Hypertension remains one of the leading causes of morbidity and mortality worldwide, affecting more than 1.28 billion people. Refugees have almost twice the risk of cardiovascular disease compared to native populations and other immigrants due to uncontrolled hypertension. Evidence on aspects of structural oppression that impact hypertension management and the experiences of minority populations in managing their hypertension post-resettlement remains lacking especially in the case of refugees whose number is increasing dramatically due to mass displacement. We explored the intersecting structural oppression impacting hypertension management among refugees using in-depth interviews with 54 Syrian and Iraqi refugees who were resettled in California. Structural oppression risk factors that were identified to impact hypertension management were (a) structural barriers (language barriers, lack of health insurance in transit countries), (b) social stigmatization (social isolation, family separation, discrimination), (c) economic inequities (living in poverty, low-pay and high-risk jobs), and (d) discriminatory policies (refugee ban). Our findings highlight that structural oppression affects hypertension management among refugees post-resettlement, highlighting the need for tailored interventions and policy changes that take these factors into account to promote hypertension management in this population to prevent health disparities.

Smoking negatively impacts lung function and cardiovascular capacity, making physical activity (PA) more challenging and contributing to mental health issues. This study investigates the role of PA in mitigating the links between smoking, sleep disorders, and depressive symptoms in adults in the United States. Data from the 2017 to 2020 National Health and Nutrition Examination Survey (NHANES) were examined. Participants were categorized by PA adherence (≥ 900 metabolic equivalent tasks [METs]/week or not) and smoking status based on serum cotinine levels (< 0.05 for non-smokers, 0.05–15 for secondhand smokers, and > 15 ng/mL for active smokers). Relationships between sleep disorders, depressive symptoms, and PA/smoking were evaluated using survey logistic regression, with non-smokers meeting PA guidelines as the reference group. Stratified analyses were conducted by age group (21 - 39, 40 - 59, 60+ years). Active smokers not meeting PA guidelines had a significantly higher likelihood of moderate to severe depressive symptoms (odds ratio [OR] 2.21, 95% confidence interval [CI] = [1.34, 3.65]). Young active smokers meeting PA guidelines had greater odds of sleep disorders (OR = 2.86, 95% CI = [1.38, 5.93]). Among middle-aged adults, those not meeting PA guidelines exhibited elevated odds of sleep disorders (OR = 2.18, 95% CI = [1.33, 3.59]) and severe depressive symptoms (OR = 3.01, 95% CI = [1.11, 8.18]). For older adults, increased odds of depressive symptoms were observed (OR = 3.37, 95% CI = [1.22, 9.29]). These findings underscore the potential of PA to mitigate mental health risks among individuals exposed to smoking. Longitudinal research is required to confirm these associations and inform targeted interventions.

This article expands and investigates what physicians perceive as facilitators and barriers to initiating preventive health education, also called anticipatory guidance or medical education, around secure firearm storage in the home (safe storage) and outside the home (Emergency Risk Protection Orders [ERPO]). We employ in-depth qualitative interviews with 36 New Jersey physicians randomly selected from two national physician panels. Participants were screened for inclusions based on their specialty (family medicine or internist, obstetrics/gynecology, or pediatrics), practice setting (office-based rather than hospital-based), and time spent (80% or more) on direct patient care. Based on interviews, we identify five physician-perceived barriers to providing secure firearm storage counseling: inadequate screening mechanisms to prompt conversations, physician perceptions of who is at risk for firearm injury, time pressures, concerns about patient receptivity, and a need for physician training. Our findings indicate that there are structural barriers to physician-initiated firearm safety guidance. Interventions designed to increase physicians’ willingness to have these conversations must first address why these conversations fail to occur. Physician participants expressed the need for revised patient screening tools, training on approaching conversations about secure firearm storage, and a mechanism to allocate sufficient time in a well-visit, among the many other topics they must discuss. Interview participants had minimal understanding of ERPO and how to counsel patients on petitioning for ERPO.

Approximately 11.3% of the U.S. population has diabetes, mostly type 2 diabetes (T2DM), and maintenance of A1c levels is vital to prevent complications among patients. Perceived discrimination in medical care settings (PDMS) affects patient care, while social support may mitigate its impact. This study aims to explore the influence of PDMS on A1c levels in T2DM patients using the All of Us Research Program, which collects health data from diverse individuals across the United States. Our study included 135 T2DM-diagnosed participants. Measures included demographic info, A1c data, self-rated health, social support, and perceived discrimination. Descriptive and multivariable regression analyses were conducted. Participants were predominantly older, female, non-Hispanic White, and had relatively high levels of education and above-average income levels. Most rated their health positively. Social support, including marital status, was considered. The average A1c level was 6.72 ± 1.54. Notably, 42% experienced high PDMS, correlating with poorer self-rated health. Multivariable regression revealed significant associations between A1c and follow-up time, age, marital status, and PDMS. Specifically, PDMS significantly correlates with poorer A1c, indicating a potential impact on diabetes management. Findings emphasize the need for tailored interventions and anti-discrimination guidelines in clinical practice. Insights from this study inform interventions mitigating discrimination and enhancing diabetes care. Health care providers fostering inclusive environments can improve patient trust and adherence to treatment, leading to better outcomes. Cultivating inclusive environments through health care providers improves patient outcomes. Diverse population inclusion in future studies is crucial.

Stigma prevents societal acceptance, reinforces social inequities, and greatly complicates the management of diabetes for those dealing with homelessness. Various forms of media, such as film, can educate audiences and play a role in reducing stigma, but the effectiveness of such interventions in changing individuals’ knowledge, attitudes, and beliefs (KAB) requires further exploration. This study assessed the impact of a film on diabetes and homelessness through pre- and post-surveys of audience members (n = 202) at 12 screening events. The surveys measured changes in KAB through Likert scale questions, with scores ranging from 1 to 5. Statistical analyses, including Wilcoxon signed-rank and Kruskal–Wallis tests, were used to assess differences in KAB before and after viewing the film, as well as variations based on prior familiarity with diabetes and homelessness. Respondents’ knowledge increased significantly across all topics related to both diabetes and homelessness. There were significant differences in all questions that assessed respondents’ attitudes. Notably, respondents’ beliefs changed significantly to be more positive, except for a single question where the pre-scores already demonstrated reasonably high baseline knowledge. In several domains, respondents familiar with diabetes did not have as significant of a change compared with individuals who were less familiar with diabetes at baseline. These findings suggest that narrative films can positively influence audience members’ KAB about stigmatized conditions like diabetes and homelessness. Future research will examine the lasting impact of such interventions on audience members’ KAB.

Rural gay, bisexual, and other sexual minority men’s (SMM) comfort levels answering sensitive health topics are unknown. This online survey explored comfort levels of 399 rural SMM in the Southern United States when responding to five sensitive health topics (sexual behavior, alcohol use, drug use, sexualized drug use, and mental health), as well as examined demographic and behavioral differences in these comfort levels. Multiple linear regression models were analyzed. More than 70% of participants reported being very or somewhat comfortable answering all five health topics. More politically liberal SMM reported higher levels of comfort with sexual behavior and drug use questions. SMM who had condomless anal sex reported more comfortability answering sexual behavior questions, whereas SMM who used alcohol reported lower comfortability levels answering alcohol use questions. Findings have implications for the conduct and approval of health behavior survey research.

Mobile phone interventions are evidence-based methods for preventing obesity among Latino adults and school-aged children; however, few such interventions exist to improve the obesogenic behaviors of children in the developmentally critical preschool years (ages 2–5). Focusing on this age group is important since over one-quarter of 2- to 5-year-old Latino children are overweight or obese. Moreover, most documented interventions target mothers exclusively, ignoring the influence that other caregivers such as fathers and grandparents have on the environment and the child’s behaviors. We describe the development and refinement of a theory-informed mobile phone intervention using an iterative, user-centered approach that supports healthy weight-related behaviors in preschool-aged Latino children by engaging mothers, fathers, and grandparents. The resulting intervention, Familias Unidas, Niños Sanos (FUNS), is a culturally centered bilingual (Spanish/English), 12-week, web-based mobile phone intervention grounded in family systems theory. Through three to four weekly text messages and links to web-based interactive multi-media content, caregivers of 2- to 5-year-old Latino children learn evidence-based practices to support specific child behaviors in three domains: healthy eating, media viewing, and physical activity. Development of specific messages is grounded in social cognitive theory. Participants can connect with a virtual coach and other participants. The prototype received high levels of acceptability and usability among members of the target audience and is ready for feasibility testing. The systematic process of development and refinement of the intervention can serve as a model for other mHealth interventions, addressing the ongoing critique of the general lack of theoretical application in such intervention work.

BackgroundTo build research capacity for early-career faculty conducting HIV/STI research with minoritized communities and to enhance diversity in the scientific workforce, the University of California, San Francisco (UCSF) Center for AIDS Prevention (CAPS) conducts a training program for visiting professors (VPs), begun in 1996. VPs are in residence at CAPS for three summers, complete a pilot research project, and prepare National Institutes of Health (NIH) grant proposals. Best practices and key elements for successfully training scholars of color, and others who work with minoritized communities, are identified.MethodsThis paper draws on qualitative interviews with 31 VPs and 10 program mentors (VPMs) who participated in the program between 1996 and 2016. All VPs were also invited to participate in an anonymous survey to assess potential differences between study participants and non-participants. Interviews took place between September 2017 and March 2018 and were audio-recorded, transcribed, and thematically coded.ResultsVPs and VPMs described key elements relevant to both human and social capital that contributed to Program success. Paramount among these were the importance of establishing trusting mentorship relationships; sustained collegial engagement over time; and fostering a training environment based on multidisciplinarity, skills-building, scholarly networking, and peer reviews.ConclusionsParticipant voices from this objectively successful training program provide directions for future initiatives to support scholars of color and those working with minoritized groups. An indispensable value of such programs is to intentionally foster trusted scholarly communities to counterbalance systemic inequities in the academy.

Despite the proven effectiveness of COVID-19 vaccines in preventing severe illness, many individuals, including older adults who are most susceptible to the virus, have opted against vaccination. Various factors could shape vaccination decisions, including seeking health information (HI). The internet is the primary source of HI today; however, older adults are often referred to as those missing out on digital benefits. The study explores the correlations between information and communication technology (ICT) use, online HI seeking, socioeconomic factors, and COVID-19 vaccination readiness among individuals aged 50 and above in Estonia. The survey data were gathered from 501 people aged 50 and older after the first lockdown in 2020. The outcomes revealed that vaccination readiness positively correlated with factors such as higher educational attainment, greater income, male gender, access to ICT, a readiness to employ digital technologies for health-related purposes, a greater demand for HI, and a higher frequency of seeking it online. There was some discrepancy in the preference of HI sources; for example, vaccination consenters preferred online versions of professional press publications and specific health portals. Based on the findings, it is advisable to encourage older adults to utilize the internet and new technology for health-related purposes. This practice expands the range of information sources available to them, ultimately enabling better decision-making regarding their health behaviors.

Smoking poses a significant threat to adolescent health because of its immediate and long-term detrimental health effects. Smoking refusal self-efficacy predicts smoking behavior in adolescence. In adolescents’ health education, digital interventions are potential tools to support smoking refusal self-efficacy. The aim of this two-arm cluster randomized controlled trial was to evaluate the effectiveness of a digital health game intervention compared with a no-intervention control group on smoking refusal self-efficacy in 10- to 13-year-old Finnish early adolescents. The early adolescents (n = 781) were randomized to the control group (n = 394) and the health game intervention group (n = 387). Smoking refusal self-efficacy, sources of smoking and snus refusal self-efficacy, and motivation to decline smoking and snus use in the future were measured at baseline, 2-week postintervention, and 3-month follow-up. Data were analyzed using linear mixed model and Wilcoxon rank-based test for clustered data. According to the results, the intervention group made improvements in sources of smoking and snus refusal self-efficacy between baseline and postintervention, and in sources of snus refusal self-efficacy between baseline and follow-up, compared with the control group. The intervention group showed improvements in smoking refusal self-efficacy among 12-year-olds between baseline and follow-up, and postintervention and follow-up compared with the control group. Similar improvements were also found among those with a smoking friend or a smoking parent between postintervention and follow-up. The results were promising for the use of digital health game interventions to promote early adolescent smoking refusal self-efficacy and preventing smoking experimentation. Further research can evaluate the long-term effects for adolescents.