Chronic Physical Health Conditions Research Articles

A Systematic Review and Meta-Analysis of Noise Annoyance as a Determinant of Physiological Changes Linked to Disease Promotion.

This systematic review investigates the certainty of evidence (CoE) regarding noise annoyance as a determinant of biological changes known to contribute to disease development. We searched PubMed MEDLINE, EMBASE, Cochrane Central, and CINAHL for English-language comparative studies conducted on humans of any age from 1 January 1940, to 28 August 2023. Further, studies that provided quantitative data on the relationship between noise annoyance and biomarkers of interest were included. Where possible, random-effects meta-analyses were used to calculate the odds ratios of noise annoyance on biomarkers and biological conditions considered to be risk factors for developing health effects. The risk of bias of individual studies was assessed using the Risk of Bias of Non-randomized Studies of Exposures (ROBINS-E) instrument. The CoE for each outcome was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The search identified 23 primary studies reporting on relevant biomarkers. Although some studies and pooled estimates suggest a possible association between noise annoyance and biological measures, the CoE overall is very low due to concerns with the risk of bias, inconsistency, and imprecision in the estimates of effects. In the context of environmental impact assessment, where guidelines aim to mitigate the prevalence of populations experiencing a high level of noise annoyance, our results suggest that such practices should be grounded in the understanding that annoyance is health-relevant because it reflects an undesirable reaction to noise, rather than a precursor to chronic physical health conditions.

Looking Toward the Future of Integrated Care: History, Developments, and Opportunities.

For almost five decades, the development and implementation of integrated care-the simultaneous combination of primary care with mental health and substance use care-has been a major challenge for the behavioral health care field. Integrated care is exceptionally important because many people with behavioral health conditions also have chronic physical health conditions. Early research findings in the mid-1980s showed that persons with mental illness are likely to develop chronic physical conditions earlier and more severely than other people. These findings precipitated efforts to understand this problem and to develop further appropriate integrated care solutions. Subsequently, the US Surgeon General made care integration a major focus of his landmark 1999 Report on Mental Health, as did the 2008 Mental Health Parity and Addiction Equity Act and the 2010 Patient Protection and Affordable Care Act. However, it was not until 2014, and later, that integrated care actually began to be implemented more broadly. This article reviews these major developmental milestones, examines current activities, and explores likely developments over the next several years. Major current issues include the response to the COVID-19 pandemic, adjusting to its effects on the behavioral health care workforce, and the growing realization that behavioral health care must address the social determinants of life. Likely developments over the next several years will include devising ways to address our workforce crisis, developing effective community interventions, and implementing population health management strategies; implementing the CMS Innovation in Behavioral Health Model; improving reimbursement practices; and exploring the potential of AI for integrated care. Implications for future service organization and training of behavioral health care providers also are discussed. Granted the severity of the current workforce crisis in behavioral health care, urgent efforts are needed to advance the deployment of integrated care in the short-term future.

The rehabilitation treatment beliefs questionnaire-revised: assessing adolescents' treatment beliefs.

While there are several studies on children's and adolescents' beliefs about illness and medication treatment, there is limited research on their treatment beliefs in the context of rehabilitation. The Rehabilitation Treatment Beliefs Questionnaire (RTBQ) was the first instrument available to assess pediatric patients' rehabilitation-related treatment beliefs. However, the RTBQ had some limitations that we aimed to address in this study: We revised the content of the RTBQ to include previously unaddressed dimensions of rehabilitation-related treatment beliefs, and we thoroughly tested its psychometric properties based on a sizeable, multicenter sample of adolescents with different chronic diseases. Across 11 pediatric rehabilitation clinics throughout Germany, eligible patients aged 12-18 years with any chronic physical or mental health condition were invited to participate in an online survey. Psychometric evaluation included item analysis, exploratory factor analysis, internal consistency and construct validity. The sample comprised N = 294 adolescents (M = 14.2 years) with various chronic conditions. Psychometric testing demonstrated a coherent factor structure with 6 interpretable scales covering process and outcome expectations, expectations of one's own role in the treatment process, structural expectations, concerns, and emotions, the latter three representing previously unaddressed dimensions of rehabilitation-related treatment beliefs. Internal consistency was acceptable to good. Construct validity analyses showed mostly hypotheses-consistent correlations with related constructs. The revised RTBQ provides a psychometrically well-tested, adolescent-specific, and disease-generic instrument that captures multiple dimensions of rehabilitation-related treatment beliefs. Practical implications include identifying adolescents' beliefs about rehabilitation treatment in order to actively involve them in their illness management.

Chronic Physical and Mental Health Conditions Associated With Employment Status in Veterans

Veterans commonly experience both poor health and employment difficulty. However, the research examining potential relationships between chronic physical and mental health conditions and employment in veterans has important limitations. This study examines those potential relationships using large-scale, nationally representative data. The authors' hypothesis was that veterans experiencing these conditions would be less likely to be employed than veterans without the conditions and, further, that there may be differences in these relationships when comparing male veterans with female veterans. The study team conducted a pooled cross-sectional analysis of nationally representative data from the 2004-2019 administrations of the Medical Expenditures Panel Survey, which had items addressing health conditions, employment, and military experience. The authors assessed the relationship between health conditions and employment using multivariate logistic regression. Control variables included demographics, SES, family size, and survey year. Veterans experiencing diabetes, high blood pressure, stroke, emphysema, arthritis, serious hearing loss, poor self-reported mental health, poor self-reported health, depression, or psychological distress were less likely to be employed than veterans without those conditions, even after adjusting for potential confounding factors. Veterans with diabetes had 25% lesser odds of being employed than veterans without the condition (95% CI=0.65, 0.85). Veterans with increased likelihood of depression had 35% lesser odds of being employed than veterans without depression (95% CI=0.52, 0.81). This study adds evidence to the understanding of the role of chronic health conditions in employment status of veterans. The results support arguments for programs that aid veterans with both their health and their employment.

Development and psychometric evaluation of a Total Worker Health® practice scale.

Occupational Safety and Health (OSH) professionals increasingly need to assess and mitigate a broad scope of worker safety, health, and well-being concerns that extend beyond traditional OSH training curricula. Work-related and non-work-related psychosocial hazards, chronic physical and mental health conditions, and changing work arrangements call for an integrative, public health approach to occupational risk management; this approach has been called, "Total Worker Health®" by United States public health authorities (Schulte et al. 2019). OSH professionals need education to ensure that Total Worker Health (TWH) practice approaches are consistently and effectively applied. This study sought to develop a valid, reliable scale that could be used to assess TWH skills gaps that can be addressed with tailored, competency-based curricula. We developed a survey scale to assess professional competency for specific TWH practice approaches described in prior literature (Lee et al. 2016; Punnett et al. 2020). The scale contained 11 statements and used a 5-point scale (not skilled to highly skilled) to rate the level of competency. We pre-tested and refined the statements for face validity then administered the scale with a convenience sample of 258 professionals from mixed OSH disciplines. A total of 210 OSH professionals (31% safety, 17% industrial hygiene, 12% occupational nurses, 11% occupational physicians, 29% other) who completed 50% or more of the questions were included in the analysis. Scale reliability was assessed with a Cronbach's alpha test. Scale validity and structure were assessed with exploratory factor analysis (EFA). The 11-item scale had high internal consistency (Cronbach's α = 0.92). The initial EFA solution suggested 2 factors that explained 65.3% of variance, with one cross-loaded question. A final 10-item, 2-factor scale was developed that accounted for 66.0% of variance with no cross-loaded items (Cronbach's alpha α = 0.91). Factor 1 (6 items) contributed to 55.5% of the variance and captured skills related to TWH program leadership (e.g. leader commitment, integrating program systems, engaging with other program leaders and workers). Factor 2 (4 items) contributed to 10.5% of the variance and captured technical skills related to hazard identification and control (e.g. identifying hazards, designing work to reduce hazards). Internal consistency was very good for both TWH program leadership (Cronbach α = 0.89) and TWH risk assessment and control (Cronbach α = 0.80) subscales. A novel 10-item TWH skill scale to assess specific TWH practice approaches was developed with very good reliability. Factor analysis revealed 2 latent constructs: TWH leadership skills and TWH risk assessment and control skills. This study offers an evidence-based tool to assess competency for specific TWH practices among OSH professionals. The results of this study contribute to the broader research base needed to formalize a TWH competency framework, as advocated by other scholars interested in TWH workforce education (Newman et al. 2020).

State of the Science: The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders

Before the development of the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP), evidence-based treatment options for commonly co-occurring anxiety, mood, and related disorders consisted of numerous single-disorder protocols that shared many similarities, reflecting the overlap among these disorders themselves. The UP distilled common elements of cognitive behavioral protocols into a unified intervention directly targeting core temperamental features underlying these disorders of emotion, namely neuroticism and associated emotion dysregulation. The UP has since become a leading “transdiagnostic” treatment for emotional disorders, which is now available in several formats (e.g., individual, group, digital) and has accumulated a strong evidence base, leading to international implementation. There is now also research evidence that the UP can be flexibly applied to a range of clinical presentations, including borderline personality disorder, trauma- and stressor-related disorders, eating disorders, alcohol use disorder, and comorbid chronic physical health conditions. Yet additional research is needed to evaluate the UP in routine clinical settings, with more heterogeneous patient populations, and under circumstances that mirror actual clinical practice. Thus, we must also continue to explore the benefits of large-scale UP training initiatives and implementation in major healthcare systems.

Family and community resilience: a Photovoice study

BackgroundAdverse childhood experiences (ACEs), in combination with adverse community environments, can result in traumatic stress reactions, increasing a person’s risk for chronic physical and mental health conditions. Family resilience refers to the ability of families to withstand and rebound from adversity; it involves coping with disruptions as well as positive growth in the face of sudden or challenging life events, trauma, or adversities. This study aimed to identify factors contributing to family and community resilience from the perspective of families who self-identified as having a history of adversity and being resilient during the COVID-19 pandemic.MethodsThis study used Photovoice, a visual participatory research method which asks participants to take photographs to illustrate their responses to a research question. Participants consisted of a maximum variation sample of families who demonstrated family level resilience in the context of the pair of ACEs during the COVID-19 pandemic. Family members were asked to collect approximately five images or videos that illustrated the facilitators and barriers to well-being for their family in their community. Semi-structured in-depth interviews were conducted using the SHOWeD framework to allow participants to share and elucidate the meaning of their photos. Using thematic analysis, two researchers then independently completed line-by-line coding of interview transcripts before collaborating to develop consensus regarding key themes and interpretations.ResultsNine families were enrolled in the study. We identified five main themes that enhanced family resilience: (1) social support networks; (2) factors fostering children's development; (3) access and connection to nature; (4) having a space of one’s own; and (5) access to social services and community resources.ConclusionsIn the context of additional stresses related to the COVID-19 pandemic, resilient behaviours and strategies for families were identified. The creation or development of networks of intra- and inter-community bonds; the promotion of accessible parenting, housing, and other social services; and the conservation and expansion of natural environments may support resilience and health.

The association between post-injury chronic physical health conditions, health status, and survival time in people with serious orthopaedic injuries

Background A better understanding of how chronic physical health conditions affect long-term outcomes following injury is essential for quantifying the burden of serious orthopaedic injuries. We aimed to describe the association between the presence of post-injury chronic physical health conditions and (i) the change in health status from before injury to six different follow-up time points after injury; and (ii) survival time. Methods A cohort study was conducted using linked data from the REcovery after Serious Trauma: Outcomes, Resource Use, and Patient Experiences study, the Victorian Registry of Births, Deaths and Marriages (BDM) (2009–2017), the victorian admitted episodes dataset (2009–2017) and the victorian emergency minimum dataset (2009–2017). Adults (≥ 18 years old) with serious orthopaedic injuries who survived to discharge from their trauma admission were included. Multivariable linear regression analysis was conducted to evaluate the association between post-injury chronic physical health conditions and the mean change in health status (EuroQol-Visual Analogue Scale) from before injury to six follow-up time points post-injury. Survival analysis was conducted to estimate the probability of survival for people with and without chronic physical health conditions following injury. Results Out of 894 participants, 177 (19.8%) had at least one chronic physical health condition recorded up to five years post-injury. People with post-injury conditions reported a greater mean decline in health status than people without post-injury conditions (difference, (95% CI): −6.9 (−9.7, −4.2), p = 0.01). Over the study period, almost six times as many people with chronic physical health conditions post-injury died as people without these conditions (AHR (95% CI): 5.7 (2.9, 11.3), p < 0.01). Conclusions Chronic physical conditions after serious orthopaedic injuries were associated with a lower survival probability and a deteriorating health status. Orthopaedic injury survivors may benefit from early detection and treatment of chronic conditions.

Chronic health conditions and adolescents' social connectedness.

This study investigated associations between chronic developmental/behavioral and physical health conditions and social connectedness of adolescents using rich population-based data from a national U.S. birth cohort study. Potentially disabling health conditions were reported by caregivers and categorized by our team as developmental/behavioral or physical. Social connectedness was assessed using a validated scale that measured adolescents' reports of positive social connectedness across relevant contexts (family, friends, school). Of the 3,207 adolescents included, over one third had at least one chronic health condition. Unadjusted and adjusted linear and logistic regression models of associations between the presence of chronic health conditions (any developmental/behavioral health condition and any physical health condition, compared to no conditions) and adolescents' social connectedness outcomes were estimated. Compared to those with no chronic health conditions, adolescents with developmental/behavioral health conditions had lower odds of high positive social connectedness scores (adjusted odds ratio [AOR]: 0.80; CI [0.67, 0.94]), having friends they really care about (AOR: 0.76; CI [0.61, 0.94]), having people who care (AOR: 0.65; CI [0.50, 0.84]), and having people with whom to share good news (AOR: 0.77; CI [0.63, 0.94]). Adolescents with chronic physical health conditions had lower odds of reporting having people who care about them (AOR: 0.72; CI [0.55, 0.94]). The findings point to the need for interventions designed to foster the development of positive interpersonal relationships, reduce loneliness, and increase positive social identity among adolescents with chronic health conditions, particularly those with developmental/behavioral health conditions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Use of Authorized Concealment to Minimize Nocebo Side Effects: A Survey of US Public Attitudes

Introduction: To minimize nocebo effects, it may be possible to employ authorized concealment, in which clinicians tell patients about the nocebo phenomenon and ask if they would prefer not to be informed about mild treatment side effects. Objective: The objective of the study was to understand public evaluations of authorized concealment for reducing nocebo effects. Methods: An online cross-sectional survey was completed by a demographically diverse US national community sample between June 2 and 6, 2023. Participants were 1,012 adults residing in 48 states, ages ranging from 18 to 94 (mean = 43.2), 65.4% regularly taking medication, and 66.6% reporting a chronic physical or mental health condition. After learning about nocebo effects, participants rated and estimated their likelihood of consenting to four potential methods for authorized concealment of mild side effects. The four methods were ranked for preference and ranked again with the options of (1) receiving all side-effect information and (2) having the opportunity to select among disclosure methods. Results: A majority of participants (86.2%) positively endorsed at least one authorized concealment method and 88.2% estimated they would consent to at least one method. Authorized concealment in which individuals learned only the most common side effects or had side-effect information available online received more positive ratings and rankings. A final ranking yielded preferences for receiving all side-effect information (30.4%) and having the opportunity to select side-effect disclosure method (31.8%). Conclusions: Our study suggests that many in the public could be open to authorized concealment for mild side effects when it is explained in reference to nocebo effects.

A Conceptual Framework for Building Individual and Team Capabilities to Provide Effective Longitudinal, Relationship-Based Clinical Case Management.

Individuals with complex, chronic diseases represent 5% of the population but consume 50% of the costs of care. These patients have complex lives, characterized by multiple chronic physical health conditions paired with a combination of behavioral health issues and/or unmet social needs. Unlike for most health problems, the problems faced by individuals with complex lives cannot be broken down into simpler parts to be solved independent from 1 another. In this article, the authors describe a 2-phase framework for improving outcomes in patients with complex lives, outline how the model works in more detail, and discuss lessons learned in this journey. In phase 1, a case manager carefully and deliberately focuses on building a relationship with the patient to first gain trust, and then identify, in partnership with the patient, how to best approach assisting the patient in improving their health. That pathway is often unknowable without a deep investment of time, a radical acceptance of the patient, faults and all, and an unwavering commitment to stay by their side, even when things are tough. Once the case manager and patient have established a trusting relationship, they enter phase 2-building a path toward wellness, including further emphasis on the relationship, solving prioritized issues, changing the health system approach, and engaging the patient in self-reflection and behavior change activities.

Childhood Abuse and Chronic Physical Health Conditions in Adulthood: A Longitudinal Analysis of Familial Support and Strain as Mediators

Childhood Abuse and Chronic Physical Health Conditions in Adulthood: A Longitudinal Analysis of Familial Support and Strain as Mediators

6.P. Workshop: Responding to violence and abuse across the life-course

Abstract Much research on the mental health effects of violence focus on domestic violence as experienced in adulthood. The mental health impacts are often gauged using cross-sectional studies and focus on current associations between violence and health. This workshop presents a range of analyses - drawing on data from New Zealand, Germany and the UK - that address the ways in which violence and abuse manifest at different life stages, including in childhood, among working-age adults, and in later life. The presentations highlight differences across the life course, as well as commonalities. They provide evidence of the long-term, even life long, shadow that violence and abuse can cast over people's health, and provide evidence of the extensive costs for society. Health impacts are shown to be broad, not only anxiety and depression, but substance dependence, chronic physical health conditions, and related health risks such as obesity. This workshop comprises four presentations that each consider violence and abuse prevalent at a particular stage of life, and provide evidence to inform the sensitive tailoring of responses from and for families, schools, health and social services, workplace human resource employees, and care and residential homes. The format of the workshop comprises brief presentations, with a focus on extended audience discussions. We invite engagement from people from a range of disciplines interested in how different forms of violence and abuse present at different life stages, the impacts on health, and the ways in which society should respond. This workshop is submitted on behalf of the EUPHA Public Mental Health Section. Key messages • Violence occurs across the life course. While its prevalence and form often vary between life stages, at every stage it has major, long-term, and diverse implications for health. • Interventions need to be tailored to the life course and sensitive to changing context, including domestic, workplace, and care home environments.

Complementary andIntegrative Medicine Prevalence andUtilization inInternational Military andVeteran Settings andCommunities: A Systematic Review.

Active duty military personnel and veterans have unique and complex health needs, with the high demands of military life often leading to chronic physical and mental health conditions. Complementary and integrative medicine (CIM) could be a possible solution to this problem. Some military health systems have started integrating CIM into health care delivery. However, there has been no systematic evaluation of the prevalence and utilization of CIM in military and veteran populations globally. A Preferred Reporting Items For Systematic Reviews and Meta-Analysis Protocols protocol was used to systematically search for original research assessing the prevalence and utilization of CIM among active serving military or veterans. CINAHL, MEDLINE, Scopus, and AMED databases were searched up to February 3, 2023. A total of 27 studies met the inclusion criteria and were included in this review. The overall quality of evidence was high with a low risk of bias. Utilization of CIM varied. The lowest utilization demonstrated that only 1.9% of services delivered by military health system were CIM. The majority of studies found utilization rates between 30% and 80%, with some studies reporting use as high as 90%. The most commonly used CIM therapies included chiropractic care, massage, mindfulness/meditation, and acupuncture. Utilization of CIM products was high and ranged from 32% to 87%. The most frequently used products were dietary supplements, particularly multivitamins and minerals and protein supplements/amino acids. The use of herbal products was high among veterans ranging from 10% to 79%. The high demand for CIM by military personnel and veterans has important implications for policy, funding allocation, and integration of these services into clinical practice, particularly by countries not currently doing so. Further research is needed to assess the implementation of CIM into real-world settings to explore barriers and facilitators for their use in clinical practice and, by extension, their integration into the wider health care system.

Relationship between severe mental illness and physical multimorbidity: a meta-analysis and call for action

BackgroundPeople with severe mental illness (SMI) have a higher prevalence of several chronic physical health conditions, and the prevalence of physical multimorbidity is expected to rise. The aim of this...

Reciprocal association between social support and psychological distress in chronic physical health conditions: A random intercept cross-lagged panel model.

The onset of a chronic physical health condition (CHC) can highly impact individuals' well-being and mental health. Social support has been shown to help people rebound after the onset of a CHC. Nonetheless, little is known about the longitudinal pattern of social support and its reciprocal association with mental health in CHC. This study aimed to illustrate the longitudinal pattern of perceived social support and to examine the reciprocal association between perceived social support and psychological distress across 6 years. Two random intercept cross-lagged panel models were conducted, one for emotional and one for practical support, using yearly assessments of 582 Swiss Household Panel's participants reporting a CHC. A reciprocal association was found, with psychological distress 1 year after the onset being linked to less emotional support in the following year and vice versa, more emotional support being linked to less psychological distress the following year. A unidirectional association was found for practical support, with more psychological distress 1 year before the CHC onset being linked to more practical support at the onset year. This study underlines the importance of involving the social environment of individuals living with a CHC, especially around the first year after the onset.

Increased rates of chronic physical health conditions across all organ systems in autistic adolescents and adults

BackgroundThe poorer physical health of autistic adults compared to non-autistic adults has been highlighted by several epidemiological studies. However, research has so far been limited to specific geographical areas and has primarily focused on young autistic individuals (aged 35 years and younger). Recent studies indicate a higher rate of mortality in autistic people, as well as poorer quality of self-reported healthcare interactions. This study aims to determine, first, whether autistic people experience greater levels of non-communicable health conditions and second, whether these are explained by differences in demographics (i.e. sex, country of residence, ethnicity, education level), alcohol use, smoking, body mass index (BMI), or family history of medical conditions.MethodWe employed a cross-sectional, convenience-sampling study via an anonymous, online survey of autistic and non-autistic adults (n = 2305, mean age = 41.6, 65.9% female, 49% autistic). The survey asked participants to self-report information about their demographics, autism diagnosis, diet, exercise, sleep, sexual health, substance use, personal medical history, and family medical history (for all first-degree, biological relatives). Binomial logistic regression across four iterative models of increasing complexity was applied to assess rates of physical health conditions. The Benjamini–Hochberg correction was used to account for multiple testing, and only physical health conditions that achieved at least 1% endorsement within the overall sample (n > 22) were included in the analysis to reduce risk of Type I errors. We also used novel network analysis methods to test whether there are increased levels of multimorbidity between autistic and non-autistic people.ResultsThere were significantly elevated rates of non-communicable conditions across all organ systems in autistic people, including gastrointestinal, neurological, endocrine, visual, ear/nose/throat, skin, liver and kidney, and haematological conditions. We confirmed previous findings by showing highly significant differences in rates of neurological and gastrointestinal symptoms (p < 0.0001). In addition, we established in the largest sample to date that Ehler-Danlos Syndrome (EDS) was more likely to occur among autistic females compared to non-autistic females. Finally, we found a higher prevalence of Coeliac’s disease among autistic individuals compared to non-autistic individuals after controlling for sex, ethnicity, country of residence, alcohol use, smoking, and BMI, but these results became non-significant after accounting for family history.LimitationsOur study is biased towards females, white individuals, highly educated people, and UK residents, likely due to sampling biases. Our self-report study design may also exclude those who lack access to computers, or those with intellectual disability. Our network analysis is also limited in size.ConclusionsThis study provides evidence of widespread, physical health comorbidity that spans nearly all major organ systems in autistic adults compared to non-autistic adults, using both binary logistic regression and network models. Healthcare professionals must be made aware of the range of co-occurring physical health conditions that may be more common among autistic people. However, our findings also point towards potential avenues requiring further exploration, such as the association of autism with both Coeliac’s disease and EDS.

Internal migration following adverse life events: Assessing the likelihood of return migration and migration toward family.

There are well-documented associations between life course changes and migration; yet, the occurrence, order, and timing of reasons for migrating are growing increasingly diverse. Migration following adverse life events, such as a divorce or an involuntary job loss, may be qualitatively distinct from migration undertaken for other reasons. Moves, especially long-distance moves, following adverse life events, may be defined more by seeking family and familiar locations. Moreover, a heightened probability of migration may occur not only immediately after an adverse life event but also in the years after. We explore these questions in the US context with longitudinal data from the 1983 to 2019 waves of the Panel Study of Income Dynamics, which provides information on residential locations, locations of family members, and adverse life events for individuals over time. We focus on five specific events: divorce, the death of a spouse, involuntary job loss, the onset of a chronic physical health condition, and the onset of a chronic mental health condition. Using multivariate regression, we find that divorce and job loss induce long-distance moves, especially return moves and moves towards family. Chronic physical conditions deter moving in general but increase the chances of return moves (after a period of time) and moves towards family. These results have implications for understanding migration as a response to adverse life events, both immediately and over time.

State-Level Anti-Immigrant Sentiment and Policies and Health Risks in US Latino Children.

Although systemic inequities, broadly defined, are associated with health disparities in adults, there is a dearth of research linking contextual measures of exclusionary policies or prejudicial attitudes to health impairments in children, particularly among Latino populations. In this study, we examined a composite measure of systemic inequities in relation to the cooccurrence of multiple health problems in Latino children in the United States. Participants included 17 855 Latino children aged 3 to 17 years from the National Survey of Children's Health (2016-2020). We measured state-level systemic inequities using a factor score that combined an index of exclusionary state policies toward immigrants and aggregated survey data on prejudicial attitudes toward immigrants and Latino individuals. Caregivers reported on 3categories of child health problems: common health difficulties in the past year, current chronic physical health conditions, and current mental health conditions. For each category, we constructed a variable reflecting 0, 1, or 2 or more conditions. In models adjusted for sociodemographic covariates, interpersonal discrimination, and state-level income inequality, systemic inequities were associated with 1.13 times the odds of a chronic physical health condition (95% confidence interval: 1.02-1.25) and 1.24 times the odds of 2 or more mental health conditions (95% confidence interval: 1.06-1.45). Latino children residing in states with higher levels of systemic inequity are more likely to experience mental health or chronic physical health conditions relative to those in states with lower levels of systemic inequity.

Differential Cortical Volume and Surface Morphometry in Youth With Chronic Health Conditions.

Up to 1 in 3 youth in the United States have a childhood-onset chronic health condition (CHC), which can lead to neurodevelopmental disruptions in cognitive functioning and brain structure. However, the nature and extent of structural neurobiomarkers that may be consistent across a broad spectrum of CHCs are unknown. Thus, the purpose of this study was to identify potential differences in brain structure in youth with and without chronic physical health conditions (e.g., diabetes, hemophilia). Here, 49 T1 structural magnetic resonance imaging (MRI) images were obtained from youth with (n = 26) and without (n = 23) CHCs. Images were preprocessed using voxel-based morphometry (VBM) to generate whole-brain voxel-wise gray matter volume maps and whole-brain extracted estimates of cortical surface area and cortical thickness. Multi-scanner harmonization was implemented on surface-based estimates and linear models were used to estimate significant main effects of the group. We detected widespread decreases in brain structure in youth with CHCs as compared to controls in regions of the prefrontal, cingulate, and visual association areas. The insula exhibited the opposite effect, with cases having increased surface area as compared to controls. To our knowledge, these findings identify a novel structural biomarker of childhood-onset CHCs, with consistent alterations identified in gray matter of regions in the prefrontal cortex and insula involved in emotion regulation and executive function. These findings, while exploratory, may reflect an impact of chronic health stress in the adolescent brain, and suggest that more comprehensive assessment of stress and neurodevelopment in youth with CHCs may be appropriate.