American (KA) immigrants; however, there is a dearth of research investigating factors associated with their willingness to discuss their end-of-life care wishes. This study aimed to examine the willingness to have end-of-life discussions with family and doctors among KA immigrants and social determinants of health (SDH) associated with willingness. A self-administered, cross-sectional survey was conducted with a convenience sample of 259 KA immigrants recruited from two counties in Alabama. Demographic, health, acculturation and SDH information were collected. Logistic regression analyses were conducted to examine associations between SDH and willingness for end-of-life discussion with family and doctors, respectively. The majority of the sample was willing to discuss end-of-life care with family (94%) and doctors (82%). Those with hospice awareness were more likely to have willingness for discussion with family (OR = 27.70, p < 0.001) and doctors (OR = 5.01, p < 0.001). Those who could not see a doctor because of cost (OR = 0.03, p < 0.01) and who had higher threats to interpersonal safety (OR = 0.74, p < 0.05) were less likely to have willingness for discussion with family. Those who had more chronic conditions (OR = 0.60, p < 0.05) and higher levels of social isolation (OR = 0.77, p < 0.05) were less likely to have willingness for discussion with doctors. The SDH identified in this study should be considered in developing interventions to promote end-of-life discussions in the KA immigrant community. Future research should investigate the associations explored in this study in a larger and more representative sample.

Although prior research finds that poor neighborhood conditions are negatively associated with employment, little study has focused on emerging adults who formerly had contact with the juvenile justice system and are frequently engaged in informal job markets. Using a hybrid model and three waves from panel data with formerly juvenile justice-involved emerging adults (18–24 at T1, 20–25 at T2, 20–26 at T3) collected in Philadelphia and Phoenix ( N = 947), we find an inter-individual increase in the degree of disorder within the neighborhood decreases weeks worked for community jobs (between-effect), whereas an intra-individual increase in neighborhood condition scores increases weeks worked for under-the-table jobs among emerging adults (within-effect). Some time-variant and invariant sociodemographic factors, including perceived opportunity for work, mental health, substance use, gang membership, race, and education, are significantly related to employment. Our findings reiterate justice-involved young people may have difficulty sustaining formal employment partially due to neighborhood conditions.

Although there is ample research on the association between employment and adults' crime, few studies have focused on formerly incarcerated juveniles transitioning to emerging adults, especially studies using panel data. Using data from the Pathways to Desistance Study (N = 1,289) with a group of high-risk emerging adults (ages 18 to 24), this panel analysis addresses the effect of employment on antisocial behavior guided by Laub and Sampson's social bond theory. The results show average weeks worked for the sample is below 26 weeks per year at each time point, indicating low levels of labor market participation. A fixed effects model using a structural equation modeling approach confirms that those with more work are significantly likely to decrease antisocial behavior. Consistent with previous studies, individuals with more substance use and gang involvement are positively associated with antisocial behavior. The article concludes with a discussion of the role of employment and emerging adults.

The present study utilised the social determinants of health (SDH) framework to see whether indicators of the framework have an impact on anxiety and depression of people living in rural Black Belt communities in Alabama. Data from a convenient sample of 159 African-Americans aged 18 or older were from two sites in rural Alabama. The levels of anxiety and depression were measured by the Patient Health Questionnaire-9 (PHQ9). Multiple linear regression model was used to examine the association between SDH and anxiety and depression level of participants. The mean PHQ9 score of participants was 5.57 out of twenty-seven. Four SDH were significantly related to PHQ9 levels amongst participants: participants with higher food insecurity scores, higher transportation needs and higher threats to interpersonal safety tended to have higher scores in PHQ9. Moreover, health literacy levels were negatively associated with PHQ9 scores amongst participants. Our study highlights understanding SDH specifically for residents in rural communities that are socially and culturally isolated is important for developing preventive approaches that enhance access to mental health treatments. A comprehensive public health policy that incorporates our study findings is needed for the rural areas of the USA.

Abstract This study aimed to examine social determinants of health (SDH) associated with Korean American (KA) immigrants’ willingness for end-of-life discussions with family and doctors. A self-administered, cross-sectional survey was conducted with 259 KAs in Alabama. Demographic, health, acculturation, and SDH information were collected. Binary logistic regression analyses were conducted to examine associations between SDH and willingness for end-of-life discussion. Most participants were willing to discuss with family (94%) and doctors (82%). Those aware of hospice care were more likely to have willingness for discussion with family and doctors. Those who could not see a doctor because of cost and who had higher threats to interpersonal safety were less likely to have willingness for discussion with family. Those with more chronic conditions and higher social isolation were less likely to have willingness for discussion with doctors. Interventions aimed to promote KAs' end-of-life discussions should consider the SDH identified in this study.

Willingness for end-of-life discussion and related factors among rural Blacks/African Americans of the Alabama Black Belt have not been well-studied. This study aims to assess their willingness for the discussion and examine its relationship with social determinants of health (SDH) and demographic factors. A cross-sectional survey was conducted with a convenience sampling of 182 participants. Most participants were willing to discuss end-of-life wishes with family (77.1%) or doctors (72.1%). Controlling for demographics, results from binary logistic regressions showed those with hospice awareness were more likely to have willingness for discussion with family ( OR = 10.07, p < .01) and doctors ( OR = 7.23, p < .05). Those who were older (50+) were less likely to have willingness for discussion with doctors ( OR = 0.19, p < .05), whereas those who were more socially isolated were less likely to have willingness for discussion with family ( OR = 0.53, p < .05). Therefore, end-of-life discussion efforts should focus on older, socially isolated individuals and consider hospice awareness.

Dual system youth, referring to those involved in the child welfare (CW) and juvenile justice (JJ) systems, require attention as they are particularly vulnerable to mental health (MH) problems. Although many of them receive MH services during their time in the CW and JJ systems, little is known about what happens to them afterward, in terms of system re-entry. Using administrative data on two cohorts of dual system youth in 2003 and 2012, we explored the proportion of dual system youth who re-enter the CW and/or JJ systems after receiving MH services, and the association between individual and case characteristics and the likelihood of system re-entry. We found that 85% of the dual system youth who received MH services became re-involved with the CW and/or JJ systems. Results from multinomial logistic regression showed that youth in the second cohort and females were less likely to become re-involved with the systems. However, youth who were older, experienced out-of-home placement and were diagnosed with disruptive behavior and anxiety disorders experienced greater odds of subsequent system re-entry.