ABSTRACT Research shows that participation in physical activity (PA) programs can benefit transgender and gender diverse (TGD) youths’ social, psychological, and physical health and development. However, previous scholars note that discriminatory environments and barriers can limit TGD youths’ organised and recreational leisure activity engagement. Despite no existing, tailored PA environments for this population, other types of programs effectively create inclusive environments for them. The purpose of this study was to gather input from adult leaders of such community programs, regarding practices and policies that could contribute to creating a safe, enjoyable PA program for TGD adolescents. Nine community leaders facilitating US-based programs with TGD and LGBTQ+ youth participants participated in individual, semi-structured interviews. They were asked about organisational policies, staff hiring, activity structure, and accessibility strategies. Template analysis revealed leaders recognise an absence of (tailored) PA programs for TGD youth. They shared concrete examples from their programs, with broad recommendations for underrepresented youth and more specific considerations for TGD youth. Leaders suggest that clear community guidelines, flexible programming, appropriate staff training, youth autonomy, and safety-promoting strategies (e.g. private meeting spaces) are necessary. Community leaders are an underutilised, invaluable resource for creating safe, enjoyable leisure contexts for TGD youth.

This study explores the relationships between ICT uses for various purposes and mental health and the moderating effect of technology learning among Chinese and Korean older Americans. The survey data were collected from 513 Chinese and Korean older Americans in New York City. Negative binomial regression was used to examine the relationships between ICT uses for social, instrumental, and health purposes, and depressive symptoms. Interaction terms between ICT use variables and technology learning styles were created for the moderation test. We found that ICT uses for social contact and health purposes were significantly associated with lower depressive symptoms among the Chinese and Korean older Americans, and the benefits were more pronounced for those who learned ICT independently. This study highlighted the importance of supporting ICT uses for social contact and health purposes and technology learning process to improve mental health of older Asian Americans.

ABSTRACT We examine the decline in U.S. 12th-graders’ self-reported happiness using Monitoring the Future (MTF) data and annual indicators for 1976–2023. General-to-specific (GETS) selection and fully modified OLS (FMOLS) cointegration estimates indicate a long-run relationship in which climate-risk perceptions, homicide rates, and GDP per capita are negatively associated with happiness. VAR generalized impulse responses and local projections (LP) show consistent dynamics, with especially persistent negative effects after climate-risk and homicide-rate shocks. The results motivate an integrated policy agenda beyond screen-time regulation, emphasizing credible climate action, community safety, youth economic opportunities, and accessible school-based mental health support.

Chronic pain is increasingly recognised as a standalone medical condition shaped by interacting biological, psychological, and social determinants, affecting nearly one in three adults worldwide. This review synthesises contemporary evidence on the epidemiology, mechanisms, and management of chronic pain, with emphasis on the convergence of genetic, neurobiological, and psychosocial factors. We draw on recent population-based studies, clinical trials, neuroimaging research, and multi-omic genetic analyses to highlight the complexity and heterogeneity of this condition. Chronic pain disproportionately affects older adults, women, and socioeconomically disadvantaged groups, and frequently co-occurs with psychiatric, cardiovascular, and neurodegenerative disorders, reflecting shared pathways of maladaptive neuroplasticity. Although pharmacological therapies often provide modest long-term benefit, integrated psychological, physiotherapeutic, and interventional approaches demonstrate more sustainable improvements in function and quality of life. Advances in genomics and large-scale genome-wide association studies (GWAS) have revealed extensive polygenic overlap with psychiatric and immune traits, while neuroimaging consistently demonstrates alterations within prefrontal, insular, and limbic circuits that shape pain perception and persistence. Despite reliance on subjective symptom reporting, emerging digital phenotyping, wearables, and AI tools offer promising avenues for objective monitoring and personalised treatment. Integrating biological, behavioural, and environmental data will be essential to achieving truly precision-based chronic pain care.

Global population aging is reshaping social structures and health demands at an unprecedented pace. Existing research indicates that decision-making power is significantly associated with health outcomes in later life. However, the underlying pathways linking household financial decision-making power to mental health remain underexplored in population-based studies. Elucidating multi-pathway effects will provide pathway-based evidence for identifying vulnerable populations and developing clinical interventions. We analyzed five waves (2005-2014) of the Chinese Longitudinal Healthy Longevity Survey(CLHLS), comprising 23,994 observations from 9,055 adults aged 65 years or older. Financial decision-making power was self-reported on a four-point ordinal scale. Mental health was assessed via five indicators: psychological resilience, subjective well-being, life satisfaction, self-rated health, and loneliness. Fixed-effects models were applied to control for time-invariant confounders, and inverse probability weighting was used to address attrition bias. Mediation pathways were tested using a bootstrapping approach (500 repetitions). A graded dose-response relationship was observed: lower financial decision-making power was associated with poorer mental health across all outcomes. Compared to those with full autonomy, older adults without decision-making power showed significantly lower psychological resilience (β = - 0.31, p < 0.001) and subjective well-being (β = - 0.51, p < 0.001). Mediation analyses revealed that activities of daily living (ADL) accounted for 13.0% to 31.8% of the total effect and leisure activities for 10.0% to 34.2%, with the strongest mediation observed for loneliness. Among the participants who were functionally independent at baseline, functional capacity exhibited dual mediating roles: a positive pathway for self-rated health and a suppression effect for loneliness. Heterogeneity analyses revealed more pronounced benefits among economically disadvantaged, financially dependent, female, and younger-old adults, with protective effects partially offsetting vulnerabilities in these populations. Financial decision-making power is a significant and potentially modifiable factor associated with mental health among older adults, representing an underexplored pathway for promoting healthy aging, with effects partially mediated through ADL and leisure engagement. Mental health promotion strategies should seek to preserve older adults' household financial decision-making power while supporting functional independence and social engagement.

Association between social determinants of health and overactive bladder: exploring the role of cardiovascular health in a cross-sectional analysis.

Intense armed conflict in Gaza gives rise to record-breaking humanitarian catastrophe. More than destructions of physical residence, the cost to health and well-being remains pressing concerns among people displaced by war. While the international community provide various forms of assistance, deliveries are challenged as blockades, according to reports, are in effect. Access to aid is reported to have been effectively restricted. Alongside with this are the reports of violations of medical neutrality - the targeting of medical facilities, making access to healthcare, treatment, and medical supplies extremely difficult if not impossible. Drawing on the WHO's framework of social determinants of health in conflict settings, this article situates the Gaza violence as a clear and profound case of how conflict dismantles the structural foundations of health and well-being. While mere peace does not guarantee positive health outcomes, peace inherits a cardinal role when war involves aid restrictions and breaches of medical neutrality. Peace becomes more fundamental to health and well-being under these cases of conflict environment. This is not to argue that peace is alternative to health. Rather, as drawn from the Gazan experience, peace is argued to be the foundation of health, indivisible to it. Peace, therefore, precedes health.

Traditional public health approaches often conceptualize physical exercise as a behavioral determinant of physical health. Yet, the psychosocial mechanisms through which exercise participation enhances wellbeing in later life remain insufficiently understood. This study reframes exercise participation as a psychosocial ecosystem that simultaneously fulfills eudaimonic (psychological) and relational (social) needs, promoting active aging through interconnected mental and social pathways. Drawing on eudaimonic wellbeing theory and the social ecology of aging, we tested a dual-mediation model linking exercise participation, psychological wellbeing, social connectedness, and life satisfaction among 412 older adults in South Korea. Structural equation modeling confirmed that exercise participation enhanced life satisfaction both directly and indirectly via psychological wellbeing ( β = 0.20, p &amp;lt; 0.001) and social connectedness ( β = 0.17, p &amp;lt; 0.001). These psychosocial mediators accounted for 43% of the total effect, underscoring the interdependence of emotional and social health in later life. The findings advance active-aging research by bridging behavioral health and social integration theories, positioning exercise as a public health catalyst for mental resilience and social cohesion. Public health strategies should therefore integrate psychological empowerment and social inclusion within community-based exercise initiatives to foster eudaimonic wellbeing and social vitality among aging populations.

Abstract Objective This study examined the impact of quality time spent with family in modifying the relationship between various negative home and social consequences of the pandemic and subsequent social and behavioral outcomes. Background Adverse consequences related to economic, health, and social factors were brought about by the COVID‐19 pandemic. In other contexts, family protective factors and resiliency have been found to mitigate similar adverse circumstances. Method This mixed‐method study included participants across five states ( N = 67). Quantitative methods included survey data on individual and family experiences related to work and education, home and social circumstances, and physical and emotional health. Qualitative measures included individual interviews to better understand familial experiences during the pandemic. Results Relationships between negative home life experiences and consequences of the pandemic and subsequent negative outcomes were found to be altered as levels of quality time spent with family and children increased. These results were replicated through robust qualitative data, which told the stories of families using quality time to support positive outcomes. Conclusion Findings suggest that quality time spent with family can be a point of emphasis for mitigating adverse social and health outcomes. Implications Quality time may serve as a low‐cost, accessible relational strategy that can be intentionally emphasized in prevention, intervention, and public health messaging to strengthen family resilience during periods of prolonged adversity.

Loneliness is increasingly recognized as a global public health concern linked to adverse mental health outcomes. However, cross-national evidence on its distribution and association with depression and generalized anxiety is limited. We analyzed data from the 2023-2024 Global Social Determinants of Health Survey, a cross-sectional, nationally representative survey of 7,997 adults across Brazil, France, India, Indonesia, Nigeria, the Philippines, Türkiye, and the United States. Depression and generalized anxiety were measured using PHQ-9 and GAD-7 screening tools, respectively, while loneliness was self-reported. Weighted bivariate and multivariate (logistic and Poisson regression) models were used to estimate associations between loneliness and mental health outcomes, adjusting for demographic factors. Overall, 38.9% of respondents reported loneliness, 9.2% met criteria for depression, and 5.5% for generalized anxiety. Loneliness was more common among younger adults, women, individuals with lower income or education, unmarried individuals, and urban residents. In fully adjusted models, loneliness was associated with depression (OR 2.82 [95% CI: 2.25-3.54]) and generalized anxiety (OR 3.89 [95% CI 2.86-5.28]). Loneliness is common and strongly associated with depression and generalized anxiety across diverse settings. These findings underscore the importance of integrating strategies that promote social connection into mental health policy and interventions. Future research should explore causal pathways.

Agreement and Fairness of Cardiovascular Risk Assessment Models Among Older People Living With HIV in China: A Multicenter Cross-sectional Study.

The present study analyses the perceptions and behavioural practices related to food habits of students studying in secondary schools of Lakhimpur-Kheri district of Uttar Pradesh. Eating habits developed during adolescence affect physical, mental and social health. In this research, questionnaires have been used to collect data from secondary school students of private and government schools. This research evaluated students' food preferences, junk food consumption, nutritional knowledge, and their attitudes toward healthy eating. Research results showed that many children understand the importance of food well, but in reality, unbalanced diet and junk food consumption was found to be very high among children. Gender, socio-economic status and family environment were found to have a significant influence on eating habits. This study suggests that school-based nutrition education and awareness programs can develop healthy eating habits among students. We are making a small attempt to conduct such a study in Lakhimpur Kheri district. Our study included 60 students, of whom 30 were boys (50.0%) and 30 were girls (50.0%). Data was collected using a questionnaire. The aim of this study is to determine the level of awareness among secondary school students regarding food habits and junk food.

Background: Teenage pregnancy remains a significant public health concern worldwide, particularly in low- and middle-income countries, where early childbearing is influenced by social, cultural, and economic determinants. Adolescent mothers are at increased risk of adverse maternal and perinatal outcomes, including preeclampsia, preterm delivery, and low birth weight. Despite its clinical relevance, local evidence from Pakistan, especially from rural settings, remains limited. Objective: To determine the frequency of adverse maternal and perinatal outcomes among teenage pregnancies presenting to a tertiary care hospital in Swat. Methodology: This descriptive prospective observational study was conducted from 15 November 2021 to 15 May 2022 at the Department of Obstetrics and Gynecology, Saidu Group of Teaching Hospital, Swat. A total of 139 pregnant adolescents aged 13–19 years were enrolled through non-probability consecutive sampling. Maternal and perinatal outcomes, including cesarean delivery, preeclampsia, preterm delivery, small for gestational age, and low birth weight, were recorded using standardized clinical definitions. Data were analyzed using SPSS version 23, and associations were assessed through stratification and multivariate logistic regression analysis. Results: Cesarean delivery was observed in 44.6% of cases, preeclampsia in 25.2%, preterm delivery in 15.8%, small for gestational age in 18.7%, and low birth weight in 24.5%. Gestational age showed a statistically significant association with preterm delivery (p = 0.001) and small for gestational age (p = 0.002). Multivariate analysis confirmed gestational age as a significant predictor of preterm delivery and SGA, while maternal age and residential status were not significantly associated with adverse outcomes. Conclusion: Conclusion: Teenage pregnancy is associated with a high burden of adverse maternal and perinatal outcomes. Strengthening targeted antenatal care, early identification of high-risk pregnancies, and focused health education interventions are essential to improve outcomes in this vulnerable population. Keywords: Cesarean Section, Gestational Age, Infant, Low Birth Weight, Pre-Eclampsia, Premature Birth, Teenage Pregnancy.

Down Syndrome Regression Disorder (DSRD) is an acute neurocognitive regression in individuals with Down syndrome (DS), causing a profound loss of acquired skills. DSRD increases demands on caregivers, to sleep disturbances, financial distress, and negative impacts on caregiver-reported social connections and perceived social support. The goal of this study was to characterize the caregiver-reported impacts of DSRD on social relationships by comparing their experiences to those of caregivers of individuals with DS and other neurological disorders (DSN). This is a narrative burden-of-care study, not a network study. Using cross-sectional study design, caregivers of individuals with DSRD (n = 228) and DSN (n = 137) were recruited from a neurology clinic and a DSRD Facebook support group. Participants completed the DSRD Caregiver Distress Survey (CDS), which included four qualitative, open-ended questions focused on self-perception of adult friendships, social relationship impact, spouse/partner impact, and perceived shrinkage of social world. Responses were analyzed using thematic coding; resulting theme frequencies summarize caregiver-reported perceptions and narratives and do not represent objectively measured social network structure. In the DSRD cohort, a high-level overview revealed that 65.66% of responses reported a negative impact on adult friendships, while 71.21% reported a negative impact on social relationships. A negative impact on spouse/partner relationships was reported in 51.53% of responses, and a perceived shrinkage of social world was found in 52.82%. Caregivers in the DSRD group were significantly more likely to report "Social Withdrawal and Isolation" (43.2% vs. 17.9%, p = 0.006), "Loss of Community Participation and/or Support" (16.7% vs 4.5%, p = 0.043) and a "Perceived Enduring Loss of Social Connections" (35.3% vs. 8.7%, p = 0.002) compared to the DSN group. This study's findings reveal a significant and complex process of perceived social disengagement among caregivers describing social withdrawal and loss of social connections that they experienced as enduring. The results emphasize the need for early interventions that address the individual's needs but also address the caregiver's social and mental health to prevent perceived long-term social isolation.

Veterans involved in the criminal legal system (CLS) exhibit disproportionately high rates of comorbid mental health and substance use disorders (COD) and homelessness-conditions that increase both the risk of recidivism and suicide. Despite elevated risk, limited research has examined the relationship between criminogenic risk factors and suicidality in this population. This study examined differences in criminogenic risk, psychiatric burden, and social determinants of health (SDOH) among CLS-involved veterans with COD, comparing those with suicidality risk to those without. Baseline data were analyzed from 127 veterans admitted to three Department of Veterans Affairs (VA) Mental Health Residential Rehabilitation Treatment Programs who were enrolled in a randomized controlled trial of the MISSION-CJ intervention (ClinicalTrials.gov Identifier: NCT04523337). Eligible veterans had recent CLS involvement and documented COD diagnoses. Assessments included the Level of Service Inventory-Revised (LSI-R), the Measures of Criminal Attitudes and Associates (MCAA), structured psychiatric interviews, standardized symptom inventories, and measures of social determinants of health. Suicidality risk was defined as experiencing recent thoughts of suicide and/or attempted suicide in their lifetime. Most veterans (80%) were classified as having moderate-high to high criminogenic risk based on total LSI-R scores. Compared to those without suicidality risk, veterans with suicidality risk demonstrated significantly higher criminogenic risk as evidenced by total LSI-R scores (p = .01), more antisocial attitudes (p = .04), particularly entitlement and violence beliefs (p = .02, p = .01, respectively), greater emotional and functional impairment (p < .001), and a higher prevalence of probable posttraumatic stress disorder (PTSD; 64% vs. 41%, p = .009). SDOH, including unstable housing and limited community integration, were highly prevalent but did not significantly differ between those with and without risk of suicide. Among CLS-involved homeless veterans with COD, suicidality was associated with elevated criminogenic risk and greater psychiatric burden, particularly PTSD. These findings underscore the need for integrated interventions that address both criminogenic and behavioral health factors to support recovery, reduce suicide risk and mental health symptoms, and mitigate CLS recidivism. This study was preregistered at https://ClinicalTrials.gov with registration number NCT04523337.

PurposeTo examine the association between the social determinants of health (SDOH) and hypertension, diabetes, heart disease, and anxiety and/or depression among adult US women.DesignCross-sectional survey.Setting2022 Health Information National Trends Survey (HINTS).SampleWomen aged ≥18 years (N = 3535) participated from the U.S.MeasureOutcome variable was diagnosis of diabetes, hypertension, heart disease, and mental illnesses. Covariates included sociodemographic characteristics along with food, housing, and transportation insecurity.AnalysisSeparate weighted bivariate and multivariate logistic regression models were used to examine the unadjusted and adjusted odds ratios (AORs) associations between insecurities and chronic conditions, controlling for sociodemographic characteristics.ResultsHypertension (35.4%) and anxiety/depression (33.4%) were the most reported chronic conditions. Approximately 27% of the sample experienced all three forms of insecurity concurrently. Women with anxiety or depression had elevated levels of food, housing, and transportation insecurity (11.3%, 7.4%, 7.5%) than those with other chronic conditions. Adjusted models indicated that all three types of insecurity were significantly associated with chronic conditions. Food, housing, transportation, and any insecurity nearly doubled the odds of reporting any chronic condition (AOR = 2.15, 2.44, 1.70, and 2.20, respectively).ConclusionFindings highlight a strong association between SDOH and chronic conditions among women, necessitating the implementation of targeted policies and interventions to address sex-related health inequities to improve women's health.

Aotearoa New Zealand experiences a disproportionately high incidence of Group A Streptococcus (Strep A) disease, particularly acute rheumatic fever (ARF), with Pacific children 80 times and Indigenous Māori children 36 times more likely to develop ARF than children of other ethnicities. This qualitative study explored Māori and Pacific Peoples' perspectives on Strep A vaccine development. Guided by Kaupapa Māori and Pacific-centred research approaches, semi-structured interviews were conducted with 29 participants, including 20 whānau (family) members and nine healthcare stakeholders. Interviews were recorded, transcribed verbatim, and analysed using a general inductive thematic approach. Three interconnected themes emerged: Perceptions of ARF, vaccine development, and vaccine delivery. These themes were grounded in cultural values such as hauora (wellbeing), whanaungatanga (relationships), kotahitanga (collective action), and tino rangatiratanga (sovereignty and self-determination). Participants' perspectives were shaped by lived experiences of colonisation and the recent Covid-19 vaccine rollout. Māori and Pacific-led approaches rooted in cultural knowledge systems were consistently highlighted. Participants emphasised that the current healthcare system is not fit-for-purpose for Māori and Pacific health and wellbeing and must be realigned to better reflect varying worldviews. Vaccine delivery models must be holistic and flexible, incorporating a whānau ora (family-centred) approach. While recognising the importance of a Strep A vaccine, participants stressed that addressing social determinants of health, such as housing, poverty, and access to health care is essential to reducing disease burden. These findings demonstrate that culturally responsive approaches are essential for successful vaccination programmes. In Aotearoa New Zealand, this requires embedding Māori and Pacific leadership, perspectives and participation from design to delivery, together with strengthened Māori and Pacific health workforces.

This article presents a comprehensive analysis of the health system of the Republic of Kazakhstan, its current state, key achievements and remaining challenges. Using the Harvard “Five Control Knobs” analytical framework (financing, payment, organization, regulation and behavior), as well as analysis of the dynamics of the main medical and demographic indicators and human resources for 2017-2023, the article seeks to fill the gap in the systemic understanding of the effectiveness of the ongoing reforms and their impact on the health of the population. Particular attention is paid to the relationship between the various components of the system and the identification of priority areas for further improvement.&lt;br /&gt; Our findings indicate a moderate improvement in population health, with average life expectancy increasing from 72.9 to 75.1 years and overall mortality returning to pre-pandemic levels. However, noncommunicable diseases continue to account for approximately 84% of all deaths. Total health expenditure remained low at 3.8% of GDP in 2023, while out-of-pocket spending accounted for 27.7% of current health expenditure, reflecting persistent gaps in financial protection. Although the introduction of mandatory social health insurance has expanded pooled financing, significant weaknesses persist in provider incentive structures, workforce distribution, and regulatory enforcement.&lt;br /&gt; Overall, the results suggest that while gradual progress has been achieved, chronic underfunding, system fragmentation, and governance challenges continue to constrain equity and efficiency, underscoring the need for coordinated, evidence-based reforms.

To advance patient-centered care for high-need homeless-experienced patients, we identified the rates of various personal health goals, the broader domains that underlie these goals, and associations between these domains and the health-related needs of this population. The sample consisted of 176 veterans from 3 VA Medical Centers who were enrolled in primary care, on VA's Homeless Registry, and high utilizers of acute care. An interview was conducted with each participant to collect information on their personal health goals and health-related needs. Exploratory factor analysis was used to identify broad domains underlying endorsement of personal health goals. Associations between these broad goal domains and health-related needs (substance use, mental and physical health, treatment engagement, and psychosocial) were examined using an exploratory structural equation modeling-within-confirmatory factor analysis approach. Three broad domains were found to underlie the personal health goals of the sample: social functioning, health promotion, and substance use. Social functioning and health promotion were highly correlated, whereas substance use was weakly correlated with both social functioning and health promotion. All substance use-related needs were positively associated with substance use goals. Mental and physical health needs were primarily associated with health promotion goals. Treatment engagement and psychosocial needs demonstrated associations across all 3 goal domains. Findings highlight the high value that many high-need homeless-experienced patients place on their social well-being and the potential benefits to measuring both deficiency and growth needs in this population. Clinical implications and future directions for research are discussed.

IntroductionColorectal cancer (CRC) is one of the leading causes of cancer-related morbidity and mortality worldwide. Although early detection through screening significantly reduces mortality, adherence to recommended screening remains suboptimal. This systematic review examines the multilevel factors influencing CRC screening adherence, and integrates the findings within the Socio-Ecological Model to provide a structured analytical framework.MethodsA systematic search was conducted across PubMed, Scopus, and Web of Science for studies published between 2000 and 2024 that employed multilevel modeling to examine CRC screening behavior. Eligible studies involved average-risk adults and reported both individual- and contextual level determinants of screening adherence. Studies focusing exclusively on clinical predictors or non-screening outcomes were excluded. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tools. A narrative synthesis was performed to identify key individual, interpersonal, community, institutional, and policy-level determinants of CRC screening adherence.ResultsNine studies met the inclusion criteria, predominantly from high-income settings. At the individual level, older age, female sex, higher socioeconomic status, and health insurance coverage were consistently associated with greater screening adherence. Community factors such as neighborhood socioeconomic status and healthcare accessibility, influenced screening behavior, while institutional elements included system structures and service availability. Policy-level determinants, such as national health insurance and national screening guidelines, were less frequently examined but demonstrated measurable effects. Despite heterogeneity in populations, synthesis within the Socio-Ecological Model highlighted the interconnected nature of these determinants and emphasized the need for multilevel interventions targeting individual, social, and structural determinants.ConclusionThis review emphasizes the importance of addressing CRC screening behavior through a multilevel perspective that incorporates individual, social, and structural determinants. Future research should explore these determinants in low- and middle-income settings and assess the effectiveness of integrated multilevel interventions in improving CRC screening adherence.