Disparities In Well-being Research Articles

COVID-19, social determinants, and African American-White disparities: policy response and pathways forward.

COVID-19 translated African Americans' greater social, economic, and health-related risk, reflecting adverse Social Determinants of Health (SDOH), into greater COVID morbidity, hospitalization, and mortality, and it threatened to enlarge the very risks causing greater COVID suffering. However, following a federal policy response injecting trillions of dollars into the US economy, longstanding African American-White disparities ineconomic well-being, insurance coverage, vaccination rates, and evictions declined. On the other hand, troubling and consequential disparities in k-12 academic achievement and college attendance disparities widened. Continuous monitoring and careful research are needed to document and explain trajectories in social determinant disparities and to offer insight into how policy intervention can decrease continuing disparities in economic well-being, health care, and housing stability.

Psychological well-being and its influence on elderly life

Abstract Background: This study examines the influence of psychological well-being (PWB) on the quality of life (QOL) among elderly individuals, considering demographic factors such as gender and urban vs. rural residence. Materials and Methods: A cross-sectional study was conducted among 255 individuals aged 65–75 years from urban and rural areas of New Delhi, India. PWB was assessed using the Psychological Well-Being Scale, and QOL was measured using the WHOQOL-BREF. The data were analyzed using descriptive statistics, t-tests, and regression analysis. Results: A significant positive relationship was found between PWB and QOL, with PWB accounting for 14% of the variance in QOL (P < 0.001). Urban males showed the highest PWB and QOL scores, whereas rural females exhibited the lowest scores. Conclusions: PWB is an important predictor of QOL among older adults. Addressing demographic disparities in well-being is crucial for designing effective interventions tailored to diverse populations.

Gender-specific impact of COVID-19 in the UAE: Analyzing gender disparities in health and well-being

Abstract Background Understanding gender disparities in health impacts during pandemics is crucial. While early observations of the COVID-19 pandemic suggested higher severity and mortality rates among males, subsequent studies hinted at a disproportionate impact on females’ health and well-being. This study aimed to explore gender-specific differences related to COVID-19 in the United Arab Emirates (UAE). Methods Data from four independent surveys were analyzed to assess gender differences in knowledge about available vaccines, vaccine hesitancy, COVID-19 severity, admission to the Intensive Care Unit (ICU), anxiety among healthcare workers (HCWs), and psychological health of healthcare workers and the general population. Gender gaps were calculated as the absolute difference between males and females. Chi-square tests and logistic regression were performed to test the association between gender, age, and selected outcome variables. Results Males had a significantly higher risk of moderate to severe COVID-19 symptoms (71%) compared to females (63%). The gender gap in symptom severity was smallest among those aged 55+ and highest among adults aged 35-54. Post-discharge, 22% more females reported multiple conditions than males. Among HCWs, females showed lower knowledge (19% gap) and higher vaccine hesitancy (20% gap), with larger gaps among older age groups. Females also experienced more anxiety and psychological stress, especially in the 35-54 age group. Logistic regression confirmed higher odds for females in reporting vaccine hesitancy, long COVID-19 symptoms, and anxiety, even after adjusting for demographic factors. Conclusions This study highlights unequal health outcomes and burdens experienced by women and men during the COVID-19 pandemic in the UAE. The distinct challenges faced by women, including higher mental health burdens and persistent post-recovery symptoms, suggest systemic gender disparities that require targeted attention in healthcare policies and practices. Key messages • Gender disparities in COVID-19 were evident in the UAE with males experiencing severe COVID-19 symptoms, while females experienced post-recovery symptons, vaccine hesitancy, and stress. • Urgent action is required to address gender disparities in COVID-19 impacts, emphasizing mental health support and post-recovery care in policy formulation.

Who Benefits from Mass Incarceration? A Stratification Economics Approach to the “Collateral Consequences” of Punishment

A rich empirical literature documents the consequences of mass incarceration for the wealth, health, and safety of Black Americans. Yet it often frames such consequences as a regrettable artifact of racially disproportionate criminal legal system contact, rather than situating the impetus and functioning of the criminal legal system in the wider context of White political and economic domination. Revisiting a quarter century of mass incarceration research through a stratification economics lens, we highlight how mass incarceration shapes Black–White competition for education, employment, and financial resources and contributes to Black–White disparities in well-being. Highlighting persistent research gaps, we propose a research agenda to better understand how mass incarceration contributes to systematic White advantage. To address mass incarceration's consequences and transform the conditions of White political and economic domination under which it arose, we call for legislative and judicial intervention to remedy White hyper-enfranchisement and reparations to eliminate the Black–White wealth gap.

Well-Being and Healthcare Inequality on Bulon-Don Island in Southern Thailand-Results of a Pre-Intervention Field Survey.

Children living in an area distant from or associated with barriers to travelling to health service centres usually experience health and well-being disparities. This is a survey of child health and well-being on Bulon-Don Island, located 22 kms. from the southern mainland of Thailand, to gather essential background data before activating responses from local service provider agencies. Demographic data, physical and crude psychological health, harm to health, and living conditions of Bulon-Don children aged 1-14 years were studied and compared with the results of the corresponding national child health survey. Descriptive statistics were used for the statistical analysis of significance (p < 0.05). A total of 21 male and 41 female children (N = 62) participated in the survey after obtaining consents from parents or care providers. The islanders are Indigenous people who use their own languages and have traditional beliefs. Comparing with the children of the national survey, most children aged <5 years were found to have significantly lower height and weight according to their age (p = 0.044 and p = 0.043, respectively), whereas those aged >5 years had a similar nutritional status. In addition, there is a lack of facilities for healthy living. However, the mean total psychological and ethical standards scores were significantly higher in the 1-5 and 6-9-year-old children. Disparity of socio-political status, cultural beliefs and practices, socioeconomic basis, and geographic distance from the mainland were the social determinants and barriers of low health service accessibility for the islander children. Comprehensive child health and well-being evaluation in an enclave of isolation like this is mandatory before an integrated intervention carried out by the local healthcare and living facilities providers is implemented.

Socioeconomic Disparities in Family Well-Being, Family Communication Quality, and Personal Happiness among Chinese: Findings from Repeated Cross-Sectional Studies in 2016–2023

AbstractSignificant socioeconomic changes in Hong Kong have coincided with a conspicuous knowledge gap regarding the impact of disparities on family well-being, family communication quality, and personal happiness. To examine changes on family well-being, family communication quality, and personal happiness before, during, and after the 2019 social unrest and the COVID-19 pandemic in Hong Kong. Five repeated territory-wide cross-sectional surveys were conducted from 2016 to 2023, using telephone and online surveys on 27,074 adults in Hong Kong. Respondents rated their family health, happiness, harmony (family 3Hs), family communication quality, and personal happiness on scales of 0–10. Family well-being was the sum of family 3Hs divided by three (0–10). Trends by socioeconomic factors were analysed using linear prediction and multiple linear regression, weighted for sex and age. Highest scores for all outcomes were observed in 2016 and 2017, followed by a noticeable decline in 2020 and 2021, with the lowest scores recorded in 2023 except for personal happiness with its lowest score recorded in 2021. The decline since 2021 was most noticeable with low monthly household income (predicted margins in 2023 ranged from 5.55 to 6.46 for ≤ HK$19,999; 5.62 to 6.51 for HK$20,000–39,999; 5.81 to 6.78 for ≥ HK$40,000), but no differences were observed by education level. Female, older age, and higher monthly household income were significantly associated with higher family well-being, family communication quality, and personal happiness (all P &lt; 0.001). Higher education level was only significantly associated with personal happiness (P = 0.008). We have first shown socioeconomic disparities in the declining family well-being, family communication quality, and personal happiness from 2016 to 2023 in Hong Kong. These alarming findings require targeted interventions and policies aimed at addressing these disparities and improving wellbeing in the population.

Police Avoidance Among Black Youth

ObjectivesPolice violence is a public health crisis that disproportionately impacts youth of color, particularly Black youth. These disparities may also compel Black youth to engage in police avoidance (i.e., efforts to circumvent police contact and surveillance). Even so, research on Black youths’ engagement in police avoidance is lacking. The present study is the first to investigate factors that may underpin police avoidance among Black youth. MethodsData come from the Survey of Police-Adolescent Contact Experiences (SPACE), a recent, cross-sectional, non-probability survey of Black youth (~52% male) aged 12-21 in Baltimore City (n = 345). ResultsFindings indicate that youth 1) identifying as bisexual or queer, 2) perceiving lower safety at home and in their neighborhoods, 3) reporting more negative attitudes about police, and 4) engaging in delinquent behaviors reported significantly greater police avoidance. Furthermore, youth who reported a greater number of known persons stopped by the police (e.g., family members, friends, neighbors) and had personally experienced officer intrusion during direct or witnessed stops (e.g., harsh language, threats of force, use of force) also exhibited greater police avoidance. ConclusionsLGBQ identity, reduced perceptions of environmental safety, negative attitudes about police, delinquent behaviors, and multiple types of police exposure may shape police avoidance among Black youth. Findings have the potential to inform targeted strategies to mitigate racial and LGBQ disparities in adolescent well-being. Clinical Trial RegistrationNone.

Mixed Methods Study Protocol: Language Identity, Discrimination, and Mental Health among Multilingual 1.5 Generation Asian/Asian American Immigrant Young Adults.

Language identity, an understudied factor, can influence isolation and discrimination, leading to disparities in well-being and mental health among immigrants. This study aims to investigate the role of language identity on structural racism and discrimination among 1.5 generation Asian/Asian American immigrants in a diverse U.S. state. We developed a three-step sequential approach: Stage 1-qualitative analysis (1A, focus group discussion; 1B, in-depth interviews); Stage 2-quantitative analysis (2A, language identity measurement scale; 2B, cross-sectional online survey; 2C, multivariate multiple linear regression); Stage 3-another round of qualitative analysis (3A, follow-up in-depth chronological interviews). Therefore, this study will contribute to the field by introducing a novel three-step mixed methods approach, marking a notable improvement over conventional explanatory or exploratory sequential designs.

Gender and Well-Being Disparities Among People who Work from Home in Chile

Gender and Well-Being Disparities Among People who Work from Home in Chile

Theory of change for addressing sex and gender bias, invisibility and exclusion in Australian health and medical research, policy and practice

Sex and gender are inadequately considered in health and medical research, policy and practice, leading to preventable disparities in health and wellbeing. Several global institutions, journals, and funding bodies have developed policies and guidelines to improve the inclusion of diverse participants and consideration of sex and gender in research design and reporting and the delivery of clinical care. However, according to recent evaluations, these policies have had limited impact on the inclusion of diverse research participants, adequate reporting of sex and gender data and reducing preventable inequities in access to, and quality provision of, healthcare. In Australia, the Sex and Gender Policies in Medical Research (SGPMR) project aims to address sex and gender bias in health and medical research by (i) examining how sex and gender are currently considered in Australian research policy and practice; (ii) working with stakeholders to develop policy interventions; and (iii) understanding the wider impacts, including economic, of improved sex and gender consideration in Australian health and medical research. In this paper we describe the development of a theory of change (ToC) for the SGPMR project. The ToC evolved from a two-stage process consisting of key stakeholder interviews and a consultation event. The ToC aims to identify the pathways to impact from improved consideration of sex and gender in health and medical research, policy and practice, and highlight how key activities and policy levers can lead to improvements in clinical practice and health outcomes. In describing the development of the ToC, we present an entirely novel framework for outlining how sex and gender can be appropriately considered within the confines of health and medical research, policy and practice.

Spatial and Temporal Variations in the Coupled Relationship between Ecosystem Services and Human Well-Being in Gansu Province Counties and the Factors Affecting Them

Investigating the interplay between ecosystem services and human well-being is crucial for enhancing ecological conservation and achieving a superior quality of development. This research examined the spatial–temporal disparities in ecosystem services and human well-being across 87 counties in Gansu Province using the coupling coordination degree model and geographically weighted regression analysis. The key findings include the following: (1) Over two decades, from 2000 to 2020, ecosystem services in Gansu Province witnessed a financial appreciation of approximately CNY 29.32 billion. The distribution displayed a notable trend, with higher values in the southeastern counties, particularly in Gannan and Longnan, whereas lower values prevailed in the Hexi area. (2) The well-being of the populace experienced a substantial enhancement, registering a 75% increase during the same period, characterized by higher well-being indices in the north, especially in Hexi, and the lowest indices in Gannan and the Linxia sector of Longzhong. (3) The coupling coordination degree between ecosystem services and human well-being escalated from 0.412 to 0.587, transitioning from moderate dysfunction to moderate coordination over the two decades. Regions such as Hexi and Gannan recorded a moderate discordance in their coupling coordination, whereas regions including Longzhong, Longnan, and Longdong demonstrated a more stable, basic coordination. (4) Influences on the coupling coordination degree between county ecosystem services and human well-being displayed significant spatial variability, often aligned along distinct geographic bands. Economic and natural foundations were predominantly aligned southeast to northwest, while investment and urbanization levels were more prominent from west to east, and industrialization levels were distributed along an east–west axis.

Gender Differences in Electronic Health Record Usage Among Surgeons.

Understanding gender differences in electronic health record (EHR) use among surgeons is crucial for addressing potential disparities in workload, compensation, and physician well-being. To investigate gender differences in EHR usage patterns. This cross-sectional study examined data from an EHR system (Epic Signal) at a single academic hospital from January to December 2022. Participants included 224 attending surgeons with patient encounters in the outpatient setting. Statistical analysis was performed from May 2023 to April 2024. Surgeon's gender. The primary outcome variables were progress note length, documentation length, time spent in medical records, and time spent documenting patient encounters. Continuous variables were summarized with median and IQR and assessed via the Kruskal-Wallis test. Categorical variables were summarized using proportion and frequency and compared using the χ2 test. Multivariate linear regression was used with primary EHR usage variables as dependent variables and surgeon characteristics as independent variables. This study included 222 529 patient encounters by 224 attending surgeons, of whom 68 (30%) were female and 156 (70%) were male. The median (IQR) time in practice was 14.0 (7.8-24.3) years. Male surgeons had more median (IQR) appointments per month (78.3 [39.2-130.6] vs 57.8 [25.7-89.8]; P = .005) and completed more medical records per month compared with female surgeons (43.0 [21.8-103.9] vs 29.1 [15.9-48.1]; P = .006). While there was no difference in median (IQR) time spent in the EHR system per month (664.1 [301.0-1299.1] vs 635.0 [315.6-1192.0] minutes; P = .89), female surgeons spent more time logged into the system both outside of 7am to 7pm (36.4 [7.8-67.6] vs 14.1 [5.4-52.2] min/mo; P = .05) and outside of scheduled clinic hours (134.8 [58.9-310.1] vs 105.2 [40.8-214.3] min/mo; P = .05). Female surgeons spent more median (IQR) time per note (4.8 [2.6-7.1] vs 2.5 [0.9-4.2] minutes; P < .001) compared with male surgeons. Male surgeons had a higher number of median (IQR) days logged in per month (17.7 [13.8-21.3] vs 15.7 [10.7-19.7] days; P = .03). Female surgeons wrote longer median (IQR) inpatient progress notes (6025.1 [3692.1-7786.7] vs 4307.7 [2808.9-5868.4] characters/note; P = .001) and had increased outpatient document length (6321.1 [4079.9-7825.0] vs 4445.3 [2934.7-6176.7] characters/note; P < .001). Additionally, female surgeons wrote a higher fraction of the notes manually (17% vs 12%; P = .006). After using multivariable linear regression models, male gender was associated with reduced character length for both documentations (regression coefficient, -1106.9 [95% CI, -1981.5 to -232.3]; P = .01) and progress notes (regression coefficient, -1119.0 [95% CI, -1974.1 to -263.9]; P = .01). Male gender was positively associated with total hospital medical records completed (regression coefficient, 47.3 [95% CI, 28.3-66.3]; P < .001). There was no difference associated with gender for time spent in each note, time spent outside of 7 am to 7 pm, or time spent outside scheduled clinic hours. This cross-sectional study of EHR data found that female surgeons spent more time documenting patient encounters, wrote longer notes, and spent more time in the EHR system compared with male surgeons. These findings have important implications for understanding the differential burdens faced by female surgeons, including potential contributions to burnout and payment disparities.

Whom Does Remote Work Make Happy? The Digital Divide in Remote Workers' Well-Being.

The global shift to remote work during the COVID-19 pandemic has intensified scholarly attention to remote workers' well-being. Although existing studies explore the varied impacts of remote work, there is a gap in understanding remote workers' well-being through the lenses of social disparity and the digital divide. Extending digital divide scholarship to the remote work context, this study disentangles why some remote workers experience better well-being than others. We conducted a two-wave longitudinal panel study in South Korea during the COVID-19 pandemic (Wave 1: February 2021, Wave 2: October 2021). Among the 501 participants who participated in both waves, we found that individuals with lower education levels were less likely to have remote work opportunities. We focused our further analyses on a subset of 144 employees who had remote work opportunities within organizations with typical hierarchical structures. We found that socioeconomic status (SES) did not directly influence remote workers' well-being but indirectly influenced it by contributing to the diversity in using information and communication technologies (ICTs). Workers with higher SES or more diversity in using ICTs demonstrated lower vulnerability and more effectiveness in maintaining their well-being in virtual organizational communication situations. This study highlights social disparities in remote workers' well-being, which arise from the complex interplay of SES either indirectly influencing the diversity in ICT usage or interacting with virtual organizational communication satisfaction and duration. This study advances remote work scholarship by restructuring theoretical discussions on social stratification and the digital divide reproduced within the evolving work environment.

A Bayesian Interrupted Time Series framework for evaluating policy change on mental well-being: An application to England’s welfare reform

Factors contributing to social inequalities are associated with negative mental health outcomes and disparities in mental well-being. We propose a Bayesian hierarchical controlled interrupted time series to evaluate the impact of policies on population well-being whilst accounting for spatial and temporal patterns. Using data from the UKs Household Longitudinal Study, we apply this framework to evaluate the impact of the UKs welfare reform implemented in the 2010s on the mental health of the participants, measured using the GHQ-12 index. Our findings indicate that the reform led to a 2.36% (95% CrI: 0.57%–4.37%) increase in the national GHQ-12 index in the exposed group, after adjustment for the control group. Moreover, the geographical areas that experienced the largest increase in the GHQ-12 index are from more disadvantage backgrounds than affluent backgrounds.

Peer Bullying Victimization Trajectories for Sexually and Gender Diverse Youth from Early Childhood to Late Adolescence

Sexually and gender diverse (SGD) youth experience more peer bullying victimization than heterosexual, cisgender youth during adolescence, yet the emergence and persistence of these disparities remain underexplored. Also, it is unclear which factors are associated with these disparities across development, and how these disparities are linked to late adolescent health discrepancies. This study utilized the sample from the Millennium Cohort Study in Britain (N = 10,080; 51.3% assigned female at birth; Mage = 2.28, SDage = 0.46 at Wave 2), in which 23.74% of youth reported non-heterosexual attraction, 21.59% reported non-heterosexual identity, and 1.08% reported gender identity not in line with the sex assigned at birth. Using latent class growth modeling, four peer bullying victimization trajectories were identified, with early peak (7.2%), late childhood peak (6.3%), adolescence onset (12.8%), and low (73.6%) rates of victimization. SGD youth, compared to heterosexual and cisgender youth, were found to have increased odds of being in the victimization-involved classes, especially the adolescence onset class. The study further revealed that SGD youth reported more mental health and relational difficulties in childhood, which were linked to their heightened risk of longer-lasting victimization. Further, long-term victimization was found to partially account for the disparities in health and well-being for SGD youth in late adolescence. In conclusion, SGD youth were more likely to experience longer-lasting bullying victimization during childhood and adolescence, its related mental and relational vulnerabilities were already established in childhood, and such victimization disparities were further linked to their detrimental health and well-being in late adolescence. The design, hypotheses, and target analyses of the current study were preregistered on 21st April 2023 at https://osf.io/f2zxy.

The Role of Family Functionality and Its Relationship with Psychological Well-Being and Emotional Intelligence in High School Students

Adolescence is acknowledged as a critical transition stage in human development, during which factors such as family environment, psychological well-being, and emotional competencies are deemed crucial for optimal growth. Objective: A descriptive study with a quantitative, correlational, and cross-sectional approach was conducted to investigate: (1) how psychological well-being, emotional intelligence, and levels of family functioning are associated with each other; (2) the presence of gender disparities in psychological well-being, emotional intelligence, and family functioning; and (3) the identification of significant differences in psychological well-being and emotional intelligence based on family functioning. Methods: Participants were recruited from six different high schools in Spain. In total, 1092 secondary school students (584 females and 508 males) aged 12–17 years (M = 14.15) completed a series of instruments that were administered in person. Subsequently, data were statistically analysed and processed. Results: A positive correlation between family functioning, psychological well-being, and emotional intelligence was observed. In addition, significant gender differences were found in measures of psychological well-being, emotional intelligence, and family functioning. Finally, higher mean scores were identified for the high-functionality group when compared to the moderate-functionality and severe-dysfunctionality groups in both psychological well-being and emotional intelligence measures. Conclusions: The authors conclude by considering the family context as a key factor in adolescent development and propose future practical applications, such as programmes aimed at improving psychological well-being.

Association of Socioeconomic Characteristics with Health and Well-Being of Rural Older Cambodians.

This study examined the demographic, socioeconomic, health, and well-being of rural-dwelling older Cambodians and identified differentials based on age and gender. The goal is to understand disparities in wealth, health, well-being, and support systems among older adults within the context of Cambodia's history of civil unrest and socio-cultural norms. A regionally representative sample from three northwestern Cambodian provinces was used to evaluate household wealth, economic satisfaction, health, psychological well-being, social support, and a government welfare program. Analysis was conducted to document how these factors differed by age and gender. Significant gender differentials in demographics, well-being, and support systems were observed. Older women outnumbered men and reported lower levels of social support and psychological well-being, potentially influenced by high widowhood rates and gender-linked cultural norms. Education levels were generally low, possibly due to disruption from wars and conflicts. Relative to neighboring countries, the health status of older Cambodians was poor, though no significant gender-based health disparities were identified. There were differences in debt and wealth accumulation among age groups but no variation in welfare support by age or gender. These findings underline the significance of addressing gender disparities and socio-cultural factors affecting older Cambodians. They underscore the need for policy attention toward older women's psychological well-being and support systems, as well as health and social support interventions for the oldest age groups. Future research should investigate these observed patterns, accounting for regional variations and survivor selection bias.

Improving Data Infrastructure for Person-Centered Outcomes Research on Intellectual and Developmental Disabilities.

Individuals with intellectual and developmental disabilities (IDD) continue to experience disparities in health and well-being despite improved provisions of person-centered care. Patient-centered outcomes research (PCOR) translates evidence into practice for meaningful outcomes. This piece describes findings from an environmental scan and stakeholder outreach to identify and prioritize opportunities to enhance IDD PCOR data infrastructure. These opportunities include developing a standardized research definition; advancing data standards for service systems; improving capture of IDD at point of care; developing standardized outcome measures; and encouraging Medicaid data use for IDD research. Within this piece, we discuss the implications of addressing data gaps for enhanced research. While the identified activities provide a path towards advancing IDD PCOR data infrastructure, collaborative efforts between government, researchers, and others are paramount.

A Co-Created Assessment Framework to Measure Inclusive Health and Wellbeing in a Vulnerable Context in the South of Europe.

Rapid urbanisation exacerbates health and wellbeing disparities in vulnerable contexts and underscores the imperative need to develop innovative and participatory co-creation approaches to understand and address the specificities of these contexts. This paper presents a method to develop an assessment framework that integrates top-down dimensions with bottom-up perspectives to monitor the impact of inclusive health and wellbeing interventions tailored to the neighbourhood's needs in Las Palmeras, a vulnerable neighbourhood in Cordoba (Spain). Drawing upon studies in the literature examining urban health and wellbeing trends, it delineates a participatory and inclusive framework, emphasising the need for context-specific indicators and assessment tools. Involving diverse stakeholders, including residents and professionals, it enriches the process and identifies key indicators and assessment methods. This approach provides valuable insights for managing innovative solutions, aligning them with local expectations, and measuring their impact. It contributes to the discourse on inclusive urban health by advocating for participatory, context-specific strategies and interdisciplinary collaboration. While not universally applicable, the framework offers a model for health assessment in vulnerable contexts, encouraging further development of community-based tools for promoting inclusive wellbeing.

How socio-political change is associated with the number of individually reported negative life events: a population-based study using the German reunification 1989/1990 as an example

BackgroundSocio-political change often leads to disruptions in employment and social networks, which can exacerbate health issues and increase mortality rates. These consequences are likely observed as an increase in negative...