Importance Of Social Determinants Research Articles

Gender and education differences in sedentary behaviour in Canada: an analysis of national cross-sectional surveys

BackgroundCanadians spend the majority of their days sedentary. Gender and education are important social determinants of health that impact health behaviours. There is evidence that gender and educational differences in sedentary behaviour exist. In Canada, while general trends suggest that leisure sedentary activities have changed; there has been no comprehensive assessment examining whether historical changes in sedentary behaviour differ by gender and education level. Our objective was to examine whether gender and educational differences in accelerometer-measured sedentary time and self-reported sedentary behaviours exist among Canadians and if differences are consistent across age groups, over time and across multiple survey sources.MethodsWe summarize amounts of total accelerometer-measured sedentary time and self-reported sedentary activities (e.g., passive travel, television, computer, video games, screen, reading) by age (i.e. children: 6–11 years, youth: 12–17 years, adults: 18–34 years, 45–49 years, 50–64 years, and older adults: ≥ 65 years), gender (girls/women, boys/men) and household education level (< post-secondary vs. ≥ post-secondary) over time in the Canadian Community Health Survey, Canadian Health Measures Survey, General Social Survey, and the Health Behaviour in School-Aged Children study. Gender and education level differences are examined using independent sample t-tests or chi-square analyses.ResultsWhile few differences were found for total accelerometer-measured sedentary time, gender and education differences in self-reported, type-specific sedentary behaviour were identified. Among youth, data from all surveys consistently identified that boys engaged in more video/computer game play (e.g., boys: 0.35–2.68 vs. girls: 0.09–2.15 h/day), while girls engaged in more leisure reading (e.g., boys: 0.45–0.65 vs. girls: 0.71–0.99 h/day). Those with a higher education or household education often reported more leisure reading and passive travel. Education level differences in screen time were often age dependent, with leisure computer use greater in higher education groups in adults only and leisure television watching generally higher in lower education groups in children and adults, but not youth.ConclusionsThis information is valuable as it helps to identify segments of the population which may be at greater risk for engaging in higher volumes of sedentary behaviour. In turn, this information can identify target audiences and behaviours for policies and interventions. Future work is needed to further understand factors contributing to these differences (e.g., preferences, occupation, family structure).

Major Depression and Stigma among Individuals with Multidrug-Resistant Tuberculosis in South Africa.

Stigma is an important social determinant of health-seeking behavior; however, the nature and extent of its association with depression among people living with multidrug-resistant tuberculosis (MDR-TB) are not well-understood. We enrolled 200 microbiologically confirmed MDR-TB inpatients at a TB specialist hospital in KwaZulu-Natal Province, an area considered the epicenter for MDR-TB coinfection in South Africa. Four aspects of stigma and their association with major depression were assessed through individual interviews: 1) community and 2) patient perspectives toward TB, and 3) community and 4) patient perspectives toward HIV. A major depressive episode (MDE), HIV coinfection, and low income were significantly associated with greater stigma subscales. Based on an adjusted regression model, the MDE was the only factor independently associated with (all aspects of) stigma. These results indicate the potential utility of addressing stigma associated with the MDE as an important step in improving health-seeking behavior to promote adherence and retention in care.

Importance of Housing and Cardiovascular Health and Well-Being: A Scientific Statement From the American Heart Association.

Cardiovascular disease disparities are shaped by differences in risk factors across racial and ethnic groups. Housing remains an important social determinant of health. The objective of this statement is to review and summarize research that has examined the associations of housing status with cardiovascular health and overall health. PubMed/Medline, Centers for Disease Control and Prevention data, US Census data, Cochrane Library reviews, and the annual Heart Disease and Stroke Statistics report from the American Heart Association were used to identify empirical research studies that examined associations of housing with cardiovascular health and overall well-being. Health is affected by 4 prominent dimensions of housing: stability, quality and safety, affordability and accessibility, and neighborhood environment. Vulnerable and underserved populations are adversely affected by housing insecurity and homelessness, are at risk for lower-quality and unsafe housing conditions, confront structural barriers that limit access to affordable housing, and are at risk for living in areas with substandard built environment features that are linked to cardiovascular disease. Research linking select pathways to cardiovascular health is relatively strong, but research gaps in other housing pathways and cardiovascular health remain. Efforts to eliminate cardiovascular disease disparities have recently emphasized the importance of social determinants of health. Housing is a prominent social determinant of cardiovascular health and well-being and should be considered in the evaluation of prevention efforts to reduce and eliminate racial/ethnic and socioeconomic disparities.

Housing insecurity and intersecting social determinants of health among transgender people in the USA: A targeted ethnography

Background: Housing is an important social determinant of health (SDOH). Transgender people face a unique blend of discrimination and compromised social services, putting them at risk for housing insecurity and associated public health concerns.Aims: This targeted ethnography explores housing insecurity as a SDOH among transgender people in the U.S.Methods: In-depth interviews were conducted with transgender people (n = 41) throughout the U.S.A., identified through purposive sampling. A semi-structured guide was used to elicit personal stories and peer accounts of insecure housing experiences and coping strategies. Interviews were audio recorded and transcribed. Data was coded, sorted, and analyzed for key themes.Results: Responses revealed pervasive housing insecurity and inter-related challenges. Respondents discussed how intersecting identities create unique constellations of vulnerability, which “intersect like a star.” Financial insecurity and interpersonal rejection were lead housing insecurity causes, often resulting in psychological strain, which was sometimes addressed with substances and sexual risk-taking. These factors were cyclically accompanied by financial and employment insecurity and a cascade of unmet social needs. Social support facilitated coping.Discussion: Findings support increasing transgender housing security intervention resources that address intersecting and cyclical discrimination, trauma, housing, employment, and health issues.

Hispanic/Latino heritage group disparities in sleep and the sleep-cardiovascular health relationship by housing tenure status in the United States

ObjectivesThe objective of this study was to investigate whether the sleep-cardiovascular health (CVH) association varies by Hispanic/Latino heritage group and housing tenure status (i.e., homeownership, unassisted housing, government-assisted housing), which is an important social determinant of health. DesignCross-sectional analysis of pooled National Health Interview Survey (2004-2017) data. SettingUnited States. ParticipantsUS-born/non–US-born Mexican, Puerto Rican, Cuban, Dominican, Central/South American, and US-born non-Hispanic (NH)-white adults. MeasurementsWithin each housing tenure category, Poisson regressions with robust variance estimated the adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) of (1) habitual sleep duration (<6-hours, 6-<7-hours, and >9-hours vs. 7-9 hours) and sleep quality for Hispanic/Latino heritage groups compared with NH-whites and (2) ideal CVH for Hispanic/Latino heritage groups within each sleep duration category, separately, compared with NH-whites who reported 7-9 hours sleep duration. ResultsAmong 283,767 NH-white and Hispanic/Latino adults (mean age=47.0±0.09 years, 50.1% female), 33% rented housing (4% government-assisted; 29% unassisted), and 67% were homeowners. Compared with their NH-white housing tenure counterparts, only Puerto Rican homeowners were more likely to report <6-hours (PR=1.70 [95% CI: 1.44-2.01]) and 6-<7-hours (PR=1.31 [1.19-1.44]) sleep duration. Overall, Hispanic/Latino heritage groups were either less likely or no more likely to report >9-hours sleep duration and poor sleep quality compared with NH-whites. Disparities in CVH were large between Puerto Rican unassisted renters and homeowners who reported >9-hours of habitual sleep compared with their NH-white housing tenure counterparts who reported 7-9 hours. ConclusionsHispanic/Latino-white disparities in the sleep-CVH relationship may vary by Hispanic/Latino heritage group and housing tenure.

Full-Service Twin Cities Mobile Market Impact: Qualitative Findings From Focus Groups With Customers

BackgroundCreative solutions are required to mitigate poor food access and related health disparities in underserved, at-risk populations because healthy food access is an important social determinant of health. Mobile markets (ie, mobile grocery stores) present a potential solution to mitigate poor food access and related health disparities. However, no research has yet evaluated the impact of a full-service mobile market that sells healthy items from all food groups and pantry staples in underserved communities. ObjectiveTherefore, the objective of this focus group research study was to inductively understand the impact of the full-service, Twin Cities Mobile Market, a mobile grocery store, that visits underserved, low-income communities. DesignQualitative focus group research. Participants/settingFour moderated and audio-recorded, qualitative focus groups with customers (n = 29) were held in community rooms at mobile market stops. AnalysisFocus group transcripts were analyzed using Krueger’s systematic analysis process and content analysis to discover major categories and themes and subthemes within the categories. ResultsFindings indicate the full-service mobile market may facilitate purchase and eating of healthy foods through decreasing barriers and increasing access to quality, affordable healthy foods. Findings also indicate mobile market shopping may positively influence customer behaviors and health outcomes (eg, dietary intake and management of weight, diabetes, blood pressure, and mental health). ConclusionsOur results provide support for the potential impact of full-service mobile markets, encouraging continued mobile market service and future rigorous research on the effectiveness of the full-service mobile market model.

Telehealth and indigenous populations around the world: a systematic review on current modalities for physical and mental health.

Approximately 370-500 million Indigenous people live worldwide. While Indigenous peoples make up only 5% of the world's population, they account for 15% of the extreme poor and have life expectancy that is 20 years shorter than that of non-Indigenous people. Access to healthcare has been identified as an important social determinant of health and key driver of health outcomes. Indigenous populations often face barriers to accessing healthcare including living in remote areas, lacking financial resources, and having cultural differences. Telehealth, the utililzation of any synchronous modality, including phone, video, or teleconferencing technology used to support the provision of long-distance health care and health education, is a feasible and cost-effective treatment delivery mechanism that has successfully addressed access barriers faced by vulnerable populations globally, however, few studies have included indigenous populations and the application of this technology to improve physical and mental health outcomes. This systematic review aims to identify trials that were conducted among Indigenous adults, and to summarize the components of interventions that have been found to effectively improve the health of Indigenous peoples. The PRISMA guidelines for reporting of systematic reviews were followed in preparing this manuscript. Studies were identified by searching PubMed, Scopus, and PsychInfo databases for clinical trial articles on Indigenous peoples and mental and physical health, published between January 1, 1998 and December 31, 2018. Eligibility criteria for determining studies to include in the analysis were as follows: (I) ≥18 years of age; (II) indigenous peoples; (III) any technology-based intervention; (IV) studies included at least one of the following mental health (depression, post-traumatic stress disorder, suicide) and physical health (mortality, blood pressure, hemoglobin A1C, cholesterol, quality of life) outcomes; (V) clinical trials. A total of 2,662 articles were identified and six were included in the final review based on pre-specified eligibility criteria. Three were conducted in the United States, one study was conducted in Canada, and two were conducted in New Zealand. Study sample sizes ranged from 20 to 762, intervention delivery times ranged from three to 20 months and utilized telephone, internet and SMS messaging as the type of technology. There is a paucity of evidence on the use of telehealth programs to increase access to chronic disease programs in Indigenous populations. This review highlights the importance of culturally tailoring programs despite the modality in which they are delivered, and recommends telephone-based delivery facilitated by a trained health professional. Telehealth has great promise for meeting the health needs of highly marginalized Indigenous populations around the world, however, at this point more research is needed to understand how best to structure and deliver these programs for maximum effect.

Gender awareness among medical students in a Swiss University

BackgroundGender is an important social determinant, that influences healthcare. The lack of awareness on how gender influences health might lead to gender bias and can contribute to substandard patient care. Our objectives were to assess gender sensitivity and the presence of gender stereotypes among swiss medical students.MethodsA validated scale (N-GAMS – Nijmegen Gender Awareness in Medicine Scale), with 3 subscores assessing gender sensitivity (GS) and gender stereotypes toward patients (GRIP) and doctors (GRID) (ranging from 1 to 5), was translated into French and was distributed to all medical students registered at the University of Lausanne, Switzerland in April–May 2017. Reliability of the three subscales was assessed calculating the alpha Cronbach coefficient. Mean subscales were calculated for male and female students and compared using two sample t-tests. A linear model was built with each subscale as a dependent variable and students’ sex and age as covariables.ResultsIn total, 396 students answered the N-GAMS questionnaire, their mean age was 22 years old, 62.6% of them were women. GS and GRID sub-scores were not significantly different between female and male students (GS 3.62 for women, 3.70 for men, p = 0.27, GRID 2.10 for women, 2.13 for men, p = 0.76). A statistically significant difference was found in the GRIP subscale, with a mean score of 1.83 for women and 2.07 for men (p < 0.001), which suggests a more gender stereotyped opinion toward patients among male students. A trend was observed with age, gender sensibility increased (p < 0.001) and stereotypes decreased (GRIP p = 0.04, GRID p = 0.02) with students getting older.ConclusionMedical students’ gender sensitivity seems to improve throughout the medical curriculum, and women students have less stereotypes towards patients than men do. The implementation of a gender-sensitive teaching in the medical curriculum could improve students’ knowledge, limit gender bias and improve patients’ care.

How Has Early Marriage, a Critical Social Determinant of Child Stunting and Wasting, Changed over a Decade in South Asia? Trends, Inequities and Drivers, 2005 to 2018

Abstract Objectives In South Asia, many women are married before their 18th birthday and give birth soon after. Delaying marriage is an attractive nutrition policy target as previous research shows that early marriage (EM) is associated with poor child growth outcomes, operating through many pathways. We sought to describe the prevalence, trends, inequities and predictors of EM in South Asia. Methods We used Demographic and Health Survey data available in the last 15 years for 7 South Asian countries: Afghanistan (AF; 2015), Bangladesh (BG; 2007, 2014), India (IN; 2006, 2016), Maldives (MV; 2009, 2017), Nepal (NP; 2005, 2016), and Pakistan (PK; 2007, 2018). EM was defined as the percentage of women aged 20–24 years who were married before 18 years of age. Our analyses included 133,680 women. The prevalence and absolute burden in terms of number of individuals affected were estimated for each survey round. Relative trends were examined using average annual rate of reduction (AARR). Inequities were examined by geography, wealth, place of residence, and education. Regression decomposition was used to examine the contribution of improvements in wealth and education to EM reductions. Results The most recent rounds of data show that EM is common in BG (69%), AF (52%), NP (52%), IN (41%), and PK (37%) but not MV (4%). IN accounts for 68% of the regional burden, with 21.9 million women married early in 2016. The fastest reductions in EM have occurred in IN (59% to 41% over 10 years, an AARR of −3.8% per year), PK (−2.8% per year), and BG (−1.5% per year). EM prevalence varies subnationally, e.g., from 5% to 52% for states within IN in 2016. Equity analysis shows that EM disproportionately burdens women who are poor, uneducated, and live in rural areas. Progress in narrowing these inequalities has been slow in the past decade. When examining predictors of EM, completion of secondary school was associated with a 20% (PK) to 36% (NP) lower EM prevalence. Decomposition analysis shows that improvements in wealth and education alone predicted between 46% (PK) and 96% (NP) of the actual EM reduction. Conclusions EM remains highly prevalent in South Asia and trends indicate an enduring problem. The nutrition community should invest in building linkages with researchers and practitioners to further understand and address this important social determinant of poor child growth. Funding Sources A4NH/IFPRI.

Cardiovascular Health in American Indians and Alaska Natives: A Scientific Statement From the American Heart Association.

Cardiovascular disease (CVD) is the leading cause of death among American Indians and Alaska Natives. Over the past 50 years, the prevalence of CVD has been rising among American Indians and Alaska Natives. The objective of this statement is to summarize population-level risk factors and management techniques tailored for the American Indian and Alaska Native populations. PubMed/MEDLINE, the Centers for Disease Control and Prevention, and the annual Heart Disease and Stroke Statistics report from the American Heart Association were used to identify risk factors and interventions specific to American Indians and Alaska Natives. Diabetes mellitus is a major contributor to disproportionately higher rates of coronary heart disease among American Indians and Alaska Natives compared with other racial and ethnic groups. Additional risk factors for CVD include low-density lipoprotein cholesterol levels, hypertension, renal disease, age, and sex. Smoking and exposure to toxic metals are risk factors for some subpopulations. A quarter of American Indians live below the federal poverty line, and thus, low socioeconomic status is an important social determinant of cardiovascular health. Community-based interventions have reduced CVD risk in American Indians and Alaska Natives. Underreporting of American Indian and Alaska Native race could underestimate the extent of CVD in this population. Prevention and treatment of CVD in American Indians and Alaska Natives should focus on control of risk factors and community-based interventions that address social determinants of health, particularly among individuals with diabetes mellitus. Accurate reporting of race/ethnicity is encouraged to address race-specific risk factors.

Gender and psychological well-being in older adults.

Gender is an important social determinant of health, but gender has played only a marginal role in the geriatric and gerontology research and practice. The aim of this study was to examine the relevance of gender to the psychological well-being of older adults. A cross-sectional study was conducted. The study was carried out in Spain. A total of 1,201 people aged between 65 and 94. The participants completed sociodemographic data and four questionnaires: The Bem sex role inventory, the Ryff's psychological well-being scale, the York self-esteem inventory, and the Social support scale. Men scored higher than women in self-acceptance, autonomy, purpose in life, and environmental mastery. Hierarchical multiple regression analyses showed that, although the most important predictors of psychological well-being in both women and men were self-esteem and social support, both masculine/instrumental and feminine/expressive traits were associated with higher psychological well-being, although the effect size was higher for the masculine/instrumental trait. Furthermore, education was associated with psychological well-being in the case of females. Gender plays an important role in the psychological well-being of older adults. The results of this research are relevant for healthcare providers and policy-makers interested in promoting successful aging and increasing the well-being of older people.

Inequalities in birth weight and maternal education: a time-series study from 1996 to 2013 in Brazil

Maternal education represents one of the most important social determinants of inequality in birth weight (BW) in developing countries. The present study sought to investigate secular trends in health inequality considering the difference in mean BW between extremes of maternal educational attainment in Brazil. Using a time-series design, data from 6,452,551 live births which occurred in all Brazilian state capitals from 1996 to 2013 were obtained from the Information System on Live Births. Secular trends of the difference in mean birth weight between low (<8 years of schooling) and high (≥12 years of schooling) educational attainment were analyzed. The main finding was that differences in mean birth weight between the two extremes of maternal educational attainment decreased over time. There was a significant decrease in mean BW in neonates born to mothers with higher educational attainment, and a slight increase in those born to mothers with lower educational attainment. One of the key factors involved in decreasing inequality was an increase in the number of antenatal visits. In view of these results, we conclude, that despite a slight increase of mean birth weight among mothers with low education, the reduction of inequality in pregnancy outcomes over time in Brazil is attributable to a worsening scenario for mothers who are better off rather than to improvements for the most vulnerable group of mothers.

Domestic Violence and Safe Storage of Firearms in the COVID-19 Era.

Domestic Violence and Safe Storage of Firearms in the COVID-19 Era.

M231. INTERNALIZED STIGMA AS A PREDICTOR OF EMPLOYMENT STATUS IN PATIENTS WITH SCHIZOPHRENIA

BackgroundEmployment is an important social determinant of health, especially for individuals with mental illnesses where it was found that gainful employment is crucial for both functional and clinical recovery. However, individuals with mental illnesses face significantly higher levels of unemployment compared to their counterparts without. Within different diagnoses of mental illnesses, it was found that patients with schizophrenia face higher levels of unemployment compared to patients with other diagnoses. Numerous qualitative studies have identified an association between internalized stigma and unemployment in individuals with schizophrenia, however, fewer quantitative studies have examined the specific relationship between the two factors. Therefore, we aim to elucidate the relationship between employment status and internalized stigma, and more specifically, its domains in patients with schizophrenia.MethodsOne hundred and seventy-nine patients with schizophrenia were included in this study. Illness severity was assessed using the Clinical Global Impression scale, internalized stigma was measured using the Internalized Stigma of Mental Illness scale (ISMI), and demographic information including employment status was collected. For the purpose of analysis, employment status was categorised into two groups, with the employed group consisting of those under full-time and part-time employment, as well as full-time students. While the unemployed group consisted of individuals who were unemployed at the time of assessment. The ISMI assesses five domains of internalized stigma, which are alienation, stereotype endorsement, discrimination experience, social withdrawal and stigma resistance. Multiple logistic regression, controlling for demographic and clinical factors, was conducted to identify the domains of internalized stigma associated with predictors of employment status.ResultsOne hundred and two participants were employed and seventy-seven were unemployed. The employed group was younger, had shorter duration of illness, more years of education and less severe illness level (all p < .001). The unemployed group consisted of more females and divorced individuals (all p < .05). The unemployed group reported significantly higher levels of internalized stigma in the total score, as well as stereotype endorsement, discrimination experience, and social withdrawal domains (all p < .05). Mean total ISMI scores for employed and unemployed groups were 62.15 (SD = 13.69) and 67.52 (SD = 13.94) respectively. Multiple logistic regression analysis, controlling for demographic and clinical factors, found that years of education (OR = 0.835, p < .05), and two domains of the internalised stigma scale, stereotype endorsement (OR = 1.210, p < .05) and stigma resistance (OR = 0.854, p < .05), were associated with employment status.DiscussionMore years of education and higher level of stigma resistance were found to be associated with being employed, suggesting that stigma resistance along with education may play protective roles in both obtaining and sustaining employment in patients. Higher level of stereotype endorsement was found to be associated with being unemployed, suggesting that patients who agree with the stereotypes about mental illness may face greater difficulties in gaining and sustaining employment. Hence, tailored interventions focused on specific domains of internalized stigma may be crucial components of any services targeted at improvement of occupational functioning in patients with schizophrenia.

Intersection of Migration and Access to Health Care: Experiences and Perceptions of Female Economic Migrants in Canada.

More people are migrating than ever before. There are an estimated 1 billion migrants globally—of whom, 258 million are international migrants and 763 million are internal migrants. Almost half of these migrants are women, and most are of reproductive age. Female migration has increased. The socioeconomic contexts of women migrants need investigation to better understand how migration intersects with accessing health care. We employed a focused ethnography design. We recruited 29 women from three African countries: Ghana, Nigeria, and South Africa. We used purposive and convenient sampling techniques and collected data using face-to-face interviews. Interviews were audio-recorded and transcribed verbatim. Data were analyzed with the support of ATLAS.ti 8 Windows (ATLAS.ti Scientific Software Development GmbH), a computer-based qualitative software for data management. We interviewed 10 women from both South Africa and Ghana and nine women from Nigeria. Their ages ranged between 24 and 64 years. The four themes that developed included social connectedness to navigate access to care, the influence of place of origin on access to care, experiences of financial accessibility, and historical and cultural orientation to accessing health care. It was clear that theses factors affected economic migrant women’s access to health care after migration. Canada has a universal health care system but multiple research studies have documented that migrants have significant barriers to accessing health care. Most migrants indeed arrive in Canada from a health care system that is very different than their country of origin. Access to health care is one of the most important social determinants of health.

Association between Living with Children and the Health and Health Behavior of Women and Men. Are There Differences by Age? Results of the "German Health Update" (GEDA) Study.

Does the health of women and men living with and without minor children differ, and are age differences evident in the association? For self-rated general health, depression, back pain, overweight, smoking and sporting inactivity, the GEDA data 2009–2012 (18–54 years, n = 39,096) were used to calculate prevalence for women and men stratified by parental status (living with children: yes/no) and age. Moreover, we calculated odds ratios and predictive margins, performing logistic regressions with interaction terms of parental status and age. Women and men aged 45–54 living with children are healthier than those not living with children. Parents aged 18–24 smoke more frequently and do less sport; young mothers are also more likely to be overweight and suffer from back pain than women not living with children. In multivariable analysis, the interaction of living with children and age is significant for all outcomes (except depression and back pain in men). Living with children is an important social determinant of health, highly dependent on age. It is to be discussed whether the bio-psycho-social situation has an influence on becoming a parent, or whether parenthood in different phases of life strains or enhances health.

Gender, justice and empowerment: creating the world we want to see

Gender is one of the most important social determinants of health. Considerable research has shown that power imbalances due to gender and sexual orientation lead to numerous negative health outcom...

Associations between perceived everyday discrimination, discrimination attributions, and binge eating among Latinas: results from the National Latino and Asian American Study

PurposeThe aim of the study was to quantify the association between perceived everyday discrimination and binge eating among Latinas in the United States. MethodsParticipants included 1014 Latinas from the 2002–2003 National Latino and Asian American Study. Modified Poisson models with robust standard errors were used to estimate sociodemographic-adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) of binge eating associated with overall and attribution-specific discrimination. ResultsApproximately 7% of Latinas reported binge eating. Increased frequency of discrimination was associated with a higher prevalence of binge eating (aPR, 1.59; 95% CI, 1.23–2.06), and Latinas reporting frequencies of discrimination in the top tertile had the greatest prevalence elevation (aPR, 3.63; 95% CI, 1.32–10.00). There were important differences by discrimination attribution: Latinas experiencing primarily height/weight-based or skin color–based discrimination had the greatest prevalence elevation relative to those reporting no discrimination (aPR, 10.24; 95% CI, 2.95–35.51; and aPR, 8.83; 95% CI, 2.08–37.54, respectively), whereas Latinas reporting primarily race-based discrimination had the lowest prevalence elevation (aPR, 1.64; 95% CI, 0.47–5.69). ConclusionsDiscrimination may be an important social determinant of Latinas’ binge eating. Future research should incorporate expanded conceptual models that account for Latinas' complex social environment, focusing on intersecting dimensions of identity.

Social Determinants of Pregnancy-Related Mortality and Morbidity in the United States: A Systematic Review.

To synthesize the literature on associations between social determinants of health and pregnancy-related mortality and morbidity in the United States and to highlight opportunities for intervention and future research. We performed a systematic search using Ovid MEDLINE, CINAHL, Popline, Scopus, and ClinicalTrials.gov (1990-2018) using MeSH terms related to maternal mortality, morbidity, and social determinants of health, and limited to the United States. Selection criteria included studies examining associations between social determinants and adverse maternal outcomes including pregnancy-related death, severe maternal morbidity, and emergency hospitalizations or readmissions. Using Covidence, three authors screened abstracts and two screened full articles for inclusion. Two authors extracted data from each article and the data were analyzed using a descriptive approach. A total of 83 studies met inclusion criteria and were analyzed. Seventy-eight of 83 studies examined socioeconomic position or individual factors as predictors, demonstrating evidence of associations between minority race and ethnicity (58/67 studies with positive findings), public or no insurance coverage (21/30), and lower education levels (8/12), and increased incidence of maternal death and severe maternal morbidity. Only 2 of 83 studies investigated associations between these outcomes and socioeconomic, political, and cultural context (eg, public policy), and 20 of 83 studies investigated material and physical circumstances (eg, neighborhood environment, segregation), limiting the diversity of social determinants of health studied as well as evaluation of such evidence. Empirical studies provide evidence for the role of race and ethnicity, insurance, and education in pregnancy-related mortality and severe maternal morbidity risk, although many other important social determinants, including mechanisms of effect, remain to be studied in greater depth. PROSPERO, CRD42018102415.

A Qualitative Analysis of Social Determinants of Entrepreneurship Success (Thematic Analysis)

This study has been conducted to explore the important social determinants of entrepreneurship success. Families’ involvement is crucial for entrepreneurship success. The myth is prevailed in our society as successful life is to be opened as to secure a position in public or private sector. Social determinants are not discussed in detail before. To know what social determinants are important to equip success in business? Qualitative exploratory case study method (Yin. K, 2014) was used to explore social determinants in detail. Field notes were taken on note book with pencil and interviews were recorded personally by the researcher himself and these field notes and data were transcribed to document the important patterns and themes. Thematic analysis was applied to the data for analysis purpose. Findings of the study depicted that family business involve in entrepreneurial intention, role model provide supportive material, family financial help, prior business experience, entrepreneurship knowledge and understanding, were the important determinants of entrepreneurship success.At the end of the paper it was suggested that entrepreneurship training must be provided by the government institution and universities must induct degree program in entrepreneurship. Seminars and conferences on entrepreneurship awareness must be organized by nongovernmental organizations with the collaboration of government agencies and institutions.