Cardiac rehabilitation programmes provide knowledge, information and support, but patient-partner dyads living with heart disease (HD) and facing socio-demographic risk factors are less likely to benefit, maintaining health inequalities. This study aims to explore how such couples perceive and navigate HD within the context of everyday life to gain a comprehensive understanding of which position HD is given in daily life. Using an explorative design, qualitative data were generated through semi-structured interviews with 12 couples recruited from hospital. Findings show that HD is often viewed as resolved and secondary once the acute phase ends. Physical improvement post-treatment reduces anxiety, and HD takes a backseat to co-occurring diseases and social challenges. Couples prioritise returning to everyday routines and preserving what they see as the good life. This study highlights the need for tailored programmes that address couples' unique circumstances and resources, offering insights for reducing health inequalities in rehabilitation.

Design of the FRESH-A study: A randomized controlled trial evaluating telehealth parent-only treatment for autistic youth with overweight/obesity.

Education for sustainable development (ESD) is increasingly recognized as a developmental imperative in a world facing ecological, social, and political challenges. While many approaches to ESD emphasize knowledge and competencies, emerging research suggests that sustainable action in youth requires the integration of cognitive, emotional, and identity-based developmental processes. We propose that Digital Civic Learning (DCL) serves as a developmentally appropriate educational approach that can scaffold this process in early adolescence. Using a sample of 149 4th and 5th graders in Mid-Western United States, we examined how civic competencies, namely civic knowledge, skills, and dispositions, relate to civic purpose and further investigated the mediating role of moral self-concept. Our findings underscore the importance of nurturing moral self-concept so that enhanced civic competencies translate into a form of civic purpose. SUMMARY: Conceptual innovation: It introduces Digital Civic Learning as a design-based, developmentally aligned model that integrates civic learning with sustainable development goals, aiming for transformative impact in education. Methodological advancement: It develops and applies a novel civic competencies coding scheme tailored for a nuanced analysis of students' civic knowledge, skills, and dispositions. Theoretical contribution: It positions moral self-concept as a developmental link connecting civic learning with a sustainability-oriented civic purpose in early adolescence, a critical period for identity formation. Empirical rigor: It employs performance-based assessments to evaluate students' civic competencies demonstrated in authentic digital classroom settings, emphasizing real-world application of civic reasoning within sustainability education.

For sustainable food production, it is necessary to build resilience in livestock to be able to adapt or respond to multiple challenges. Farmers have not been involved in the development of resilience indicators for dairy cattle. The aim of this study was to understand how farmers conceptualise resilience in dairy cows. Twenty farmers from the UK and Channel Islands were interviewed and the data were analysed using reflexive thematic analysis. Four themes were generated from the analysis: "Fitting the system", "An invisible cow", "A Will to Live", and "She holds her own". Farmers conceptualised a resilient cow as one that requires little to no individual intervention. The farmers' overall goal for their cows was to be healthy, fertile and have a stable milk yield, reflecting the purpose of resilience in cows. Farmers perceived that cows enact resilience through their motivation to survive and thrive. Farmers also observed that cows enact resilience through "holding their own", a process where cows maintained their position over resources such as feed and lying space despite potential social challenge, by being assertive but not aggressive. Furthermore, farmers recognised that resilience in a cow was distributed across different systems, such as herd, housing environment, feeding, and farmer. Whilst resilience is often considered an individual trait in animal science, we conceptualise it as complex and dynamic process by which cows navigate and negotiate resources that sustain their health, fertility, and productivity. Resources are multisystemic and can reside at individual, social, and environmental levels. We suggest adopting a systems approach to understanding resilience in cows.

Social motivation diminishment is a core autism feature, yet prior research has been inconsistent, focusing on single dimensions and overlooking heterogeneity in motivational expressions among autistic individuals. This mixed-methods study compared social motivation in 104 individuals with autism (male: 74, Mage = 18.55 years) and 192 non-autistic peers (male: 101, Mage = 16.65 years), using eye-tracking and behavioral tasks, self-/parent-reports, and qualitative analysis of open-ended responses. Quantitative analyses revealed autistic participants had lower self-determined motivation, driven by reduced intrinsic motivation and identified regulation. Parent-report results corroborated lower perceived social motivation in the autistic group. The eye-tracking task showed decreased orientation to social stimuli, and behavioral task indicated reduced willingness to exert effort for social rewards, with no significant associations with age or autistic trait. Qualitative data highlighted that despite challenges, many autistic participants valued friendship and sought connection through shared activities, often preferring compact, stable social networks. The group-level quantitative findings align with social motivation theory but underscore heterogeneity, showing that diminished social motivation in autism may stem from contextual challenges rather than uniform amotivation. This study advances the understanding of social motivation dynamics, emphasizing the need for inclusive assessments that recognize diverse motivational expressions and prioritize subjective experiences.Lay AbstractSocial motivation refers to how much people want to engage with others, notice social cues, and seek connections. Researchers have long debated whether autistic people's social challenges stem from lower social motivation. However, past studies often focused on only one aspect of social motivation and ignored individual differences among autistic people. We recruited 104 autistic and 192 non-autistic adolescents and young adults. Participants and their caregivers completed questionnaires about social motivation from their own and caregivers' perspectives. We used two behavioral tasks to measure how much attention participants devoted to social content, and how willing they were to exert effort for social rewards. Open-ended questions captured autistic participants' perspectives on friendship dynamics, social inclusion, and the meaning of social connection. We found that autistic participants reported lower social motivation, a finding supported by parent reports. They spent less time looking at social content and exerted less effort to obtain social rewards than non-autistic peers. However, their open-ended responses showed that they sought social connection through shared activities, preferred small and stable social networks, and found joy and belonging in close friendships, despite challenges such as the strain of social interaction. Our results can help professionals avoid misinterpreting autistic people's social behaviors, and help families and peers recognize autistic individuals' expressions of social interest, reducing unfair judgments and promoting more respectful interactions. In addition, these findings support the development of assessments and social programs that reflect autistic perspectives.

Aqidah Akhlak learning in Madrasah Tsanawiyah faces various social challenges, including bullying, peer conflicts, social media influence, low empathy, and value conflicts among adolescents. These conditions require religious education to be connected to students’ real-life experiences rather than delivered solely through theoretical instruction. This study aims to describe the implementation of social case-based Aqidah Akhlak learning and examine its role in developing moral reasoning, empathy, and students’ understanding of value conflicts. The research was conducted at MTs Ma’arif NU Al-Hidayah Purwokerto using a qualitative approach. Data were collected through interviews, observations, and documentation involving the school principal, Aqidah Akhlak teacher, and students. The findings show that the teacher used cases of bullying, peer conflict, dishonesty, and social media issues as discussion materials. Through these discussions, students learned to evaluate actions based on religious values and their social consequences while developing empathy toward others. The study also found value conflicts between religious norms, adolescent culture, and students’ social experiences. The findings indicate that social case-based Aqidah Akhlak learning strengthens moral reasoning, enhances empathy, and helps students understand value conflicts in a more contextual and meaningful way.

ABSTRACT This article explores how public value is created in the complex and contested field of refugee integration, identifing three key arenas – service delivery, social and community activities, and advocacy – whereby NPOs create value in the multiple domains of refugee integration. We develop a conceptual model illustrating mechanisms of public value creation from the perspective of NPOs (full co-creation, societal creation of value between volunteers and service users only, and contestation), highlighting the roles of local and refugee volunteers. We contribute to public management scholarship by advancing theoretical understanding of how value is created in politicized policy fields and by whom.

ABSTRACT The transition toward more sustainable fashion consumption is crucial for addressing global ecological and social challenges. Informed consumer choices play a central role in this transition but rely on adequate knowledge of fashion sustainability. To date, no scientifically robust measure exists to assess such knowledge. This study addresses this gap by developing a comprehensive scale of consumers’ objective knowledge of fashion sustainability. Drawing on current literature, existing scales, and consumer feedback (n = 319), and validated through qualitative interviews with two fashion experts, an initial item pool was created. Using Item Response Theory (IRT), a 25-item scale was developed, capturing system, action-related, and effectiveness knowledge across all three dimensions of sustainability and the entire product life cycle. The scale was tested with 394 participants, demonstrating appropriate item difficulty distribution. This instrument provides a reliable, extendable measure of consumer knowledge, supporting further research to promote sustainable fashion consumption.

The article is devoted to the analysis of public-private-philanthropic partnership and the improvement of the regulatory and legal regulation of its activities, to create a regulatory basis for attracting charitable funds to socially important investment projects, in particular, regarding rehabilitation, reintegration, preservation and restoration of human capital. The study focuses on the analysis of the current state of the private medical services market in Ukraine and existing cases of involving charitable partners in investment projects in the field of rehabilitation. The preference for the development of public-private-philanthropic partnerships is justified, as opposed to classic public-private partnerships, which are associated with the social significance of rehabilitation problems and insufficient funding. It was found that the activities of rehabilitation centers with the support of charitable partners are aimed not only at the quantity, but also at the quality of rehabilitation, orientation to the best international practices and advanced training of medical personnel. Therefore, such an investment approach is relevant especially in times of unstable economy and social challenges. The purpose of the article is to summarize the practical experience of creating and operating rehabilitation centers on the principles of public-private-philanthropic partnership in Ukraine, and to develop recommendations for improving the regulatory and legal framework to create a favorable legislative framework for the implementation of this model. It was found that today the regulatory and legal framework does not regulate the activities of such partnerships, as they are new to Ukrainian practice and are a response to the challenges of Ukrainian realities. Therefore, the proposals provided for improving the regulatory and legal framework are designed to provide a legislative basis for the development of this investment model. This will allow scaling up successful projects and will contribute to increasing the role of the charitable sector in areas related to the humanitarian dimension, such as: rehabilitation, reintegration, preservation and restoration of human capital. The novelty of the study lies in the attempt to adapt existing regulatory documents to the activities of these partnerships, because despite the lack of special regulatory and legal regulation, partnerships of this type already exist in Ukraine and are innovative. The article uses general scientific and special research methods: case study method, comparative analysis and logical generalization. Their application allowed us to widely explore the issues of the development of public-private-philanthropic partnerships, and to identify their advantages over classical public-private partnerships. Since Ukraine already has successful experience in the functioning of public-private-philanthropic partnerships in the field of rehabilitation, further scaling up of this practice requires the identification of criteria by which institutional support for sanatorium-resort and rehabilitation institutions should be carried out within the framework of this investment model. Therefore, the proposed criteria are designed to intensify the attraction of funds from the charitable partner in those areas that require optimization of the costs of the private partner and the state.

Higher education students face unique stressors, including academic pressure, social challenges, and life transitions. These stressors can affect their mental health, academic performance, and overall well-being. Research has shown that high levels of stress can lead to anxiety, depression, poor sleep quality, and decreased academic motivation. This study investigates the effectiveness of an 8-week mindfulness-based stress reduction (MBSR) among students at the University of Hyderabad, India. Using an experimental research design, 50 students were randomly assigned to either an experimental group, which participated in weekly MBSR sessions supplemented with daily at-home practices, or a control group that received no intervention. Stress levels and mindfulness were assessed pre- and post-test-intervention using the Perceived Stress Scale (PSS) and the Five Facet Mindfulness Questionnaire (FFMQ). The findings revealed a significant reduction in stress levels (p = 0.038) and substantial improvements in mindfulness dimensions, including observing, describing, acting with awareness, nonjudging, and nonreactivity, among the experimental group compared to the control group (p < 0.001). Large effect sizes highlighted the intervention’s effectiveness in promoting mindfulness, self-awareness, and stress management. This research highlights the potential of mindfulness-based programs as accessible, noninvasive strategies to enhance students’ mental health and academic performance. The study suggested that for integrating mindfulness practices into student support services and curricula, it is helpful to emphasiz cultural adaptations such as yoga to increase engagement and acceptance. Future research should explore the long-term effects of mindfulness interventions on academic outcomes and overall life satisfaction, contributing to sustainable mental health solutions in higher education.

Patterns of social determinants of health and their associations with health indicators: A latent class analysis.

Ageing is a global concern, and the growing geriatric population in developing countries such as Nepal faces significant health and social challenges. This study aimed to assess the health status and lifestyle behaviours of older adults. A cross-sectional analytical study was conducted in 2023 with 275 older adults in Mahalaxmi Municipality, Dhankuta, Nepal, using non-probability convenience sampling. Structured interview schedules, based on WHO recommendations and the Katz Index of Independence in Activities of Daily Living (ADLs), were used to collect data. Descriptive and Inferential statistical analyses were performed, followed by a binary multiple logistic regression model to assess statistically significant factors associated with chronic health problems and functional status in ADLs among older adults. The mean age of participants was 73.12 ± 5.29 years; 50.9% were male, and 96.7% were unable to read and write. Nearly half of the older adults reported at least one chronic health problem (48.4%), and 45.0% mentioned moderate to severe functional impairment in ADL. The fitted model revealed that unmarried or widowed older adults had higher odds of chronic health problems (AOR:2.83, 95% CI:1.42-5.66, p = 0.003). Smoking was also associated with increased odds (AOR: 2.10, 95% CI: 1.03-4.30, p = 0.042), whereas engagement in light-to-moderate physical activity was associated with significantly lower odds of chronic health problems (AOR = 0.15, 95%CI:0.08-0.29, p < 0.001). Functional impairment in ADL was more likely among older adults aged ≥ 75 years (AOR = 2.09, 95% CI:1.07-4.08, p = 0.03) and was strongly associated with the presence of chronic health problems (AOR = 18.43, 95% CI: 9.64-35.24, p < 0.001). The findings indicate a high burden of self-reported chronic health problems and functional dependency among older adults in a hilly municipality of Nepal. Marital status, smoking, and physical activity were significantly associated with chronic illness, while age and chronic illness were significantly associated with ADL dependency. These results highlight the need for community-based geriatric screening and targeted behavioural interventions to improve health status among older adults.

Our objectives were to understand migraine-related perceptions among college students and the lived experiences of those with migraine on college campuses and to generate recommendations for supporting college students with migraine. During young adulthood, there is a sharp growth in migraine prevalence and disability-adjusted life years. Migraine prevalence is approximately 16% among university students and negatively influences several aspects of a student's college experience. This was a qualitative study using phenomenological inquiry via virtual semistructured focus groups. Recruitment took place between April 2025 and July 2025. An initial 60-min focus group was conducted in May 2025 with an all-women's college to assess our questions' relevance and comprehensiveness. We then conducted four national focus groups in June 2025 and July 2025 with college students from across the United States. All focus groups included students with and without severe headache or migraine (self-reported). Focus groups were transcribed and independently coded twice. We developed themes for the five focus groups using content analysis. Qualitative analysis was conducted between July 2025 and September 2025. Three students attended the all-women's college focus group and 47 students attended one of the four national focus groups (n = 50). The following themes emerged from the five focus groups: (1) Migraine is often misunderstood and not discussed on campus, with misconceptions surrounding severity and its distinction from headache. (2) The impact of migraine on campus is significant, with students reporting various triggering environments, difficulty maintaining focus, attending class, performing academically, preserving social relationships, and participating in extracurricular activities. (3) The most commonly reported accommodations for migraine were academic, specifically exam- and attendance-related, though not always honored by professors. (4) Access to migraine care for students is challenging, with reports that student health centers are typically unapproachable, inconvenient, and unhelpful, with students seeking external providers for migraine. Students recommended more awareness and education initiatives for improved understanding of migraine as well as increased access to migraine resources and accommodations. The experiences captured in our study provide unique qualitative insights by highlighting how misunderstanding of migraine on campus contributes to social and academic challenges faced by students with migraine. Students described unmet needs related to widespread misunderstanding of migraine, limited academic flexibility, environmental triggers, limited access to care, and inconsistent implementation of accommodations, highlighting that greater awareness of migraine, especially by professors and student health services, is crucial on college campuses. There are opportunities for migraine education programs on college campuses to increase knowledge and awareness about migraine and create a more supportive migraine environment.

The coronavirus disease 2019 (COVID-19) pandemic created substantial social, economic, and psychological challenges worldwide. This study examines changes in subjective well-being and happiness patterns during the COVID-19 period compared with the pre-pandemic period in Türkiye as an emerging country context. We analyze nationally representative Life Satisfaction Survey data from the Turkish Statistical Institute (TurkStat) for the 2019-2021 period, covering approximately 10 thousand individuals aged 18 and above each year. Multinomial logistic regression models are employed for each year, preserving the original five-category happiness variable ranging from "very happy" to "very unhappy". First, during the COVID-19 period, the percentage of individuals who defined themselves as happy or very happy decreased from approximately 54% in 2019 to 48.7% in 2020, before slightly recovering to 50.1% in 2021. Second, "health" remained the most frequently reported source of happiness among categories such as success, job, love, and money both before and during the pandemic period. The findings indicate that the main determinants of happiness remained broadly stable during the pandemic-period years, although the magnitude of several associations changed. Women reported higher happiness levels than men, whereas employed women exhibited relatively lower happiness levels. Having a job alone did not consistently affect happiness; however, employed individuals with at least a high school education tended to report higher happiness levels before the pandemic period. Furthermore, higher income, being married, health satisfaction, income satisfaction, and social life satisfaction were positively associated with happiness. A U-shaped relationship between happiness and age groups was also observed. Although higher-income individuals consistently reported greater happiness levels, the strength of this association weakened during the pandemic-period years. Finally, hopefulness about the future demonstrated the strongest and most consistent association with happiness. Hopeful individuals exhibited substantially greater odds of belonging to the "very happy" category, with odds ratios of approximately 18.0 in 2019, 15.1 in 2020, and 17.9 in 2021. The findings suggest that although happiness levels declined during the COVID-19 period in Türkiye, the main determinants of happiness remained largely stable. Socioeconomic conditions, health satisfaction, and future expectations were important factors associated with happiness, while hopefulness about the future emerged as the strongest and most consistent predictor across all years.

Population aging has received considerable attention across economies presenting significant social, economic, and health challenges. While research has focused on demographics and health, limited attention has been given to the context, processes and outcomes of active aging in Ghanaian society. An exploration into this is essential to understanding the underlying dynamics between social stability, socioeconomic growth, health promotion and quality of life of older adults in Ghana. We conducted a systematic review to compile and report on existing empirical evidence on population trends, age-related health issues, available support systems, and needs of older adults in Ghana to inform age-friendly services and policies. In accordance with PRISMA guidelines, we screened peer-reviewed articles published between 2015 and 2025 using search terms related to aging in Ghana. Through thematic synthesis, four themes were identified - health utilization, health status, social support, and policy implications. Older adults who had better emotional, relational, and instrumental support from family and the community demonstrated higher levels of wellbeing, greater use of healthcare services, and reduced feelings of social isolation. Individuals reported unmet needs in food insecurity, financial hardship, lack of assistance with daily activities, and limited access to healthcare. Furthermore, older adults who reported multiple chronic conditions reported high levels of functional disabilities and physical difficulties. This review underscores an immediate, coordinated policy intervention and research action to prepare Ghana for its next demographic phase. Priority action should focus on enhancing healthcare access, fostering social inclusion and promoting community engagement among older adults in Ghana to improve their quality of life.

Adolescents in Denmark increasingly report poor mental wellbeing and health behaviour. Additionally, they spend less time being physically active and being with friends and more time on gaming and social media. The eHOOD intervention was developed to address physical and mental wellbeing of adolescents in vulnerable positions using their motivation for gaming to engage them in a community entailing physical and social activity, and education with peers. This study aimed to assess the evaluability of the eHOOD intervention, to develop an evaluation design, and to test the feasibility and acceptability of the evaluation design and the intervention. Evaluability assessment was performed by a working group in a series of workshop-style meetings involving a literature review, creation of a theory of change, and preparation of an evaluation plan including outcome measures, instruments, and data collection procedures. Subsequently the evaluation design and the intervention were tested in a single arm feasibility study. Participants were 13 adolescents aged 13-16 years. The participants met with a coach and a local pedagogue in an after-school club four hours a week for 25 weeks practicing gaming, engaging in physical and social activities, and learning about healthy lifestyle habits through education and communal cooking and dining. Feasibility and acceptability of outcome measures, instruments, and data collection procedures were assessed, and initial changes in outcome measures were measured. Recruitment and retainment of participants were monitored, and participants' motivation for and benefits of participating were explored. Data were collected with qualitative and quantitative methods. An evaluation plan was developed and found to be suitable for use in the subsequent feasibility study. The evaluation design was overall feasible and acceptable, although several important adjustments to measurements and data collection procedures were identified. Initial changes in wellbeing were observed and the World Health Organization-Five Well-Being Index (WHO-5) was deemed relevant as a primary outcome in future evaluation. The intervention was found feasible and acceptable among participants in the present format. This combined evaluability assessment and feasibility study suggests that the eHOOD intervention is ready for larger-scale evaluation, although refinements to outcome measures and data collection procedures are warranted before effectiveness can be evaluated. ClinicalTrials.gov, March 23, 2026. Identifier NCT07489365. Retrospectively registered.

Haitians have a high incidence of sickle cell disease. The Comparative Study of Children in Haiti and Miami with Sickle Cell Disease (CSHSCD) assessed clinical and social characteristics of children of Haitian immigrants and African American controls comparing them with Haitian children living in Haiti with the purpose of overcoming differences during follow-up. We hypothesized that at baseline there would be significant differences and that time since migration may correlate with improved access to medical care. Baseline clinical characteristics and parental self-reported barriers to care were compared. Acculturation measured as English proficiency was assessed among Haitian American parents. Two hundred fifty-five children (mean age 38months) were recruited: 204 Haitians, 32 Haitian Americans and 19 African Americans. African American and Haitian American children with hemoglobin SS were more likely receiving hydroxyurea (p < 0.001) and were less likely to have experienced a vaso-occlusive crisis than children in Haiti (p < 0.001). Being in the United States over 10years was associated with better English proficiency. Children in Haiti were more anemic, more likely to be malnourished and to lack pneumococcal conjugate vaccinations. Haitian families could not afford treatment. Longer length of stay in the United States was associated with appropriate pneumococcal vaccination, higher parental education, and better English competency. Haitians living in Haiti were at a significant disadvantage in every aspect of care, requiring ongoing assistance with community resources, medications and vaccines. We encourage global partnerships to decrease barriers to care in disadvantaged populations.

The lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) community represents a high-risk group for lung cancer given higher smoking rates. We evaluated implementation of a pilot patient navigation intervention for smoking cessation services combined with lung cancer screening (LCS) care for eligible LGBTQ+ adults. We completed a concurrent mixed-methods evaluation of the intervention to enhance adaptation and future scale. Forty-one LGBTQ+-identifying individuals who were eligible for LCS and currently smoking were enrolled, completed baseline surveys, and underwent the intervention for a 90-day period. Thirty-four participants completed post-intervention surveys and 15 were invited for semi-structured interviews. We conducted a thematic analysis of qualitative data, integrated with quantitative and qualitative survey data through joint displays, guided by the Health Equity Implementation Framework. We identified fourteen themes in three topical domains. Key themes related to Intervention Success included: flexible communication; iterative contact through a longitudinal relationship; improved confidence and comfort; multimodal and tailored elements. Themes related specifically to LGBTQ+ Care included: LGBTQ+-specific social challenges; the impact of historic discrimination; emphasis on non-judgmental care; and varied responses to LGBTQ+-specific tailoring. Themes related to Future Adaptations included: more education and information on the LGBTQ+-tailored approach; synergy with trusted primary care clinicians; upfront information on financial risks; community connection and peer support; and variable need for more intense support. LGBTQ+-tailored patient navigation is an acceptable and well-suited intervention to facilitate and integrate LCS care and smoking cessation. Further adaptation should include more education and incorporate components of community support.

IntroductionAdolescent pregnancy remains a significant public health and social challenge in sub-Saharan Africa, including Tanzania. The study aimed to explore contextual reasons and determinants of adolescent pregnancy among girls using a mixed-methods approach.DesignA convergent mixed-methods study integrating a community-based cross-sectional survey with qualitative in-depth interviews and focus group discussions. Quantitative and qualitative data were analysed separately and integrated during interpretation using triangulation and comparative joint analysis.SettingCommunity-based study conducted in Korogwe District, Tanga Region, northeastern Tanzania.ParticipantsA total of 418 adolescent girls aged 15–19 years were selected through multistage sampling for the quantitative survey. The qualitative component purposively recruited pregnant and parenting adolescents, parents/guardians and community stakeholders.Primary and secondary outcome measuresThe primary outcome was adolescent pregnancy, defined as ever having been pregnant, including current pregnancy. Secondary variables included sociodemographic, educational, economic, relational and contraceptive factors associated with adolescent pregnancy.ResultsThe prevalence of adolescent pregnancy in Korogwe District was 16%. In multivariable analysis, older age (18–19 years), school discontinuation, marital union and economic vulnerability were independently associated with adolescent pregnancy. Current contraceptive use was more commonly reported among adolescents who had experienced pregnancy, a finding likely reflecting post pregnancy uptake rather than a protective effect, given the cross-sectional design. Qualitative findings revealed that poverty, transactional relationships, early unions, gendered power imbalances and misconceptions about contraception constrained adolescents’ reproductive autonomy. Integrated analysis demonstrated convergence between statistical associations and lived experiences, showing that economic precarity and educational limitations operated as structural pathways influencing early union formation and limiting contraceptive decision making.ConclusionsAdolescent pregnancy among girls aged 15–19 years in Korogwe District is shaped by interrelated socioeconomic, educational and gendered factors. The identified factors and contextual reasons suggest that adolescent pregnancy is a socially patterned outcome rather than solely an individual behavioural issue. Multisectoral interventions addressing school retention, economic insecurity and gender power relations are essential to reduce vulnerability.

Introduction Intentional diphenhydramine ingestions increased in 2020 due to the Coronavirus pandemic and social media challenges. The purpose was to describe trends in frequency, management, and outcomes of massive (≥2,500 mg) and non-massive diphenhydramine ingestions in children from 2016–2023, which are prior to and after the COVID-19 and the TikTok® “Benadryl Challenge.” Methods This retrospective time-series utilized the National Poison Data System (NPDS)® records of diphenhydramine ingestions in patients 6–18 years of age between January 1, 2016-December 31, 2023. The primary objective was to evaluate the frequency of massive and non-massive diphenhydramine ingestions. Secondary objectives included comparison of frequency of diphenhydramine ingestions in 2016–2019 to 2020–2023, and comparison of outcomes and management of massive and non-massive ingestions. Bivariate comparisons were made using Chi-Square or Fisher’s Exact tests, and interrupted time-series analysis and segmented linear regression models to compare rates of diphenhydramine ingestions between time periods. Results There were 24,358 cases, with a 34.3% increase from 2016–2019 to 2020–2025. Of those, 1,190 cases (4.9%) were classified as massive ingestions. Massive ingestions increased from 4.6% to 5.1% of cases from 2016–2019 and 2020–2023, respectively, with an estimated quarterly change of 0.03% (95% CI: −0.01-0.06%). Inpatient admission was required in 69.6% and 26.2% of massive and non-massive ingestions, respectively (P <0.001). Massive ingestion resulted in major effects (i.e.,, life-threatening symptoms or residual disability or death) in 21.3% and 1.0% of cases, respectively, resulting in greater use of mechanical ventilation, pharmacologic therapies, and gastrointestinal decontamination. Discussion Diphenhydramine ingestions increased from 2016–2023, but the percentage of massive ingestions was not statistically different prior to and after 2020. Management is variable, with a greater percentage of massive ingestion cases requiring inpatient admission and receiving pharmacologic treatment. Conclusion The percentage of massive diphenhydramine ingestions ranged from 2.7-6.7% of reported ingestions from 2016–2023, and the trend since 2020 was not significantly increased. Massive diphenhydramine ingestions are associated with more severe symptoms and higher levels of care.