Rates Of Poor Health Research Articles

How Live Music Can Be Delivered to Children and Young People to Support Their Mental Health and Wellbeing: Co-Produced Solutions and Key Findings from a Series of Intergenerational Multi-Disciplinary Workshops

Background: Children and young people’s (CYP) mental health is a policy priority, with rates of poor mental health reported to be as much as one in five across the UK. Traditional mental health support services cannot meet demand, and new approaches are needed. The creative arts can be an effective tool in supporting mental health. However, little is known about how live music can be used to support CYP mental health and wellbeing. We facilitated three, two-day intergenerational and multi-disciplinary workshops to co-produce ideas about how live music could be delivered to this end. Results: Workshops were held in three locations in Scotland, attended by a mixture of CYP, youth workers, mental health practitioners, teachers, and musicians (n = 91). A range of co-created solutions were generated including a live music festival designed for and with CYP and free gig tickets. Barriers and facilitators for CYP accessing live music were also identified. Furthermore, these workshops were found to increase confidence for musicians in delivering live music events to CYP, and CYP felt their voices were heard in their design of the delivery. Conclusions: This study presents novel co-created solutions about how live music can be delivered to CYP that need to be tried and tested in future research. It also provides key insights for musicians, live music providers, and people supporting CYP about the best approach to delivering live music for CYP.

Long COVID in the UAE: symptomatology, gender gaps, and health implications among COVID-19 survivors

Abstract Background A growing number of COVID-19 survivors are experiencing symptoms post-SARS-CoV-2 infection, known as long COVID. It is a new multisystem condition and understanding its associated factors and its impact on individuals is crucial. This study aims to characterize long COVID in previously hospitalized patients in the UAE, identifying associated factors and assessing its impact on patients’ daily lives. Methods A multicenter retrospective cohort study was conducted in hospitals in Dubai and Sharjah from January 29, 2020 to October 14, 2021, involving RT-PCR confirmed cases. Clinical, epidemiologic, and long COVID data were collected via hospital records and phone interviews. Results Long COVID affected 48.7% of 533 patients, with 46.6% prevalence persisting over a year. A total of 43 symptoms across 11 organ systems were reported. Females had 1.83 times higher odds of long COVID (95% CI [1.22, 2.74], p = 0.003). Each additional initial symptom (AOR = 1.22, 95% CI [1.05, 1.40], p = 0.008), ICU admission (AOR = 1.77, 95% CI [1.06, 2.98], p = 0.030), and ≥ 2 comorbidities (AOR = 2.19, 95% CI [1.09, 4.40], p = 0.027) increased the odds of long COVID. Long COVID significantly impacted daily life, with poorer health ratings (AOR = 5.576, 95% CI [3.029, 10.265], p < .001), worse health status (AOR = 7.842, 95% CI [4.954, 12.415], p < .001), and work limitations due to physical (AOR = 4.808, 95% CI [3.229, 7.158], p < .001) and emotional issues (AOR = 3.149, 95% CI [2.01, 4.933], p < .001). This impact persisted beyond 12 months post-infection. Conclusions Long COVID presents prolonged multisystem involvement and substantial disability among survivors, necessitating further research to understand its lasting effects and intervention development to mitigate its impact Key messages • Long COVID poses a substantial challenge to public health in the UAE, affecting almost half of hospitalized survivors and extending its impact beyond 12 months post-infection. • Risk factors like gender initial symptoms, ICU stay, and comorbidities increase the risk of long COVID, warranting the need for tailored interventions and support strategies for vulnerable populations.

Where should health system investments be made to protect the mental health of healthcare workers?

Abstract Background This study explores trends and work-related determinants of mental health and wellbeing among health and care workers in Europe since the COVID-19 pandemic. The aim is to determine where investments can best be made to protect and support mental health and wellbeing among health and care workers to improve retention and recruitment. Methods Data are analysed from the National Health Service staff survey in England and the Health Service Executive ‘Your Opinion Counts’ survey in Ireland to explore trends in mental health and wellbeing and burnout. Evidence is then taken from a series of European Observatory policy briefs, based on expert-led literature reviews, to explore determinants of poor mental health and wellbeing and to identify potential areas for investment. Results Rates of burnout and poor mental health and wellbeing have increased in England and Ireland since the start of the pandemic among all professional groups. Workplace-based factors are important determinants of poor mental health and wellbeing, and can be grouped into: macro-level structural factors such as staff shortages, poor working conditions and low pay; meso-level organisational factors including poor leadership, and insufficient education, training and support; micro-level individual factors such as insufficient self-care or not seeking support. However, determinants at the micro-level, especially seeking support from others, are largely shaped by structural or organisational factors. Conclusions Increased financing to address structural and organisational determinants of mental health and wellbeing contributes to improved patient care, better staff experience, lower rates of absenteeism, and enhanced recruitment and retention. It is therefore one of the best health system investments that can be made.

Employment and mental health for adults on probation, 2002-2021.

The 21st century has seen a decline in employment rates in the US at the same time that it has experienced a historically unprecedented rise in the numbers of adults under criminal justice system control. Both low employment and high incarceration have posed serious challenges for public health. Using data from the National Survey on Drug Use and Health from 2002-2021, we estimated employment rates by community supervision status. Variations by sociodemographic subgroups were explored as well as correlations between employment and a range of mental and behavioural health variables. Those on probation were twice as likely as those not to live in poverty. They experienced higher rates of poor mental and behavioural health, including three times the rate of substance use. Employment rates varied little by community supervision status. Health risk factors were associated with more risk and protective factors did less to mitigate risk for those under community supervision. Despite the range of adversities faced by individuals under criminal justice system control, their employment rates are remarkably close to those not. Despite near equivalent involvement in the labour force, this population has substantially poorer health and substantially reduced likelihood of escaping poverty.

Lesbian, Gay, Bisexual, Transgender and Queer People's Experiences of Stigma Across the Spectrum of Inpatient Psychiatric Care: A Systematic Review.

Lesbian, gay, bisexual, transgender, queer and other diverse sexual orientations and gender identity groups (LGBTQ+) face high rates of poor mental health. In the most severe and emergent of instances, inpatient psychiatric care may be required. LGBTQ+ people report experiences of mistreatment in healthcare settings broadly, such as denial of healthcare services and harassment from healthcare providers and other patients. However, little is known about the experiences of LGBTQ+ people in inpatient psychiatric care settings, specifically. The purpose of this review was to assess the existing literature for descriptions of LGBTQ+ people's experiences within inpatient psychiatric care. We searched multiple databases (i.e., PubMed, PsychINFO, CINAHL, Web of Science and Google Scholar) for peer-reviewed articles that described the experiences of LGBTQ+ people within inpatient psychiatric care that were published in English. The included articles (N = 14) were analysed using a conceptual model of stigma and organised within those strata (structural, interpersonal and individual stigma) across the inpatient experience, (admission, inpatient unit, and discharge). Themes identified included: noninclusive intake tools and pervasive misgendering during the admission process; lack of healthcare infrastructure, inadequate training and lack of cultural humility, pervasive discrimination and victimization, silencing of LGBTQ+ patients, and feelings of fear and shame while on inpatient units, and lack of community resources during the discharge process. Clinicians should consider the perspectives and experiences of LGBTQ+ people to enact identity-affirming care practices that may increase mental healthcare engagement and improve long-term mental health outcomes.

Mental Health and Suicide Risk Among High School Students and Protective Factors - Youth Risk Behavior Survey, United States, 2023.

Adolescent mental health and suicide risk remain substantial public health concerns. High pre-COVID rates of poor mental health and suicide-related behaviors have continued to rise, highlighting the need to identify factors that might foster positive mental health outcomes and reduce suicide-related behaviors at population levels. Using CDC's 2023 Youth Risk Behavior Survey, CDC analyzed the prevalence of mental health and suicide risk indicators and their associations with individual-, family-, and school- or community-level protective factors. Prevalence estimates were calculated for each of the mental health and suicide risk indicators by demographic characteristic. Prevalence ratios adjusted for sex, sexual identity, grade, and race and ethnicity were calculated to examine the association between protective factors and mental health and suicide risk indicators. Overall, 39.7% of students experienced persistent feelings of sadness and hopelessness, 28.5% experienced poor mental health, 20.4% seriously considered attempting suicide, and 9.5% had attempted suicide. Mental health and suicide risk indicators differed by sex, sexual identity, grade, and race and ethnicity. All protective factors were associated with lower prevalence of one or more risk indicators. Findings from this report can serve as a foundation for the advancement of research on protective factors and for the development and implementation of programs, practices, and policies that protect and promote mental health and emotional well-being among youth.

Differences in the Oral Health of Children With Medical Complexity

ObjectiveChildren with medical complexity (CMC), a subgroup of children with special health care needs (CSHCN) with the most serious medical conditions and disabilities, are at risk for negative effects from poor oral health. CSHCN have high rates of poor oral health, including cavities. This study aimed to compare oral health status between CMC and CSHCN. MethodsThis was a cross-sectional analysis of the 2016–17 National Survey of Child Health data. CMC and CSHCN were identified using validated algorithms. The primary outcome was oral health status; secondary outcomes included dental service use. Bivariate analyses compared the prevalence and service use by medical complexity status. Multivariable logistic regression assessed oral health outcomes by complexity, adjusting for influencing variables. ResultsOf 16,178 CSHCN ages 1 to 17 years, 6% were CMC and 94% were non-CMC CSHCN. Compared to CSHCN, CMC had a higher prevalence of fair/poor teeth conditions (19% vs 9%; P < 0.001) and higher odds for fair/poor teeth conditions after adjusting for socioeconomic factors (aOR: 1.54; 95% CI: 1.01–2.34). There was no statistically significant difference between groups when assessing cavities, toothache, or receipt of most preventive dental services. ConclusionsOne in 5 CMC are reported by caregivers as having poor oral health, including cavities, despite high rates of receiving preventive dental services. After adjusting for socioeconomic factors, medical complexity remained associated with fair or poor teeth conditions. Understanding potentially modifiable targets could further help families of CMC prioritize dental needs and potentially reduce negative effects on overall health.

Trends in mental health and smoking disparities between sexual minority and heterosexual adults in Canada, 2003–2020

Sexual minority populations experience a higher burden of mental health and substance use/misuse conditions than heterosexual comparators—a health inequality that has predominantly been attributed to forms of minority stress experienced by the former group. Sexual minority-affirming legislative and policy advances, as well as improvements in social attitudes toward sexual minorities in recent decades, should presumably reduce experiences of minority stress, thereby attenuating these disparities. We conducted temporal trend analyses of annual prevalence of anxiety, depression, poor self-rated mental health, and cigarette smoking, stratified by sexual orientation and gender/sex subgroups using the Canadian Community Health Survey, 2003–2020. Descriptive analyses were used to display temporal trends; joinpoint regression was used to identify significant changes in prevalence data during 2003–2020; and prevalence ratios were estimated by year to detect any reduction in disparities. The prevalence of self-rated mental health and mood and anxiety disorders increased, whereas the prevalence of smoking decreased, between 2003 and 2020, among both sexual minority and heterosexual people in Canada. We observed a significant inflection point in 2009 in the self-rated mental health trend among bisexual women, where rates of poor mental health initially decreased from 2003 but then increased drastically from 2009 to 2020. Significant inflection points in current smoking trends were observed in 2012 among bisexual and heterosexual women and in 2013 among heterosexual men; in all three groups, both segments demonstrated decreasing trends, however, the slope of the trend became more pronounced in the latter period. Consistent with other North American studies, we found that relative differences between sexual minority and heterosexual groups for all four outcomes remained the same or increased during this 18-year period. Findings highlight the need to better understand mechanisms bolstering sexual orientation health disparities.

Strategies for Improving Firefighter Health On-Shift: A Review.

The fire service suffers from high rates of cardiovascular disease and poor overall health, and firefighters often suffer fatal and non-fatal injuries while on the job. Most fatal injuries result from sudden cardiac death, while non-fatal injuries are to the musculoskeletal system. Previous works suggest a mechanistic link between several health and performance variables and injury risk. In addition, studies have suggested physical activity and nutrition can improve overall health and occupational performance. This review offers practical applications for exercise via feasible training modalities as well as nutritional recommendations that can positively impact performance on the job. Time-efficient training modalities like high-intensity interval training and feasible modalities such as resistance training offer numerous benefits for firefighters. Also, modifying and supplementing the diet and can be advantageous for health and body composition in the fire service. Firefighters have various schedules, making it difficult for planned exercise and eating while on shift. The practical training and nutritional aspects discussed in this review can be implemented on-shift to improve the overall health and performance in firefighters.

COVID-19, lockdowns, and the mental wellbeing of LGBTQ people in Australia

LGBTQ communities around the world entered the COVID-19 pandemic with generally high rates of poor mental health and faced additional challenges including stigma, discrimination, and barriers to care. This study sample was drawn from a survey of 3135 LGBTQ adults residing in Australia during the pandemic. Regression analysis was used to explore individual differences in psychological distress and perceived change in mental wellbeing since the onset of the pandemic as well as the impact of lockdowns, by taking advantage of a natural experiment comparing the states that experienced more extensive lockdowns (Victoria and New South Wales) to the rest of Australia. The burden of mental health was found to vary across gender, sexual orientation, age, and area of residence. While no impact of lockdowns on psychological distress was observed, participants living in the states of Victoria (β = −0.15; 95% CI = −0.23, −0.07) and New South Wales (β = −0.13; 95% CI = −0.21, −0.05) self-reported a more negative impact of the pandemic on their mental wellbeing compared to the rest of the country. The findings suggest that the COVID-19 pandemic had a negative impact on the mental wellbeing of LGBTQ populations, particularly among those who experienced extensive lockdowns and highlight the need for increased efforts to enable access to mental health supports during times of crisis.

Why is there a gap in self-rated health among people with hypertension in Zambia? A decomposition of determinants and rural‒urban differences

BackgroundHypertension affects over one billion people globally and is one of the leading causes of premature death. Low- and middle-income countries, especially the sub-Saharan Africa region, bear a disproportionately higher share of hypertension globally. Recent evidence shows a steady shift in the burden of hypertension from more affluent and urban populations towards poorer and rural communities. Our study examined inequalities in self-rated health (SRH) among people with hypertension and whether there is a rural‒urban gap in the health of these patients. We then quantified factors driving the health gap. We also examined how much HIV accounts for differences in self-rated health among hypertension patients due to the relationship between HIV, hypertension and health in sub-Saharan Africa.MethodsWe utilized the Zambia Household Health Expenditure and Utilization Survey for data on SRH and other demographic and socioeconomic controls. District HIV prevalence information was from the Zambia Population-Based HIV Impact Assessment (ZAMPHIA) survey. We applied the Linear Probability Model to assess the association between self-rated health and independent variables as a preliminary step. We then used the Blinder-Oaxaca decomposition to identify self-rated health inequality between urban and rural patients and determine determinants of the health gap between the two groups.ResultsAdvanced age, lower education and low district HIV prevalence were significantly associated with poor health rating among hypertension patients. The decomposition analysis indicated that 45.5% of urban patients and 36.9% of rural patients reported good self-rated health, representing a statistically significant health gap of 8.6%. Most of the identified health gap can be attributed to endowment effects, with education (73.6%), district HIV prevalence (30.8%) and household expenditure (4.8%) being the most important determinants that explain the health gap.ConclusionsUrban hypertension patients have better SRH than rural patients in Zambia. Education, district HIV prevalence and household expenditure were the most important determinants of the health gap between rural and urban hypertension patients. Policies aimed at promoting educational interventions, improving access to financial resources and strengthening hypertension health services, especially in rural areas, can significantly improve the health of rural patients, and potentially reduce health inequalities between the two regions.

Justice involvement and mental health in LGBTQ young people

Lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) young people experience higher rates of justice involvement (e.g., arrests, detainment) and poor mental health compared to their peers. This study examined the relationship between justice involvement and mental health among 33,993 LGBTQ young people (ages 13–24) from the United States. Being from particular regions, experiencing housing instability, and holding specific racial/ethnic, sexual, and gender identities were related to higher rates of justice involvement. Multivariate logistic regression analyses revealed that past arrests and detainment were each associated with greater odds of attempting suicide in the past year, as well as depression and anxiety symptoms, self-harm, and considering suicide. LGBTQ young people who had been arrested (aOR = 6.54, 95% CI = 5.17, 8.26) or detained (aOR = 6.33, 95% CI = 4.19, 9.57) in the past year had more than six times greater odds of attempting suicide in the past year compared to peers who had never been arrested or detained. Better understanding the association between justice involvement and mental health among LGBTQ young people can provide important insights on how to reduce mental health risks and suicide in a particularly vulnerable community.

Food Insecurity and Mental Health Outcomes Among Transgender and Gender-Diverse Communities in the United States Post-COVID-19

A growing body of literature has shown that people in the transgender and gender-diverse (TGD) community have worse health outcomes than cisgender (cis) people, including higher rates of poor mental health. Additionally, during COVID-19, TGD persons experienced higher rates of food insecurity. In this article, we extend the literature by looking at new data in the post-COVID-19 period, a period of greater stability. Using data from the U.S. Census Household Pulse Survey (HPS), we explore the relationship between gender identity and health outcomes. The HPS began collecting data on gender identity of participants from July 2021. We analyze responses from 1.2 million survey participants between July 2021 and May 2023. Using an ordinary least squares regression model with state and week fixed effects, we show that, on average, TGD people are seven percentage points more likely to report experiencing food insecurity compared with cis persons. TGD persons also report more symptoms of depression (six percentage points) and anxiety (four percentage points) than cis persons. These results hold after controlling for the socioeconomic, demographic, and sexual identity characteristics of the individuals, suggesting that this gender identity imposes an additional cost that cannot be explained by social determinants of health. We find that health insurance and the Supplemental Nutrition Assistance Program do not provide very much protection to TGD individuals. In summary, our article suggests the need for safety nets that target specific contextual and institutional challenges faced by TGD communities to reduce health disparities across the country.

"What Works" to Support LGBTQ+ Young People's Mental Health: An Intersectional Youth Rights Approach.

Despite overwhelming international evidence of elevated rates of poor mental health in LGBTQ+ youth compared to their cis-heterosexual peers, we know relatively little about effective mental health services for this population group. This study aims to produce the first early intervention model of "what works" to support LGBTQ+ youth with emerging mental health problems. Utilizing a mixed method case study, we collected data across 12 UK mental health service case study sites that involved: (a) interviews with young people, parents, and mental health practitioners (n = 93); (b) documentary analysis; (c) nonparticipant observation. The data analysis strategy was theoretical using the "explanation-building" analytical technique. Our analysis suggests an intersectional youth rights approach with 13 principles that must be enacted to provide good mental health services as advocated by the United Nations Convention on the Rights of the Child and World Health Organization. This approach should address the multiple forms of marginalization and stigmatization that LGBTQ+ youth may experience, enable informed independent decision-making, and uphold the right to freedom of safe self-expression. A rights-based approach to mental health services for LGBTQ+ young people is not prominent. This needs to change if we are to tackle this mental health inequality and improve the mental well-being of LGBTQ+ youth worldwide.

Help-seeking intentions of UK construction workers: a cross-sectional study.

In response to the high rates of poor mental health in the construction industry, numerous workplace interventions have been designed to address the known and suspected risk factors to employee mental health and well-being. A key challenge of these strategies is low engagement in support services. The goals of this research were to investigate the help-seeking intentions of employees in the construction industry, explore levels of mental well-being in this population and provide insight into employee engagement with mental health support strategies. Employees from two UK construction companies completed an online cross-sectional questionnaire (n = 119), designed to measure help-seeking intentions, levels of mental well-being and worker attitudes towards workplace mental health support strategies. One-third of the sample reported experiencing an episode of mental health difficulties in the past 6 months. Employees reported a greater preference for seeking support from informal versus formal help sources. Participants were most likely to seek help from a partner and least likely to seek help from a Mental Health First Aider/ Champion. The study also showed some association between help-seeking intention and age of employees. Given the poor levels of mental well-being in this population, it is essential that adequate workplace support is provided. Whilst formal help sources are important for this population, our study highlights the potential benefits of informal help sources to support employees. Future interventions may therefore wish to consider developing tailored, informal workplace support networks and programmes.

Mental health in the COVID-19 pandemic: A longitudinal analysis of the CLoCk cohort study.

Little is known about the long-term mental health consequences of the pandemic in children and young people (CYP), despite extremely high levels of exposure to the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus and the disruption to schooling and leisure activities due to the resultant restrictions. There are mixed findings from systematic reviews of how the pandemic affected CYP's mental health, which may be due to heterogeneous methods and poor quality studies. Most, but not all, suggest deterioration in mental health but population level studies may obscure the differing experiences of subgroups. The study questions are: (i) are there subgroups of CYP with distinct mental health profiles over the course of the second year of the Coronavirus Disease 2019 (COVID-19) pandemic (between April 2021 and May 2022); and (ii) do vulnerability factors influence CYP's mental health trajectories. A matched longitudinal cohort study of non-hospitalised test-positive and test-negative 11- to 17-year-old CYP in England were recruited from the UK Health Security Agency having undergone PCR testing for COVID-19. They completed the Strengths and Difficulties Questionnaire (SDQ) at least twice over a 12-month follow-up period. Overall, 8,518 of 17,918 (47.5%) CYP who returned their first SDQ at 3 or 6 months post-testing were included in the analytical sample. Associations between age, sex, ethnicity, socioeconomic status (SES), and an educational health and care plan (EHCP, indicating special educational needs) on SDQ score trajectories were examined separately, after adjusting for PCR test result. Findings from multilevel mixed-effects linear regression model showed that on average mental health symptoms as measured by the total SDQ score increased over time (B = 0.11 (per month), 95% CI = 0.09 to 0.12, p < 0.001) although this increase was small and not clinically significant. However, associations with time varied by age, such that older participants reported greater deterioration in mental health over time (B = 0.12 (per month), 95% CI = 0.10 to 0.14 for 15 to 17y; 0.08 (95% CI = 0.06 to 0.10) for 11 to 14y; pinteraction = 0.002) and by sex, with greater deterioration in girls. Children with an EHCP experienced less deterioration in their mental health compared to those without an EHCP. There was no evidence of differences in rate of change in total SDQ by ethnicity, SES, or physical health. Those with worse prior mental health did not appear to be disproportionately negatively affected over time. There are several limitations of the methodology including relatively low response rates in CLoCk and potential for recall bias. Overall, there was a statistically but not clinically significant decline in mental health during the pandemic. Sex, age, and EHCP status were important vulnerability factors that were associated with the rate of mental health decline, whereas ethnicity, SES, and prior poor physical health were not. The research highlights individual factors that could identify groups of CYP vulnerable to worsening mental health.

Improving the mental health of farmers: what types of remote support are acceptable, feasible, and improve outcomes? A feasibility RCT

BackgroundThe farming community have high rates of poor mental health, and are relatively ‘hard to reach’ with mental health services. The aim of this study was therefore to undertake a feasibility RCT, based on two mental health interventions. These were (1) CBT based ‘Living Life to the Full for Farming Communities’ (LLTTF-F; www.llttf.com), and (2) a holistic social and emotional support service delivered by the Royal Scottish Agricultural Benevolent Institution (RSABI). The feasibility was supplemented by process evaluation.MethodsThis feasibility study aimed to recruit 40 individuals from the farming community who were experiencing a common health problem defined as a score of > = 8 on PHQ-9. A snowball approach was used to recruit interested individuals who had an association with farming. An initial telephone call screened for eligibility and obtained consent to randomisation to the two specified interventions, or to a thirdly group receiving a combination of both LLTTF-F and ‘Social and emotional support’. Participants were permitted to override the randomised option if they expressed a strong preference before the interventions began.ResultsThirty-two participants provided baseline and three-month data. All three interventions showed positive improvements on PHQ-9 scores as follows: the ‘combined intervention’ mean baseline score was 18.1 compared to 12.0 at 3-month follow-up (mean change 6.1). ‘Social and emotional support’ mean baseline score was 11.3 compared to 6.7 at 3-month follow-up (mean change 4.6). ‘LLTTF-F CBT-based intervention only’ mean baseline score was 11.8 compared to 4.5 at 3-month follow-up (mean change 7.3). The retention rate was 81% at three months.In a sub-group of the LLTTF-F CBT-based intervention online materials were supplemented by telephone guided support. This approach received very positive feedback.ConclusionsRecruitment from the farming community required intense effort, and good engagement can then be retained for at least three months. There is evidence that the interventions used were feasible, and tentative evidence that they had a demonstrable effect on mental wellbeing, with the LLTTFF providing the largest effect on PHQ-9 scores.Trial Registration Number ISRCTN27173711, submitted 25/08/2023, confirmed 22/092023.

The CATCH My Breath Vaping Prevention Curriculum: An Evaluation of Impacts in Central Appalachian Middle and High Schools, 2019-2023.

Since 2015, the rise in e-cigarette use among youth has concerned public health authorities. After peaking in 2019, usage rates have declined but remain high. In 2023, 10% of high school and 4.6% of middle school students reported current use. This report describes the implementation and evaluation of a school-based e-cigarette prevention program, CATCH My Breath (CMB), in 8 central Appalachian counties. These counties have some of the highest rates of tobacco use, poor health, and premature death in the United States. A total of 6217 students across 25 middle and high schools in West Virginia and Kentucky received the CMB program from 2019 to 2023. Lists of participating counties, schools, and teachers were maintained on a rolling basis over the 4 years of the project. Program reach and impact on e-cigarette knowledge and use are reported. Thirteen-item pre- and post-tests were completed electronically by students before and after each course delivery. Questions assessed knowledge about e-cigarettes, current (past 30-day) e-cigarette use, and interest in future use. From 2019 to 2023, there were 9399 deliveries of the 4-session CMB course, primarily to middle school students. Approximately 84% reported being less likely to use e-cigarettes following the program. Significant improvements in e-cigarette knowledge and beliefs on 5 of 8 items were observed, including a significant increase in knowledge composite score (4.15-4.75, P < .001). From pre- to post-test, declines in current e-cigarette use (5.1% to 4.4%; P = .005) and peer influence (4.9% to 4.0%; P = .025) were also observed. CMB was feasible, effective, and well-received in a convenience sample of central Appalachian counties and schools. This curriculum, combined with other policy initiatives, offers hope for curbing the growing epidemic of youth e-cigarette use and nicotine dependence. The success of this project contributed to a decision by the West Virginia Bureau for Public Health and the West Virginia Department of Education to launch a joint effort to bring CMB to middle schools in all 55 counties during the next 3 school years of 2023-2026.

Transition is associated with lower disease activity, fewer relapses, better medication adherence, and lower lost-to-follow-up rate as opposed to self-transfer in pediatric-onset inflammatory bowel disease patients: results of a longitudinal, follow-up, controlled study.

Despite the continuously rising rate of pediatric-onset inflammatory bowel diseases (PIBD), there are no consensus transitional guidelines or standardized practices. We aimed to examine: (1) the determinants of a successful transfer, (2) the effects of the transfer versus transition on the disease course and patient compliance, (3) the unique characteristics of PIBD patients, that need special attention in adult care. Longitudinal, follow-up, controlled study conducted between 2001 and 2022, with retrospective data collection until 2018, thence prospective. Three hundred fifty-one PIBD patients enrolled in the study, of whom 152 were moved to adult care, with a mean post-transfer follow-up time of 3 years. Seventy-three patients took part in structured transition, whereas 79 self-transferred to adult care. The main outcome measures were disease activity (defined by PCDAI, PUCAI, CDAI, and Mayo-scores) and course, hospitalizations, surgeries, IBD-related complications, including anthropometry and bone density, patient compliance, medication adherence, and continuation of medical care. Patients who underwent structured transition spent significantly more time in remission (83.6% ± 28.5% versus 77.5% ± 29.7%, p = 0.0339) and had better adherence to their medications (31.9% versus 16.4% non-adherence rate, p = 0.0455) in adult care, with self-transferred patients having a 1.59-fold increased risk of discontinuing their medical care and a 1.88-fold increased risk of experiencing a relapse. Post-transfer the compliance of patients deteriorated (38.5% versus 29%, p = 0.0002), with the highest lost-to-follow-up rate during the changing period between the healthcare systems (12.7%), in which female gender was a risk factor (p = 0.010). PIBD patients had experienced IBD-related complications (23.4%) and former surgeries (15%) upon arriving at adult care, with high rates of malnutrition, growth impairment, and poor bone health. Structured transition plays a key role in ensuring the best disease course and lowering the lost-to-follow-up rate among PIBD patients. Structured transition plays a key role in ensuring the best disease outcome among PIBD patients, as in our study it was associated with lower disease activity, fewer relapses, better medication adherence, and lower lost-to-follow-up rate as opposed to self-transfer.

Evaluating the Equity of Urban Streetscapes in Promoting Human Health—Taking Shanghai Inner City as an Example

Environmental justice research largely focuses on the allocation of public resources in terms of quantified distribution and accessibility. This study suggests that the quality of landscape equity, an important urban resource, should be evaluated as it typically appears as a combination of elements. This brings another perspective to the attention of landscape equity in addition to the provision equity: the equity in the quality and level of provision. From this perspective, this study explores the equitable role of streetscape qualities in promoting human physical, mental, and social health. Using street view images, questionnaires, artificial intelligence-based image analysis, geographic information system-based cluster analysis, and correlational analysis, the spatial distribution of health promotion streetscapes and health-influential streetscape elements were presented and compared within the scope of the Shanghai Outer Ring Road. The results disclosed an uneven distribution of streetscapes that can promote human health within research sites. Streets with poor health ratings are concentrated in the Huangpu, Hongkou, and Yangpu districts, primarily in the western part of Shanghai around Shanghai Railway Station, People’s Square, and Yuyuan Garden, where the old city centre is located. Compared with the distribution of health-influential elements, less healthy streets are more likely to be accompanied by low visibility of ‘vegetation’ and a high proportion of ‘buildings’. Streetscape design implications were then discussed in terms of providing people with equal health opportunities. Research outcomes inspired an essential quality perspective in health equity research, and it can be especially helpful when the provision and accessibility can hardly be moderated in high-density cities.