This integrative qualitative review examines barriers and facilitators affecting sexual health service access among Asian-born men who are gay, bisexual, or who have sex with men in Australia. Despite advancements in HIV prevention, this group remains under-represented in research and health care, contributing to health disparities. The analysis identified a 'socioecological cascade' where external, structural-level forces such as pervasive stigma and perceived threat of health-related visa requirements are progressively internalised, culminating in individual-level barriers to care. On the positive side, a supportive attitude from the clinic's staff and the connection to the gay community improve access. Findings highlight the need for culturally sensitive outreach, clinician training, and policy reforms.

Objectives. To examine how socioeconomic status (SES) shaped intraracial health disparities among Black women before, during, and after the COVID-19 pandemic. Methods. Using Behavioral Risk Factor Surveillance System data (2018-2023; n = 89 634 Black women), we analyzed temporal trends in self-rated health, days of poor physical and mental health, and SES (education, income, employment). Results. Educational disparities in self-rated health temporarily compressed during the pandemic (health disparity decreased by 3.9%) before partially reexpanding after the pandemic. Income-based physical health disparities persisted: the lowest-income women reported 7.48 poor physical health days before the pandemic versus 2.38 days for highest-income peers. Mental health decreased universally, with lowest-income women reporting 7.00 poor mental health days per year after the pandemic versus 6.09 days before the pandemic. Unemployed women experienced temporary pandemic-period health improvements (b = -2.07; P = .05) Conclusions. Although the pandemic temporarily compressed educational disparities, income and employment-based inequities persisted or widened, underscoring SES as a partial buffer and site of structural health inequality. Public Health Implications. Sustaining pandemic-era protections (expanded health care, income supports) and prioritizing mental health equity are critical to addressing systemic inequities exacerbated by crises. (Am J Public Health. 2026;116(4):502-511. https://doi.org/10.2105/AJPH.2025.308348).

Does aggressive policing worsen infant health disparities? Evidence from 'Stop and Frisk' in New York City.

Physiological regulation is critical for survival. Interoception (the ability to sense internal body state) is a key mechanism by which allostasis (the proactive adjustment of physiological systems) is achieved to maintain physiological stability. Because of the crucial role of the central nervous system in these functions, studying the effects of brain damage can enhance knowledge of these processes. This scoping review synthesises empirical evidence on how stroke affects interoceptive functions and allostatic load (the long-term "cost" to the body of maintaining the internal milieu), and whether these disruptions relate to stroke outcomes, recovery, and specific neural substrates. We reviewed 39 studies examining interoceptive abilities or allostatic load in stroke patients. Only one study assessed allostatic load directly, highlighting a major gap in the literature. Results indicate that stroke frequently impairs interoception across multiple domains, including cardiac and respiratory awareness, affective touch, temperature perception, hunger, and fatigue. These impairments are often linked to poorer functional outcomes, including reduced recovery, cognitive dysfunction, and altered body awareness. Insular and somatosensory lesions were most commonly associated with interoceptive deficits, though lesion mapping was inconsistently reported. Findings from a single study suggest that allostatic load may exacerbate post-stroke cognitive decline and health disparities, particularly in high-risk populations. We conclude that stroke disrupts internal bodily regulation in ways that likely affect recovery trajectories, yet systematic research into the interoceptive and allostatic consequences of stroke is nascent. Future research should prioritise mechanistic studies, standardised assessments, and targeted interventions to address interoception-related physiological dysregulation in stroke rehabilitation.

Despite being one of the largest organized industries in India, the tea plantation sector faces a significant crisis, especially in Assam. The workers, especially women, are some of the most underpaid, exacerbating their marginalization. Through an extensive review of existing literature, this study aims to explore the social disparities experienced by female tea workers, contributing to their health disparities. The article illuminates the urgent need for comprehensive policies aimed at improving their well-being. It explores why, despite assurances of adequate health care under the Tea Plantation Act of 1951, there continues to be a rise in reported diseases among female laborers in Assam's tea gardens. This investigation will not only focus on their health but will also explore various aspects of their lives to fully understand the factors impacting their overall health. The primary objective of the study is to illustrate how labor-particularly "female labor"-in the tea industry is coerced by management to produce surplus value at the expense of their sanitation, hygiene, and health.

Mental health across the lifecourse as predictors of epigenetic aging from a longitudinal birth cohort in the United States.

Maternal health disparities persist globally, including among Sub-Saharan African immigrant women in high-income countries. Many come from contexts where pregnancy, childbirth, and the postpartum period are embedded in communal traditions. In Aotearoa New Zealand, the birthplace of cultural safety, limited research has examined African women's maternity experiences. This study forms part of a midwife-led qualitative exploration of the maternity journeys of women from Sub-Saharan Africa in New Zealand, using interpretive description informed by cultural safety and structural competency. Semi-structured interviews were conducted with eleven women between July 2024 and January 2025. Data were analysed inductively using Braun and Clarke's reflexive thematic analysis. Participants described a repertoire of cultural practices, including herbal and dietary remedies, postpartum rituals, and newborn care customs. Herbal medicine was used to ease labour and promote physiological birth, while cultural nutrition supported recovery and breastfeeding. The extended family played a vital role in postpartum recovery and breastfeeding support. Migration, however, disrupted this communal model, leaving women socially isolated in New Zealand. Participants reported loneliness, lack of family care, and, in some cases, a history of postpartum depression. Despite these challenges, women demonstrated resilience, adapting practices and advocating through transnational family ties and community networks. Participants' cultural practices strongly shape maternity expectations yet often conflict with New Zealand's individualised model of care. Addressing these gaps requires culturally safe, structurally competent maternity models that integrate positive cultural traditions and reduce the risk of isolation. The next phase of this project describes women's clinical maternity care experiences, highlights how structural barriers, misdiagnoses rooted in cultural assumptions, and limited recognition of traditional practices further compromise the delivery of woman-centred care.

More than 740 000 people identified as female at intake were incarcerated globally as of 2022, reflecting a 60% global increase since the year 2000, with a concomitant increase in gynecologic conditions experienced behind bars. The purpose of this scoping review was to examine the breadth of benign and malignant gynecologic conditions experienced during incarceration, including the prevalence, special management considerations, access to services, and the patient experience. The search strategy included a combination of keywords and subject headings for incarceration and benign or malignant gynecologic conditions with no language or date limits. Studies were eligible for the review if they: (i) discussed a benign or malignant gynecologic condition; (ii) included a population of people experiencing incarceration; and (iii) answered one or more of the four key questions identified prior to the search. One researcher independently screened each reference title and abstract for eligibility, and two reviewers independently screened each full text reference. One researcher extracted data from each study using a data extraction template, with verification and consensus by the primary and senior investigators. After screening, 135 studies corresponding to 137 reports from 38 countries were included in the review. Included studies focused on cervical dysplasia and human papilloma virus (56), normal menstruation (38), vaginitis (36), routine gynecologic care (23), abnormal bleeding (17), pelvic pain (13), menopause (8), urinary incontinence (7), and gynecologic malignancy (5) during incarceration. The included studies demonstrate that across the globe, gynecologic conditions in carceral settings are common and can be exacerbated by the physical and emotional stress of incarceration, trauma histories, lack of access to care, and conditions of confinement in these settings. Gaps in the published literature exist on health education and interventions to address gynecologic health disparities and the gynecologic health needs of aging and older adults. There is a pressing need for parallel efforts at global de-carceration and policy interventions to provide for basic gynecologic needs, decrease intersectional stigma, and improve the conditions of confinement.

Tuned In!: 12-month longitudinal outcomes of an affirmative mindfulness intervention for sexual and gender diverse youth and young adults.

Fifteen-year trends in depression symptoms by sex, race, and financial stress among U.S. College Students.

Deaths in jails and prisons are rising, yet the federal government lacks a reliable system to track or prevent them. This essay examines the Department of Justice's failure to implement the Death in Custody Reporting Act and produce accurate and timely data on deaths behind bars. We call for transferring responsibility for carceral mortality monitoring to public health systems with capacity to identify multilevel drivers of death and support interventions that promote prevention and accountability. Shifting this responsibility affirms the value of lives lost and moves surveillance from error-prone, passive recordkeeping to epidemiological systems better equipped to account for how carceral institutions contribute to premature death and population health disparities. Amid political interference and instability in public health, independent scholars must help lead this transition. We outline a path forward focused on strengthening data integrity, improving timely public data access, expanding oversight, and building sustained research infrastructure rooted in public health. Until public health systems are fully empowered, independent scholars, advocates, and journalists remain essential to resisting the erasure of, and holding systems accountable for, preventable deaths behind bars. (Am J Public Health. 2026;116(4):552-560. https://doi.org/10.2105/AJPH.2025.308360).

Lifestyle modification interventions among women with gestational diabetes mellitus (GDM) history have shown to be effective on preventing or delaying the onset of diabetes, however, the differentiating benefits of lifestyle interventions due to socioeconomic inequalities have remained understudied. The Intensive LifeStyle Modification Program (ILSM) was tailored for women with a history of GDM in low-resource rural areas of China. The current study aimed to examine the effect of the ILSM intervention on physiological and behavioral outcomes between subgroups of women from different socioeconomic backgrounds. This study used the baseline, 3-month, 6-month, and 18-month data from a cluster randomized controlled trial in rural women with GDM history in Hunan Province of China. The lifestyle program consisted of a combination of in-person group sessions and telephone consultation sessions on dietary intake, physical activity, and stress management. Using generalized estimating equation, we conducted several subgroup analyses based on indicators of socioeconomic status, including age, ethnicity, income, employment, and education. A total of 320 women were analyzed. The ILSM intervention showed a consistent significance on reducing fasting blood glucose across subgroups. On the contrary, women with full-time employment and high income (≥3000RMB, approximately 425 dollars, per month) were reported to have greater benefits on intentions to eat low-glycemic foods, BMI and waist circumference, and diabetes risk. Women with younger age (≤35 years) or high education (15 years of education or above) were more likely to benefit on improving higher intentions to eat low-glycemic foods and lowering diabetes risk. Interestingly, compared to ethnic majority, ethnic minority women were more likely to increase intentions to eat low-glycemic foods. The ILSM program demonstrated a consistent significance on reducing fasting blood glucose across women from different socioeconomic backgrounds along with an increase of intentions to eat low-glycemic foods for ethnic minority women, despite of showing ineffective in lower socioeconomic status women on intention to have healthy diet, BMI, waist circumference, and diabetes risk. To fully address health disparities from socioeconomic inequalities, lifestyle interventions should be tailored for individuals with older age, lower education levels, and lower income without full-time employment. Chinese Clinical Trial Registry (ChiCTR2000037956), registered on 3rd Jan 2018.

Maternal health disparities persist despite advances in obstetric care and disproportionately affect historically marginalized populations. Quality Improvement (QI) initiatives, including those led by national and state perinatal quality collaboratives, aim to address these disparities; however, sustaining physician engagement in such initiatives remains challenging. This study applies the Tailored Implementation for Chronic Diseases (TICD) framework to identify key determinants influencing physician participation in QI initiatives within obstetric care. A qualitative study was conducted using semi-structured interviews with 24 obstetricians and gynecologists actively engaged in maternal health QI programs across diverse healthcare settings. Participants were selected based on their involvement in QI initiatives. Data were collected between November 2021 and August 2022. Thematic analysis, guided by the TICD framework, categorized facilitators and barriers to engagement, focusing on leadership support, multidisciplinary collaboration, resource availability, and physician motivation. All participants were already engaged in QI; therefore, the study examines determinants of sustained engagement among participating physicians rather than initial participation. Participants described participatory leadership, interdisciplinary collaboration, and patient-centered motivation as key drivers of sustained QI engagement. Supportive organizational culture and clear role expectations facilitated collaboration and resource allocation. While career advancement and financial incentives were relevant, commitment to improving maternal outcomes was the predominant motivator. Reported barriers included limited time, administrative burden, misalignment between QI priorities and clinical workflows, and insufficient training in QI methods. Physicians emphasized the value of longitudinal QI education and flexible, evidence-based guidelines adaptable to local context and patient populations. Findings suggest that sustaining physician involvement in QI may be facilitated by participatory leadership, institutional investment (including protected time), and alignment with physician values and patient-centered priorities. Balancing standardization with adaptability and embedding longitudinal QI education were viewed as important for reducing maternal health disparities and improving implementation.

BackgroundBlood pressure is a major modifiable risk factor for both cardiovascular disease and dementia, yet its relationship with blood-based biomarkers of Alzheimer's disease (AD) and neurodegeneration remains unclear.ObjectiveTo evaluate associations of systolic blood pressure, diastolic blood pressure (DBP), and pulse pressure with plasma biomarkers of AD and neurodegeneration, and to examine whether these associations differ across Non-Hispanic White, Non-Hispanic Black, and Hispanic participants.MethodsParticipants were 2636 cognitively normal older adults enrolled in the Health and Aging Brain Study-Health Disparities. Participants with hypotension or hypertensive crisis were excluded. The outcomes were plasma biomarkers including phosphorylated Tau181, phosphorylated tau217 (p-Tau217), amyloid-β 42 to 40 ratio, neurofilament light chain (NfL), and glial fibrillary acidic protein (GFAP). Adjusted multivariable linear regression models evaluated associations between blood pressure measures and log transformed plasma biomarker concentrations. Additional models examined the American Heart Association blood pressure categories as a predictor.ResultsHigher DBP was associated with lower concentrations of neurodegeneration related plasma biomarkers, including p-Tau217, NfL, and GFAP, after correction for multiple comparisons. Analyses using American Heart Association blood pressure categories demonstrated that stage 1 and stage 2 hypertension were associated with lower GFAP concentrations compared with normal blood pressure, with patterns that were broadly consistent across racial and ethnic subgroups.ConclusionsIn this multi-racial ethnic cohort of cognitively normal older adults without hypotension or hypertensive crisis, higher DBP and clinical blood pressure categories were associated with lower levels of select plasma biomarkers of neurodegeneration (NfL and GFAP).

Understanding Structural Health Disparities: Public Health Lessons from Black College Students During COVID-19.

ABSTRACT Race and ethnicity are commonly examined variables in health research. However, racial and ethnic disparities in health and the systemic mechanisms that generate them remain insufficiently understood. As a result, efforts to reduce these inequalities remain fragmented, and progress toward health equity has been limited. In this article, we discuss four problems that continue to constrain research on and efforts to address racial and ethnic health inequalities: (1) conceptual ambiguity, or inconsistent use of racial and ethnic categories; (2) binary and White-referent logic, which normalizes whiteness and western perspectives; (3) majority-centred health outcomes, which privilege dominant perspectives of health, and (4) Black-box mechanisms, where differences are described but not well explained. We use articles in Ethnic and Racial Studies to illustrate how these problems manifest in published research. Finally, we outline pathways to advance research on race and ethnicity and their relationships to health and broader social outcomes.

With China's rapidly aging population, the oral health of older adults living alone has become a growing concern due to their limited social support and potential health disparities. This study aimed to compare oral health status between Chinese adults aged 65-74 living alone versus those cohabiting with others and identify factors associated with oral health disparities. A cross-sectional analysis utilized data from China's 4th National Oral Health Survey, including 4,406 participants (312 living alone; 4,094 cohabiting). Oral examinations assessed caries, periodontal status, and tooth loss; structured questionnaires captured demographics, socioeconomic status, behaviors, and self-perceived oral health. The survey was conducted according to the basic methods proposed by the World Health Organization (WHO). Older adults living alone (7.1%) showed worse oral health: higher caries prevalence (83.01% vs. 76.26%), more tooth loss (8.26 vs. 6.76), less occluding pairs (6.85 vs. 8.14), lower oral health knowledge scores (5.88 ± 2.51 vs. 6.32 ± 2.31), and worse self-perceived oral health (P < 0.05). Regression confirmed living situation, age, gender, education, income, area, smoking and drinking alcohol as key predictors of oral health outcomes (P < 0.05). Oral health is significantly poorer among Chinese seniors living alone and is significantly associated with socioeconomic and behavioral factors. Targeted interventions-including enhanced social support, financial aid, and oral health education-are urgently needed for this vulnerable group.

Sociodemographic factors influencing COVID-19 vaccine uptake and dropout rates in England.

Stroke is the leading cause of aphasia, disproportionately impacting racially and ethnically diverse populations. With the aging and diversification of the U.S. population, stroke-related aphasia prevalence is expected to rise significantly. This article estimates projected prevalence trends of poststroke aphasia through 2050, focusing explicitly on racial/ethnic differences and contributing social determinants of health (SDOH). This article synthesizes national epidemiological data on stroke prevalence, integrating population projections from the U.S. Census Bureau and public health sources to assess the expected rise in aphasia across racial and ethnic groups. A brief review of literature on SDOH, including socioeconomic status, health care access, and neighborhood factors, is included to contextualize disparities observed in projected aphasia prevalence. The findings demonstrate significant disparities in stroke and aphasia prevalence across different racial and ethnic groups. Specifically, by 2050, poststroke aphasia cases are projected to nearly double, with the Black population expected to have the highest prevalence rate among all racial and ethnic groups. These trends are driven by demographic shifts, including the aging population and racial/ethnic diversification. The findings highlight the need for targeted health care interventions that address disparities rooted in SDOH affecting stroke and aphasia care. Key priorities include expanding culturally responsive speech-language services, improving access to preventive care and poststroke rehabilitation, and supporting high-risk regions like the Stroke Belt. Integrating demographic and SDOH factors into public health planning and workforce development is essential to reduce the growing burden of stroke-related aphasia and prevent deepening health disparities. https://doi.org/10.23641/asha.31141657.

ASO Author Reflections: Eliminating Surgical Oncology Health Disparities Through Actionable Change.