Structural Barriers Research Articles

Reducing the harms of cannabis use in youth post-legalization: insights from Ontario youth, parents, and service providers.

Canada has one of the highest prevalence of cannabis use globally, particularly among young adults aged 20-24 (50%) and youth aged 16-19 (37%). In 2018, Canada legalized recreational cannabis with the aim of protecting youth by restricting their access and raising public awareness of health risks. However, there has been limited qualitative research on the perceptions of harms associated with youth cannabis use since legalization, which is crucial for developing effective harm reduction strategies. This qualitative study examined perceptions of cannabis use among youth from the perspectives of youth, parents, and service providers. We explored how participants described the perceived risks or harms associated with youth cannabis use, as well as how they described their own and others' approaches to reducing cannabis-related risks and harms. This qualitative study used a community-based participatory research approach in partnership with Families for Addiction Recovery (FAR), a national charity founded by parents of youth and young adults with addiction issues. Virtual semi-structured interviews were conducted, and the data were analyzed using thematic analysis. The study included 88 participants from three key groups (n = 31 youth, n = 26 parents, n = 31 service providers). Two main themes emerged regarding perceived risks or harms associated with cannabis use: (1) concerns about cannabis-related risks and harms, including addiction, brain development, impact on family, and various adverse effects on areas such as motivation, concentration, finances, employment, education, physical and mental health; and (2) minimization of risks and harms, featuring conflicting messages, normalization, and perceptions of cannabis being less harmful than other substances. Additionally, two themes related to harm reduction approaches were identified: (1) implementation of harm reduction, and (2) challenges in implementing a harm reduction approach. Specific challenges for each participant group were noted, along with structural barriers such as unavailable and inaccessible services, easy access to cannabis, inadequate public education, and insufficient information on lower-risk cannabis use guidelines. Youth cannabis use is a significant public health concern that requires a multi-pronged approach. Developing youth-centered harm reduction strategies that recognize the developmental needs and vulnerabilities of youth, as well as the important role of families, is imperative.

Understanding society: a reflexive foresight matrix for navigating complexity and shaping the future

Purpose This paper introduces the foresight matrix, a conceptual framework for foresight analysis rooted in critical realism (CR) and complexity theory. It aims to address the need for a comprehensive theoretical perspective that embraces emergence and recognizes the interplay between different layers of reality. Informed by critical theory within futures studies, the study seeks to provide additional foresight theoretical perspectives in addressing contemporary societal challenges and collectively shaping desirable futures. Design/methodology/approach The proposed reflexive foresight matrix incorporates elements of CR, complexity theory and morphogenesis theory, providing an alternative conceptual framework for analyzing complex social challenges. It integrates the vertical layers – empirical, actual and real – and horizontal dimensions – structure, agency and culture. This matrix guides researchers through a systematic analysis of structural barriers, cultural influences and individual agency, offering a comprehensive tool for understanding the underlying mechanisms driving social change. Findings The reflexive foresight matrix dissects complex situations into structure, agency and culture dimensions, enabling a thorough understanding of societal dynamics by examining the interplay between these dimensions and their influence on individual and collective behaviors. This conceptual framework guides researchers through a systematic analysis of structural barriers, cultural influences and individual agency, uncovering the mechanisms driving social change. Through reflexive monitoring and temporal action analysis, it explores historical and contextual factors, informing future tendencies. Practical implications The reflexive foresight matrix provides a multidimensional lens for understanding social issues, prompting researchers to consider the interplay between structure, agency and culture across different layers of reality. By exploring historical and contextual factors, this framework enables an insight into diverse perspectives and their impact on future outlooks. Furthermore, the matrix facilitates critical inquiry into prevailing power dynamics and narratives, offering insights into societal injustices and inequalities. This critical examination empowers stakeholders to challenge dominant narratives and work toward more equitable and desirable futures. Social implications The proposed reflexive foresight matrix offers a comprehensive approach to analyzing complex social challenges, potentially impacting futures thinking and foresight practices. By integrating CR, complexity theory and morphogenesis theory, the framework fosters a deep understanding of the interplay between various factors influencing future tendencies. This comprehensive view of problems allows analysts to consider structural barriers, cultural influences and agency, thereby enhancing foresight efforts in addressing contemporary challenges. Originality/value The proposed reflexive foresight matrix contributes to futures thinking and foresight practices by offering a comprehensive approach to analyzing complex social challenges. By combining CR, complexity theory and morphogenesis theory, the framework fosters an insightful understanding of the interplay between various factors influencing future trajectories. Moreover, the integration of critical perspectives and reflexive methodologies into foresight practices underscores the importance of challenging dominant narratives, fostering inclusive decision-making processes and empowering individuals and communities to shape their futures.

Ru-Incorporation-Induced Phase Transition in Co Nanoparticles for Low-Concentration Nitric Oxide Electroreduction to Ammonia at Low Potential.

Electrocatalytic reduction of nitric oxide (NO) to ammonia (NH3) represents a potential solution for improving the disrupted nitrogen cycle balance. Unfortunately, designing efficient electrocatalysts for NO reduction reaction (NORR) remains a notable challenge, especially at low concentrations. Herein, a displacement-alloying strategy is reported to successfully induce the phase transition of Co nanoparticles supported on carbon nanosheets from face-centered cubic (fcc) to hexagonal close-packed (hcp) structure through Ru incorporation. The obtained RuCo alloy with hcp phase structure (hcp-RuCo) exhibits apparent NORR activity with a record-high Faraday efficiency of 99.2% and an NH3 yield of 77.76µg h-1 mgcat -1 at -0.1V versus reversible hydrogen electrode at a NO concentration of 1vol %, surpassing Co nanoparticles with fcc phase structure and most reported catalysts. Density functional theory calculations reveal that the excellent NORR activity of hcp-RuCo can be attributed to the optimized electronic structure of Co site and lowered energy barrier of the potential rate-determining step through phase transition. Furthermore, the assembled Zn-NO battery using hcp-RuCo as the cathode achieves a power density of 2.33mW cm-2 and an NH3 yield of 45.94µg h-1 mgcat -1. This work provides a promising research perspective for low-concentration NO conversion.

Bibliometric analysis of citizen science in global healthcare: Current trends, challenges, and future directions

With the development of information technologies such as big data, cloud computing, and artificial intelligence, the application scenarios of citizen science worldwide are no longer limited to natural science research. A large number of application cases have emerged in the field of medical health, which suggests that the development of citizen science may bring new impetus to medical health. This study employs CiteSpace for a bibliometric analysis to evaluate the current status, objectives, and methodologies of citizen science in global healthcare. An analysis of 248 articles from the Web of Science Core Collection reveals that citizen science is predominantly implemented in high-income countries, including the United States, the United Kingdom, Germany, and the Netherlands, with significant applications in public health, chronic disease management, infectious disease surveillance, and digital health. The COVID-19 pandemic has further catalyzed the integration of citizen science into health surveillance and public health responses. Conversely, in low- and middle-income countries (LMICs), the development and implementation of citizen science remain nascent, primarily concentrated in traditional domains such as environmental science, ecology, and biodiversity conservation, with limited penetration into the healthcare sector. Several structural barriers, including inadequate technological infrastructure, insufficient policy support, limited public engagement, and constrained resource allocation, have impeded the broader adoption of citizen science in these regions. To mitigate these challenges, this study proposes targeted strategies, these interventions are anticipated to facilitate the expansion of citizen sciences role in global health governance, ultimately contributing to improved public health outcomes and social welfare.

Changes in Mental Health Services Use Under the ACA in One State: Role of Mental Health Provider Shortages.

This study aimed to examine whether changes in mental health services use under the Patient Protection and Affordable Care Act (ACA) differed in Mental Health Professional Shortage Areas (MHPSAs) versus non-MHPSAs. Multiple waves of data from the California Health Interview Survey (2011-2018) were analyzed. The sample (N=10,497) was restricted to adults (ages 18-64) who reported experiencing serious psychological distress (SPD) during the past 12 months. MHPSAs were identified by using scores from the Health Resources and Services Administration and were matched to respondents' zip codes. Weighted logistic regression and generalized linear models were used to identify adjusted changes in the rates of four measures of mental health services use (any primary care visit for mental health reasons, any specialty mental health care visit, any prescription psychiatric medication, and total number of outpatient visits for mental health) before and after implementation of the ACA. Rates of uninsured nonelderly adults with SPD in MHPSAs and non-MHPSAs decreased under the ACA. Changes in rates of specialty mental health services use under the ACA were statistically significant only in non-MHPSAs. Changes in mental health services use did not differ significantly between MHPSAs and non-MHPSAs for any of the four measures. Changes in the four measures of mental health use under the ACA did not differ in MHPSAs versus non-MHPSAs. Future research into the ACA's long-term effects should examine systemic and structural barriers to mental health care and to having sufficient numbers of mental health professionals.

A Systematic Review of the Trends, Effects, and Deterrents of Collective Marketing Participation Among Smallholder Farmers in Sub-Saharan Africa

Smallholder farmers’ participation in collective marketing is essential for the growth of smallholder farming businesses and the sustainability of their livelihoods. Collective marketing provides smallholder farmers with increased opportunities to scale up market access and participation. Given the challenges that the majority of smallholder farmers still face regarding market access and participation, this review was conducted to explore the trends and effects of collective marketing participation, as well as the barriers to participation among smallholder farmers in Sub-Saharan Africa (SSA). The results show that collective marketing has a high potential to give smallholder farmers access to both formal and informal market participation, as well as recognition by public and private support structures. To improve collective marketing participation among SSA countries, more focused and content-specific strategies and interventions are needed to address the complex socio-economic and structural barriers that limit smallholder farmers’ ability to fully benefit from collective marketing initiatives across the region.

Exploring the role of the built environment and psychosocial mediators on knee function in knee osteoarthritis patients in Singapore: a cross-sectional study.

(1) To examine if a more accessible built environment (BE) is significantly associated with better knee function outcomes in knee osteoarthritis (OA) patients. (2) To assess if the relationship between BE and knee function is mediated by fear of movement and self-efficacy. Cross-sectional study. Two tertiary hospitals in Singapore. 212 knee OA patients (mean: 63.81±8.27 years old), majority female (69.8%). (i) meets National Institute for Health and Care Excellence criteria for knee OA, (ii) independent community ambulant. (i) alternative diagnosis to knee OA, (ii) secondary osteoarthritis, (iii) severe medical and/or cognitive comorbidity impairing activities of daily living, (iv) previous knee arthroplasty, (v) wheelchair bound, or (vi) pregnant. PRIMARY AND SECONDARY OUTCOME MEASURES; STATISTICS: How self-efficacy (Arthritis Self-Efficacy Scale-8 (ASES-8)) and fear of movement (Brief Fear of Movement (BFOM)) mediates impact of overall BE (IPAQ-Environment module: Access to Destinations) and five item-specific domains of BE accessibility on knee function (Knee Injury and Osteoarthritis Outcome Score-12 (KOOS-12)). For variables significantly correlated with BE and KOOS-12 in bivariate Pearson correlation tests, mediation analysis was performed with confounders adjusted. Total BE (r=0.142, p=0.038) and accessibility to transit station (r=0.161, p=0.019) were positively correlated with KOOS-12. Structural barriers (r=-0.138, p=0.045) were negatively correlated with KOOS-12. ASES-8 was a significant mediator in the relationship between accessibility to transit station and KOOS-12 (coeff=0.87, 95% CI=(0.24, 1.69), p=0.005) and between total BE and KOOS-12 (coeff=0.25, 95% CI=(0.10, 0.45), p=0.004). BFOM was a marginally significant mediator between structural barriers and KOOS-12 (coeff=-0.36, 95% CI=(-0.86, -0.02); p=0.054). More accessible BE and lesser structural barriers in the BE are associated with better knee function. Self-efficacy mediates the relationship between overall BE accessibility and knee function. Fear of movement mediates the negative association between barriers in the BE and knee function.Applications include assessing BE barriers and psychosocial mediators in clinician consultations, developing multidisciplinary integrated care models and urban designers planning mobility friendly BEs. The study has been registered under clinicaltrials.gov registry (Identifier: NCT04942236).

Early medical abortion provision via telehealth in Victoria: A qualitative descriptive study.

Little is known about the views of service providers currently working in telehealth early medical abortion (EMA) provision in Victoria, Australia. This study aims to contextualise the enablers and barriers to telehealth EMA provision, providing insight for healthcare policy and practice to improve the accessibility of this service. This was a qualitative descriptive study involving semi-structured interviews with 14 Victorian stakeholders with expertise and knowledge on telehealth EMA provision. Data were analysed using conventional content analysis. This study presents perceived enablers and barriers across four different contexts of the Victorian abortion system: (1)perceived patient context; (2) perceived provider context; (3) health organisation-system context; and (4)sociopolitical context. The COVID-19 pandemic's disruption of healthcare services led to greater patient and provider acceptance of telehealth EMA. However, barriers within the patient context included the inability to ensure safety and confidentiality, digital access and literacy issues, language barriers, and theimportance of trusting provider-patient relationships. Providers encountered challenges in delivering holistic care via telehealth, including time and workload issues and working with interpreters. Shortcomings within the organisational context encompassed structural barriers for culturally and linguistically diverse population groups, the absence of standard telehealth guidelines and varying interpretations of telehealth. Although temporary Medicare item number changes improved access, they presented financial challenges for mixed and private billing practices. The application of these findings by relevant health services and policymakers has the potential to improve the quality of, and increase accessibility to, telehealth EMA, better meeting the needs of individuals seeking this service.

Teachers as first responders in marginalized, urban communities: Stress and coping during unprecedented times for public education

The present study examines workplace priorities, challenges, and experiences of burnout and coping among teachers in marginalized urban communities, where structural barriers elevate job demands and minimize job resources. Specifically, we amplify the voices of public elementary school teachers in an urban hub of Florida during a time of unprecedented stressors (COVID-19, staff shortages, racial injustice, school shootings) to identify possible avenues of support. Participants (N = 12) were teachers in grades 3 through 5 from one large urban district; six participants served predominately Black or African American students, and six participants served predominately Hispanic students. All teachers self-identified as female and from a racially and/or ethnically minoritized background themselves. Semi-structured interviews (conducted remotely by the first author) were organized around five questions. Qualitative content analysis highlighted two core priorities (support students holistically and address interconnecting social emotional skills and academic success) and two core challenges (mismatch between administration expectations/supports and teacher needs/values, and difficulty managing student behavior). Teachers attributed the ubiquitous experience of burnout to factors at levels of work (e.g., responding to student stressors and traumas on top of curriculum demands), organization (e.g., poor compensation, excessive work demands), and society (e.g., school shootings, COVID-19), and they offered concrete recommendations for improving their work conditions. Altogether findings inspire opportunities to reevaluate supports for teachers serving as first responders for youth in marginalized urban communities.

Correlation Between Regulation of Intestinal Flora by Danggui-Shaoyao-San and Improvement of Cognitive Impairment in Mice With Alzheimer's Disease.

The abnormal central glucose metabolism in Alzheimer's disease (AD) is related to the brain-gut axis. This study aims to explore the target of Danggui-Shaoyao-San (DSS) in improving cognitive impairment. This study analyzed the differences in mice intestinal flora by 16S rRNA sequencing. The cognitive protective effects of DSS were observed through the Morris water maze and the new object recognition. The mitigation effects of DSS on Aβ and p-tau, regulatory effects on glucose metabolism targets, and intestinal structure effects were observed through brain and colon slices staining. The differences in neural ultrastructure were compared by transmission electron microscopy. The results showed that DSS affected the composition of intestinal dominant bacteria and bacteria genera and regulated the abundance of intestinal bacteria in AD mice. DSS improved the behavior of AD mice, alleviated the deposition of AD pathological products in the brain and colon, regulated the expression of glycometabolism-related proteins, and improved the colon barrier structure and neural ultrastructure in the brain of mice with AD. Our findings suggest that DSS may affect AD central glucose metabolism and improve cognition by regulating the gut-brain axis.

Gender Inequality in Economic Participation: A Socio-Economic Analysis in Indonesia

This research addresses gender inequality in economic participation in Indonesia, an issue that poses a barrier to sustainable development and social equality. Although there has been an increase in women's participation in the economic sector, women's labor participation rate is still significantly lower than men's, with an average labor participation rate of 83-84% for men and only 50-53% for women (BPS, 2018-2023). Various social and structural barriers, including patriarchal culture and the burden of domestic responsibilities, limit women's role in the public sector. This study uses descriptive analysis to evaluate trends and patterns of gender inequality in the Indonesian economy from 2018 to 2023, utilizing data from BPS. The findings show that gender inequality in economic participation disadvantages women and slows national economic growth. With more inclusive policies, Indonesia can correct this imbalance and increase its potential productivity and economic competitiveness.

Structural Influences on Methamphetamine Use Among Black Sexual Minority Men (HISTORY Study): Protocol for a Longitudinal Cohort Study.

Sexual minority men are disproportionately affected by methamphetamine use, with recent studies suggesting an increase in use specifically among Black sexual minority men. Black sexual minority men face unique structural barriers to achieving optimal health. Given its harmful effects, and in light of existing health disparities, an increase in methamphetamine use among Black sexual minority men poses a significant public health concern. The Health Impacts and Struggles to Overcome the Racial Discrimination of Yesterday (HISTORY) study is investigating the potential impacts of exposure to the census tract-level structural racism and discrimination (SRD) on methamphetamine use among Black sexual minority men in Atlanta, Georgia, and will identify intervention targets to improve prevention and treatment of methamphetamine use in this population. This study uses a mixed methods and multilevel design over a 5-year period and incorporates participatory approaches. Individual-level quantitative data will be collected from a community-based cohort of Black sexual minority men (N=300) via periodic assessment surveys, ecological momentary assessments, and medical record abstractions. Census tract-level measures of SRD will be constructed using publicly available administrative data. Qualitative data collection will include longitudinal, repeated in-depth interviews with a subset (n=40) of study participants. Finally, using a participatory group model-building process, we will build on our qualitative and quantitative data to generate causal maps of SRD and methamphetamine use among Black sexual minority men, which in turn will be translated into actionable recommendations for structural intervention. Enrollment in the HISTORY study commenced in March 2023 and is anticipated to be completed by November 2024. The HISTORY study will serve as a crucial background upon which future structural interventions can be built, to mitigate the effects of methamphetamine use and SRD among Black sexual minority men. DERR1-10.2196/63761.

Centering equity, diversity, and inclusion in youth digital mental health: findings from a research, policy, and practice knowledge exchange workshop

BackgroundYouth mental health service organizations continue to rapidly broaden their use of virtual care and digital mental health interventions as well as leverage artificial intelligence and other technologies to inform care decisions. However, many of these digital services have failed to alleviate persistent mental health disparities among equity-seeking populations and in some instances have exacerbated them. Transdisciplinary and intersectional knowledge exchange is greatly needed to address structural barriers to digital mental health engagement, develop and evaluate interventions with historically underserved communities, and ultimately promote more accessible, useful, and equitable care.MethodsTo that end, the Digital, Inclusive, Virtual, and Equitable Research Training in Mental Health Platform (DIVERT), the Maritime Strategy for Patient Oriented Research (SPOR) SUPPORT (Support for People and Patient-Oriented Research and Trials) Unit and IWK Mental Health Program invited researchers, policymakers, interprofessional mental health practitioners, trainees, computer scientists, health system administrators, community leaders and youth advocates to participate in a knowledge exchange workshop. The workshop aimed to (a) highlight local research and innovation in youth-focused digital mental health services; (b) learn more about current policy and practice issues in inclusive digital mental health for youth in Canada, (c) participate in generating action recommendations to address challenges to inclusive, diverse and equitable digital mental health services, and (d) to synthesize cross-sector feedback to inform future training curriculum, policy, strategic planning and to stimulate new lines of patient-oriented research.ResultsEleven challenge themes emerged related to white-colonial normativity, lack of cultural humility, inaccessibility and affordability of participating in the digital world, lack of youth and community involvement, risks of too much digital time in youth's lives, and lack of scientific evidence derived from equity-deserving communities. Nine action recommendations focused on diversifying research and development funding, policy and standards, youth and community led promotion, long-term trust-building and collaboration, and needing to callout and advocate against unsafe digital services and processes.ConclusionKey policy, training and practice implications are discussed.

Occupational and social mobility of skilled migrants: an intersectional analysis

ABSTRACT Research on skilled migration has grown substantially in recent years. Drawing on 58 in-depth interviews with skilled Americans in China, this paper explores how the intersectionality of race, gender, and citizenship shapes their occupational and social mobility, and whether these two forms of mobility align. The findings suggest that skilled migrants’ social identities simultaneously create both advantages and disadvantages in their occupational and social mobility. I coined the term ‘glass box’ to describe their experiences: while many enjoyed enhanced occupational mobility, they eventually hit a ‘glass ceiling’ that blocked access to top positions and faced ‘glass walls’ that pigeonholed them into a narrow range of occupations. However, their social identities also brought privileges, forming a ‘glass floor’ that protected them from employment precarity. Their social mobility, extending beyond occupational mobility, improved to varying degrees after migration to China but declined rapidly and unexpectedly following the outbreak of COVID-19. While changes to skilled Americans’ occupational and social mobility aligned most of the time, there were notable exceptions where these two forms of mobility shifted in opposite directions. Such contradictory experiences highlight the persistent structural barriers that shape their professional and social trajectories.

Performance of dual-band infrared photodetectors based on M-structure superlattices

Abstract The mainstream dual-band photodetector structures are complex, requiring careful design of each absorption layer, making it difficult to customize according to specific requirements. We simplified the structure and proposed an alternative design, which based on the nBn barrier structure combined with the M-structure superlattice (M-SL). With the utmost consideration for lattice matching, we have enabled tailored design and arbitrary adjustment of the absorption coefficients for both detection bands and the overall absorption characteristics as needed. This manuscript presents a series of dual-band photodetectors. The performance of these devices was simulated at 77K, with quantum efficiency exceeding 22% in the MWIR band of the MWIR-LWIR detector, and normalized detectivity reaching 10^(11)cm·Hz^(1/2)/W. Quantum efficiency in the LWIR to VLWIR bands surpasses 19%, with normalized detectivity reaching 10^(11)cm·Hz^(1/2)/W.

Effect of the Chemical Composition and Geometry of Nanotubes on the Structure and Internal Rotation Barrier of Encapsulated Ammonia‐Boron Trifluoride: A Theoretical Investigation

AbstractThe study of the structure and conformational properties of ammonia–boron trifluoride in the cavity of 24 carbon and inorganic nanotubes using the PBE/3ζ DFT approximation showed that the conformational preference of the encapsulated molecule is determined by geometry and chemical composition of the host nanostructure. The combined effect of these factors leads to the predominance of eclipsed conformation of guest molecule for four endoclusters. In other cases, the main minimum on the potential energy surface corresponds to the staggered or pseudo‐staggered forms of BF3←NH3. The guest molecule carries the electric charge and has a shortened B←N bond. These conclusions are confirmed by the results of the virtual reaction of ammonia and boron trifluoride in the cavity of individual nanotubes.

Intervention Strategies to Reduce Maternal Mortality in the Context of the Sustainable Development Goals: A Scoping Review

According to the United Nations Population Fund, approximately every two minutes, a woman dies, totalling approximately 800 deaths per day for reasons related to a maternal causes. Therefore, within the Sustainable Development Goals of the 2030 Agenda, the goal is to reduce the global maternal mortality rate to less than 70 deaths per 100,000 live births by 2030. We aim to analyse strategies to reduce maternal mortality in the context of the Sustainable Development Goals, identify barriers that hinder their implementation, and analyse the impact of the COVID-19 pandemic on their achievement. We performed a scoping review of the following databases and distributors of specialised information in the health area: PubMed, Medes, Lilacs, Cuiden, Cinahl, Scopus, SciELO, and websites of the United Nations (UN), United Nations Population Fund (UNFPA), and Cooperanda. A total of 24 articles were reviewed. The results obtainded determined that reviewed studies agree that despite efforts to reduce maternal mortality, significant social and structural barriers still exist in developing countries that slow the implementation of strategies to protect maternal health, especially in the most at-risk populations, and the improvement of the health system. The main strategy consists of increasing the number of deliveries attended by qualified personnel, which is the greatest indicator of progress in reducing maternal mortality. To conclude, Economic, social, and political barriers remain in developing countries in the context of the Sustainable Development Goals. The intervention that has shown the most success is the attendance of deliveries by qualified personnel. It is essential to prioritise maternal care, triangular cooperation, and effective connection between the different Sustainable Development Goals.

Factors Associated with Inequities in Donor Milk Bank Access Among Different Hospitals.

Objective: Donor human milk (DHM) can provide many benefits to neonates. This study examines access to DHM and how structural barriers may exacerbate inequities. Study Design: The median test and analysis of variance test were used to compare the distribution of maternal race/ethnicity and insurance status variables with DHM access for California neonatal intensive care units (NICUs) in 2021. Results: Across 124 NICUs, those serving a higher percentage of white families were more likely to have access to DHM (p = 0.04). NICUs with a higher percentage of Hispanic families were less likely to have access to DHM (p = 0.03). Hospitals that had higher proportions of uninsured patients were also less likely to have access to DHM (p = 0.015). Conclusion: Inequities in DHM access and use among NICU infants begin at the structural level. Policies that reduce barriers to DHM access may reduce health inequities for Hispanic and uninsured families.

Out of sight, into mind: a socioecological model-informed qualitative study on barriers and facilitators to hepatitis B care among West African immigrants in the Bronx, New York

BackgroundThere is a high burden of hepatitis B virus (HBV) in West Africa. Over the past 20 years, West African immigration to the United States (U.S.) has been increasing. Prevalence of HBV infection in West Africa has been reported to be as high as 5–10%.MethodsWe sought to understand knowledge and attitudes of and barriers and facilitators to HBV screening, vaccination, and treatment in a cohort of West African immigrants in the Bronx living with or at risk for HBV through a series of one-on-one qualitative interviews. We interviewed 23 West African immigrants and analyzed transcripts for recurring themes using Applied Thematic Analysis. We situated our analysis in the socioecological model (SEM) and adhered to the consolidated criteria for reporting qualitative research (COREQ).ResultsMultiple themes emerged, most prominently themes relating to HBV knowledge/awareness, trust in U.S. healthcare providers and the U.S. healthcare system, positive social support improving healthcare access, knowledge sharing, stigma towards those with HBV, issues concerning immigration status, insurance status, and access to healthcare services.ConclusionRaising awareness of HBV, addressing social and structural barriers such as stigma and health insurance, and improving access to culturally sensitive programs among West African communities are needed to increase HBV screening, vaccination, and linkage to care.

The Black Box of Single-Family Zoning Reform

America faces a staggering housing affordability crisis. The consequences of the crisis include reduced economic productivity, suppressed labor mobility, greater social inequity, and increased homelessness. A scholarly consensus blames excessive land-use regulation for these problems and advocates now call for deregulation. Several jurisdictions have recently elected to allow middle housing—small, multi-family developments—in areas previously zoned for single-family detached housing. The results of these reforms, however, have been disappointing. This Article examines why they have fallen short and how to do better. This Article identifies an analytical disconnect between the deregulatory consensus and actual single-family zoning reforms adopted to date. Given this disconnect and the limited success of single-family zoning reforms thus far, it is unclear why such reforms continue to be adopted. Moreover, these reforms cannot achieve their promised ends. Interviews of middle housing builders in reform jurisdictions reveal legal and structural barriers that prevent market participants from responding to the housing crisis with scale and urgency. This Article proposes several regulatory alternatives that offer a greater probability of success in achieving the consensus’s goals: (1) modestly expanding multi-family zones to allow redevelopment and densification of underutilized non-residential properties; (2) providing affordable-housing density bonuses; (3) streamlining land-use procedures and eliminating administrative delay to reduce uncertainty in permitting processes; and (4) reevaluating financing mechanisms for new housing development. Taken together, these policies are necessary complements to single-family zoning reforms for addressing undersupply of market- and below-market-rate housing.