Inequalities In Access Research Articles

Global Knowledge Inequality from AI-driven Media: A Study Based on Knowledge Acquisition Dilemmas in Developing Countries

In the era of rapid globalization and informatization, AI-driven media is profoundly transforming how information is disseminated. However, using AI algorithms in the media has introduced new disparities in knowledge access, especially impacting developing countries. To recognize these challenges, the paper aims to explore the global knowledge inequality in the age of AI-driven media: challenges for developing countries. The study focused on AI-driven media users in developing countries and adopted a qualitative analysis approach based on literature review. The article commences with a definition of AI-driven media and knowledge, examines the status of knowledge inequality under AI-driven media, and discloses the potential factors of knowledge inequality in developing countries under AI-driven media from three aspects: (1) capital control and AI technology monopoly in developed countries, (2) conflict between mainstream consciousness and social and cultural diversity, and (3) the impact of algorithms on individual self-awareness. This paper finds that AI-driven media often exacerbate existing inequalities of information and knowledge access in developing countries due to capital controls, cultural dominance, algorithmic bias, recommendations in developing countries, etc. Without key interventions, AI-driven media could further exacerbate the knowledge gap

Feasibility of home blood pressure screening in the paediatric outpatient clinic setting

ObjectiveThe aim of this study was to evaluate the acceptability and feasibility of home-based blood pressure (BP) screening in a group of paediatric patients with known elevated risk of developing...

High Schools' Role in Promoting Equity for Multilingual Learners' Access to College

AbstractHigh school plays a pivotal role in preparing students for college. Accordingly, a large body of research examines how high schools shape general education students' postsecondary options. However, there is a dearth of research on high schools' role in promoting multilingual learners' (MLs) college access. MLs' educational experiences differ from those of other minoritized students because MLs are still developing English language proficiency while also learning academic content. It is thus important to examine high schools' role in shaping MLs' postsecondary pathways. Adopting a multisite qualitative case study approach and an ecology of equity framework, we compare the policies and practices of two Massachusetts public high schools that both successfully expanded MLs' postsecondary options but in different ways. We argue that expanding equity in MLs' college access looks very different depending on the context of schools and the socioeconomic circumstances and the immigration status of the students they serve. Sending many MLs to 4‐year colleges need not be the only measure of success; expanding MLs' awareness of other postsecondary options and helping them choose a path that is aligned with their goals is also a valid approach to equity.

Gtfswizard: a set of tools for exploring and manipulating general transit feed specification in R language

The public transport system is fundamental to sustainable urban mobility, offering cost-effectiveness, scalability, and environmental benefits while addressing equity challenges. This study identifies a research gap in existing tools for General Transit Feed Specification (GTFS) data analysis, which often lack integration, usability, and flexibility for comprehensive transit planning. In response, GTFSwizard is developed, a R package that facilitates exploration, and manipulation of GTFS feeds. To demonstrate its potential, a case study in Fortaleza, Brazil, evaluates interventions designed to enhance accessibility equity. The interventions, which include bus corridors, optimized boarding, and increased frequency, were tested exclusively using GTFSwizard, which, with simple functions, allowed the analysis and modification of GTFS data as well as the estimation of accessibility. Results showed an 18% reduction in the number of individuals under critical accessibility levels, a reduction in accessibility inequity, and operational efficiency gains, including a 2.7% reduction in required fleet size and a slightly increase of 0.35% in vehicle-kilometer traveled. The ease with which the scenarios are generated highlights the package's ability to perform GTFS analysis and manipulation in a simple and unified manner.

“I think we're on a cusp of some change:” coping and support for mental wellness among Black American women

IntroductionPublic discussions in the media (e.g., social media and reality shows) about Black women's mental health have become more common. Notably, celebrities have become more vocal about their own mental health challenges and sought to normalize seeking care. This study aimed to gain a better understanding of Black women's: (1) past and current causes of stress, anxiety, and depression, and coping skills used; (2) their attitudes and perceptions toward mental health and receiving mental health treatment; and (3) times in their life they felt anxious or depressed, and what type of support or resources would have been helpful to have access to.MethodsFocus groups were conducted with 20 women (mean age 36.6 years, SD 17.8 years), with 5 participants per group. Descriptive qualitative content analysis of the focus group transcripts was conducted.ResultsResults consistently showed that intersectional identities of being both Black and a woman resulted in feelings of both hypervisibility and invisibility, representation matters when it comes to mental health providers, an increased openness to therapy across age groups, and a willingness to try digital health tools (e.g., smartphone app) for mental health needs. There is still work to be done to normalize mental health treatment among Black women.DiscussionSubgroups within the community (e.g., young adults) have less stigma around mental health and are acting as catalysts for change. Intentional inclusion of Black women in mental health research and evolving treatment paradigms is important to eliminate inequities in access to culturally relevant mental health care.

Diet Quality, Healthy Dietary Restrictions, and Adherence to the Mediterranean Diet in Food Deserts Among the Elderly in Spain

Background/Objectives: Food deserts are areas characterized by limited access to affordable and healthy food, often due to significant distances from supermarkets—exceeding 1.6 km in urban areas and 16 km in rural settings. These spatial limitations exacerbate health and socioeconomic disparities. This study aimed to assess diet quality and explore the barriers influencing dietary behaviors among individuals aged 60 and older residing in food deserts in Aragón, Spain. Methods: An exploratory qualitative study using a phenomenological approach was conducted, complemented by descriptive analyses of sociodemographic data and adherence to the Mediterranean diet, assessed through the PREDIMED questionnaire. Data were collected through in-depth interviews and a focus group with residents of food deserts. Results: Half of the participants showed high adherence to the Mediterranean diet, while the other half had moderate adherence. Despite the lack of access to supermarkets and higher food costs, many participants perceived their diet quality positively. Challenges, such as long distances to stores, limited public transport, and economic constraints, were mitigated through strategies like home gardening, hunting, and traditional cooking, which often reduced reliance on processed foods. However, participants also reported increased alcohol consumption as a means of socializing. Conclusions: Diet quality in Aragón’s food deserts reflects a balance between significant access barriers and community-driven resources. While participants leveraged local strategies to maintain diet quality, systemic issues remain. Public policies should focus on improving transportation, enhancing local food systems, and fostering community-based initiatives to reduce inequalities in food access and promote healthier dietary habits in rural areas.

Application of the Blended Learning Approach in Developing Student Character in the Digital Era of the 21st Century

In the digital era of the 21st century, the development of information and communication technology has had a significant impact on the world of education, opening up more flexible learning spaces through online platforms. Learning that is no longer limited to the classroom, utilizes blended learning—a combination of face-to-face and online learning—to accommodate the needs of developing 21st century skills such as critical thinking, creativity, and collaboration. This study aims to explore the application of the blended learning approach in student character development, focusing on values such as responsibility, discipline, and cooperation. The method used is a literature study, reviewing various previous studies related to blended learning and character education. The results of the study show that blended learning can strengthen students' character education, by providing opportunities for them to be more independent in managing learning and engaging in collaborative activities. However, the main challenges faced are the inequality of access to technology and the limitations of digital literacy which can affect the effectiveness of this method. Therefore, an education policy that supports equal access and increased digital literacy is needed to optimize the implementation of blended learning.

Simulated retail food environments: A literature review of systems science approaches to advance equity in access to healthy diets.

As researchers increasingly utilize systems science simulation modeling (SSSM), little is known about how and by whom SSSMs are being leveraged to address inequities in access to healthy diets. We evaluated the extent to which studies (n = 66) employing SSSM to examine retail food environments (RFEs): included three pillars of equity (social position, human capital, socioeconomic and political context) that shape RFEs and access to healthy diets; grounded model design and development in theory; engaged with diverse stakeholders and lived experiences related to RFEs; and translated model findings towards addressing inequities in RFEs. Most studies (n = 58) included some model characteristics related to social position (e.g., age). Characteristics related to human capital (e.g., meal planning skills) were the least integrated fundamental pillar (n = 15). All studies included some characteristics related to socioeconomic and political context; however, we found little to no incorporation of social contexts (e.g., cultural and societal norms). Regarding model design and development, less than one-third of studies specified theoretical frameworks or engaged with local domain experts and stakeholders. While certain research objectives and, consequently, model types lend themselves better than others to address key pillars that influence RFEs, findings show that models are not fully leveraging SSSMs to analyze the multiple, interacting dimensions - particularly social phenomena - influencing equity in access to healthy diets. Greater attention to engaging stakeholders and the role of human capital and social contexts will likely better equip models to more holistically examine equitable food access, including essential pathways and unintended consequences of programs and policies.

Improving the Prioritization of Heart Transplantation Candidates for Optimal Clinical Outcomes: A Narrative Review.

This narrative review evaluates the limitations of current heart transplantation allocation models, which prioritize medical urgency and waitlist time but fail to adequately predict long-term post-transplant outcomes. It aims to identify advanced metrics that can strengthen the prioritization framework while addressing persistent racial, geographic, and socioeconomic inequities in access to transplantation. Recent research indicates that incorporating frailty, nutritional status, immunological compatibility, and pulmonary hemodynamics into allocation frameworks can enhance the prediction of transplant outcomes. The growing use of mechanical circulatory support (MCS) as a bridge to transplantation provides stabilization for critically ill patients; however, disparities in access persist. Studies continue to emphasize the barriers faced by minority and pediatric populations, highlighting the need for expanded donor networks and improved matching criteria. This review highlights the necessity of shifting transplantation prioritization toward multidimensional candidate evaluations that consider both clinical complexity and long-term outcomes. Policy reforms aimed at addressing healthcare disparities and optimizing donor utilization are crucial for improving patient outcomes. Future research should focus on assessing the effectiveness of advanced allocation models, such as continuous distribution frameworks, to promote equitable and sustainable transplantation systems.

How do women with Rokitansky syndrome and healthcare professionals reflect on the provision of uterine transplantation? Insights from an interview study in France, Norway, and Sweden.

Uterine transplantation is currently intended for women with absolute uterine infertility. Since proof of the concept in 2014, many countries have started research programs and clinical activities. However, access to uterine transplantation remains limited given that only a few hundred transplants have been described worldwide compared with the 1.5 million women of childbearing age who suffer from absolute uterine infertility. The aim of this study was to investigate how limited access to uterine transplantation is perceived by women with Mayer-Rokitansky-Küster-Hauser syndrome and health professionals involved in uterus transplantation programs. We conducted a qualitative study with semistructured interviews in France, Norway, and Sweden with women with Mayer-Rokitansky-Küster-Hauser syndrome and health professional involved in uterine transplantation programs. The interviews were analyzed manually using thematic content analysis. The research questions were: How do (a) women with Mayer-Rokitansky-Küster-Hauser syndrome and (b) healthcare professionals involved in uterus transplantation programs perceive uterus transplantation and its accessibility 10 years after proof of concept? The interviews enabled us to highlight a number of themes addressed by doctors and women with Mayer-Rokitansky-Küster-Hauser syndrome, the main ones being the hope raised by this technique and the disappointment for those who do not have access to it, the lack of perception of the risks associated with the technique, and finally, an inequity of access and the training difficulties this entails for the teams. Access to uterine transplantation varies widely across Europe owing to legislative restrictions and limited access due to resources or competence. The result is a feeling of injustice/misunderstanding and despair for these women who had planned to become parents and cannot benefit from a transplant. They appear to be poorly supported. Women who are ultimately unable to access a transplant program should perhaps be given psychological support to deal with this disappointment, whereas the minority who finally have had access to transplant programs are supervised by well-trained multidisciplinary teams.

Development and Validation of a Simplified Financial Toxicity Screening Tool for Use in Clinical Practice.

Cancer-related financial toxicity occurs frequently and is a key driver of inequities in access to care and disparities in treatment outcomes. Current practices to screen for financial toxicity are inconsistent because of the lack of a validated and clinically integrated screening tool. This analysis aimed to create and assess an abbreviated version of the validated Comprehensive Score for Financial Toxicity (COST) tool, a measure of financial toxicity used for research purposes, which could easily be added into often-lengthy clinical screening workflows. At an urban comprehensive cancer center with suburban satellite locations, a financial toxicity screening quality improvement project was conducted from June 2022 to August 2023 as part of routine clinical care: 57,526 longitudinal COST surveys were completed by 38,249 patients with cancer. An iterative algorithm selected the items with highest correlation with the total score. Using a separate validation data set, positive and negative predictive values (PPV and NPV, respectively) of the abbreviated tool (two-item) were assessed against the full COST score, with varying risk thresholds. Inclusion of two COST questions (Q3: "I worry about the financial problems I will have in the future as a result of my illness or treatment"; Q6: "I am satisfied with my current financial situation") yielded a score that had a correlation of 0.922 with the full instrument score. For the two-item scale, PPV ranged from 74% to 91%, and NPV ranged from 91% to 98% when compared with the full COST tool. This analysis of a large data set finds that a simplified COST tool has high predictive value when compared with the full validated measure. An abbreviated COST measure of two questions is suitable for implementation into clinical screening workflows.

Impact of HELLP Syndrome on Maternal Mortality and the Role of Nursing in Peru

In 2022, hypertensive disorders of pregnancy continued to be a global concern, affecting 10% of pregnant women, while HELLP syndrome (HS) complicated between 0.1% and 0.9% of pregnancies. In Latin America, approximately 27.6% of women with preeclampsia developed HS, with a maternal mortality rate of 14%. In Peru, maternal mortality increased significantly compared to previous years, with hypertensive disorders accounting for 30% of cases.HELLP syndrome, characterized by hemolysis, elevated liver enzymes, and thrombocytopenia, caused severe complications such as postpartum hemorrhage, pulmonary edema, and death. In rural areas of Peru, the lack of resources and specialized personnel hindered the timely management of this condition, exacerbating the risks for patients.The strategies implemented included improving prenatal care and training healthcare professionals. Nurses played a crucial role in the early identification of risk factors, continuous monitoring, and interdisciplinary management of critical patients. Additionally, the nursing care process ensured comprehensive care based on scientific and humanistic principles.Despite these efforts, inequity in access to healthcare services persisted, especially in remote areas. The need for public policies to strengthen healthcare infrastructure and promote equity was evident, being key to reducing maternal complications and improving health indicators in the country

Social Risk Factors, Health Insurance Coverage, and Inequities in Access to Care.

Social risk factors are associated with worse access to care. This study measured the prevalence of social risk factors among low-income adults, assessed the relationship between number of social risk factors and access to care, and examined heterogeneity by health insurance type. Using 2022 Behavioral Risk Factor Surveillance Survey data from 39 states, the association between number of SRFs (0, 1, 2-3, 4, or more) and three access to care measures (having a personal doctor, having a routine checkup, and inability to see doctor because of cost) were measured using multivariable linear probability models. The analysis was stratified by health insurance coverage type (private, Medicare, Medicaid, or uninsured) to assess whether effects were differential. Analyses were conducted in 2024. Among 90,208 low-income adults, 46.6% reported at least one SRF. Compared to people who reported no SRFs, those who reported four or more were more likely to report being unable to afford care (28.21 percentage points [PP], p<0.001) and less likely to have a personal doctor (-4.98 PP, p<0.001) or routine checkup in the last two years (-4.29 PP, p<0.001). The magnitude of disparity by number of SRFs in inability to afford care was larger among privately insured and uninsured people compared to those with Medicare or Medicaid coverage. Higher levels of SRFs were associated with worse access to care among low-income adults. Policies that minimize cost-related barriers to care, coupled with care delivery reforms and social policies that address SRFs, may improve access to care.

Measuring social, economic, policy, and health system determinants of maternal health and survival: An urgent global priority.

In 2015, the World Health Organization (WHO) released global targets and strategies for reducing maternal mortality in the Sustainable Development Goal (SDG) period developed through broad stakeholder consultations. The targets and strategies identified in the "Strategies toward Ending Preventable Maternal Mortality (EPMM)" report are grounded in a systemic and human rights approach to maternal health and aim to address the broad spectrum of key social, political, economic, and health system determinants of maternal health and survival, as exemplified by 11 Key Themes. These upstream determinants of maternal survival are not well represented in maternal health measurement efforts, which tend to focus on service delivery. Thus, work was undertaken to develop a core set of maternal health indicators that could drive progress toward achieving the recommendations laid out in the EPMM Strategies that identified a menu of 25 indicators and 7 standard stratifiers related to the legal and policy environment, accountability mechanisms, inequities in access and quality, and empowerment of women, girls, families, and communities. Measurement experts have called for more research to ensure that indicators for monitoring maternal health, including its upstream determinants, are valid, which is critical if such measures are to be effective for driving and tracking progress toward ending preventable maternal deaths. This paper describes nine research reports emanating from seven discrete research studies to validate ten indicators in India, Ghana and Argentina that are compiled in a PLOS Collection with the aim of illustrating the breadth of the validation work, extracting some unifying themes and common findings, and discussing the implications for policy and practice they suggest.

De Novo Genome Assembly for an Endangered Lemur Using Portable Nanopore Sequencing in Rural Madagascar.

As one of the most threatened mammalian taxa, lemurs of Madagascar are facing unprecedented anthropogenic pressures. To address conservation imperatives such as this, researchers have increasingly relied on conservation genomics to identify populations of particular concern. However, many of these genomic approaches necessitate high-quality genomes. While the advent of next-generation sequencing technologies and the resulting reduction in associated costs have led to the proliferation of genomic data and high-quality reference genomes, global discrepancies in genomic sequencing capabilities often result in biological samples from biodiverse host countries being exported to facilities in the Global North, creating inequalities in access and training within genomic research. Here, we present the first published reference genome for the endangered red-fronted brown lemur (Eulemur rufifrons) from sequencing efforts conducted entirely within the host country using portable Oxford Nanopore sequencing. Using an archived E. rufifrons specimen, we conducted long-read, nanopore sequencing at the Centre ValBio Research Station near Ranomafana National Park, in rural Madagascar, generating over 750 Gb of sequencing data from 10 MinION flow cells. Exclusively using this long-read data, we assembled 2.157 gigabase, 2980-contig nuclear assembly with an N50 of 101.6 Mb and a 17,108 bp mitogenome. The nuclear assembly had 30× average coverage and was comparable in completeness to other primate reference genomes, with a 96.1% BUSCO completeness score for primate-specific genes. As the first published reference genome for E. rufifrons and the only annotated genome available for the speciose Eulemur genus, this resource will prove vital for conservation genomic studies while our efforts exhibit the potential of this protocol to address research inequalities and build genomic capacity.

Perceptions of radiographers on reporting chest images at Public Hospitals in Malawi

IntroductionMalawi health facilities' major challenge is inequalities in access to reporting services due to a shortage of radiologists to report on radiographic images. Radiographers in the developed world acquire formal training in image reporting, however, there is no postgraduate training programme in Malawi. Thus, there is a need to explore radiographers' perceptions of reporting chest images in Malawi's hospitals. The study aims to explore radiographers’ perceptions of being tasked with the responsibility of reporting on chest images at public hospitals in Malawi. MethodThe study was conducted through a quantitative cross-sectional design. Data was collected using a self-developed questionnaire. Data collected was analyzed with the assistance of a statistician using the Statistical Package for Social Scientists (SPSS) version 29. The measurement scales and questions included quantitative 10-point Likert. Statistical analysis used the Mann -Whitney U test. ResultsSeventy-one (71) radiographers representing 81 % of the total population from five public hospitals participated in the study. The results from this study found that most radiographers (97.2 %) agreed that radiographers needed to report on chest images in the department. Findings demonstrated that the majority of radiographers (80.3 %) supported ongoing professional development, and of the radiographers (78.9 %) also agreed that reporting on chest images required post-graduate training. Overall confidence in reporting chest images was 81.6 % with no difference by years worked as a qualified radiographer (p=0.196) with the less than 10 years were as confident to report chest images as 10 years or more . Confidence in detecting abnormality on chest images (78.8 %) demonstrated no variation by years worked as qualified radiographer (p=0. 196) or level in department (junior of senior radiographer (p =0.323). Perceived impact of radiographer's involvement in chest image reporting to improved cost effective service delivery, work efficiently, and potential impact on patient care and safety. ConclusionBased on the findings of this study, there were positive perceptions among the majority of radiographers about the reporting of chest images in Malawi. It was recommended that policymakers change Malawi's health care policy, especially the radiological sector to allow radiographers to report on chest images.

The "uneven road" to food: Socioeconomic disparities in the mobility burden of food purchasing behavior in major US cities, 2019-2023.

Socioeconomic factors contribute to distinct patterns of food-purchasing behaviors, placing a higher burden of mobility on vulnerable, deprived populations. Traditional approaches often overlook the dynamics of human activity as contextual influences, simulating a perceived food environment that contradicts the actual use thereof. The rise of large-scale mobile phone data presents a unique opportunity to capture real behavioral patterns and their mobility implications at a fine-grained level. Using a Time-Weighted Kernel Density Estimation (TWKDE) model on mobile phone data, this study introduces two novel measures - the Spatial Engel's Coefficient (SEC) index and the Distance-to-Activity Curve (DAC) - to assess the equity of food-purchasing travel across nine U.S. cities over five years, analyzed by socioeconomic status, time period, and location. Our findings reveal that lower socioeconomic status is strongly associated with greater mobility burdens in food-purchasing travel. This mobility gap between the highest and lowest socioeconomic groups was further exacerbated during the COVID-19 pandemic, manifesting in the form of spatial segregation of opportunities within cities. This paper contributes to the literature by developing novel activity-based tools that offer a more nuanced understanding of the behavioral characteristics of food-purchasing activities. These empirical insights can help policymakers identify the communities facing the greatest mobility burdens and guide targeted, place-based interventions to promote equity in food access.

Metaverse for Enhancing Animal Welfare - Leveraging Sensor Technology and Ethical Considerations

The metaverse, a virtual world where real-world aspects merge with artificial intelligence, immersive experiences, and high-level digital connectivity, is increasingly being applied in animal farming. This integration offers significant opportunities for addressing climate change and promoting sustainable food production. However, it also raises several ethical issues, particularly concerning animal rights. This paper evaluates these ethical considerations, emphasizing the need for a thorough examination of how sensor technology affects animals' perception and autonomy. Key findings indicate that while metaverse technologies can enhance animal welfare through improved monitoring and optimized living conditions, they also pose risks of detachment and commodification. The design of animal-friendly environments must balance technological advancement with ethical approaches to animal welfare. Critical factors such as ethical reflection, socio-economic impact, and the ability to retrieve meaningful information must be considered to maintain sensitivity and trust in these technologies. Moreover, the paper highlights the importance of addressing inequalities in access and adoption of metaverse technologies, which can significantly benefit animal farming. The potential of the metaverse to revolutionize the agri-food sector, particularly in animal agriculture, remains vast but requires further research to fully understand its implications. This paper concludes that a conscientious and ethical approach is essential for integrating metaverse technologies into animal farming, ensuring that animal welfare and equitable practices are prioritized for a sustainable future.

Estimates and determinants of HPV non-vaccination in 14-year-old Canadians: Results from the childhood national immunization coverage survey, 2019

ABSTRACT Human papillomavirus (HPV) infections, the most common sexually transmitted infections, are associated with various health outcomes including anogenital warts and cancers. Despite significant investments in HPV vaccination programs, ensuring adequate vaccination coverage for adolescents remains a challenge in Canada. This analysis used data collected through the 2019 Childhood National Immunization Coverage Survey (CNICS) to determine national estimates of HPV non-vaccination and investigate determinants of HPV non-vaccination for adolescents aged 14-years old in Canada, both overall and stratified by gender. The primary outcome of interest was HPV vaccination status, categorized as vaccinated with at least one dose or unvaccinated. Simple and multiple logistic regression models were used to investigate determinants of HPV non-vaccination. In 2019, an estimated 19.8% of the 14-year-olds in Canada were unvaccinated for the HPV vaccine, with males having higher non-vaccination rates than females (27.0% compared to 12.9%). In the unstratified analysis, factors associated with HPV non-vaccination for 14-year-olds were gender and region of residence. These factors differed by gender – for males, region of residence and respondent’s age were significant factors, whereas for females, total household income was a significant factor. These results could help public health officials and policymakers develop and implement tailored interventions to enhance the delivery of HPV vaccination programs for male and female adolescents. By targeting populations that are under-vaccinated, vaccine uptake could be better facilitated to help reduce inequalities in access to the HPV vaccine, which could also potentially reduce disparities in HPV-related health outcomes.

THE ROLE OF HOUSING IN LONG-TERM NURSING HOME UTILIZATION IN THE UNITED STATES: AN INTEGRATIVE REVIEW

Abstract Given the growing housing crisis, researchers increasingly point to housing as a possible risk factor for nursing home (NH) utilization, yet the exact pathways from housing to NH utilization are unclear. The purpose of this integrative review was to develop an understanding of how housing acts as a mechanism that impacts NH utilization in the United States. Five databases were searched in April 2024 and 16 total articles were included. This review highlights four pathways for this relationship: 1) Financial Asset vs. Burden, represents how some leverage home equity to help finance necessary NH placements, while for others the cost-burden of housing may lead to early nursing home placements; 2) Access to Affordable Housing, represents how the supply of affordable housing impacts the ability of NH residents to return to community living; 3) (Mis)match Between Needs and Housing, represents how functional needs rapidly evolve, leading to housing transitions and NH placements; and 4) Compounding Systemic Inequities, represents how systemic inequities in access to affordable, quality housing lead to disparities in NH placement for socio-economically marginalized older adults. The results from this review provide evidence of the relationship between housing and NH utilization across these four pathways; however, due to weak quality of evidence, and limited methodological diversity, more research is needed to strengthen this evidence. Clinicians, researchers, and policymakers should still recognize the importance of housing in NH utilization and seek to target policies and interventions towards improving housing conditions for those at risk for NH placement.