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Open Access June 06, 2025

Food security, dietary diversity, and age as determinants of nutritional status among adolescent girls in coastal Bangladesh

Abstract Background: Adolescent girls living in disaster-prone coastal regions of Bangladesh face heightened nutritional vulnerability due to limited food access, poor dietary diversity, and environmental stressors. Despite growing concerns about adolescent malnutrition, few studies have examined the combined influence of food security, dietary diversity, and age on nutritional outcomes in these [...] Read more.
Background: Adolescent girls living in disaster-prone coastal regions of Bangladesh face heightened nutritional vulnerability due to limited food access, poor dietary diversity, and environmental stressors. Despite growing concerns about adolescent malnutrition, few studies have examined the combined influence of food security, dietary diversity, and age on nutritional outcomes in these settings. Objectives: This study aimed to assess the association between dietary diversity, food security, and age with the nutritional status of adolescent girls in coastal Bangladesh. Methods: A cross-sectional survey was conducted among 345 adolescent girls aged 10–19 in Chattogram and Cox’s Bazar. Data on dietary intake were collected using a 24-hour dietary recall and a food frequency questionnaire. Household food security was assessed using a validated scale. Nutritional status was determined using BMI-for-age classifications. Bivariate and multivariate analyses explored associations between dietary diversity, food security, age, and nutritional status. Results: Among participants, 10.14% were underweight, and 29.85% were either overweight or obese. While 17.39% demonstrated high dietary diversity (≥7 food groups), the majority had moderate diversity (5 or 6 food groups) (59.42%). Food-insecure households were significantly more likely to have overweight or obese adolescents (p < 0.05). Although dietary diversity was associated with BMI in bivariate analysis, it was not a significant predictor in the multivariate model. Age showed a significant relationship with both dietary diversity and nutritional status. Conclusion: The findings emphasize the importance of addressing household food security and age-related nutritional vulnerabilities in coastal areas. Interventions should prioritize age-sensitive, culturally appropriate strategies to improve dietary quality and prevent the double burden of malnutrition among adolescent girls.
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Open Access March 29, 2025

The Role of Type 3 Diabetes in Alzheimer’s Disease: A Review of Current Evidence

Abstract Background: Type 2 Diabetes Mellitus (T2DM) and Alzheimer’s Disease (AD) are increasingly linked through shared pathophysiological mechanisms, giving rise to the concept of Type 3 Diabetes Mellitus (T3DM). Brain insulin resistance, oxidative stress, and neuroinflammation are central to both conditions, contributing to cognitive decline and AD progression. Aim: This review aims to [...] Read more.
Background: Type 2 Diabetes Mellitus (T2DM) and Alzheimer’s Disease (AD) are increasingly linked through shared pathophysiological mechanisms, giving rise to the concept of Type 3 Diabetes Mellitus (T3DM). Brain insulin resistance, oxidative stress, and neuroinflammation are central to both conditions, contributing to cognitive decline and AD progression. Aim: This review aims to explore this emerging relationship and its implications for prevention and management. Methods: Using an integrative review, 21 studies were systematically analyzed. The review focused on identifying demographic, genetic, and lifestyle factors contributing to T2DM and AD and examined shared molecular pathways such as insulin dysregulation and amyloid-beta accumulation. Results: The findings reveal that T3DM shares key features with T2DM and AD, including insulin resistance and chronic inflammation. Lifestyle interventions, such as diet and exercise, alongside routine cognitive and metabolic screenings, are critical in mitigating progression. Conclusions: Further research into diagnostic biomarkers and targeted therapies is essential to manage T3DM and its impact on AD. The role of nursing professionals in early detection, education, and holistic management is emphasized as vital in addressing this dual disease burden. This review offers actionable insights into integrated strategies for addressing these interconnected conditions.
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Review Article
Open Access March 06, 2025

Impact of Food Security on Dietary Diversity and Nutritional Intake Among Pregnant Women in Low-Resource Settings

Abstract Background: Food security and dietary diversity are essential determinants of maternal health, particularly among pregnant women in refugee populations who face heightened vulnerabilities due to displacement and inadequate living conditions. This study examines the impact of food security on dietary diversity and nutritional intake among pregnant Rohingya women residing in the makeshift [...] Read more.
Background: Food security and dietary diversity are essential determinants of maternal health, particularly among pregnant women in refugee populations who face heightened vulnerabilities due to displacement and inadequate living conditions. This study examines the impact of food security on dietary diversity and nutritional intake among pregnant Rohingya women residing in the makeshift camps of Ukhiya, Cox’s Bazar. Methods: A descriptive cross-sectional study was conducted among 96 pregnant Rohingya women from June to September 2022. Data were collected using structured questionnaires assessing socio-demographic characteristics, food security, and dietary diversity. Food security was evaluated using the Household Food Insecurity Access Scale (HFIAS), while dietary diversity was assessed through a 24-hour dietary recall and a 7-day food frequency questionnaire. Data were analyzed using SPSS (Version 26) and Stata (Version 13), employing descriptive statistics and chi-square tests to examine associations. Results: Most participants (57.3%) were food secure, and 85.4% demonstrated high dietary diversity, consuming seven or more food groups. However, 21.9% of households experienced severe food insecurity, highlighting ongoing challenges in food access. The highest consumption was observed for starch, flesh foods, dark green leafy vegetables, and vitamin A-rich fruits and vegetables (99.0%), while dairy products (69.8%) and organ meat (34.4%) were consumed less frequently. Despite high dietary diversity, severe food insecurity persists, indicating gaps in food assistance programs. Conclusions: While food support programs appear to contribute to high dietary diversity among pregnant Rohingya women, severe food insecurity remains a significant concern. Strengthening food security interventions, improving access to diverse nutrient-rich foods, and integrating sustainable food assistance models are essential to addressing these challenges. Future research should explore long-term strategies to enhance food security and assess the impact of targeted nutritional interventions on maternal health outcomes in refugee settings.
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Open Access February 24, 2025

Women Hearts on the Line: Exploring the Correlation Between Anthropometric Parameters, Blood Pressure, and Peripartum Cardiomyopathy

Abstract Background: Peripartum cardiomyopathy (PPCM) is a life-threatening heart muscle disease of unknown aetiology that affects women during the peripartum period, particularly in sub-Saharan Africa. While many studies have observed normal blood pressure (BP) in PPCM patients, none have explored whether their BP is appropriate for their body size. This study investigated the correlation between [...] Read more.
Background: Peripartum cardiomyopathy (PPCM) is a life-threatening heart muscle disease of unknown aetiology that affects women during the peripartum period, particularly in sub-Saharan Africa. While many studies have observed normal blood pressure (BP) in PPCM patients, none have explored whether their BP is appropriate for their body size. This study investigated the correlation between body anthropometric parameters and BP in PPCM patients, comparing the findings with those of age-matched normal peripartum controls. Methods: A cohort of 105 women, each from PPCM and matched normal peripartum control groups, were recruited from three healthcare facilities in Sokoto. Blood pressure (BP) parameters were assessed in relation to their anthropometric measurements, and the findings were compared between the two groups. Results: The PPCM patients were significantly smaller in body weight (57.0 ±11.6 Kg vs 66.8 ±13.8 Kg, P <.0001), body mass index (BMI) (21.9 ±4.1 Kg/m2 vs 25.4 ±5.4 Kg/m2, P <.0001, body surface area (BSA) (1.3 ±0.7 m2 vs 1.7 ±0.2 m2, P <.0001), Lean body mass (LBM) (45.3 ±7.0 Kg vs 49.4 ±4.1 Kg, P <.0001) and Percentage body fat (BF) (23.5 ±10.9 % vs 31.2 ±6.9 %, P <.0001). Similarly, PPCM patients had significantly higher systolic BP (SBP), Pulse pressure (PP) and Mean arterial blood pressure (MABP) compared to the normal peripartum PPCM control. Further, linear regression analysis showed that there was higher slope of the relationship between anthropometric indices and SBP and PP in the PPCM cohort, compared to the normal peripartum control group. A similar trend of the slope was seen in the Pearson’s coefficient of the relationship of the anthropometries and BP parameters. Conclusions: This study found that women with peripartum cardiomyopathy (PPCM) exhibited disproportionately higher systolic blood pressure (SBP) and pulse pressure (PP) for each unit increase in anthropometric measurements compared to normal peripartum controls. Notably, PPCM patients had significantly lower anthropometric measures, potentially attributable to poverty and chronic undernutrition. Additionally, the effects of poor antenatal care, lack of immunization and recurrent infection should be considered. These findings suggest an abnormal relationship between anthropometry and blood pressure in PPCM patients, which may have detrimental effects on their cardiovascular health. This abnormal relationship may contribute to the development of heart failure (HF) in PPCM patients and potentially increase the risk in women susceptible to PPCM. Even-though our assumption, yet to be proven. To address this concerning trend in vulnerable populations, improvements in nutritional status, socioeconomic determinants health, adequate antenatal care (ANC), immunization, and infection prevention should be considered.
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Open Access February 21, 2025

Diminished Returns of Educational Attainment on Unpaid and Paid Maternity Leave of Mothers Giving Birth in Poverty

Abstract Background: Maternity leave, whether paid or unpaid, is a critical resource that can significantly impact maternal well-being and newborn outcomes. However, its availability and utilization among mothers living in poverty remain understudied. Education is widely recognized as a key factor that increases access to both paid and unpaid leave. However, the theory of Minorities’ [...] Read more.
Background: Maternity leave, whether paid or unpaid, is a critical resource that can significantly impact maternal well-being and newborn outcomes. However, its availability and utilization among mothers living in poverty remain understudied. Education is widely recognized as a key factor that increases access to both paid and unpaid leave. However, the theory of Minorities’ Diminished Returns (MDRs) posits that structural racism, segregation, and labor market discrimination limit the benefits of socioeconomic resources, such as education, for Black and Latino individuals. This suggests that the effects of education on maternity leave may not be uniform across racial and ethnic groups. Objective: This study aimed to examine the MDRs of education on access to unpaid and paid maternity leave among Black and Latino mothers compared to White mothers giving birth while living in poverty. Methods: We utilized baseline data from the Baby’s First Years Study (BFY), a longitudinal investigation of the effects of poverty on child development. The sample consisted of 1,050 mothers living in poverty who had recently given birth. Maternity leave (paid and unpaid) was assessed via self-report, and educational attainment was measured in years of schooling. Structural equation modeling (SEM) and interaction terms were employed to analyze racial and ethnic differences in the relationship between education and access to maternity leave. Results: Educational attainment was positively associated with access to unpaid maternity leave for the overall sample of mothers giving birth in poverty, but this association was weaker for Black and Latino mothers compared to non-Latino White mothers. Education did not significantly increase the likelihood of paid maternity leave, and there were no group differences for this association. Conclusion: This study highlights the urgent needs to address structural racism, labor market discrimination, and residential segregation that diminish the impact of education on living conditions for Black and Latino mothers, compared to non-Latino White mothers, even for those living under poverty. Policymakers and practitioners should develop targeted interventions to reduce racial and ethnic disparities in access to paid and unpaid maternity leave and other critical resources, particularly for new mothers living in poverty. Addressing these inequities is essential for improving maternal and newborn health outcomes and promoting social justice.
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Open Access January 10, 2025

Artificial Immune Systems: A Bio-Inspired Paradigm for Computational Intelligence

Abstract Artificial Immune Systems (AIS) are bio-inspired computational frameworks that emulate the adaptive mechanisms of the human immune system, such as self/non-self discrimination, clonal selection, and immune memory. These systems have demonstrated significant potential in addressing complex challenges across optimization, anomaly detection, and adaptive system control. This paper provides a [...] Read more.
Artificial Immune Systems (AIS) are bio-inspired computational frameworks that emulate the adaptive mechanisms of the human immune system, such as self/non-self discrimination, clonal selection, and immune memory. These systems have demonstrated significant potential in addressing complex challenges across optimization, anomaly detection, and adaptive system control. This paper provides a comprehensive exploration of AIS applications in domains such as cybersecurity, resource allocation, and autonomous systems, highlighting the growing importance of hybrid AIS models. Recent advancements, including integrations with machine learning, quantum computing, and bioinformatics, are discussed as solutions to scalability, high-dimensional data processing, and efficiency challenges. Core algorithms, such as the Negative Selection Algorithm (NSA) and Clonal Selection Algorithm (CSA), are examined, along with limitations in interpretability and compatibility with emerging AI paradigms. The paper concludes by proposing future research directions, emphasizing scalable hybrid frameworks, quantum-inspired approaches, and real-time adaptive systems, underscoring AIS's transformative potential across diverse computational fields.
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Open Access December 03, 2024

Diabetes Nursing Education Its Implication Towards an Improved Quality of Life of Persons with Diabetes: A Systematic Review

Abstract Background: Diabetes is a chronic global health issue that requires effective management to improve patient outcomes and quality of life. Nursing education plays a critical role in empowering diabetic patients with self-management skills. Aim This systematic review evaluates the impact of diabetes-focused nursing education on patient outcomes and quality of life. Methods: This study [...] Read more.
Background: Diabetes is a chronic global health issue that requires effective management to improve patient outcomes and quality of life. Nursing education plays a critical role in empowering diabetic patients with self-management skills. Aim This systematic review evaluates the impact of diabetes-focused nursing education on patient outcomes and quality of life. Methods: This study uses PRISMA guidelines and a systematic approach to identify and evaluate relevant literature. Results and Discussion: Among the 14 studies reviewed, eight emphasized self-management education, while four incorporated multidisciplinary approaches. Findings consistently demonstrated that structured nursing education programs significantly improved self-management behaviors, glycemic control, and patient knowledge. For instance, nurse-led self-management programs resulted in substantial enhancements in self-care skills and diabetes-related knowledge. Moreover, interventions that combined health education with psychological support were particularly effective, leading to better blood glucose control and increased adherence to treatment. Studies that examined quality of life reported reductions in anxiety, improved lifestyle habits, and better overall self-management. These findings highlight the multifaceted benefits of nursing education, suggesting that structured, supportive programs positively impact both clinical and psychological aspects of diabetes care. Conclusion: The review emphasizes the value of comprehensive nursing education that integrates both clinical guidance and psychological support for holistic diabetes management. Implications: Ongoing professional development and culturally sensitive education programs are recommended to address the diverse needs of diabetic patients. Future research should investigate the long-term effects of nursing education and explore innovative strategies to enhance diabetes management outcomes.
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Systematic Review
Open Access November 15, 2024

Education Does Not Equally Increase Financial Well-being for All

Abstract Background: Financial well-being is a key domain of overall well-being, encompassing an individual's ability to meet financial obligations, secure their financial future, and maintain a sense of financial freedom. Education is often viewed as a critical pathway to enhancing financial well-being. However, the returns of education on financial well-being are not uniform across racial, ethnic, [...] Read more.
Background: Financial well-being is a key domain of overall well-being, encompassing an individual's ability to meet financial obligations, secure their financial future, and maintain a sense of financial freedom. Education is often viewed as a critical pathway to enhancing financial well-being. However, the returns of education on financial well-being are not uniform across racial, ethnic, and nativity groups. The theory of Minorities’ Diminished Returns (MDRs) suggests that the positive effects of education on outcomes such as income and financial security are weaker for marginalized groups, including Black individuals, Latinos, and immigrants. Objective: This study examines the diminished returns of education on financial well-being among Black, Latino, and immigrant populations in the United States. We aim to investigate how structural inequalities contribute to weaker financial returns on education for these groups compared to their White and native-born counterparts. Methods: We utilized data from the Understanding America Study (UAS 2014) to conduct a cross-sectional analysis of adult respondents. The study assessed financial well-being outcomes (e.g., income, savings, and financial security) and their association with educational attainment across racial, ethnic, and nativity groups. Regression models were employed to test for interaction effects between education and race/ethnicity/nativity, adjusting for sociodemographic factors such as age, gender, employment, and family structure. Results: Our analysis included 8,121 individuals. The mean age of the respondents was 48 years (SD = 16). High education was associated with higher financial well-being (B = 1.284, 95% CI: 1.157, 1.410). The interaction terms between education and immigrant status (B = -0.507, 95% CI: -0.930, -0.084), race (Black) (B = -0.770, 95% CI: -1.208, -0.331), and ethnicity (Hispanic) (B = -0.589, 95% CI: -0.969, -0.210) were all significant, suggesting that immigrant, Black, and Hispanic individuals experience diminished returns on education in terms of financial well-being, relative to US-born non-Hispanic White individuals. The significant negative interactions between education and minority statuses (Black, Hispanic, and immigrant) indicate that while education generally improves financial well-being, the magnitude of this improvement is substantially smaller for these marginalized groups. Conclusion: Understanding how education translates to financial well-being across different racial, ethnic, and nativity groups is critical for addressing persistent financial disparities.
Article
Open Access March 05, 2024

Culture Shock in Nursing: A Concept Analysis

Abstract 1) Background: Culture shock is a common experience by internationally educated nurses (IENs) working in foreign countries, characterized by disorientation and discomfort due to distinct norms, values, and rituals. 2) Aim: this study explores culture shock in IENs and explores mitigation techniques to enhance understanding of challenges faced in foreign cultural contexts. [...] Read more.
1) Background: Culture shock is a common experience by internationally educated nurses (IENs) working in foreign countries, characterized by disorientation and discomfort due to distinct norms, values, and rituals. 2) Aim: this study explores culture shock in IENs and explores mitigation techniques to enhance understanding of challenges faced in foreign cultural contexts. 3) Method: Using Concept Analysis by Walker and Avant (2019). 4) Results: A total of 20 articles were reviewed. Four major attributes were identified: psychological and emotional impact, communication barriers, acculturation and quality of life, and organizational challenges. 5) Conclusion: This paper explores the challenges faced by nurses from foreign countries due to cultural adjustment and proposes solutions to minimize its effects. It is beneficial for nurses, healthcare organizations, and policymakers, aiming to improve patient care and health outcomes. 6) Implication for Practice: Addressing culture shock can promote a smooth transition, enhance nurses' experience, and improve their cultural competence. Providing tailored orientation and mentorship programs can help IENs feel supported and empowered, leading to increased job satisfaction, retention rates, and better patient outcomes.
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Open Access November 03, 2023

Quality of Communication between Healthcare Providers and Pregnant Women: Impact on Maternal Satisfaction, Health Outcomes, and Shared Decision-Making

Abstract The quality of communication between healthcare providers and pregnant women is a topic of paramount importance within the realm of maternal healthcare. It is not merely an aspect of medical interaction; rather, it is the prerequisite that influences various critical dimensions of maternal care, including maternal satisfaction, health outcomes, and shared decision-making. Effective communication [...] Read more.
The quality of communication between healthcare providers and pregnant women is a topic of paramount importance within the realm of maternal healthcare. It is not merely an aspect of medical interaction; rather, it is the prerequisite that influences various critical dimensions of maternal care, including maternal satisfaction, health outcomes, and shared decision-making. Effective communication between healthcare providers and pregnant women is essential for optimal maternal care during pregnancy and childbirth. Maternal satisfaction is a fundamental metric of patient-centered care, and improved communication, characterized by empathy, information sharing, and active listening, cultivates trust and enhances women's contentment with their care experiences. Positive provider-patient interactions are associated with improved emotional well-being, reduced stress levels, and increased adherence to prenatal recommendations, contributing to positive health outcomes for both mother and fetus. Shared decision-making is impacted by open and transparent dialogue between healthcare providers and pregnant women. Inclusive discussions about available interventions, risks, and benefits empower women to make informed choices aligned with their preferences and values. This shared decision-making promotes autonomy, self-efficacy, and a collaborative care partnership, potentially influencing the birthing experience and postpartum adaptation. However, challenges persist in communication quality, such as variability in healthcare provider communication styles, cultural considerations, and system-level factors. Addressing these challenges through targeted interventions, training, and policy implementation can further enhance the overall maternal care experience. Further research is needed to explore innovative strategies that optimize communication and promote positive outcomes throughout the continuum of maternal care.
Review Article
Open Access November 02, 2023

Off-Label Use of Esketamine

Abstract Major depressive disorder (MDD) is a significant psychiatric condition, with many affected individuals not gaining remission from conventional treatments, leading to classification as treatment-resistant depression (TRD). This study aimed to investigate the potential of intravenous (IV) ketamine, particularly the S-enantiomer esketamine in nasal spray form, for treating patients with TRD and [...] Read more.
Major depressive disorder (MDD) is a significant psychiatric condition, with many affected individuals not gaining remission from conventional treatments, leading to classification as treatment-resistant depression (TRD). This study aimed to investigate the potential of intravenous (IV) ketamine, particularly the S-enantiomer esketamine in nasal spray form, for treating patients with TRD and associated comorbidities. We report three cases of patients with diverse psychiatric and medical backgrounds whom all reported significant symptomatic relief from depressive episodes and suicidal ideation (SI) following esketamine administration. Additionally, esketamine seemed to proffer benefits beyond the primary depressive symptoms, positively impacting other comorbid conditions, such as agitation, self-injurious behavior (SIB), and chronic pain. The goal of this paper is to highlight that while esketamine's primary utility is in addressing TRD, its therapeutic potential may extend to a variety of associated conditions. However, it is crucial to underscore the heterogeneity of MDD, emphasizing the necessity for individualized therapeutic approaches and further research into esketamine's broader applications.
Case Series
Open Access November 01, 2023

Individual Wave Component Signal Modeling, Parameters Extraction, and Analysis

Abstract The accurate estimation of Individual Wave Components (IWC) is crucial for automated diagnosis of the human digestive system in a clinical setting. However, this process can be challenging due to signal contamination by other signal sources in the body, such as the lungs and heart, as well as environmental noise. To address this issue, various denoising techniques are commonly employed in bowel [...] Read more.
The accurate estimation of Individual Wave Components (IWC) is crucial for automated diagnosis of the human digestive system in a clinical setting. However, this process can be challenging due to signal contamination by other signal sources in the body, such as the lungs and heart, as well as environmental noise. To address this issue, various denoising techniques are commonly employed in bowel sound signal processing. While denoising is important, it can increase computational complexity, making it challenging for portable devices. Therefore, signal processing algorithms often require a trade-off between fidelity and computational complexity. This study aims to evaluate an IWC parameter extraction algorithm that was previously developed and reconstruct the IWC without denoising using synthetic and clinical data. To that end, the role of a reliable model in creating synthetic data is paramount. The rigorous testing of the algorithm is limited by the availability of quality and quantity recorded data. To overcome this challenge, a mathematical model has been proposed to generate synthetic bowel sound data that can be used to test new algorithms. The proposed algorithm’s robust performance is evaluated using both synthetic and clinically recorded data. We perform time-frequency analysis of original and reconstructed bowel sound signals in various digestive system states and characterize the performance using Monte Carlo simulation when denoising is not applied. Overall, our study presents a promising algorithm for accurate IWC estimation that can be useful for predicting anomalies in the digestive system.
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Open Access October 03, 2023

Pharmaceutical Drug Serialization: A Comprehensive Review

Abstract A persistent problem in the pharmaceutical industry that has existed for centuries is the prevalence of counterfeit drugs, and the World Health Organization (WHO) estimates that millions of people are affected by this issue each year. In particular, 4 out of 10 drugs in poor or underdeveloped countries may be adulterated, which can lead to severe adverse events. To address this problem, many [...] Read more.
A persistent problem in the pharmaceutical industry that has existed for centuries is the prevalence of counterfeit drugs, and the World Health Organization (WHO) estimates that millions of people are affected by this issue each year. In particular, 4 out of 10 drugs in poor or underdeveloped countries may be adulterated, which can lead to severe adverse events. To address this problem, many countries have implemented regulatory compliance measures such as pharmaceutical drug serialization, which requires the unique identification of every drug package manufactured. This enables tracking and tracing of individual packages throughout the supply chain and helps to prevent counterfeit drugs from entering the market. In this paper, we conduct a systematic review of the serialization process evaluation and its impact on the pharmaceutical industry. We discuss the benefits of pharmaceutical drug serialization, including its ability to improve drug security and reduce adverse events and investigations. We also examine the challenges associated with implementing serialization processes and the regulatory requirements necessary for compliance. Finally, we explore the various tracking and tracing technologies used in serialization processes and their effectiveness in preventing the distribution of counterfeit drugs. Overall, this paper highlights the importance of pharmaceutical drug serialization in ensuring the safety and efficacy of drugs in the healthcare industry, particularly in poor or underdeveloped countries where the problem of adulterated drugs is especially prevalent.
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Review Article
Open Access September 19, 2023

Lonely No More: Investigating the Connection between Family Health, Social Support, and Well-being in Chinese “Empty Nest Youth”

Abstract Background: The phenomenon of "empty nest youth" is becoming increasingly ubiquitous, capturing the attention of society at large. However, few studies have been conducted in recent years on this group, especially focusing on their family and mental health. As such, this study investigates the correlation between family health and well-being among "empty nest youth," as well as the function of social support and loneliness in this relationship. Methods: A cross-sectional survey was conducted from June to August 2022 across 32 provinces, municipalities, and autonomous regions in China, utilizing a multi-stage sampling technique. And we screened individuals who were unmarried, living alone, and between 22-44 years old, resulting in a valid sample size of 908 cases; multiple regression analysis, mediation effect testing, and moderation effect testing are used to examine research hypotheses. Results: The regression analysis results show that family health not only has a direct impact on well-being (β = 0.36, p < 0.001) but also indirectly affects well-being through social support [β = 0.23, 95% CI: 0.19 0.28]. Additionally, the loneliness moderates the predictive impact of not only family health on social support (β = -0.13, p < 0.001) but also social support on well-being (β = -0.06, p [...] Read more.
Background: The phenomenon of "empty nest youth" is becoming increasingly ubiquitous, capturing the attention of society at large. However, few studies have been conducted in recent years on this group, especially focusing on their family and mental health. As such, this study investigates the correlation between family health and well-being among "empty nest youth," as well as the function of social support and loneliness in this relationship. Methods: A cross-sectional survey was conducted from June to August 2022 across 32 provinces, municipalities, and autonomous regions in China, utilizing a multi-stage sampling technique. And we screened individuals who were unmarried, living alone, and between 22-44 years old, resulting in a valid sample size of 908 cases; multiple regression analysis, mediation effect testing, and moderation effect testing are used to examine research hypotheses. Results: The regression analysis results show that family health not only has a direct impact on well-being (β = 0.36, p < 0.001) but also indirectly affects well-being through social support [β = 0.23, 95% CI: 0.19 0.28]. Additionally, the loneliness moderates the predictive impact of not only family health on social support (β = -0.13, p < 0.001) but also social support on well-being (β = -0.06, p < 0.001). Conclusions: These findings underscore the significance of directing policymakers and healthcare professionals towards the "empty nest youth's" familial and social support systems. It underscores the need for the development of policies aimed at addressing their emotional and material requirements by leveraging these familial and social networks. This approach ultimately contributes to the enhancement of their overall psychological well-being, promoting a more coherent and logical pathway for intervention and support.
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Open Access July 24, 2023

Role of Oncology Nurse Navigators: An Integrative Review

Abstract Background: Oncology nurse navigators (ONNs) are becoming even more vital as healthcare continues to develop into a more complicated, confusing maze for patients. When many specialists on the treatment team have divergent points of view due to the nature of their respective professions or other factors, the patient may experience feelings of confusion. In the end, this can cause delays in [...] Read more.
Background: Oncology nurse navigators (ONNs) are becoming even more vital as healthcare continues to develop into a more complicated, confusing maze for patients. When many specialists on the treatment team have divergent points of view due to the nature of their respective professions or other factors, the patient may experience feelings of confusion. In the end, this can cause delays in treatment, pose a threat to the established standard of care, and lead to a decrease in patient satisfaction. Aim: To enumerate various ways in which ONNs may help improve the quality of life of cancer patients. Design: An integrative review. Results: A total of 19 studies related to the topic are evaluated. Four main themes namely: provider of psychological support, facilitator of timely care, oncology nurse navigators perception of their role and patient’s perception of oncology nurse navigators and 3 sub themes which are: information giver, source of emotional support and coordinator, were identified to be the roles of the ONNs. The findings showed that oncology nurse navigators help reduce patients anxiety and distress, increase patient satisfaction, shorten the time from diagnosis to treatment, provide necessary information, support them emotionally and coordinate their care with the different members of the healthcare team and resources. Conclusion: The main function of the ONNs is to address any barrier that may hinder the patient’s cancer treatment, survivorship and even palliative care. ONNs make sure that each patient has individualized nursing care according to the patients and their families' needs. Implications for Practice: ONNs have the potential to significantly contribute not only to the quality of life of cancer patients but also to the process of achieving better service integration. The result of this integrative review contributes to the growth of the healthcare system by improving accessibility, fairness, efficiency, effectiveness, and the ability to maintain health services throughout time brought about by ONNs.
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Review Article
Open Access May 06, 2023

Socioeconomic Drivers of Conservation Commitment: Residents’ Willingness to Pay for Ecosystem Services Provided by Beaches in Lagos State, Nigeria

Abstract Beaches are known for their ability to provide people with several services – these are generally referred to as ‘ecosystem services’ and they have been identified as one of the ways through which nature relates to humans. However, beaches in Nigeria are challenged by mismanagement caused by anthropogenic factors. It is expected that people will demonstrate a certain amount of dedication to [...] Read more.
Beaches are known for their ability to provide people with several services – these are generally referred to as ‘ecosystem services’ and they have been identified as one of the ways through which nature relates to humans. However, beaches in Nigeria are challenged by mismanagement caused by anthropogenic factors. It is expected that people will demonstrate a certain amount of dedication to protecting this ecosystem to address this issue. Sometimes, a person's commitment to conservation is based on the advantages they anticipate or are currently experiencing from the ecosystem, which are a result of their socioeconomic traits. Against this backdrop, this study captured individuals’ commitment as their Willingness to Pay (WTP) for these ecosystem services, assessed their level of awareness of the various ecosystem services provided by beaches and investigated the impact of socioeconomic factors on participants’ willingness to pay. Data were collected using a structured questionnaire and a total of 221 responses were analyzed using descriptive statistics, logistic regression and content analysis. The results revealed that the cultural service provided by beaches was the most common ecosystem service identified by the participants. Furthermore, most of the participants were willing to pay less than $3 for beach maintenance while the major determinants of WTP were age, household size and education. This study recommended that the government should work with other stakeholders to set up programs that would boost people’s awareness of ecosystem services provided by beaches as well as reiterate the need to maintain this ecosystem to ensure continued enjoyment of the services provided.
Article
Open Access March 03, 2023

Novel Approaches to Address the Dual Challenges of Neurodegeneration and Aging

Abstract Neurodegeneration and aging are pressing issues with significant personal, economic, ethical, and social consequences. However, the underlying biological mechanisms of these conditions remain largely unknown, making the development of effective treatments challenging. The difficulty in early detection and diagnosis of neurodegenerative diseases further compounds the issue. Recent advancements in [...] Read more.
Neurodegeneration and aging are pressing issues with significant personal, economic, ethical, and social consequences. However, the underlying biological mechanisms of these conditions remain largely unknown, making the development of effective treatments challenging. The difficulty in early detection and diagnosis of neurodegenerative diseases further compounds the issue. Recent advancements in genetics, genomics, and brain imaging technology hold great promise for improving our understanding of neurodegeneration and aging, as well as the development of personalized medicine and new drugs and therapies. Addressing these challenges will require a multi-disciplinary and collaborative approach from researchers in various fields. This Special Issue offers valuable insights and perspectives on this critical area of research, which can help advance our understanding and improve the health and well-being of our aging population.
Editorial
Open Access February 21, 2023

Clinicians’ Perception of Spirituality in Oncology Care: A Qualitative Synthesis

Abstract Background: By rediscovering the medical field spiritual foundation, clinicians sought to balance their care and realize that spirituality is frequently associated with healthcare, thus one’s spiritual beliefs influence patients' decisions between aggressive care and complementary therapies in oncology care. Aim: This study investigates clinicians’ experiences and perceptions of [...] Read more.
Background: By rediscovering the medical field spiritual foundation, clinicians sought to balance their care and realize that spirituality is frequently associated with healthcare, thus one’s spiritual beliefs influence patients' decisions between aggressive care and complementary therapies in oncology care. Aim: This study investigates clinicians’ experiences and perceptions of spirituality in oncology care that clinicians can utilize to improve cancer and spiritual care provision. Methods: A thematic, qualitative synthesis. Results: Four main themes emerged from the synthesis of the 11 included studies that can steer future framework and policies to make clinicians more inept in providing care to address spiritual well-being of the patients and their family from a clinician's point of view of spirituality: “Maintaining Hope and Spiritual Wellness, Clinician’s Sensitivity to Cancer Patients, Provision of Culturally Respectful Spiritual Care, and Education in Providing Spiritual Care”. Conclusion: Cancer patients, cancer survivors, and clinicians’ quality of life is correlated with measures of spirituality and spiritual well-being. Spirituality also fulfill these oncologic patients has been linked to improved emotional and spiritual adjustment. Implications: Clinicians with different proficiencies, novice or expert, develop a strong spiritual belief can also be a strength when it comes to caring for those terminally ill patients, to be able to aid them in their sufferings. Amidst the challenges of spiritual care, these clinicians provide a patient strategy approach that is holistic to the care.
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Review Article
Open Access February 07, 2023

Building a Holistic Approach: Uniting Marxist and Smithian Economics for a More Resilient Economic Theory

Abstract In this article, we discuss a new proposed concept of economic engineering that seeks to innovate a new model by combining the theories of Karl Marx and Adam Smith, taking into consideration main economic factors to create a sustainable and inclusive economic system that addresses existing challenges and provides a roadmap for future economic growth. Through a brief analysis of the existing gaps [...] Read more.
In this article, we discuss a new proposed concept of economic engineering that seeks to innovate a new model by combining the theories of Karl Marx and Adam Smith, taking into consideration main economic factors to create a sustainable and inclusive economic system that addresses existing challenges and provides a roadmap for future economic growth. Through a brief analysis of the existing gaps between Marxist and Smithian economics, we developed a new economic matrix that leverages the strengths of both theories while also incorporating the latest insights from modern economic research. Our novel approach to economic engineering represents a fresh perspective on the economy and offers practical tool for addressing the most pressing challenges facing society today.
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Review Article
Open Access December 16, 2022

A Framework for the Application of Optimization Techniques in the Achievement of Global Emission Targets in the Housing Sector

Abstract The building construction industry holds a crucial role in the reduction of greenhouse gas emissions globally. The targets for greenhouse gas emissions may not be achieved without a defined strategic plan to meet up with the set targets from various sectors of the economy. Recognizing the enormous potential that the building industry holds in contributing to global greenhouse gas GHG emission [...] Read more.
The building construction industry holds a crucial role in the reduction of greenhouse gas emissions globally. The targets for greenhouse gas emissions may not be achieved without a defined strategic plan to meet up with the set targets from various sectors of the economy. Recognizing the enormous potential that the building industry holds in contributing to global greenhouse gas GHG emission reduction, this study describes a framework on how optimization techniques can be used as a guide for emission reduction targets for the housing sector using illustrations of the onsite and offsite building construction industry. Given that some of the GHG gases are also sources of air pollution, this study includes a discussion on how the effort to address air pollution can be used to find a consensus towards addressing the concern about GHG emissions. This study presents procedures for simplified methods of estimation of GHG emissions that various municipalities around the globe can use to estimate and report the emissions from the building construction industry. The study presents a unifying strategy for emission management. The study also demonstrates how programming methods can be applied to GHG emissions management. The approach used in this study is transferable to other industries. The study recommends a unifying strategy for the management and control of emissions in the building construction industry. The study also recommends a coordinated effort in sharing best practices for emission control and management from all jurisdictions globally. In the effort to reduce global emission targets, further studies like this and its expansion is recommended for all sectors of the global economy. It is recommended that these studies should be followed by a concrete effort to achieve good implementation of sustainable emission reduction targets globally.
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Article
Open Access October 29, 2022

Patient Perspectives on Factors Influencing Initiation of Gynecologic Care

Abstract Addressing adolescent and sexual reproductive healthcare is essential to providing young patients with the resources they need to navigate and empower themselves with. However, there is limited data about how often this occurs. Several studies have previously indicated that there is a large gap in accessing this gap in low-income neighborhoods. Our study aims to identify the establishment of [...] Read more.
Addressing adolescent and sexual reproductive healthcare is essential to providing young patients with the resources they need to navigate and empower themselves with. However, there is limited data about how often this occurs. Several studies have previously indicated that there is a large gap in accessing this gap in low-income neighborhoods. Our study aims to identify the establishment of gynecologic care among adolescent cisgender women and elucidate potential reasons for seeking or not seeking out care. We approached women in the pediatric emergency room that matched the inclusion criteria set out. Qualitative surveys were conducted until thematic saturation was reached and a cross-section study design was employed. Interviews were analyzed through modified ground theory. The study was conducted at the pediatric emergency department at University Hospital located in Newark, NJ. In 2018 estimates, the Newark population consists of 47.0% Black and 39.2% Hispanic or Latinos. Semi-structured interviews were conducted with 27 cisgendered, English-speaking females between ages 18 to 25 presenting to the pediatric emergency room who may or may not have previously established primary care with a gynecologist. Transcriptions were analyzed using modified grounded theory and themes were identified using inductive coding of patient interviews.
Article
Open Access May 06, 2022

Drivers of Acute Diarrhea in Mothers of Children between 6 and 59 Months old in Kinshasa Households, Democratic Republic of the Congo

Abstract Acute diarrhea is a common affection, among children under 59 months old in Sub-saharan Africa and Asia known to be a global public health concern. It is responsible for significant mortality in developing countries. The main purpose of this study was to identify drivers of acute diarrhea in mothers of children aged 6-59 months in Kinshasa households. This study was conducted in two health areas [...] Read more.
Acute diarrhea is a common affection, among children under 59 months old in Sub-saharan Africa and Asia known to be a global public health concern. It is responsible for significant mortality in developing countries. The main purpose of this study was to identify drivers of acute diarrhea in mothers of children aged 6-59 months in Kinshasa households. This study was conducted in two health areas in Kinshasa namely Centre Supérieur Militaire Mobikisi and Hopital Militaire Central. It is a cross-sectional study of analytical type having a correlational design. In fact, 114 mothers having children aged 6 to 59 months old who had experienced at least three diarrheal episodes were selected and this research was carried out in January 2020. Independent variables were socio-economic factors and dependent variables were biological factors. Descriptive statistical analyses of which frequency and percentage were performed to describe the sampling profile. To measure the strength of association between different variables, the Pearson's Chi-Square (X2) test was used. The findings showed that 57% live in a high socio-economic environment compared to 43% who have a low socio-economic environment responsible for the occurrence of acute diarrhea. It was observed that 67.7% of participants knew the importance of access to health care services, compared to 32.3% who did not know. Meanwhile, 50.8% lived in a healthy environment versus 49.2% who had an unhealthy environment. Furthermore, 53.8% were in an acceptable demographic and biological situation, compared to 46.2% who were in a precarious demographic and biological situation. Acute diarrhea in children aged 6-59 months is one of the causes of morbidity and mortality in Kinshasa city. Obstacles to effective care are related to the lack of quality service provision. Policy makers must therefore put in place interventions to address these challenges in order to reduce infant morbidity and mortality in this area.
Article
Open Access June 21, 2021

The rising role of age stratification in sleep and CPAP therapy adherence in elderly population

Abstract Proper and effective management of obstructive sleep apnea (OSA) in elderly patients represents an important yet under-researched therapeutic target. Therefore, the main purpose of our research was to employ age stratification to analyse sleep quality and sleep fragmentation, the daily sleepiness, OSA severity and CPAP compliance in elderly. Conforming to the inclusion criteria of minimum 70 years [...] Read more.
Proper and effective management of obstructive sleep apnea (OSA) in elderly patients represents an important yet under-researched therapeutic target. Therefore, the main purpose of our research was to employ age stratification to analyse sleep quality and sleep fragmentation, the daily sleepiness, OSA severity and CPAP compliance in elderly. Conforming to the inclusion criteria of minimum 70 years of age at the time of polysomnography and CPAP titration night a total number of 162 elderly patients was included, median age 73,00±4 (MED±IQR). The comparison group consisted of 448 adult subjects under the age of 70 years old, median age 54,00±14,00 (MED±IQR). Sleep fragmentation in elderly was promoted to suboptimal CPAP adherence, as the probability of CPAP use ≥ 4 hours per day was less than 20%. Overall CPAP compliance hours in the elderly group achieved 3,991±3,804 hours/day with bigger variation in between the subjects versus 5,547±3,465 hours/day for the controls, (MED±IQR, p<0,001). Despite naturally occurring sleep fragmentation worsened by OSA, less than 30% of elderly patients would score ≥ 10 points on Epworth sleepiness scale. The study emphasizes acute need for standardized age-specific diagnostic tools to address different perception of daily drowsiness and sleepiness by older people. Further, it underlines the importance of early recognition of possible comorbid OSA and insomnia and suggest paying more attention to “non-obese phenotype” in the subgroup of elderly patients with suspected OSA. Elderly patients might also need development of more flexible CPAP compliance criteria; however, those must be standardized and objective.
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Article
Open Access January 23, 2026

Synthesising Stage Blood Using Ghanaian Indigenous Materials: From Material Scarcity to Artistic Self-Reliance

Abstract This study addresses the critical challenge of material scarcity within Ghana’s creative industries by pioneering the synthesis of professional-grade stage blood from indigenous, locally-sourced materials. In the context of Ghanaian theatre and film, practitioners face significant barriers due to the high cost and limited availability of imported special effects products, often resulting in the [...] Read more.
This study addresses the critical challenge of material scarcity within Ghana’s creative industries by pioneering the synthesis of professional-grade stage blood from indigenous, locally-sourced materials. In the context of Ghanaian theatre and film, practitioners face significant barriers due to the high cost and limited availability of imported special effects products, often resulting in the use of inadequate substitutes that compromise aesthetic realism, safety, and narrative authenticity. This paper responds by exploring the potential of cassava starch, tapioca, kenkey dough, and fufu wax. Grounded in Schumacher’s theory of Appropriate Technology, the paper reframes indigenous resources not as inferior alternatives but as technologically and contextually appropriate solutions that align with Ghana’s economic, environmental, and social realities. The study provides detailed, reproducible recipes for both flowing and clotted blood variants, validated through practical application in simulated special effects such as gunshot wounds and deep-tissue scars. These formulations meet key performance criteria: visual fidelity under theatrical and cinematic conditions, controlled viscosity, ease of application and removal, and performer safety. Beyond technical innovation, this research contributes to shifting academic and professional discourse from dependency and scarcity toward resourcefulness, sustainability, and artistic self-reliance. It offers a practical framework for reducing production costs, enhancing the quality of visual storytelling, and fostering local value chains within Ghana’s growing creative economy.
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Article
Open Access October 27, 2025

Electronic Cigarette Perception in Baltimore High Schools

Abstract Background: Electronic cigarette (e-cigarette) use among adolescents is a growing public health concern, particularly in low-income and Black communities. However, little is known about how social determinants of health shape e-cigarette perceptions in this population. Aims: This study examined social determinants associated with perceptions of e-cigarette safety among Baltimore high [...] Read more.
Background: Electronic cigarette (e-cigarette) use among adolescents is a growing public health concern, particularly in low-income and Black communities. However, little is known about how social determinants of health shape e-cigarette perceptions in this population. Aims: This study examined social determinants associated with perceptions of e-cigarette safety among Baltimore high school students. Methods: A cross-sectional survey (CEASE Youth: School Survey) was conducted with 604 Baltimore high school students aged 14–20. Participants completed a questionnaire assessing perceptions of e-cigarette safety, as well as parental education, race/ethnicity, parental employment, household composition, and community tobacco use. Results: Higher parental education was associated with lower perceived e-cigarette safety among students. Students in higher grades also reported lower perceived e-cigarette safety. In contrast, male students—particularly those in upper grades—were more likely to perceive e-cigarettes as safe. Race/ethnicity, household composition, parental employment, and community tobacco exposure were not associated with perceived e-cigarette safety. Conclusion: Higher parental education, female gender, and being in higher grades were associated with perceiving e-cigarettes as unsafe. These findings highlight the need for targeted interventions to address vaping perceptions among youth in urban settings.
Article
Open Access October 21, 2025

Trends in Smoking and Flavored Tobacco Use in California: Black–White Disparities, 2003–2023

Abstract Background: Tobacco control policies nationwide have contributed to a substantial decline in cigarette and tobacco use, with particularly sharp reductions observed in states such as California that have implemented restrictive bans, strong prevention measures, and high excise taxes. While these policies have led to overall decreases in tobacco use, progress has not necessarily been [...] Read more.
Background: Tobacco control policies nationwide have contributed to a substantial decline in cigarette and tobacco use, with particularly sharp reductions observed in states such as California that have implemented restrictive bans, strong prevention measures, and high excise taxes. While these policies have led to overall decreases in tobacco use, progress has not necessarily been distributed equally across racial groups. Understanding long-term trends by race is critical for addressing equity gaps in tobacco prevention and control. Evidence suggests that some racialized groups may experience slower or delayed declines, raising concerns about equity in public health gains. Methods: We analyzed data from the California Health Interview Survey (CHIS) spanning 2003–2023. Trends in current smoking were examined separately for non-Latino Black and non-Latino White adults. We also assessed current use of flavored tobacco products, given California’s statewide ban enacted in 2021. Changes were evaluated in both absolute terms (percentage point declines) and relative terms (percent reduction from baseline). Results: Smoking prevalence declined from 17.2% in 2003 to 5.2% in 2023 among White adults and from 19.9% to 9.0% among Black adults. This represents a 12.0 percentage point (69.8%) decline for Whites compared with a 10.9 percentage point (54.8%) decline for Blacks. For flavored tobacco use, prevalence decreased from 8.0% to 4.7% among White adults but only from 11.9% to 10.8% among Black adults. This corresponds to a 3.3 percentage point (41.3%) decline for Whites compared with a 1.1 percentage point (9.2%) decline for Blacks. Conclusions: Although both Black and White adults in California experienced reductions in smoking over the past two decades, White adults showed larger declines in both absolute and relative terms. Disparities were even more pronounced for flavored tobacco use, where declines were minimal among Black adults despite the statewide ban. These findings suggest that Black populations in California may have been left behind by tobacco control progress, especially regarding flavored products. Given the history of targeted marketing by the tobacco industry, the role of flavors in increasing dependence, and reduced access to cessation resources in Black communities, targeted policies and culturally tailored interventions are needed to ensure equitable reductions in tobacco use. Greater attention to flavored tobacco in Black communities may help narrow these disparities and advance California’s tobacco endgame goals.
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Article
Open Access October 09, 2025

Simulation-Based Learning in Nursing Education: Perspectives of Student Nurses in the Philippines

Abstract Simulation-based learning (SBL) is widely recognized as an effective educational approach that bridges theory and practice in nursing education. Despite its global adoption, limited research has examined the experiences of Filipino nursing students with SBL, particularly in resource-constrained settings. This study explored the perspectives of Bachelor of Science in Nursing students from a [...] Read more.
Simulation-based learning (SBL) is widely recognized as an effective educational approach that bridges theory and practice in nursing education. Despite its global adoption, limited research has examined the experiences of Filipino nursing students with SBL, particularly in resource-constrained settings. This study explored the perspectives of Bachelor of Science in Nursing students from a university in Metro Manila, Philippines, on the impact of SBL on their skills, emotional responses, and challenges encountered. A descriptive qualitative design was employed using purposive sampling of ten students who had participated in at least one SBL activity. Data were collected through semi-structured interviews and short written reflections and analyzed thematically following Braun and Clarke’s framework to capture nuanced experiences. Three major themes emerged from the analysis. First, students reported initial anxiety, nervousness, and stress during their early SBL experiences, which gradually transformed into confidence, adaptability, and resilience as they gained familiarity and competence. Second, SBL enhanced technical and cognitive skills such as clinical judgment, decision-making, teamwork, and patient-centered care, supporting students’ readiness for real-world practice. Third, students identified resource limitations, insufficient equipment, and time constraints as significant barriers to optimal learning, though these challenges also fostered creativity and perseverance. The findings demonstrate that SBL fosters technical competence, critical thinking, and professional growth but requires institutional support to address resource constraints and faculty development needs. This study underscores the importance of expanding SBL in Philippine nursing curricula to align with international best practices and to contribute to Sustainable Development Goals 3 (good health and well-being), 4 (quality education), and 5 (gender equality).
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Article
Open Access October 01, 2025

Place-Based Diminished Returns of Economic Resources in Rural America: A Framework for Understanding Geography-Conditioned Inequality

Abstract Background: Socioeconomic status (SES) is widely associated with improved health, behavioral, and educational outcomes. However, emerging research suggests that these benefits are not uniformly experienced across populations or contexts. The theory of Marginalization-related Diminished Returns (MDRs) has primarily focused on racial and ethnic disparities, showing that individuals from [...] Read more.
Background: Socioeconomic status (SES) is widely associated with improved health, behavioral, and educational outcomes. However, emerging research suggests that these benefits are not uniformly experienced across populations or contexts. The theory of Marginalization-related Diminished Returns (MDRs) has primarily focused on racial and ethnic disparities, showing that individuals from racially marginalized groups often experience weaker protective effects of SES. There is a lack of evidence on geography—particularly rural residence—as a moderator of SES effects. Objective: This review explores how place, especially rural contexts in the U.S., shapes the extent to which SES translates into improved outcomes. We extend the MDRs framework to include place-based and geography-based marginalization, arguing that even among non-Hispanic White populations, rural residence can lead to diminished returns on education, income, and other forms of capital. Content: Drawing on theoretical models such as Fundamental Cause Theory and Bronfenbrenner’s Ecological Systems Theory, and synthesizing empirical findings from studies of academic achievement, substance use, and educational aspirations, this review highlights how structural disadvantages in rural areas weaken the effectiveness of individual and family-level resources. Conclusion: Rural health and educational disparities are not solely due to a lack of resources but may also reflect systemic conditions that erode the value of existing resources. Policy interventions must be place-aware and address the contextual constraints that limit opportunity. Future research should more explicitly test how geography moderates the effects of SES across a range of outcomes and populations.
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Perspective Article
Open Access September 19, 2025

Effectiveness of Subglottal Suctioning Could Prevent the Develop of VAP in the Patient on Mechanic Ventilator

Abstract VAP, or Ventilator Associated Pneumonia, is a type of pneumonia that arises in patients receiving mechanical ventilation. This condition is a serious complication and can lead to the patient's decline while on a mechanical ventilator, posing a significant risk for secondary complications if not addressed promptly. In particular, VAP is a prevalent issue in intensive care units, where the [...] Read more.
VAP, or Ventilator Associated Pneumonia, is a type of pneumonia that arises in patients receiving mechanical ventilation. This condition is a serious complication and can lead to the patient's decline while on a mechanical ventilator, posing a significant risk for secondary complications if not addressed promptly. In particular, VAP is a prevalent issue in intensive care units, where the healthcare team works to prevent further deterioration of the patient. VAP is associated with a notably high mortality rate, particularly in individuals with weakened immune systems, as well as in younger and older populations. Extended intubation and prolonged sedation can contribute to the onset of VAP. The previous study had found that incidence of VAP accounts for 9 % to 27 % endotracheal intubated patients, whereas VAP has a mortality rate ranging from 25 % to 50 % [1-3]. VAP increased ICU and hospital length of stay, antibiotic consumption, and healthcare cost (Zhi Mao et al, 2016) [4]. While using the subglottic suctioning could prevent and help the intubated patient to decreased the development of VAP. The study shown by Smith et al (2021) [5] SSD is a technique employed to reduce micro aspiration of oropharyngeal secretions in patients with cuffed endotracheal airways. Aspiration of oropharyngeal secretions is the accepted cause of the majority of ventilator-associated pneumonia (VAP), a complication of invasive ventilation with high associated mortality. Another study by Rahul Gujadhur et al (2005) [6], subglottic suction has also been shown to delay the onset of VAP but no benefits in terms of ventilation time, hospital stay or mortality benefit have ever been shown. This investigation into subglottic suctioning may assist the healthcare team, particularly in the intensive care unit, in preventing the development of VAP and shortening the duration of ventilation for patients. The advantages of subglottic suctioning are often debated, particularly regarding its impact on the duration of intubation. However, recent research indicates that implementing subglottic suctioning within a time frame of fewer than three days could help reduce intubation duration and lead to improved patient recovery.
Abstract
Open Access September 04, 2025

Evidence-Based Protocols for the Prevention and Treatment of Prosthetic Joint Infection in Total Hip Arthroplasty: A Systematic Review

Abstract Objective: This systematic review aimed to identify, synthesize, and critically analyze the available evidence on clinical protocols used for the prevention and treatment of prosthetic joint infection (PJI) in total hip arthroplasty (THA), based on studies published between 2000 and 2025. Methods: The review was conducted according to PRISMA guidelines. Electronic searches were performed in PubMed (MEDLINE), Scopus, Web of Science, and Embase between January and April 2025. Eligible studies included clinical trials, cohort studies, case-control studies, systematic reviews, and meta-analyses published in English that addressed either preventive or therapeutic strategies for PJI in THA. Study selection, data extraction, and quality assessment were carried out independently by two reviewers. Due to the heterogeneity of the included studies, a qualitative synthesis was performed. Results: A total of 32 studies were included. Preventive measures identified in the literature comprised combined antibiotic prophylaxis (cefazolin and gentamicin), multimodal perioperative protocols such as ACERTO, nasal decolonization for Staphylococcus aureus [...] Read more.
Objective: This systematic review aimed to identify, synthesize, and critically analyze the available evidence on clinical protocols used for the prevention and treatment of prosthetic joint infection (PJI) in total hip arthroplasty (THA), based on studies published between 2000 and 2025. Methods: The review was conducted according to PRISMA guidelines. Electronic searches were performed in PubMed (MEDLINE), Scopus, Web of Science, and Embase between January and April 2025. Eligible studies included clinical trials, cohort studies, case-control studies, systematic reviews, and meta-analyses published in English that addressed either preventive or therapeutic strategies for PJI in THA. Study selection, data extraction, and quality assessment were carried out independently by two reviewers. Due to the heterogeneity of the included studies, a qualitative synthesis was performed. Results: A total of 32 studies were included. Preventive measures identified in the literature comprised combined antibiotic prophylaxis (cefazolin and gentamicin), multimodal perioperative protocols such as ACERTO, nasal decolonization for Staphylococcus aureus, silver-impregnated dressings, and structured post-discharge surveillance. Treatment strategies included DAIR (Debridement, Antibiotics, and Implant Retention), the DAPRI technique, one-stage and two-stage revision surgeries, muscle flap reconstructions, and protocols without spacers. These interventions were associated with significantly reduced infection rates and improved clinical outcomes when applied appropriately and in accordance with patient-specific factors. Conclusion: Effective prevention and treatment of PJI in total hip arthroplasty require a systematic and evidence-based approach. Integrated protocols—spanning preoperative optimization, meticulous intraoperative techniques, and rigorous postoperative monitoring—have proven effective in reducing infection incidence. In cases of established infection, surgical management must be tailored to the timing of infection, microbial profile, and host conditions. Two-stage revision remains the gold standard for complex infections, while one-stage revision and emerging techniques like DAPRI offer promising results in selected cases. This review contributes to the standardization of clinical practice and supports improved patient outcomes.
Systematic Review
Open Access July 25, 2025

Significance of Job Satisfaction and Quality Patient Care

Abstract This commentary letter was conducted to evaluate Wang et al.'s (2025) research study on the relationship between perceived staffing and quality of care among hospitals. The current study's findings show that the relationship between professional self-efficacy and job performance is mediated by work engagement. Life contentment influences work engagement, which is associated with enhanced job [...] Read more.
This commentary letter was conducted to evaluate Wang et al.'s (2025) research study on the relationship between perceived staffing and quality of care among hospitals. The current study's findings show that the relationship between professional self-efficacy and job performance is mediated by work engagement. Life contentment influences work engagement, which is associated with enhanced job performance. However, involvement acts as a mediator between job performance and burnout, which could affect the quality of patient care. Staffing satisfaction and quality patient care are closely related, and it is essential for healthcare institutions to prioritize appropriate workforce levels and address the nursing shortage. However, there are still unanswered questions in this sector, such as researching nursing-specific care procedures, addressing data challenges, and understanding the connections between nursing practice and patient care outcomes. Future research should address the "black box" of nursing practice and address variations in the quality of patient care provided by nurses.
Commentary Letter
Open Access June 26, 2025

The Intersection of Climate Change Adaptation and Smallholder Farmer Food Security: A Review of Strategies and Barriers

Abstract Smallholder farmers play a pivotal role in global food security; however, they remain exceptionally vulnerable to the impacts of climate change due to their reliance on natural resources and limited adaptive capacities. This narrative review synthesizes a wide range of global sources to explore the intersection of smallholder agriculture and climate adaptation strategies. The review examines [...] Read more.
Smallholder farmers play a pivotal role in global food security; however, they remain exceptionally vulnerable to the impacts of climate change due to their reliance on natural resources and limited adaptive capacities. This narrative review synthesizes a wide range of global sources to explore the intersection of smallholder agriculture and climate adaptation strategies. The review examines adaptation practices, agroecological methods, and the adoption of climate-resilient crop varieties. It reveals that the implementation of these strategies is frequently hindered by systemic barriers such as financial constraints, limited technological access, and institutional inefficiencies. Recognizing that previous studies have addressed isolated aspects of adaptation or relied on secondary data, this review highlights research gaps and offers a comprehensive synthesis of relevant literature. This review uses a narrative synthesis model suitable for integrating evidence from agronomy, economics, and social science to capture the complex challenges faced by smallholder farmers. The review emphasizes the importance of policy frameworks and participatory approaches that empower smallholder communities. This review synthesizes current evidence to inform potential directions for targeted interventions and future field-based studies, while recognizing the limitations of relying on secondary data. These recommendations aim to facilitate integrated policy reforms and drive research initiatives, ultimately strengthening the resilience and adaptability of smallholder agriculture in the face of ongoing climate change.
Review Article
Open Access June 18, 2025

The socio-economic influencers of school dropout amidst the implementation of the Free Senior High School policy in Ghana: A case study approach

Abstract The Free Senior High School (FSHS) policy implementation in Ghana has garnered significant attention in academic research, with various studies delving into its advantages and implementation obstacles. Nevertheless, there has been a rise in school dropout rates among secondary school students amidst the programme implementation. There is therefore the need for a more localized scientific inquiry [...] Read more.
The Free Senior High School (FSHS) policy implementation in Ghana has garnered significant attention in academic research, with various studies delving into its advantages and implementation obstacles. Nevertheless, there has been a rise in school dropout rates among secondary school students amidst the programme implementation. There is therefore the need for a more localized scientific inquiry into the socio-economic factors contributing to school dropout among Senior High School (SHS) students in the Abofour community. The study employed a qualitative approach, using the case study design to conduct interviews with 22 students who had dropped out of SHS, to explore their experiences and identify key socio-economic factors influencing their decisions to leave school. Thematic data analysis revealed six main themes, namely, lack of parental support, peer influence, early marriage and pregnancy, economic conditions, and unsupportive school environment, as among the causative factors. The findings suggest that while the Free SHS policy has removed some direct financial barriers, other social, economic, and institutional factors continue to spur up dropout rates. The study concludes that addressing these underlying issues requires a multi-faceted approach that includes strengthening family support systems, improving school environments, and providing targeted interventions for at-risk students. In this regard, policymakers and other educational stakeholders are required to provide targeted supports to enhance student retention and reduce dropout rates in the Abofour community.
Article
Open Access June 03, 2025

Complexity Leadership Theory Integration into Nursing Leadership and Development in Addressing COVID-19 and Future Pandemics

Abstract Complexity Leadership Theory (CLT) is a new and revolutionary concept in addressing healthcare crises worldwide. Its relevance and applications were tested during the COVID-19 pandemic. However, no definite and encompassing research was done to apply it to nursing leadership. Thus, this study examines CLT integration into nursing leadership to address the challenges posed by the pandemic. Through [...] Read more.
Complexity Leadership Theory (CLT) is a new and revolutionary concept in addressing healthcare crises worldwide. Its relevance and applications were tested during the COVID-19 pandemic. However, no definite and encompassing research was done to apply it to nursing leadership. Thus, this study examines CLT integration into nursing leadership to address the challenges posed by the pandemic. Through a systematic review of literature from PubMed, Scopus, and Web of Science, relevant studies were analyzed to determine how complexity leadership theory was defined, conceptualized, and operationalized within nursing leadership context. The findings reveal that traditional hierarchical leadership models are insufficient in a dynamic crisis environment like the pandemic. Instead, CLT’s framework which encompasses adaptive, administrative, and enabling leadership facilitates innovation, resilience, and effective interprofessional collaboration. Nurse leaders employing these strategies are better positioned to manage resources limitation, foster shared decision-making, and implement technological advancements in rapidly changing healthcare settings. Overall, this study underscores the potential of complexity leadership theory to transform nursing leadership practices by promoting continuous learning and empowerment, thereby enhancing crisis response and preparedness for future pandemics.
Systematic Review
Open Access May 15, 2025

Teaching Social Studies in an Integrated Manner: The Lived Experience of Out-Of-Field Social Studies Teachers

Abstract This study investigated the pedagogical implications of out-of-field teaching in Social Studies. The Out-of-field Social Studies teachers could encounter several challenges in their preparation and the implementation of the integrated Social Studies curriculum. This study sought the lived experiences of the out-of-field teachers concerning the causes of out-of-field teaching in social studies, [...] Read more.
This study investigated the pedagogical implications of out-of-field teaching in Social Studies. The Out-of-field Social Studies teachers could encounter several challenges in their preparation and the implementation of the integrated Social Studies curriculum. This study sought the lived experiences of the out-of-field teachers concerning the causes of out-of-field teaching in social studies, problems encountered by the out-of-field teachers and the mechanisms they employ to cope with the teaching of Social Studies. The study chose the qualitative phenomenological research design. Data were collected from all the 17 out-of-field Social Studies teachers through in-depth structured interview. Data were transcribed and analysed, through the inductive thematic analysis approach, unveiling of themes and concepts from the narratives of the research participants. The study revealed that out-of-field teaching in Social Studies occurs as a result of teacher shortage in integrated social studies programme. It is also caused by the perception that any teacher could teach Social Studies irrespective of the teachers’ qualification. Out-of-field teacher encounter problems such as inadequate content and pedagogical knowledge, lack of classroom managerial techniques and inability to deliver lessons through the integrated approach. Engaging in professional development courses, peer coaching, in-service training and workshops were some of the mechanisms employed by out-of-field teachers to cope with the teaching of Social Studies. The pedagogical implications of this phenomenon are that when teaching the Social Studies, the out-of-field teachers place more emphasis on aspects of the Social Studies curriculum where they have much knowledge and skip or put less emphasis on other aspects they lack in-depth knowledge, thus, the integrated approach to teaching Social Studies is not adopted effectively by out-of-field teachers. This waters down the content of Social Studies at the Senior High School level. Addressing the problem of out-of-field teaching in Social Studies requires training and recruiting more teachers who have background training and experience in the integrated approach to the teaching of Social Studies.
Review Article
Open Access May 05, 2025

Persistent Social Welfare Needs Among Educated Caribbean Black Individuals: Evidence of Minorities' Diminished Returns

Abstract Background: Educational attainment is strongly linked to increased employment opportunities, higher income, and greater financial security, making its inverse relationship with reliance on social welfare programs well-documented. However, consistent with the Minorities' Diminished Returns (MDRs) theory, the protective effects of education may be weaker for racial and ethnic minority [...] Read more.
Background: Educational attainment is strongly linked to increased employment opportunities, higher income, and greater financial security, making its inverse relationship with reliance on social welfare programs well-documented. However, consistent with the Minorities' Diminished Returns (MDRs) theory, the protective effects of education may be weaker for racial and ethnic minority groups compared to non-Latino Whites. This study examines whether the impact of educational attainment (measured as years of schooling) on social welfare use differs between Caribbean Black and White adults in the United States, focusing on outcomes since age 18 and in the past year. Objective: To investigate the relationship between years of schooling and the likelihood of using social welfare programs, while exploring whether this association varies between Caribbean Black and White adults, in alignment with the MDRs framework. Methods: Data were derived from the National Survey of American Life (NSAL), a nationally representative dataset with a robust sample of Black and White adults in the United States. The study focused on Caribbean Black and White participants aged 18 and older. Structural equation modeling (SEM) was employed to examine the relationship between years of schooling and social welfare use, adjusting for covariates including age, gender, employment status, and marital status. Interaction terms were used to assess potential differences in the returns of education across racial groups. Results: Higher educational attainment was associated with reduced likelihood of using social welfare programs overall. However, consistent with the MDRs framework, the protective effect of education was weaker for Caribbean Black individuals compared to their White counterparts. Caribbean Blacks with similar levels of education as Whites were more likely to report using social welfare programs since age 18 and in the past year, highlighting diminished returns on education for this population. Conclusion: This study extends the MDRs framework to Caribbean Black populations, a group rarely studied in the U.S., revealing significant disparities in the economic benefits of education. The findings underscore the need for policies that address systemic barriers limiting the economic returns of education for racial and ethnic minorities, including Caribbean Blacks, to promote greater equity in social and economic outcomes.
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Article
Open Access May 05, 2025

Educated Yet Unhealthy? Diminished Returns of Education for Immigrants in the USA

Abstract Background: Minorities’ Diminished Returns (MDRs) theory posits that the health benefits of socioeconomic resources, such as education, are smaller for marginalized and minoritized populations, including immigrants. While MDRs have been extensively documented for racial and ethnic minorities, less is known about whether these diminished returns extend to immigrant populations. This study [...] Read more.
Background: Minorities’ Diminished Returns (MDRs) theory posits that the health benefits of socioeconomic resources, such as education, are smaller for marginalized and minoritized populations, including immigrants. While MDRs have been extensively documented for racial and ethnic minorities, less is known about whether these diminished returns extend to immigrant populations. This study tested MDRs of education on various health and cognitive outcomes, including self-rated health (SRH), cognitive function, numeracy, number of chronic medical conditions, and limitations in activities of daily living (ADLs) among immigrants compared to non-immigrants in the United States. Objective. To examine whether educational attainment confers weaker protective effects on SRH, cognitive function, numeracy, chronic medical conditions, and ADLs in immigrants compared to non-immigrants, confirming the presence of MDRs across these domains. Methods: We used data from the Understanding America Study (UAS), a nationally representative survey of U.S. adults. We tested the association between educational attainment and five outcomes—SRH, cognitive function, numeracy, number of chronic medical conditions, and limitations in ADLs—across immigrant and non-immigrant groups. Multivariate regression models were employed, adjusting for key sociodemographic covariates. Results: The protective effects of education on a range of health outcomes were significantly weaker for immigrants compared to non-immigrants. Education level showed weaker associations with SRH, cognitive function, numeracy, number of chronic conditions, and ADLs among immigrants. These findings suggest that even at higher levels of educational attainment, immigrants experience poorer health and cognitive functioning than their U.S.-born counterparts. Conclusion: This study offers strong evidence for the MDRs of education on multiple health outcomes among U.S. immigrants. One possible explanation is that, despite achieving higher levels of education, immigrants often face structural barriers—such as discrimination, limited access to resources, and economic inequities—that constrain the health-related benefits typically associated with educational attainment. Additionally, a portion of immigrant education may be acquired outside the United States, where credentials may not be fully recognized or rewarded within the U.S. labor market. These findings highlight the importance of policies aimed at addressing systemic inequities and improving access to healthcare, employment opportunities, and social support for immigrant communities. Future research should further explore the mechanisms underlying these diminished returns and identify policy solutions to reduce their impact. Keywords: Educational Attainment, Immigrants, Nativity, Self-Rated Health, Chronic Disease, Activities of Daily Living (ADL), Cognitive Function
Original Article
Open Access May 04, 2025

Educational Attainment Better Protects Non-Latino than Latino People Against Diabetes Mellitus

Abstract Background: High educational attainment is a well-recognized protective factor against health problems such as diabetes. However, the theory of Minorities' Diminished Returns (MDRs) suggests that this protective effect is weaker for ethnic minorities compared to non-Latino Whites. This diminished effect is thought to result from structural inequalities, such as lower-quality [...] Read more.
Background: High educational attainment is a well-recognized protective factor against health problems such as diabetes. However, the theory of Minorities' Diminished Returns (MDRs) suggests that this protective effect is weaker for ethnic minorities compared to non-Latino Whites. This diminished effect is thought to result from structural inequalities, such as lower-quality education and fewer occupational opportunities, faced by ethnic minorities. Objective: This study examined the protective effect of years of schooling—used as a proxy for educational attainment—on diabetes mellitus (DM), overall and by ethnicity. Based on the MDRs framework, we hypothesized that the protective effect of education would be weaker for Latino individuals compared to non-Latinos. Methods: Data were drawn from the 2012 wave of the Understanding America Study (UAS), a nationally representative, internet-based panel. The outcome of interest was self-reported doctor diagnosis of DM. Logistic regression models were used to assess the association between educational attainment and DM, with an interaction term to explore differences between Latino and non-Latino individuals. Models were adjusted for age, sex, employment, immigration status, and marital status. Findings were presented as adjusted odds ratios (OR), p-values, and 95% confidence intervals (CIs). Results: Higher educational attainment was associated with lower odds of DM in both Latino and non-Latino individuals (p < 0.001). An interaction between education and ethnicity (p < 0.05) indicated that the protective effect of education was weaker for Latino individuals compared to non-Latinos. Conclusion: The findings align with the MDRs framework, which suggests that the health benefits of education are not equally distributed across ethnic groups. For Latino individuals, structural barriers such as lower educational quality and labor market discrimination may limit the protective effect of education against DM. While education is a key determinant of health, its unequal returns contribute to ethnic health disparities. Policymakers must address structural inequalities in education and employment that disproportionately affect ethnic minorities. Tackling these disparities through multi-sector policy interventions will require bipartisan political support.
Article
Open Access April 30, 2025

An Alternative Renewable Energy Source: Thermal Expansion and Contraction of Materials

Abstract The processes of technical and technological development are unequivocally linked to increasing energy consumption, with a significant portion of energy being produced from fossil fuels worldwide. The reserves of natural energy sources such as petroleum, gas, coal, and turf are finite. The transition to renewable energy sources has been ongoing for a long time, but share in global energy [...] Read more.
The processes of technical and technological development are unequivocally linked to increasing energy consumption, with a significant portion of energy being produced from fossil fuels worldwide. The reserves of natural energy sources such as petroleum, gas, coal, and turf are finite. The transition to renewable energy sources has been ongoing for a long time, but share in global energy consumption remains lower than desired. The main limitations include limited availability, inability to operate continuously throughout the year, high costs, and a lack of materials and devices capable of withstanding high temperatures and pressures. The goal of our research is to create a device that generates electricity using a new type of renewable energy source based on the thermal expansion and contraction of materials. This paper presents the construction, details, and working principles of the new device. The primary focus is on utilizing materials and components that are readily available. The proposed method has own advantages, addresses some of the aforementioned limitations, and can be particularly beneficial for providing electrical energy in remote areas. Calculations indicate that the device built using this new method will be competitive with appliances that utilize other renewable energy sources in terms of features and efficiency.
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Article
Open Access March 29, 2025

How Stigma Affects Patients Seeking Help for Drug Addiction

Abstract Stigma surrounding drug addiction remains a critical barrier to effective treatment, significantly influencing healthcare access, patient engagement, and recovery outcomes. This study explores the multifaceted impact of stigma on individuals seeking help for substance use disorders (SUDs), with a focus on healthcare-related discrimination, internalized stigma, and structural barriers. Research [...] Read more.
Stigma surrounding drug addiction remains a critical barrier to effective treatment, significantly influencing healthcare access, patient engagement, and recovery outcomes. This study explores the multifaceted impact of stigma on individuals seeking help for substance use disorders (SUDs), with a focus on healthcare-related discrimination, internalized stigma, and structural barriers. Research indicates that negative perceptions among healthcare providers contribute to delayed treatment-seeking behaviors, reduced adherence to medication-assisted treatment (MAT), and increased relapse rates. Additionally, patients internalizing these societal judgments experience heightened psychological distress, social isolation, and decreased self-efficacy, further hindering their recovery process. To address these challenges, evidence-based strategies such as addiction medicine education, trauma-informed care, harm reduction approaches, and peer support models have been shown to effectively reduce stigma and improve treatment outcomes. Hospital administrators and nursing leaders play a critical role in fostering a culture of empathy, advocating for the reframing of addiction as a neuro-psycho-biological disease rather than a moral failing. Future research should explore digital mental health interventions, motivational interviewing techniques, and interdisciplinary collaboration to further dismantle stigma and enhance the effectiveness of addiction treatment programs. This study highlights the urgent need for systemic policy changes, targeted educational programs, and a shift in clinical attitudes to create a more inclusive and stigma-free healthcare environment. Through implementing these approaches, healthcare providers can ensure equitable access to treatment and improve long-term health outcomes for individuals with opioid use disorder (OUD) and other substance-related conditions.
Essay
Open Access March 20, 2025

Weaker Effects of Parental Education on Oral Nicotine Use of High School Students in Rural Areas: Marginalization-Related Diminished Returns

Abstract Background: Nicotine pouches, gummies, and candies have emerged as popular alternatives to traditional tobacco products among U.S. adolescents. While parental educational attainment is generally associated with youth substance use, marginalization-related diminished returns (MDRs) suggest that this effect may be weaker in marginalized populations, including non-Latino White communities. In [...] Read more.
Background: Nicotine pouches, gummies, and candies have emerged as popular alternatives to traditional tobacco products among U.S. adolescents. While parental educational attainment is generally associated with youth substance use, marginalization-related diminished returns (MDRs) suggest that this effect may be weaker in marginalized populations, including non-Latino White communities. In particular, place-based marginalization—such as neighborhood economic disadvantage and school-level poverty—may attenuate the benefits of parental education. This study examines MDRs in the relationship between parental educational attainment and nicotine pouch/gummy/candy use among non-Latino White 12th graders in the 2024 Monitoring the Future (MTF) study. Methods: This study analyzed nationally representative data from the 2024 MTF study, focusing on non-Latino White 12th graders who reported parental education levels and adolescents’ use of nicotine pouch/gummy/candy. Structural equation modeling (SEM) was used to estimate the effects of parental education on adolescents’ use of nicotine pouches, gummies, and candies, while adjusting for demographic covariates. Place-based marginalization was operationalized using rural vs urban /suburban residence. Interaction terms tested whether the effect of parental education varied based on place of residence. Results: Higher parental educational attainment was associated with lower use of nicotine pouches, gummies, and candies. However, this effect was significantly weaker in rural areas. Conclusion: Public health interventions should account for place-based disparities rather than assuming a uniform effect of SES factors. This study highlights the need for policy responses that address structural inequities beyond individual family SES.
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Original Article
Open Access March 12, 2025

Academic Aspirations of 12th Grade Students in the United States: Place-Based Diminished Returns of Parental Education in Rural Areas

Abstract Background: The Motivational Theory of Life-Span Development suggests that individual aspirations are shaped by both internal and external resources. Parental education is a key determinant of educational aspirations, yet its effects may vary by geographic location, demonstrating spatial patterns of Minorities’ Diminished Returns (MDRs). Objectives: This [...] Read more.
Background: The Motivational Theory of Life-Span Development suggests that individual aspirations are shaped by both internal and external resources. Parental education is a key determinant of educational aspirations, yet its effects may vary by geographic location, demonstrating spatial patterns of Minorities’ Diminished Returns (MDRs). Objectives: This study examines the association between parental education and aspirations for graduate or professional education among non-Latino White adolescents, with a specific focus on urban-suburban versus rural differences. Methods: Using data from the 12th-grade cohort of the Monitoring the Future (MTF) 2024 survey, we conducted multivariate analyses to assess the relationship between parental education and aspirations for graduate or professional education. We further examined whether this association was moderated by geographic location (urban-suburban vs. rural) to identify place-based MDRs. Results: Higher parental education was associated with greater aspirations for advanced education; however, this effect was weaker in rural areas compared to urban and suburban settings. These findings highlight that even among non-Latino White adolescents, rural residence diminishes the benefits of socioeconomic resources, providing evidence of place-based MDRs. Conclusion: Rural residents face a dual disadvantage—both lower socioeconomic status and weaker returns on those resources—necessitating targeted interventions beyond resource allocation. To address disparities in educational aspirations in rural areas, policymakers should focus on improving equitable access to educational opportunities and ensuring that these resources translate into comparable outcomes across different social and geographic contexts.
Article
Open Access March 11, 2025

Why High Income Fails to Reduce E-Cigarette Use: The Knowledge-Attitude Paradox in the SMOKES Study

Abstract Background: Electronic cigarette (e-cigarette) use and vaping tobacco have increased rapidly worldwide, raising concerns about their health effects, social acceptability, and regulatory challenges. In many countries, e-cigarettes are more commonly used by individuals from higher socioeconomic status (SES) backgrounds, who, in theory, should have greater knowledge about e-cigarettes and [...] Read more.
Background: Electronic cigarette (e-cigarette) use and vaping tobacco have increased rapidly worldwide, raising concerns about their health effects, social acceptability, and regulatory challenges. In many countries, e-cigarettes are more commonly used by individuals from higher socioeconomic status (SES) backgrounds, who, in theory, should have greater knowledge about e-cigarettes and their associated risks. However, it remains unclear why a group with more knowledge about e-cigarette risks would also hold more positive attitudes toward vaping and exhibit higher usage rates — a phenomenon that may represent a knowledge-behavior paradox. Understanding this paradox, along with the complex relationships between e-cigarette knowledge, attitudes, and behaviors, is critical for informing effective public health interventions, campaigns, social media messaging, and regulatory policies. Objectives: This study aimed to evaluate the complex relationship between SES, e-cigarette knowledge, pro-vaping attitudes, and e-cigarette use. Methods: The SMOKES Study (Study of Measurement of Knowledge and Examination of Support for Tobacco Control Policies) used a multi-center, cross-sectional design, collecting data from 2,403 college and university students across 15 provinces in Iran (covering nearly half of the country's provinces). The survey measured family income, age, sex, ethnicity, e-cigarette use, knowledge, and attitudes. Structural Equation Modeling (SEM) was employed to examine the interrelations between SES, knowledge, attitudes, and behavior, while adjusting for age, sex, and ethnic minority status. Results: SEM analysis confirmed the hypothesized paradox. Although greater knowledge about e-cigarettes was linked to less favorable attitudes toward vaping and lower use, pro-vaping attitudes emerged as the strongest predictor of vaping behavior, while knowledge played a weaker protective role. Notably, individuals with higher SES simultaneously showed higher knowledge and, paradoxically, more pro-e-cigarette attitudes and greater usage. Female students and ethnic minority students reported higher correct knowledge and lower pro-vaping attitudes and use. Although age and higher family income were associated with more favorable attitudes, they did not directly predict vaping behavior. These results suggest that for higher SES individuals, poor knowledge is not the main driver of e-cigarette use; rather, their pro-e-cigarette attitudes, which seem to outweigh the influence of knowledge, play a key role. Conclusions: Although individuals from higher SES backgrounds report greater correct knowledge about e-cigarettes, this knowledge does not necessarily translate into reduced positive attitudes or lower usage. This study highlights the complexity of these paradoxical effects and suggests that public health strategies need to go beyond simple education and knowledge-based interventions. Targeted approaches should address industry messaging, challenge misconceptions, and strengthen regulatory efforts to reduce e-cigarette use among young adults, including those from higher SES backgrounds.
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Original Article
Open Access March 09, 2025

Place-Based Diminished Returns of Parental Education on Adolescents’ Inhalant Use in Rural Areas

Abstract Background Adolescent substance use is often influenced by socioeconomic and geographical factors. While higher parental education is typically associated with lower substance use, these protective effects may be weaker for marginalized groups facing structural disadvantages that limit the utility and returns of their economic and social resources. Rural areas, characterized by fewer [...] Read more.
Background Adolescent substance use is often influenced by socioeconomic and geographical factors. While higher parental education is typically associated with lower substance use, these protective effects may be weaker for marginalized groups facing structural disadvantages that limit the utility and returns of their economic and social resources. Rural areas, characterized by fewer employment opportunities and limited recreational activities, may contribute to marginalization-related diminished returns (MDRs) of parental education on adolescent substance use, including inhalant use. Objectives This study applies the MDRs framework to examine whether the protective effect of higher parental education on current inhalant use (past 30 days) among 12th-grade American adolescents varies by geographic location. Specifically, we assess whether youth from highly educated families in rural areas are at a disproportionate risk of inhalant use compared to their urban and suburban peers. Methods Using data from the 2024 Monitoring the Future (MTF) study, a nationally representative survey of 12th-grade adolescents in the U.S., we tested main effects and statistical interactions between parental education and residence (rural vs. urban/suburban) in predicting the odds of inhalant use over the past 30 days. Logistic regression models, both with and without interaction terms, were applied to evaluate whether the protective effects of parental education varied by residence location, controlling for relevant demographic and socioeconomic factors. Results Findings indicate a significant interaction between parental education and rural residence. While higher parental education was associated with lower odds of inhalant use in urban and suburban areas, this protective effect was substantially weaker in rural settings. Adolescents from highly educated families in rural areas exhibited a higher-than-expected risk of inhalant use, suggesting that geographic marginalization attenuates the benefits of parental socioeconomic resources. Conclusions These results highlight the role of place-based marginalization in shaping adolescent substance use disparities, demonstrating that MDRs extend beyond race and ethnicity to location-based disadvantages. Rural youths from highly educated families may face unique structural and social challenges that counteract the protective effects of parental education. Public health efforts should consider place-based interventions that address the economic, recreational, and social limitations of rural environments to reduce substance use risk among high-SES adolescents residing in rural areas.
Article
Open Access March 06, 2025

Tobacco-control policy support and tobacco use: SMOKES study

Abstract Background: Tobacco control policies are implemented globally to reduce tobacco-related morbidity and mortality. Emerging evidence suggests that individual tobacco use may influence the level of support for these policies. However, the extent to which personal use affects policy endorsement remains underexplored, particularly among young adults in academic settings. Aims: This study [...] Read more.
Background: Tobacco control policies are implemented globally to reduce tobacco-related morbidity and mortality. Emerging evidence suggests that individual tobacco use may influence the level of support for these policies. However, the extent to which personal use affects policy endorsement remains underexplored, particularly among young adults in academic settings. Aims: This study aimed to examine whether college students who use tobacco exhibit lower support for tobacco control policies compared to their non-user counterparts. Methods: We conducted a multi-center, cross-sectional study involving 2403 college students from various provinces in Iran. Tobacco use was ascertained based on self-reported consumption of cigarettes, electronic cigarettes, and hookah. Attitudes toward tobacco control policies were evaluated using a structured survey instrument, and comparative analyses were performed to assess differences in policy support between tobacco users and non-users. Results: The analysis revealed that tobacco users demonstrated significantly lower support for tobacco control policies compared to non-users. This association was consistently observed across users of cigarettes, electronic cigarettes, and hookah, suggesting a systematic pattern irrespective of the type of tobacco product used. Conclusion: These findings indicated a clear association between tobacco use and reduced endorsement of tobacco control policies among Iranian college students. These results have potential implications for public health policy, emphasizing the importance of addressing individual tobacco use behaviors in the development and implementation of tobacco control strategies. Further research is needed to elucidate the underlying mechanisms of this relationship.
Article
Open Access March 04, 2025

SMOKES: Study of Measurement of Knowledge and Examination of Support for tobacco control policies

Abstract Background: Tobacco use remains a major global health concern, and understanding the factors that influence tobacco-related knowledge and support for tobacco control policies is critical for effective development of tobacco control policies that are accepted by the public. Objectives: This study introduces the rationale, design, methodology, and participants of the SMOKES Study [...] Read more.
Background: Tobacco use remains a major global health concern, and understanding the factors that influence tobacco-related knowledge and support for tobacco control policies is critical for effective development of tobacco control policies that are accepted by the public. Objectives: This study introduces the rationale, design, methodology, and participants of the SMOKES Study (Study of Measurement of Knowledge and Examination of Support for tobacco control policies), which is conducted to evaluate tobacco use, tobacco-related knowledge and attitude, as well as support for tobacco control policies among college and university students. Methods: The SMOKES Study was designed to address significant gaps in literature by focusing on college and university students in a non-Western context. A multi-center, cross-sectional design was employed to collect data from a diverse sample of college and university students across different geographical provinces in Iran. The survey instrument incorporated a range of measures covering socio-demographic characteristics, university-related variables, family tobacco use status, personal tobacco consumption behaviors (including detailed assessments of cigarette, hookah, and electronic cigarette use), and attitudinal as well as knowledge-based assessments related to vaping. Support for tobacco control policies is also measured. Data were collected using an online survey that included self-administered questionnaires, enabling access to a large diverse sample. This study may be used to determine the prevalence of ever and current use of cigarettes, electronic cigarettes, and hookah, as well as examining the correlates of single, dual, and poly-tobacco use. The study also aims to assess the role of social determinants, attitudes, and ethnic/geographic differences in shaping these outcomes. Results: The study sample consisted of 2403 college and university students, including undergraduates enrolled in different academic programs from all faculties and disciplines. Participants were drawn from universities across 15 provinces, and 11 ethnic groups, ensuring a heterogeneous sample with respect to socio-demographic background, ethnicity, and institutional affiliation. This diversity enhances the generalizability of the findings and allows for the exploration of subgroup differences in tobacco use patterns and policy support. Conclusions: The SMOKES Study offers a framework for examining tobacco-related knowledge and the acceptability of tobacco control policies among a key part of the population, being college and university students. By providing detailed insights into the prevalence and correlates of tobacco knowledge, attitude, use, as well as the tobacco control policy support, the study lays the groundwork for tailored public health interventions and more effective tobacco regulation strategies particularly for college campuses in a non-Western setting.
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Article
Open Access February 26, 2025

Innovations and Challenges in Pharmaceutical Supply Chain, Serialization and Regulatory Landscape

Abstract The pharmaceutical supply chain has become increasingly complex and vulnerable to various risks, including counterfeit drugs, diversion, and fraud. As these challenges threaten patient safety and the integrity of global healthcare systems, serialization has emerged as a pivotal innovation in pharmaceutical logistics and regulatory compliance. Serialization involves assigning unique identifiers to [...] Read more.
The pharmaceutical supply chain has become increasingly complex and vulnerable to various risks, including counterfeit drugs, diversion, and fraud. As these challenges threaten patient safety and the integrity of global healthcare systems, serialization has emerged as a pivotal innovation in pharmaceutical logistics and regulatory compliance. Serialization involves assigning unique identifiers to individual drug packages, enabling precise tracking and authentication at every stage of the supply chain. This process provides unprecedented transparency, enhances product security, and facilitates real-time monitoring of pharmaceutical products as they move from manufacturers to end consumers. Despite its potential to revolutionize pharmaceutical traceability, the integration of serialization technologies faces numerous obstacles. These include high implementation costs, regulatory inconsistencies across regions, and the technological challenges of managing vast amounts of data. Moreover, the complex, multi-tiered nature of the global supply chain introduces additional risks related to data integrity, cybersecurity, and interoperability between systems. As pharmaceutical companies seek to navigate these challenges, innovations in serialization technology—such as blockchain, artificial intelligence (AI), the Internet of Things (IoT), and radio frequency identification (RFID)—are providing promising solutions to enhance efficiency, reduce fraud, and increase visibility. This manuscript explores both the innovative advancements and the key challenges associated with the integration of serialization in the pharmaceutical supply chain. It delves into the evolving regulatory landscape, highlighting the need for global harmonization of serialization standards, and examines the impact of serialization on securing pharmaceutical distribution networks. Additionally, the paper emphasizes the importance of collaboration among manufacturers, technology providers, and regulatory bodies in overcoming implementation barriers and realizing the full potential of serialization. As the pharmaceutical industry moves towards a more interconnected and data-driven future, serialization promises to play a central role in shaping the next generation of drug safety and supply chain management. By addressing the hurdles to adoption and leveraging emerging technologies, the pharmaceutical sector can create a more secure, transparent, and efficient supply chain that better serves public health and fosters greater trust among consumers and healthcare professionals alike.
Review Article
Open Access February 19, 2025

The CEASE Tobacco Cessation Controlled Trial for Low-Income Racial and Ethnic Minority Participants: Key Predictors of Success

Abstract Background: Tobacco use remains disproportionately high among low-income and racial-ethnic minority populations. The CEASE program, with its self-help, hybrid/online, and in-person modalities, has demonstrated efficacy in promoting tobacco cessation. However, predictors of successful cessation among participants in these groups remain unclear. Objective: To identify baseline predictors of successful tobacco cessation among low-income and racial-ethnic minority participants in the CEASE program, with a focus on demographic, socioeconomic, behavioral, and psychosocial factors. Methods: Participants were allocated into three intervention arms: self-help, CEASE hybrid/online, and CEASE in-person. Baseline characteristics, including demographics (e.g., age, gender), socioeconomic status (e.g., education, employment), substance use profiles (e.g., cigarette packs per week, use of other tobacco products, menthol tobacco use), physical health (e.g., general health, number of cardiometabolic risk conditions), mental health (e.g., depressive symptoms, perceived stress), perceived social support, and nicotine dependence, were analyzed as potential predictors of cessation success. Multivariable logistic regression models were used to identify factors associated with successful quitting, controlling for the study arm. Results: In addition to the study arm, gender, baseline depression, cardiometabolic conditions, tobacco flavor, and the use of other tobacco products were significant predictors of quit success. Individuals receiving in-person interventions had significantly higher odds of quitting (AOR = 3.79, p < 0.05). Women were significantly less likely to quit compared to men (AOR = 0.24, p < 0.01). Participants with a greater number of cardiometabolic risk conditions were more likely to quit (AOR = 1.93, p < 0.05), while those with higher levels of depression had lower odds of quitting (AOR = 0.61, p < 0.05). Menthol tobacco users were also less likely to quit (AOR = 0.10, p < 0.05). Interestingly, individuals who used other forms of tobacco in addition to cigarettes had increased odds of quitting (AOR = 2.86, p [...] Read more.
Background: Tobacco use remains disproportionately high among low-income and racial-ethnic minority populations. The CEASE program, with its self-help, hybrid/online, and in-person modalities, has demonstrated efficacy in promoting tobacco cessation. However, predictors of successful cessation among participants in these groups remain unclear. Objective: To identify baseline predictors of successful tobacco cessation among low-income and racial-ethnic minority participants in the CEASE program, with a focus on demographic, socioeconomic, behavioral, and psychosocial factors. Methods: Participants were allocated into three intervention arms: self-help, CEASE hybrid/online, and CEASE in-person. Baseline characteristics, including demographics (e.g., age, gender), socioeconomic status (e.g., education, employment), substance use profiles (e.g., cigarette packs per week, use of other tobacco products, menthol tobacco use), physical health (e.g., general health, number of cardiometabolic risk conditions), mental health (e.g., depressive symptoms, perceived stress), perceived social support, and nicotine dependence, were analyzed as potential predictors of cessation success. Multivariable logistic regression models were used to identify factors associated with successful quitting, controlling for the study arm. Results: In addition to the study arm, gender, baseline depression, cardiometabolic conditions, tobacco flavor, and the use of other tobacco products were significant predictors of quit success. Individuals receiving in-person interventions had significantly higher odds of quitting (AOR = 3.79, p < 0.05). Women were significantly less likely to quit compared to men (AOR = 0.24, p < 0.01). Participants with a greater number of cardiometabolic risk conditions were more likely to quit (AOR = 1.93, p < 0.05), while those with higher levels of depression had lower odds of quitting (AOR = 0.61, p < 0.05). Menthol tobacco users were also less likely to quit (AOR = 0.10, p < 0.05). Interestingly, individuals who used other forms of tobacco in addition to cigarettes had increased odds of quitting (AOR = 2.86, p < 0.05). No other factors, including demographic variables (e.g., age), socioeconomic status (e.g., education, marital status), substance use profiles (e.g., cigarette packs per week, NRT use), or nicotine dependence, were significant predictors of cessation success. Conclusion: Baseline self-reported anxiety/depression and depressive symptoms play a critical role in reducing the likelihood of successful tobacco cessation among low-income and racial-ethnic minority participants in the CEASE program. These findings underscore the importance of addressing mental health challenges as part of tobacco cessation interventions to enhance their efficacy. Future research should explore targeted strategies for integrating mental health support into cessation programs to improve outcomes for underserved populations.
Article
Open Access February 17, 2025

Gender Differences in the Association Between Socioeconomic Status and Cardiometabolic Health: National Health and Nutrition Examination Survey

Abstract Background: Socioeconomic status (SES) is a well-established determinant of health, often associated with lower risk of cardiometabolic diseases (CMD). However, the extent to which SES influences CMD may vary by gender due to differences in social roles, health behaviors, and biological susceptibilities. This study examined the relationship between SES, measured by the [...] Read more.
Background: Socioeconomic status (SES) is a well-established determinant of health, often associated with lower risk of cardiometabolic diseases (CMD). However, the extent to which SES influences CMD may vary by gender due to differences in social roles, health behaviors, and biological susceptibilities. This study examined the relationship between SES, measured by the poverty-to-income ratio (PIR), and CMD indicators—including obesity, diabetes, and cardiovascular disease (CVD)—among men and women using data from the National Health and Nutrition Examination Survey (NHANES). Methods: This cross-sectional study utilized NHANES data (1999-2018), adjusting for race/ethnicity and age. SES was operationalized using PIR, with CMD outcomes (obesity, diabetes, and CVD) as dependent variables. Generalized linear models (GLM) were employed to evaluate the main effects of SES on CMD, with gender included as a moderator. Results: Higher SES was associated with lower overall CMD risk. However, the protective effects of SES were more pronounced in women than in men for all outcomes. These findings suggest that gender-specific pathways may mediate the relationship between SES and CMD. Women may derive greater health benefits from higher SES due to factors such as reduced stress exposure, healthier behaviors, and increased healthcare utilization. Conversely, the weaker association observed in men may reflect differences in social hierarchy sensitivity, responses to unemployment, or other contextual factors. Conclusion: The findings highlight the importance of gender-specific considerations when addressing SES-related disparities in CMD outcomes. Policies and interventions aimed at reducing CMD burden should account for these gender differences to promote equitable improvements in cardiometabolic health. Further research is needed to unravel the mechanisms driving these differences and to inform targeted strategies.
Article
Open Access February 16, 2025

Uneven Impact of Maternal Education at Birth on High School Grades of Black and White Students

Abstract Background: The Minorities' Diminished Returns (MDRs) theory posits that social determinants of health, such as parental education, exert weaker protective effects on health and educational outcomes in racialized and minoritized populations compared to White populations. Aim: This study examines whether higher maternal education is associated with better high school GPA in Black [...] Read more.
Background: The Minorities' Diminished Returns (MDRs) theory posits that social determinants of health, such as parental education, exert weaker protective effects on health and educational outcomes in racialized and minoritized populations compared to White populations. Aim: This study examines whether higher maternal education is associated with better high school GPA in Black youth and whether this association aligns with the MDRs framework. Methods: Data were drawn from the Future of Families and Child Wellbeing Study also known as Fragile Families and Child Wellbeing Study (FFCWS) baseline and 22nd year follow-up (1990-2022). This study included 1873 Black or White participants who were followed from birth to age 22. Linear regression models were used to assess the association between maternal education and high school GPA, adjusting for sociodemographic covariates. Analyses focused on the differential effects of maternal education across racial groups, particularly among Black youth. Results: While maternal education was positively associated with high school GPA, this effect was weaker for Black students compared to their White counterparts. Specifically, each additional year of maternal education corresponded to a lower GPA increase in Black students, consistent with the MDRs hypothesis. Conclusion: Findings support the MDRs theory, indicating that maternal education has a reduced protective effect on high school GPA among Black youth. These results underscore the need for policies that address structural factors beyond education to promote equitable academic achievement.
Article
Open Access February 14, 2025

Trauma Erodes Financial Returns of Educational Attainment

Abstract Background: Educational attainment is often regarded as a pathway to economic stability and social mobility. However, the Minorities’ Diminished Returns (MDRs) framework has demonstrated that the effects of educational attainment on various economic, behavioral, and health outcomes are weaker for marginalized populations, including racial/ethnic minorities, immigrants, LGBTQ+ individuals, [...] Read more.
Background: Educational attainment is often regarded as a pathway to economic stability and social mobility. However, the Minorities’ Diminished Returns (MDRs) framework has demonstrated that the effects of educational attainment on various economic, behavioral, and health outcomes are weaker for marginalized populations, including racial/ethnic minorities, immigrants, LGBTQ+ individuals, and those living in disadvantaged areas. While MDRs have been documented for various marginalized demographic groups, the role of trauma in moderating socioeconomic outcomes remains underexplored. Objective: This study examines whether lifetime trauma exposure diminishes the positive association between educational attainment and poverty-to-income ratio (PIR), a key indicator of economic well-being. Methods: Using data from the National Survey of American Life (NSAL), we analyzed a nationally representative sample of 6,008 adults, including Black, White, Latino, and Other racial/ethnic groups. We employed linear regression models to evaluate the association between the independent variable educational attainment and the outcome PIR. We then tested lifetime trauma as a moderator of this association. Models controlled for age, gender, employment, and race/ethnicity. Results: Educational attainment was positively associated with PIR across all groups, but the strength of this association was significantly attenuated for individuals with a history of lifetime trauma. These effects were independent of covariates. Conclusions: These findings extend the MDRs framework by highlighting trauma as a potential contributor to diminished returns of education on socioeconomic wellbeing. Structural inequities that increase trauma exposure in minoritized populations may also limit the economic benefits of education, particularly for groups with multiple trauma exposures. Policies aimed at addressing economic inequality must integrate social policies that reduce trauma and stress.
Article
Open Access February 12, 2025

Unequal Benefits: How Parental Education Falls Short for Black and Latino Youth

Abstract Background: Parental education is a key determinant of academic performance, yet its protective effects may differ by race and ethnicity. The concept of Minorities’ Diminished Returns (MDRs) highlights the weaker association between socioeconomic resources and outcomes for marginalized populations, including Black and Latino youth. Objective: To investigate whether the [...] Read more.
Background: Parental education is a key determinant of academic performance, yet its protective effects may differ by race and ethnicity. The concept of Minorities’ Diminished Returns (MDRs) highlights the weaker association between socioeconomic resources and outcomes for marginalized populations, including Black and Latino youth. Objective: To investigate whether the positive association between parental education and school performance (letter grades) is weaker for Black and Latino youth compared to non-Latino White youth. Methods: Data were drawn from the Monitoring the Future (MTF) 2023 study. The sample included Black, Latino, and non-Latino White youth. The outcome was a nine-level continuous measure of academic performance based on self-reported letter grades, with higher scores indicating better performance. Multivariate regression models tested interactions between parental education and race/ethnicity in predicting grades, adjusting for confounders such as family income, gender, and school characteristics. Results: A total number of 7584 12th graders entered the study. Parental education was positively associated with school performance across all groups, but the magnitude of this association was significantly smaller for Black and Latino youth compared to non-Latino White youth. Even after controlling for socioeconomic and contextual factors, the racial and ethnic differences in the strength of this association persisted. Conclusions: Our findings provide evidence of Minorities’ Diminished Returns (MDRs) in the academic domain, with Black and Latino youth experiencing weaker benefits of parental education on school performance. These disparities suggest that structural barriers and systemic inequities undermine the translation of parental educational attainment into academic success for marginalized groups. Policy interventions must address these structural barriers to promote equity in educational outcomes.
Article
Open Access February 10, 2025

Diminished Returns of Educational Attainment on Welfare Receipt of American Indian/Alaska Native People: National Health Interview Survey (NHIS) 2023

Abstract Background: Educational attainment is generally associated with reduced reliance on Social Security and disability benefits; however, the Minorities' Diminished Returns (MDRs) theory suggests that the socioeconomic benefits of education are weaker for minoritized populations. This study investigates the relationship between educational attainment and welfare receipt among American [...] Read more.
Background: Educational attainment is generally associated with reduced reliance on Social Security and disability benefits; however, the Minorities' Diminished Returns (MDRs) theory suggests that the socioeconomic benefits of education are weaker for minoritized populations. This study investigates the relationship between educational attainment and welfare receipt among American Indian/Alaska Native (AIAN) and White adults in the United States. Objective: Using the MDRs framework, we analyzed data from the National Health Interview Survey (NHIS) 2023 to examine how educational attainment impacts welfare receipt among AIAN and White adults. Methods: We analyzed a nationally representative sample of AIAN and White adults from the NHIS 2023 dataset. Welfare receipt was assessed as the receipt of any public assistance or welfare payments from state or local welfare offices. Educational attainment was categorized into three levels: less than high school (reference), high school diploma to some college, and college degree or higher. Logistic regression models were used to assess the relationship between educational attainment and welfare receipt, with separate analyses for AIAN and White adults to evaluate differential effects. Results: Higher educational attainment (high school diploma to some college and college degree or higher) was associated with lower odds of welfare receipt across both groups. However, the protective effect of a college degree was significantly weaker for AIAN adults compared to White adults. Consequently, AIAN adults remain at a higher risk of welfare reliance even with higher education, consistent with the Minorities' Diminished Returns (MDRs) framework. Conclusions: Although educational attainment generally reduces welfare reliance, this protection is less pronounced for AIAN adults than for White adults. This discrepancy suggests that structural factors, segregation, and social stratification may undermine the economic and health benefits of education for racialized groups in the U.S. Addressing these disparities requires policy interventions that extend beyond education, emphasizing quality job opportunities, healthcare access, and reduced labor market discrimination for individuals with advanced educational credentials, regardless of race.
Article
Open Access February 09, 2025

The Future of Longevity Medicine from the Lens of Digital Therapeutics

Abstract Digital therapeutics (DTx) are emerging as a pivotal tool in promoting longevity by addressing non-communicable diseases (NCDs) such as diabetes, cardiovascular diseases, and mental health disorders. These software-driven interventions offer personalized, evidence-based treatments that can be accessed via digital devices, making healthcare more accessible and scalable. One of the key advancements [...] Read more.
Digital therapeutics (DTx) are emerging as a pivotal tool in promoting longevity by addressing non-communicable diseases (NCDs) such as diabetes, cardiovascular diseases, and mental health disorders. These software-driven interventions offer personalized, evidence-based treatments that can be accessed via digital devices, making healthcare more accessible and scalable. One of the key advancements in DTx is the integration of artificial intelligence (AI) and machine learning (ML) to tailor interventions based on individual health data. This personalization enhances the effectiveness of treatments and supports preventive care by identifying risk factors early. The need for digital therapeutics is underscored by the rising prevalence of NCDs, which are responsible for a significant portion of global mortality and healthcare costs. Traditional healthcare systems often struggle to provide timely and personalized care, especially in low-resource settings. DTx can bridge this gap by offering cost-effective solutions that are easily scalable. Moreover, digital therapeutics can address health inequities by providing low-cost interventions to underserved populations, thereby reducing the burden of NCDs and improving overall health outcomes. As technology continues to evolve, the potential for DTx to enhance longevity and quality of life becomes increasingly promising. Recent advancements in longevity medicine and technology have focused on extending both lifespan and healthspan, ensuring that people not only live longer but also maintain good health throughout their extended years. This review article highlights these advancements that are contributing to this compelling subject of Longevity.
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Open Access February 07, 2025

CEASE Tobacco Cessation Program: Validation of Self-Rated Quit with Fagerstrom Test for Nicotine Dependence

Abstract Background: Despite advancements in smoking cessation interventions, few programs have demonstrated sustained effectiveness among low-income, underserved populations. The Communities Engaged and Advocating for a Smoke-free Environment (CEASE) program was developed to address this gap and support tobacco cessation in these communities. However, it remains unclear whether self-reported [...] Read more.
Background: Despite advancements in smoking cessation interventions, few programs have demonstrated sustained effectiveness among low-income, underserved populations. The Communities Engaged and Advocating for a Smoke-free Environment (CEASE) program was developed to address this gap and support tobacco cessation in these communities. However, it remains unclear whether self-reported outcome measures in this context are in line with more objective outcome measures. Aims: This study aimed to validate self-reported quit rates using the Fagerström Test for Nicotine Dependence (FTND) as a gold standard outcome measure for evaluation of the effectiveness of the CEASE smoking cessation intervention compared to a self-help approach among low-income, underserved adult smokers. Methods: A quasi-experimental design was employed to evaluate this community-based intervention. Although participants were initially assigned to three groups, this report focuses on two arms that show the major difference in the efficacy of the program: (1) the self-help group (reference; Arm 1) and (2) the in-person CEASE group (Arm 2). Outcomes included successful quitting, assessed through self-reports, and changes in FTND scores. To examine the concordance between these measures, we tested whether changes in FTND scores fully explained the relationship between the intervention and self-reported quitting. Potential confounders included demographic, socioeconomic, and health-related variables. Data were analyzed using regression and structural equation modeling (SEM). Results: The majority of participants were Black Americans, followed by White individuals and those of other racial backgrounds. The CEASE intervention (Arm 2) demonstrated effectiveness in reducing nicotine dependence (measured by FTND) and increasing self-reported quit rates compared to the self-help group. Importantly, changes in FTND scores fully explained the effect of the CEASE intervention on self-reported quitting, highlighting the program’s impact on addiction severity. Conclusion: Successful quitting measured using self-report is in line with the decline in nicotine addiction severity among low-income racial minority populations. CEASE holds promise as a scalable solution to address smoking disparities in underserved communities.
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Article
Open Access January 24, 2025

High Socioeconomic Status Black Adolescents Attend Worse Schools than Whites

Abstract Background: School characteristics — including poverty levels, teacher experience, graduation rates, and college enrollment — are essential determinants of students’ academic outcomes and long-term success. Families often use their socioeconomic resources, such as parental education and household income, to secure access to high-quality schools with favorable attributes. However, [...] Read more.
Background: School characteristics — including poverty levels, teacher experience, graduation rates, and college enrollment — are essential determinants of students’ academic outcomes and long-term success. Families often use their socioeconomic resources, such as parental education and household income, to secure access to high-quality schools with favorable attributes. However, Minorities’ Diminished Returns (MDRs) theory suggests that Black families may not experience the same benefits of high family SES due to structural barriers. This study examines the association between family SES and school characteristics, focusing on racial disparities in access to high-quality educational environments. Objective: To investigate the relationship between family SES (parental education and household income) and multiple school characteristics (poverty, teacher experience, graduation rates, and college enrollment), and to assess racial differences in these associations. Methods: Data from the Adolescent Brain Cognitive Development (ABCD) study, a national sample of US adolescents, was analyzed. We used multivariate regression models to examine associations between family SES and school characteristics and to test for interactions by race, specifically comparing Black and White adolescents. Results: Higher family SES was associated with positive school characteristics overall, including lower school poverty, greater teacher experience, and increased graduation and college enrollment rates. However, these positive effects of high family SES on school characteristics were significantly weaker for Black adolescents than for White adolescents. Black adolescents from high-income families were more likely than White adolescents from similar backgrounds to attend schools with higher poverty rates, less experienced teachers, and reduced graduation and college enrollment rates. Conclusion: Our findings highlight persistent racial inequities in access to educational opportunities, even among families with comparable socioeconomic resources. The diminished returns of family SES for Black adolescents underscore the role of structural barriers in limiting access to high-quality schools. These findings emphasize the need for policy interventions to address systemic inequalities that hinder Black families from fully leveraging their SES to access favorable educational environments.
Article
Open Access January 24, 2025

Neurocognitive, Emotional, and Behavioral Costs for Adolescents Due to Diminished Returns of Parental Employment on Trauma

Abstract Background: Parental employment is a significant social determinant of children's developmental outcomes, shaping their cognitive and behavioral trajectories. However, the effects of parental employment may not be equally protective across racial groups. The Minority Diminished Returns (MDRs) framework suggests that socioeconomic status (SES) factors, such as employment, yield fewer [...] Read more.
Background: Parental employment is a significant social determinant of children's developmental outcomes, shaping their cognitive and behavioral trajectories. However, the effects of parental employment may not be equally protective across racial groups. The Minority Diminished Returns (MDRs) framework suggests that socioeconomic status (SES) factors, such as employment, yield fewer protective benefits for Black families compared to White families. Objective: This study investigates the diminished returns of parental employment on trauma and associated neurocognitive and behavioral outcomes in children, with a focus on racial variation in these effects. Methods: Using data from the Adolescent Brain Cognitive Development (ABCD) study, a large and diverse sample of children was analyzed. We applied MDRs theory and social determinants of health frameworks to examine the association between parental employment, trauma, and children's cognitive and behavioral outcomes. The analysis controlled for family SES, neighborhood factors, and racial group differences. Results: Preliminary findings suggest that while parental employment is generally protective against trauma, the strength of this association is diminished for Black children. Black families with employed parents experience higher levels of trauma and stress compared to their White counterparts, which may contribute to racial disparities in cognitive and behavioral outcomes. Conclusion: Parental employment may not equally buffer against trauma-related risks for Black children, reflecting the broader pattern of diminished returns for racially disadvantaged groups. These findings highlight the need for policies addressing the unequal benefits of SES across racial groups.
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Open Access January 23, 2025

Weaker Effects of Educational Attainment on Chronic Medical Conditions in American Indian Alaska Native, Black, and Latino Adults: National Health Interview Survey 2023

Abstract Background: Chronic medical conditions are major drivers of healthcare spending, morbidity, and mortality in the United States, as well as critical indicators of health disparities. The disproportionately high rates of chronic medical conditions among Black, Latino, and American Indian and Alaska Native adults compared to non-Latino Whites highlight the urgent need to examine the factors [...] Read more.
Background: Chronic medical conditions are major drivers of healthcare spending, morbidity, and mortality in the United States, as well as critical indicators of health disparities. The disproportionately high rates of chronic medical conditions among Black, Latino, and American Indian and Alaska Native adults compared to non-Latino Whites highlight the urgent need to examine the factors contributing to these disparities. While higher socioeconomic status is generally associated with better health outcomes, this benefit may be diminished for racialized and minoritized populations. Objective: This study investigates the protective effects of educational attainment and income-to-poverty ratio on the prevalence of chronic medical conditions and examines whether these effects vary across racial and ethnic groups, specifically among Black, Latino, and American Indian and Alaska Native adults compared to non-Latino White adults. Methods: Using data from the 2023 National Health Interview Survey (NHIS), this cross-sectional study analyzed the association between educational attainment and chronic medical conditions across racial and ethnic groups. Logistic regression models were employed to assess whether the strength of the relationship between education and chronic medical conditions differed by racial/ethnic group, controlling for key demographic and socioeconomic covariates. Sample size was 29,373 which was reflective of 256,566,689 US population. Results: Consistent with the theory of Minorities' Diminished Returns, findings showed that the protective effects of higher educational attainment on chronic medical conditions were significantly weaker for Black, Latino, and American Indian and Alaska Native adults than for their non-Latino White counterparts. Even among individuals with higher education, Black, Latino, and American Indian and Alaska Native adults faced elevated risks of chronic medical conditions. Conclusion: While educational attainment generally reduces the prevalence of chronic medical conditions, this protective effect is moderated by racial and ethnic background. Structural barriers limit the health benefits of educational attainment. This underscores the need for policies that address structural inequities—such as low-quality education and occupational segregation—that constrain the protective health effects of educational attainment for minoritized groups.
Article
Open Access January 23, 2025

Diminished Returns of Educational Attainment on Hypertension Prevalence among American Indian and Alaska Native Adults: National Health Interview Survey 2023

Abstract Background: Research on Minorities’ Diminished Returns (MDRs) consistently reveals that social determinants of health, especially educational attainment, do not yield equal health benefits across racial and ethnic groups in the United States. MDRs suggest that social stratification, segregation, lower education quality, and labor market discrimination contribute to diminished health returns [...] Read more.
Background: Research on Minorities’ Diminished Returns (MDRs) consistently reveals that social determinants of health, especially educational attainment, do not yield equal health benefits across racial and ethnic groups in the United States. MDRs suggest that social stratification, segregation, lower education quality, and labor market discrimination contribute to diminished health returns of education among minoritized groups. However, few studies have tested the relevance of MDRs in American Indian and Alaska Native (AIAN) populations compared to non-Hispanic White adults. Objectives: This study aimed to examine the strength of the inverse association between educational attainment and hypertension prevalence, hypothesizing that the protective effect of education on hypertension risk is reduced among AIAN adults relative to non-Hispanic Whites. Methods: Using data from the 2023 National Health Interview Survey (NHIS), we analyzed a nationally representative sample of adults aged 18 and older. Logistic regression models examined the association between educational attainment and self-reported hypertension diagnosis, stratified by racial/ethnic group (AIAN vs. non-Hispanic White). Models were adjusted for key covariates, including age, gender, income, and insurance status. Results: Higher educational attainment was associated with a lower prevalence of hypertension in the combined sample of AIAN and non-Hispanic White adults. However, this protective association was significantly weaker among AIAN adults compared to non-Hispanic White adults, as evidenced by a significant interaction between race and education. Conclusion: AIAN adults exhibit a higher prevalence of hypertension even at higher levels of educational attainment compared to non-Hispanic White adults, supporting the relevance of MDRs for AIAN populations. This finding underscores the need for public health interventions that address structural barriers and contextual factors unique to AIAN populations. Policies focused solely on educational access may be insufficient to reduce hypertension risk among AIAN adults without addressing broader social and structural inequities.
Article
Open Access January 21, 2025

A Disaster Management Contingency and Training Plan for Nursing Service Personnel

Abstract Background: Disasters such as typhoons, floods, and earthquakes frequently impact the Philippines, placing nurses at the forefront of response and care. Given these recurring threats, ensuring that nurses possess adequate awareness, knowledge, and skills is crucial to mitigate risks, enhance preparedness, and promote effective disaster management. Aim/Objectives: This study sought to [...] Read more.
Background: Disasters such as typhoons, floods, and earthquakes frequently impact the Philippines, placing nurses at the forefront of response and care. Given these recurring threats, ensuring that nurses possess adequate awareness, knowledge, and skills is crucial to mitigate risks, enhance preparedness, and promote effective disaster management. Aim/Objectives: This study sought to (1) assess the current levels of awareness, knowledge, skills, and involvement of private hospital nurses in Rizal Province across four phases of disaster management—mitigation and prevention, preparedness, response, and rehabilitation and recovery; and (2) propose a contingency and training plan based on identified gaps. Methods: A descriptive correlational design was employed. A total of 350 nurses from Level 1, 2, and 3 hospitals participated by completing a validated questionnaire. Data were analyzed using descriptive statistics, analysis of variance, and correlation tests to identify differences and relationships among variables. Results: Overall, the nurses reported very high levels of awareness and skills, coupled with a high level of knowledge and significant involvement in disaster-related activities. Nurses in larger (Level 3) hospitals exhibited higher practical readiness and engagement, while those in Level 1 and 2 facilities had comparatively lower scores. Positive correlations emerged between higher levels of awareness, knowledge, and skills and increased engagement in disaster initiatives. Conclusion: Building on these findings, a targeted contingency and training plan was designed using Pucel’s Performance-based Instructional Design, emphasizing hands-on simulations, structured policy briefings, and collaborative efforts with local disaster risk reduction offices. Addressing these specific gaps can bolster hospital preparedness, strengthen community resilience, and ensure more effective disaster response and patient care.
Article
Open Access January 16, 2025

Heat Exposure Predicts Earlier Childhood Pubertal Initiation, Behavioral Problems, and Tobacco Use

Abstract Background: Climate change has raised significant concerns about its impact on health, particularly for vulnerable populations such as children and adolescents. While extensive research has examined physical health effects, limited attention has been given to the influence of extreme heat on developmental and behavioral outcomes. Objectives: This study investigates the association [...] Read more.
Background: Climate change has raised significant concerns about its impact on health, particularly for vulnerable populations such as children and adolescents. While extensive research has examined physical health effects, limited attention has been given to the influence of extreme heat on developmental and behavioral outcomes. Objectives: This study investigates the association between extreme heat exposure and early puberty initiation (ages 9-10), using data from the Adolescent Brain Cognitive Development (ABCD) study. It further explores how early puberty correlates with behavioral problems and tobacco use initiation. Methods: Data from 11,878 participants in the ABCD study were analyzed to examine the relationship between extreme heat exposure (independent variable) and puberty initiation (outcome). Behavioral problems and tobacco use initiation were evaluated as downstream outcomes of early puberty. Covariates included age, sex, and race/ethnicity, and behavioral problems were assessed using the Child Behavior Checklist (CBCL). Structural equation modeling (SEM) was employed for analysis. Results: Extreme heat exposure was significantly associated with earlier puberty initiation at ages 9-10. Early puberty, in turn, correlated with higher levels of behavioral problems and an increased likelihood of tobacco use initiation. Conclusions: These findings underscore the importance of addressing environmental factors such as extreme heat to reduce risks associated with early maturation, including behavioral and substance use challenges. Targeted interventions and policies are needed to mitigate the impact of extreme heat on child development, and longitudinal studies are essential to confirm these results and inform effective prevention strategies.
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Open Access January 15, 2025

Too Much Heat May Make You Smoke

Abstract Background: The rising concerns surrounding climate change have drawn attention to its potential impact on health, particularly among vulnerable groups such as children and older adults. Despite extensive research on health consequences, limited studies have explored the connection between extreme heat exposure and tobacco use initiation among adolescents in the United States. [...] Read more.
Background: The rising concerns surrounding climate change have drawn attention to its potential impact on health, particularly among vulnerable groups such as children and older adults. Despite extensive research on health consequences, limited studies have explored the connection between extreme heat exposure and tobacco use initiation among adolescents in the United States. Objectives: This study examines the relationship between extreme heat exposure and the initiation of tobacco use in adolescents, using data from the Adolescent Brain Cognitive Development (ABCD) study. It also evaluates the mediating roles of major depressive disorder (MDD) and childhood behavioral problems. Methods: Data from 11,878 participants in the ABCD study were analyzed to explore the link between extreme heat exposure (independent variable) and tobacco use initiation (dependent variable). Covariates included age, sex, and race/ethnicity, while MDD and behavioral problems (measured using the Child Behavior Checklist, CBCL) were assessed as potential mediators. Structural equation modeling (SEM) was applied for analysis. Results: The findings indicated a significant association between extreme heat exposure and an increased likelihood of tobacco use initiation in adolescents aged 9 to 15. MDD and behavioral problems partially mediated this relationship. Conclusions: These results underscore the importance of targeted interventions aimed at mitigating the impact of extreme heat on adolescent health, including its influence on tobacco use initiation. Addressing mental health and behavioral challenges could help reduce these risks. Future longitudinal research is needed to confirm these findings and evaluate the efficacy of strategies to protect vulnerable youth populations.
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Open Access November 23, 2024

Digital Design as a Tool for Assessing Attitudes

Abstract This study investigated the use of digital design as a tool for assessing attitudes among male sex offenders by exploring how artistic expression can reveal complex emotional landscapes related to their crimes. The study utilized digital paintings, a type of digital design that involves creating artwork using digital tools and software. Digital painting tools allowed the researcher to simulate [...] Read more.
This study investigated the use of digital design as a tool for assessing attitudes among male sex offenders by exploring how artistic expression can reveal complex emotional landscapes related to their crimes. The study utilized digital paintings, a type of digital design that involves creating artwork using digital tools and software. Digital painting tools allowed the researcher to simulate traditional painting techniques, while benefiting from the flexibility and versatility of digital media. It is essential to comprehend and address offenders’ attitudes towards sexual crimes to create prevention and rehabilitation plans that work. The effectiveness of digital paintings that illustrate the consequences of sexual crimes on offender, victim and the offender’s family was examined in this study. The study examined whether exposure to these visual representations could result in a quantifiable decrease in supporting attitudes toward sexual crimes by comparing participants' pre-test and post-test attitudes using the Crime Pics II tool. There is little research on how visual cues can change offenders' attitudes and perceptions, despite the urgent need for creative evaluation techniques in this delicate field. This study adds to the continuing conversation on crime prevention and offender rehabilitation by demonstrating how well digital design can change perceptions of sexual crimes. A total of 61 male convicts of defilement and rape were purposively sampled for the study. The study utilized an art exhibition and Rapid Serial Visual Presentation format to repeatedly display digital paintings to participants aged 18-45. The artwork produced in both monochrome and polychrome schemes and in realist and surrealist styles was designed to elicit immediate emotional and cognitive responses. Qualitative and quantitative analyses of the participants' responses and reflections provided important insights into their attitudes, including sentiments of regret and guilt as well as a sophisticated awareness of the wider effects of their behaviour. Monochrome paintings tended to portray darker emotions, whereas polychrome paintings showed a wider range of emotions, including hope and recognition of the harm done. The findings demonstrate that digital design can effectively support offenders' emotional processing and self-reflection, demonstrating its potential as a helpful tool in rehabilitative and assessment contexts.
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Open Access November 21, 2024

Financial Strain Partially Explains Diminished Returns of Parental Education in the ABCD Study

Abstract Background: Previous research shows that socioeconomic status (SES) positively impacts children's development, yet the benefits are not equally distributed across racial groups. According to the Minorities’ Diminished Returns (MDRs) framework, Black children tend to experience smaller gains from parental education compared to White children. Objective: Building on the MDRs framework, [...] Read more.
Background: Previous research shows that socioeconomic status (SES) positively impacts children's development, yet the benefits are not equally distributed across racial groups. According to the Minorities’ Diminished Returns (MDRs) framework, Black children tend to experience smaller gains from parental education compared to White children. Objective: Building on the MDRs framework, this study examines whether high financial strain contributes to the diminished returns of parental education for Black children, using data from the Adolescent Brain Cognitive Development (ABCD) Study. We hypothesized that: (1) there would be a positive effect of parental education on total cortical volume, (2) this effect would be weaker for Black than White children, and (3) higher household financial strain in Black families would mediate the diminished returns of parental education on total cortical volume for Black children. Methods: Data were drawn from the baseline ABCD Study, focusing on 7,936 9- and 10-year-old children identified as either Black (n = 1,775) or White (n = 6,161). Parental education was the key independent variable, covariates included age, sex, household income, and marital status, race was the moderator, financial strain was the mediator, and total cortical volume was the outcome. Structural Equation Models (SEMs) were employed to examine the associations between parental education and cortical volume, with financial strain as a mediator and race as a moderator. Results: Higher parental education was associated with greater cortical volume in the pooled sample. However, this effect was significantly weaker for Black children. Financial strain partially mediated the observed diminished returns of parental education. Conclusion: High financial strain experienced by middle-class Black families partially explains why the association between parental education and child development is weaker in Black than White families. Interventions aimed at enhancing educational quality, increasing employability, expanding access to higher-paying jobs, and reducing labor market discrimination against Black individuals may help address racial inequities in child development in the U.S. Efforts to reduce financial strain should extend beyond low-income populations to also support higher-educated minority families.
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Open Access November 21, 2024

Diminished Returns of Educational Attainment on Body Mass Index Among Latino Populations: Insights from UAS Data

Abstract Background: Educational attainment is a well-established predictor of physical health outcomes, including body mass index (BMI). However, according to the theory of Minorities' Diminished Returns (MDRs), the health benefits of education tend to be weaker for ethnic minorities compared to non-Latino Whites, due to structural inequalities and social disadvantages. Objective: [...] Read more.
Background: Educational attainment is a well-established predictor of physical health outcomes, including body mass index (BMI). However, according to the theory of Minorities' Diminished Returns (MDRs), the health benefits of education tend to be weaker for ethnic minorities compared to non-Latino Whites, due to structural inequalities and social disadvantages. Objective: This study examines whether the association between educational attainment and BMI is weaker among Latino individuals compared to non-Latino individuals, in line with the MDRs framework. Methods: Data were drawn from the 2014 wave of the Understanding America Study (UAS), a nationally representative internet-based panel. Body mass index (BMI) was the outcome of interest. Linear regression models were used to analyze the association between educational attainment and BMI, with an interaction term for ethnicity to explore differences in the relationship between Latino and non-Latino people. Models were adjusted for age, sex, marital status, and labor market participation and results were presented as beta coefficients, p-values, and 95% confidence intervals (CIs). Results: Higher educational attainment was associated with lower BMI for both Latino and non-Latino participants (p < 0.001). However, the interaction between educational attainment and ethnicity was significant (p < 0.05), indicating that Latino individuals experienced smaller reductions in BMI because of higher education compared to non-Latino people. Conclusion: This study provides evidence of diminished returns from educational attainment on BMI among Latino individuals. These findings support the MDRs framework, suggesting that structural barriers may limit the health benefits of education for Latino populations. While education is a key determinant of physical and mental health, its benefits are not equitably distributed across ethnic groups. Structural inequalities, chronic stress, poor neighborhood environments, and adverse educational and occupational conditions likely contribute to this disparity. Addressing these underlying factors through targeted policy interventions is necessary to promote health equity for Latino populations.
Article
Open Access November 21, 2024

Unequal Returns: Education Fails to Fully Prepare Black and Latino Americans for Retirement

Abstract Background: Retirement is a universal life stage, marking the culmination of an individual's working years. However, many people face financial challenges during retirement due to insufficient financial planning. Retirement preparedness is essential for ensuring economic security and maintaining a high quality of life in later years. Education is often viewed as a key driver of retirement [...] Read more.
Background: Retirement is a universal life stage, marking the culmination of an individual's working years. However, many people face financial challenges during retirement due to insufficient financial planning. Retirement preparedness is essential for ensuring economic security and maintaining a high quality of life in later years. Education is often viewed as a key driver of retirement preparedness, as it is linked to higher earnings, better financial literacy, and improved decision-making. However, the Minorities' Diminished Returns (MDRs) theory suggests that the economic, cognitive, and behavioral benefits of education are weaker for racial and ethnic minorities compared to non-Latino Whites. Objective: This study aims to examine the relationship between educational attainment and retirement preparedness, focusing on whether this association differs among Black, Latino, and non-Latino White individuals, using data from the Understanding America Study (UAS). Methods: Data were drawn from the UAS, a nationally representative internet-based panel survey. The sample included participants from diverse racial and ethnic backgrounds. Linear regression models were used to evaluate the association between educational attainment, measured in years of schooling, and retirement preparedness. Interaction terms were included to test whether the association varied by race and ethnicity. Models were adjusted for potential confounders, including age, sex, marital status, employment status, and immigration. Results: In the overall sample, higher educational attainment was significantly and positively associated with better retirement preparedness (p < 0.001). However, consistent with the MDRs framework, the strength of this association was significantly weaker for Black and Latino participants compared to non-Latino White participants (p < 0.05). Non-Latino Whites with higher education levels reported substantially better retirement preparedness, while the same level of education yielded smaller gains in retirement preparedness for Black and Latino individuals. Conclusion: The findings support the Minorities' Diminished Returns theory, showing that although educational attainment enhances retirement preparedness for all groups, Black and Latino individuals derive fewer benefits compared to their non-Latino White counterparts. These disparities point to persistent structural inequalities and systemic barriers within the education system and labor market, as well as the effects of segregation and discrimination, which undermine the economic benefits of education for marginalized populations. Addressing these disparities requires targeted policy interventions aimed at eliminating racial and ethnic inequalities in retirement outcomes and ensuring equitable benefits from educational attainment for all groups.
Article
Open Access November 19, 2024

Social Epidemiology of Dual Use of Electronic and Combustible Cigarettes Among U.S. Adults: Insights from the Population Assessment of Tobacco and Health (PATH) Study

Abstract Background: The dual use of e-cigarettes and combustible cigarettes poses significant public health concerns due to the compounded risks associated with the use of both products. Understanding the predictors of dual use can inform targeted interventions and tobacco control strategies aimed at reducing nicotine dependence and health risks among adults. Objective: This study [...] Read more.
Background: The dual use of e-cigarettes and combustible cigarettes poses significant public health concerns due to the compounded risks associated with the use of both products. Understanding the predictors of dual use can inform targeted interventions and tobacco control strategies aimed at reducing nicotine dependence and health risks among adults. Objective: This study aims to identify the sociodemographic predictors of dual use of e-cigarettes and combustible cigarettes among U.S. adults using baseline data from the Population Assessment of Tobacco and Health (PATH) Study. Methods: We analyzed baseline data from the PATH Study, focusing on adult participants who reported the use of both e-cigarettes and combustible cigarettes. Logistic regression models were used to identify the associations between dual use and key sociodemographic variables, including age, gender, race/ethnicity, and education level. Results: The analysis revealed that dual use of e-cigarettes and combustible cigarettes was predominantly observed among young, female, non-Latino, White, and highly educated adults. Younger adults were more likely to engage in dual use compared to older age groups. Females showed higher rates of dual use compared to males. Non-Latino White individuals were more likely to be dual users than individuals from other racial/ethnic backgrounds. Additionally, higher educational attainment was associated with increased dual use, contrary to traditional smoking patterns. Conclusion: The findings highlight specific demographic groups that are at higher risk of dual use of e-cigarettes and combustible cigarettes, particularly younger, highly educated, non-Latino White females. These insights suggest the need for tailored public health interventions that address the unique needs and behaviors of these populations. Future research should explore the underlying motivations and contextual factors contributing to dual use to enhance the effectiveness of tobacco control policies and cessation programs.
Article
Open Access November 19, 2024

High Education, Low Returns: Financial Literacy Challenges for African Americans and Hispanics

Abstract Background: Education is widely regarded as a key driver of financial literacy, yet racial and ethnic disparities persist. Even among highly educated individuals, African American and Hispanic populations may face challenges in financial literacy, likely due to structural racism and socioeconomic inequalities that diminish the benefits of education. This study examines the relationship [...] Read more.
Background: Education is widely regarded as a key driver of financial literacy, yet racial and ethnic disparities persist. Even among highly educated individuals, African American and Hispanic populations may face challenges in financial literacy, likely due to structural racism and socioeconomic inequalities that diminish the benefits of education. This study examines the relationship between education and financial literacy among African American and Hispanic individuals compared to their White counterparts, focusing on how structural factors contribute to these disparities. Objective: To determine whether highly educated African American and Hispanic individuals exhibit lower financial literacy compared to similarly educated White individuals and to explore the role of structural factors in explaining these disparities. Methods: Data from the 2016 Understanding America Study (UAS) were used to evaluate financial literacy among U.S. adults. The sample was stratified by race/ethnicity (African American, Hispanic, and White) and educational attainment. Financial literacy was assessed using standardized financial knowledge tests. Multivariate regression models were employed to investigate the relationship between race/ethnicity, education, and financial literacy, adjusting for socioeconomic factors such as income, employment, and household wealth. Results: African American and Hispanic individuals with higher levels of education demonstrated significantly lower financial literacy scores than their White peers (p < 0.001). The positive association between education and financial literacy was notably stronger for White individuals than for African American and Hispanic individuals. Further analyses suggest that structural barriers, including systemic discrimination in access to financial resources and disparities in educational quality, contribute to these diminished returns on education for racial and ethnic minorities. Conclusion: This study highlights persistent financial literacy disparities among highly educated African American and Hispanic individuals, underscoring the limitations of education alone in overcoming structural inequalities. The findings emphasize the need for targeted policies to address systemic barriers that restrict the financial knowledge and opportunities typically associated with higher education for racial and ethnic minority groups.
Article
Open Access November 18, 2024

Technological Caring Competence for Nursing Education (TCCNE) in Filipino Nurse Educators: Toward the Development of Basis for a Training Plan

Abstract Background: Nowadays, integrating online and remote instruction into education presents unique challenges, particularly in nursing education, where combining technology with the core value of caring is essential. Nurse educators must address students’ holistic needs, as their circumstances can influence overall learning development. Objectives: This study aims to ascertain the [...] Read more.
Background: Nowadays, integrating online and remote instruction into education presents unique challenges, particularly in nursing education, where combining technology with the core value of caring is essential. Nurse educators must address students’ holistic needs, as their circumstances can influence overall learning development. Objectives: This study aims to ascertain the technological caring competence of nurse educators Methodology: A descriptive design using an adapted tool on technological caring competence for nursing education (TCCNE) Results: A total of 243 Filipino nursing educators participated in this study. Overall, the participants’ perceived level of TCCNE was quite high. This sample representative of nursing educators holds strong perceptions of their TCCNE with the values of being considerate, supportive, and respectful to their students as the highest rated competency. This result implies that the educators keep the essence of what nursing is about as they model the importance of caring even in an academic setting considering that these teachers are using remote instruction. Conclusion: The study opens up a discussion on assessing the TCCNE of nursing education in an academic setting. Thus, its advocacy could start from implementing the research training plan. Further, the nurse educators should strengthen in balancing care with appropriate technology is viewed as a necessary step to maintain the essence of nursing, which is on caring that can be modeled out not just in clinical practice alone, but in nursing education.
Article
Open Access November 09, 2024

Educated but Unhealthy? Examining Minorities' Diminished Returns

Abstract Background: Educational attainment is known to improve self-rated health; however, research suggests that these benefits may be less pronounced for racial and ethnic minority groups. The Minorities' Diminished Returns (MDRs) theory posits that the protective effects of resources such as education are weaker for marginalized populations, such as Black and Latino individuals, compared to [...] Read more.
Background: Educational attainment is known to improve self-rated health; however, research suggests that these benefits may be less pronounced for racial and ethnic minority groups. The Minorities' Diminished Returns (MDRs) theory posits that the protective effects of resources such as education are weaker for marginalized populations, such as Black and Latino individuals, compared to their White counterparts. Objective: This study aims to investigate racial and ethnic disparities in the association between years of schooling and self-rated health among U.S. adults, with a focus on understanding the reduced health benefits of education for Black and Latino individuals. Methods: Using data from the Understanding America Study (UAS; 2014), we conducted a cross-sectional analysis of adults aged 18 and older (N = 6,785). Self-rated health was the outcome, and years of schooling was the primary independent variable. We controlled for sociodemographic factors including age, gender, employment status, immigration status, and marital status. Stratified analyses were conducted by race/ethnicity (Non-Latino White, Non-Latino Black, and Latino). Linear regression models were used to examine the association between years of schooling and self-rated health, and interaction terms were included to assess variation in this relationship across racial/ethnic groups. Results: While years of schooling was positively associated with better self-rated health overall, the magnitude of this effect was weaker for Black and Latino individuals compared to White individuals. After adjusting for sociodemographic factors, Black and Latino adults reported worse self-rated health for each additional year of schooling, compared to their White counterparts, supporting the MDRs hypothesis. Conclusion: The findings suggest that while higher educational attainment is protective against worse self-rated health, this protection is not equally distributed across racial and ethnic groups. Black and Latino individuals experience diminished returns from their years of schooling in terms of self-rated health, likely due to structural barriers and social inequalities. Policies addressing health disparities must consider these diminished returns and aim to reduce structural racism and discrimination that undermine the benefits of education for minoritized populations.
Article
Open Access November 09, 2024

Educated but on Social Security Disability Insurance: Minorities’ Diminished Returns

Abstract Background: Educational attainment is widely regarded as a key predictor of economic and social outcomes in later life, including the likelihood of receiving Social Security Disability Insurance (SSDI). According to the Minorities' Diminished Returns (MDRs) theory, however, the benefits of education may be less pronounced for racial and ethnic minorities compared to non-Latino [...] Read more.
Background: Educational attainment is widely regarded as a key predictor of economic and social outcomes in later life, including the likelihood of receiving Social Security Disability Insurance (SSDI). According to the Minorities' Diminished Returns (MDRs) theory, however, the benefits of education may be less pronounced for racial and ethnic minorities compared to non-Latino Whites. This study investigates whether the effects of education on the likelihood of receiving SSDI differ by race and ethnicity, focusing on Black and Latino Americans. Objective: The primary aim of this study was to examine the relationship between educational attainment (measured in years of schooling) and the likelihood of receiving SSDI, with a specific focus on exploring how this relationship varies by race and ethnicity, in line with the MDRs framework. Methods: Data were drawn from the Understanding America Study (UAS), a nationally representative, internet-based panel survey. The sample included Black, Latino, and non-Latino White U.S. adults. Our sample size was 12,975 adults over the age of 18. Logistic regression models were used to assess the association between educational attainment and receiving SSDI, adjusting for demographic variables such as age, sex, employment status, and marital status. Interaction terms between race/ethnicity and educational attainment were included to explore whether the returns on education varied across racial and ethnic groups. Results: Higher educational attainment was significantly associated with a lower likelihood of receiving SSDI in the overall sample. However, consistent with the MDRs framework, the protective effect of education was significantly weaker for both Black and Latino individuals compared to non-Latino Whites. Black and Latino participants with similar levels of education as their non-Latino White counterparts were more likely to receive SSDI, reflecting diminished returns on educational attainment for these groups. Conclusion: This study provides strong evidence supporting the MDRs theory, demonstrating that the protective effects of education on the likelihood of receiving SSDI are not equally distributed across racial and ethnic groups. Black and Latino Americans experience weaker returns on their education when it comes to avoiding SSDI, likely due to structural inequalities and systemic barriers. These findings highlight the need for policies that address not only educational disparities but also the broader societal factors that limit the benefits of education for racial and ethnic minorities.
Article
Open Access November 05, 2024

Diminished Returns of Educational Attainment on Numeracy Score of Latino Populations: Insights from UAS Data

Abstract Background: Educational attainment is a well-established social determinant of various domains of cognitive function across the lifespan. However, the theory of Minorities' Diminished Returns (MDRs) suggests that the health benefits of educational attainment tend to be weaker for ethnic minorities compared to non-Latino Whites. This phenomenon may reflect the impact of structural [...] Read more.
Background: Educational attainment is a well-established social determinant of various domains of cognitive function across the lifespan. However, the theory of Minorities' Diminished Returns (MDRs) suggests that the health benefits of educational attainment tend to be weaker for ethnic minorities compared to non-Latino Whites. This phenomenon may reflect the impact of structural inequalities, social stratification, and historical disadvantage. Objective: This study examines whether the association between educational attainment and numeracy score, one domain of cognitive function, is weaker in Latino individuals compared to non-Latino individuals, as predicted by the MDRs framework. Methods: Data were drawn from the 2014 wave of the Understanding America Study (UAS), a national internet-based panel. Numeracy score, a domain of the cognitive function was measured using an 8-item measure. Linear regression models were used to analyze the association between educational attainment and numeracy score, with an interaction term for ethnicity x educational attainment to explore differences between Latino and non-Latino participants. Models were adjusted for age, gender, marital status, immigration, and employment, and results were presented as beta coefficients, p-values, and 95% confidence intervals (CIs). Results: Overall, 5,659 participants entered our analysis. Higher educational attainment was positively associated with higher numeracy score for both Latino and non-Latino participants (p < 0.001). However, the interaction between education and ethnicity was significant (p < 0.05), indicating that Latino individuals experienced smaller numeracy benefits from education compared to non-Latino individuals. These results support the MDRs framework, suggesting that structural barriers may reduce the numeracy returns of education for Latino individuals. Conclusion: This study provides evidence of diminished returns of educational attainment in terms of numeracy scores among Latino individuals. While education is a key determinant of cognitive abilities such as numeracy, its benefits are not equitably distributed across ethnic groups. Structural inequalities particularly in educational opportunities likely contribute to this disparity. Addressing these underlying factors through targeted policy interventions is necessary to promote cognitive equity for Latino populations.
Article
Open Access November 05, 2024

Black-White Gap Across Levels of Educational Childhood Opportunities: Findings from the ABCD Study

Abstract Objective: This study examines racial disparities in educational outcomes—including reading proficiency, grade point average (GPA), school discrimination, and school disciplinary actions—across regions with different levels of educational childhood opportunity index (COI). Our aim is to explore how these racial gaps between Black and White students vary in areas with differing educational [...] Read more.
Objective: This study examines racial disparities in educational outcomes—including reading proficiency, grade point average (GPA), school discrimination, and school disciplinary actions—across regions with different levels of educational childhood opportunity index (COI). Our aim is to explore how these racial gaps between Black and White students vary in areas with differing educational opportunities. We hypothesize that higher COI is associated with smaller academic achievement gaps but may also correspond with greater racial bias in unfair school treatment. Methods: Data were drawn from the Adolescent Brain Cognitive Development (ABCD) study, which provides comprehensive measures of educational outcomes, cognitive performance, and COI. National COI rankings were used to classify regions into five categories: very high, high, average, low, and very low educational opportunity. We analyzed racial gaps in reading proficiency, and experiences of discrimination and suspension across these COI categories. Multi-group Structural Equation Models (SEM) were used to assess how the relationship between race and educational outcomes varies across COI levels. Results: Our findings confirmed that Black-White gaps in reading proficiency and cognitive test performance (Flanker task) were less pronounced in regions with higher COI. However, racial disparities in school disciplinary actions and experiences of discrimination were more pronounced in higher-opportunity areas. Specifically, the effect of Black race was stronger in regions with the highest COI, where Black students experienced a disproportionately higher rate of unfair school treatment, including both school discrimination and suspensions, compared to their White peers. Conclusion: This exploratory study supports that while higher educational opportunities are associated with smaller academic achievement gaps between Black and White students, they might be linked to increased racial bias in school disciplinary actions and discriminatory treatment. These findings underscore the complexity of educational equity, suggesting that improving access to quality education alone is insufficient to eliminate racial disparities in school experiences. Addressing school-based bias and discrimination must accompany efforts to enhance educational opportunities.
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Open Access November 03, 2024

School Poverty Partially Mediates the Effects of Structural Racism on Youth Tobacco Use Initiation

Abstract Background. Although youth from high socioeconomic status (SES) backgrounds are generally protected against tobacco use, this protection is weaker for racialized and marginalized families, particularly Black youth. While Minorities' Diminished Returns (MDRs) of household income on tobacco use have been documented for Black youth, the mechanisms underlying these effects are not well understood. [...] Read more.
Background. Although youth from high socioeconomic status (SES) backgrounds are generally protected against tobacco use, this protection is weaker for racialized and marginalized families, particularly Black youth. While Minorities' Diminished Returns (MDRs) of household income on tobacco use have been documented for Black youth, the mechanisms underlying these effects are not well understood. Objective. This study investigates whether school poverty and associated peer deviance and delinquent behaviors explain the disproportionately higher tobacco use among Black youth from high-income backgrounds, using data from the Adolescent Brain Cognitive Development (ABCD) study. Methods. We conducted a longitudinal analysis of Black youth from high-income families within the Adolescent Brain Cognitive Development (ABCD) study. A total of 8,777 youth was included in our analysis. We examined the associations between household income and tobacco use, with school poverty and associated peer deviance and delinquent behaviors as mediators. Race was considered as a moderator. Results. Compared to their high-income White counterparts, Black youth from high-income backgrounds were more likely to live in areas with higher school poverty, which exposed them to increased levels of peer deviance and delinquent behaviors compared to their White counterparts. These exposures, in turn, were associated with higher rates of tobacco use among Black youth. Thus, higher school poverty, along with the related peer deviance and delinquent behaviors, contributed to the elevated tobacco use observed among Black adolescents from high-income backgrounds. Conclusion. The study suggests that residing in areas with school poverty, peer deviance, and youth delinquency may explain Minorities' Diminished Returns, which are defined as the weaker protective effects of socioeconomic status on tobacco use among Black youth. Interventions aiming to prevent tobacco use need to include structural components addressing these broader social determinants of health.
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Open Access November 01, 2024

Impacts of Drug Shortages in the Pharmaceutical Supply Chain

Abstract Drug shortages represent a significant and growing challenge within the pharmaceutical supply chain, with profound implications for patient care, public health, and healthcare costs. This manuscript provides a comprehensive examination of the causes and impacts of drug shortages, highlighting the multifaceted nature of this issue. Key factors contributing to shortages include manufacturing [...] Read more.
Drug shortages represent a significant and growing challenge within the pharmaceutical supply chain, with profound implications for patient care, public health, and healthcare costs. This manuscript provides a comprehensive examination of the causes and impacts of drug shortages, highlighting the multifaceted nature of this issue. Key factors contributing to shortages include manufacturing complications, limited availability of active pharmaceutical ingredients (APIs), market dynamics that discourage the production of less profitable medications, and regulatory challenges that slow down the approval process for new manufacturing capacities. The consequences of these shortages are far-reaching. Patients often face treatment delays, which can lead to adverse health outcomes, increased hospitalization rates, and even mortality. Healthcare providers experience heightened operational costs as they seek alternative therapies and manage complications resulting from inadequate treatment. Furthermore, the frequent occurrence of drug shortages erodes public trust in both the healthcare system and the pharmaceutical industry, leading to decreased patient adherence to prescribed therapies. To mitigate the impacts of drug shortages, this manuscript proposes several strategic solutions, including enhanced communication among stakeholders, diversification of supply sources, increased regulatory flexibility, and collaborative approaches between public and private sectors. Additionally, raising awareness among healthcare providers and patients regarding the causes and potential alternatives can empower stakeholders to navigate shortages effectively. Ultimately, addressing drug shortages necessitates a proactive and coordinated effort from all participants in the pharmaceutical supply chain. By implementing these strategies, stakeholders can enhance the resilience of the supply chain, ensuring that essential medications remain accessible and that patient care is not compromised. The findings of this manuscript underscore the urgent need for ongoing vigilance and collaborative action to tackle the challenges posed by drug shortages, safeguarding public health and improving healthcare outcomes globally.
Review Article
Open Access October 31, 2024

The Long Shadow of Early Poverty: Poverty at Birth, Epigenetic Changes at Age 15, And Youth Outcomes at Age 22

Abstract Background: Early life socioeconomic conditions and race/ethnicity are critical determinants of long-term health and behavioral outcomes. Epigenetic changes, particularly those measured by the GrimAge biomarker, may mediate the impact of these early adversities on later life outcomes. This study investigates the relationships between race/ethnicity, poverty at birth, epigenetic aging at age [...] Read more.
Background: Early life socioeconomic conditions and race/ethnicity are critical determinants of long-term health and behavioral outcomes. Epigenetic changes, particularly those measured by the GrimAge biomarker, may mediate the impact of these early adversities on later life outcomes. This study investigates the relationships between race/ethnicity, poverty at birth, epigenetic aging at age 15, and subsequent self-rated health, school discipline, depression, and school dropout at age 22. We explored sex differences in these paths. Methods: Data were drawn from the Fragile Families and Child Wellbeing Study (FFCWS), which included 733 youth with comprehensive follow-up data up to age 22. Structural Equation Modeling (SEM) was employed to assess the pathways from race/ethnicity and poverty at birth to epigenetic aging (GrimAge) at age 15, and subsequently to self-rated health and school discipline at age 22. The model controlled for potential confounders including sex, family structure, and parental education. Results: Race/ethnicity and poverty at birth were significantly associated with higher GrimAge scores at age 15 (p < 0.05). Higher GrimAge scores were predictive of poorer self-rated health (β = -0.08, p < 0.05) and increased instances of school discipline (β = 0.13, p < 0.01) at age 22. The indirect effects of race/ethnicity and poverty at birth on self-rated health and school discipline through GrimAge were also significant (p < 0.05), suggesting that epigenetic aging partially mediates these relationships. Sex differences were also observed. Poverty at birth predicted faster epigenetic aging at age 15 for males not females. We also observed that faster epigenetic aging at age 15 was predictive of school discipline of male not female participants at age 22. In contrast, faster epigenetic aging at age 15 was predictive of self-rated health (SRH) of female not male participants at age 22. Conclusions: This study provides evidence that with some sex differences, race/ethnicity and poverty at birth contribute to accelerated epigenetic aging (GrimAge) by age 15, which in turn predicts poorer self-rated health and increased school discipline issues by age 22. These findings emphasize the importance of early interventions targeting social determinants to mitigate long-term health and behavioral disparities. Addressing these early life conditions is crucial for improving health equity and outcomes in young adulthood.
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Open Access October 30, 2024

Social Determinants of Successful Smoking Cessation: An Eight-Year Analysis of Population Assessment of Tobacco and Health (PATH) Data

Abstract Background: Smoking cessation is a crucial public health goal due to its substantial impact on reducing the morbidity and mortality associated with tobacco use. However, significant disparities in smoking cessation success persist across socioeconomic groups in the United States. Objectives: This study aimed to examine differences in smoking cessation rates among daily smokers [...] Read more.
Background: Smoking cessation is a crucial public health goal due to its substantial impact on reducing the morbidity and mortality associated with tobacco use. However, significant disparities in smoking cessation success persist across socioeconomic groups in the United States. Objectives: This study aimed to examine differences in smoking cessation rates among daily smokers based on race, ethnicity, and socioeconomic status (SES) using data from the Population Assessment of Tobacco and Health (PATH) study, spanning waves 1 to 6 (eight years). Methods: Longitudinal data from PATH were analyzed, focusing on baseline daily cigarette smokers followed over an eight-year period to assess cessation outcomes. SES was measured by education and poverty status. Successful smoking cessation was defined as sustained abstinence from cigarettes for 12 months or more at the final wave. Logistic regression models identified predictors of successful cessation, adjusting for potential confounders, including age, nicotine dependence, and access to cessation resources. Results: The analysis revealed significant disparities in cessation success across racial, ethnic, and SES groups. Smokers living in poverty and those with lower educational attainment were less likely to achieve cessation success than their counterparts. Race (Black) and ethnicity (Latino) were also significantly associated with lower cessation success. Conclusions: This study highlights the social determinants of smoking cessation success among U.S. adult smokers, with lower success rates observed among those in poverty and with less educational attainment. These findings emphasize the need for targeted interventions that address the unique barriers to cessation faced by low-SES groups. Public health strategies should prioritize equitable access to cessation resources and culturally tailored interventions to reduce these disparities and improve cessation outcomes among all smokers.
Article
Open Access October 18, 2024

A study on epistemic modal elements expressed in the selected State of the Nation Address of Ghana

Abstract This study addressed the frequency of occurrence of the epistemic modal elements that the Ex-president prefers to express in the selected State of the Nation Addresses of Ghana. The study adopted a qualitative approach. Purposively, the two addresses selected for the study are State of the Nation Address: 16th February 2001 and State of the Nation Address: 14th February 2008. The selected [...] Read more.
This study addressed the frequency of occurrence of the epistemic modal elements that the Ex-president prefers to express in the selected State of the Nation Addresses of Ghana. The study adopted a qualitative approach. Purposively, the two addresses selected for the study are State of the Nation Address: 16th February 2001 and State of the Nation Address: 14th February 2008. The selected addresses are a good starting point for determining tendencies in the meaning expressed by the selected modal categories. The focus is on the semantics of the epistemic category of modality and other related variables within the contexts in which they are used. The data were analysed based on specific epistemic modal meanings and the modal elements expressed. It was observed that there were more expressions of certainty during the 2008 State of the Nation Address than the first one delivered by the Ex-president. Additionally, it is observed that the selection of a particular modal element in a particular context is primarily influenced by the interplay of the speaker and the participants involved. Therefore, an epistemic modal element used in a different linguistic environment may have a different contextual meaning from another. The lower expressions of uncertainty during the last State of the Nation, which ended the tenure of office of the ex-president, show that he was sure he had performed well and was bold enough to make categorical statements. The study exhibited some occurrences of expression of tentativeness with the use of modal verbs alone. All the categories recorded any instance of tentativeness. It is also recommended that politicians, spokespersons, and speech writers be cautious when indicating their information sources and how they obtain them. This helps maintain political credibility, which is the dominant index of the electorate's quest for people who know the conditions and problems prevailing in the country and their solutions.
Article
Open Access September 27, 2024

The Relationship between Physical Education Activity Programs and Academic Achievement

Abstract The benefits of physical activity are immense and indisputable; however, the inclusion of Physical Education Activity Programs (PEAP) within the college setting, specifically the University Undergraduate Core Curriculum, is largely disregarded and viewed as unnecessary. Increased physical activity has shown to have a positive relationship throughout the human development process. Health promotion [...] Read more.
The benefits of physical activity are immense and indisputable; however, the inclusion of Physical Education Activity Programs (PEAP) within the college setting, specifically the University Undergraduate Core Curriculum, is largely disregarded and viewed as unnecessary. Increased physical activity has shown to have a positive relationship throughout the human development process. Health promotion programs should target people of all ages, since the risk of chronic disease starts in childhood and increases with age. In addition to the physical activity benefits associated with human development, decrease disease rate, and extended lifespan, physical activity has also been thoroughly researched and documented to have positive effects on academic achievement. Despite the evidence identified through the results of the research, PEAP at the college level are consistently being ignored and removed from university undergraduate core curriculum. The purpose for university exclusion of PEAP is unknown; however, addressing the gap within the literature may provide justification for re-installment; research has not yet identified the impact of PEAP on the academic achievement of undergraduate students. A positive outcome could be gained by increasing the curricular value of compulsory PK-12 health and physical education requirements.
Commentary
Open Access September 05, 2024

Caste-based Diminished Returns of Educational Attainment on Wealth Accumulation in India

Abstract Background: Education is widely recognized as a key driver of wealth generation, providing individuals with the opportunity to enhance their socioeconomic status. However, the effectiveness of education in generating wealth varies significantly across different social groups. In the United States, research has shown that Black individuals experience weaker economic returns on education [...] Read more.
Background: Education is widely recognized as a key driver of wealth generation, providing individuals with the opportunity to enhance their socioeconomic status. However, the effectiveness of education in generating wealth varies significantly across different social groups. In the United States, research has shown that Black individuals experience weaker economic returns on education compared to their White counterparts, a phenomenon explained by the theory of Minorities' Diminished Returns (MDRs). Although MDRs have been documented in various countries, their relevance to caste-based disparities in India remains unexplored. Objective: This study aims to investigate the caste-based diminished returns of education on wealth in India. We hypothesize that the returns on educational attainment, in terms of wealth generation, will be weaker for individuals from Scheduled Castes (SCs) compared to those from higher castes, using data from the India Demographic and Health Surveys (DHS). Methods: This study was a cross-sectional analysis of DHS -2019/2021 data from India, examining the relationship between educational attainment and wealth across different caste groups (scheduled castes and non-scheduled castes). Multivariate regression models will be employed to assess the interaction between caste and education in predicting wealth outcomes, controlling for relevant covariates such as age, gender, and region. Results: The study is expected to find that the returns on education, in terms of wealth, are significantly weaker for individuals from Scheduled Castes compared to those from higher castes. This would indicate that caste-based discrimination continues to hinder the economic progress of Scheduled Castes, even when they achieve similar levels of education as their upper-caste counterparts. Conclusion: The findings of this study will extend the MDR framework to the Indian context, demonstrating that caste-based disparities result in diminished returns on education for wealth generation. This study underscores the need for targeted policies that address the specific barriers faced by Scheduled Castes in translating educational attainment into economic success and highlights the ongoing impact of caste-based discrimination in India.
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Open Access September 04, 2024

Social Epidemiology of Early Initiation of Electronic and Conventional Cigarette Use in Early to Middle Adolescents

Abstract Background: Early initiation of tobacco use among adolescents is a significant public health concern. While there is extensive research on overall tobacco use, much of it focuses on initiation in late adolescence, uses cross-sectional designs, and lacks specific exploration of electronic versus conventional cigarette use. This study aims to investigate social determinants influencing the [...] Read more.
Background: Early initiation of tobacco use among adolescents is a significant public health concern. While there is extensive research on overall tobacco use, much of it focuses on initiation in late adolescence, uses cross-sectional designs, and lacks specific exploration of electronic versus conventional cigarette use. This study aims to investigate social determinants influencing the early initiation of electronic and conventional cigarette use among U.S. adolescents. Methods: We utilized data from the Adolescent Brain Cognitive Development (ABCD) study, which follows a cohort of tobacco-naïve children from age nine through age 16. The social determinants examined included household income, parental education, financial difficulties, racial/ethnic minority status, family structure, neighborhood income, and gender minority status. Structural equation models were employed to assess associations between these determinants and early initiation of electronic and conventional cigarette use. Results: Male gender was associated with a higher likelihood of conventional cigarette use, while the risk of early initiation of electronic cigarette use was similar across genders. White adolescents were at a higher risk of conventional cigarette use; however, the risk for electronic cigarette use was comparable across White and non-White groups. Financial difficulties were linked to an increased likelihood of early initiation of conventional cigarette use but not electronic cigarette use. Higher household income was associated with a reduced risk of initiating conventional cigarettes but did not significantly impact electronic cigarette use. Adolescents from married families were less likely to initiate electronic cigarette use. No significant effects were found for parental education or neighborhood income on the initiation of either type of cigarette use. Age did not significantly affect the initiation of either cigarette type, and gender minority status was marginally associated with early initiation of conventional cigarette use. Conclusions: The social patterning of electronic cigarette use differs from that of conventional cigarette use, suggesting that distinct tobacco products do not pose a uniform risk across all adolescents. This study underscores the importance of tailored prevention efforts that address the unique challenges associated with early initiation of electronic and conventional cigarette use among adolescents. The differential risk factors identified suggest targeted prevention strategies for conventional cigarette use, focusing on financial difficulties, household income, and gender-specific interventions. In contrast, prevention efforts for electronic cigarette use may require broader, more inclusive approaches that address all adolescents, regardless of their background. Comprehensive universal screening for electronic cigarette use and targeted screening for conventional cigarette use among adolescents are recommended.
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Open Access August 29, 2024

Adversities Mediate Social Determinants of Youth Tobacco Use Initiation

Abstract Background: Social determinants of health (SDOH) significantly influence health behaviors, including tobacco use among youth. Adversities such as perceived discrimination, perceived neighborhood stress, life trauma, and financial strain are stressors that may mediate the relationship between various SDOH and youth tobacco use. This study aims to investigate whether multidimensional adversities [...] Read more.
Background: Social determinants of health (SDOH) significantly influence health behaviors, including tobacco use among youth. Adversities such as perceived discrimination, perceived neighborhood stress, life trauma, and financial strain are stressors that may mediate the relationship between various SDOH and youth tobacco use. This study aims to investigate whether multidimensional adversities mediate the effects of SDOH on tobacco use among youth. Methods: Data from the Adolescent Brain Cognitive Development (ABCD) study were used to test our hypotheses. The sample included a diverse cohort of youth aged 9-10 years old followed until they were 15-16 years old. We examined the effects of baseline parental education, household income, neighborhood income, and family structure on subsequent youth tobacco use. Structural equation models were used to test if adversities (perceived discrimination, life trauma, financial strain) operate as potential mediators. Results: All ABCD participants were eligible for our analysis, regardless of race, ethnicity, or SDOHs (n = 11,878). The findings indicated that the effects of parental education, household income, neighborhood income, and family structure on youth tobacco use were partially mediated by adversities. Higher levels of parental education and household income were associated with lower tobacco use, and this relationship was weakened when accounting for adversities. Similarly, stable family structures and higher neighborhood income were linked to reduced tobacco use, with adversities playing a mediating role. Conclusions: Multidimensional adversities partially mediate the relationship between SDOH at baseline and subsequent youth tobacco use. Interventions aimed at reducing youth tobacco use should address both the social determinants and multiple adversities experienced by adolescents. Policies to improve the educational and economic situations of families, enhance neighborhood environments, and support stable family structures all reduce youth tobacco use, with lower exposure to adversities explaining this effect.
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Open Access August 27, 2024

Role of Impulsivity in Explaining Social Gradient in Youth Tobacco Use Initiation: Does Race Matter?

Abstract Background: Socioeconomic status (SES) is traditionally viewed as a protective factor against impulsivity and subsequent tobacco use in youth. The prevailing model suggests that higher SES is associated with lower impulsivity, which in turn reduces the likelihood of future tobacco use. However, this pathway may not hold uniformly across racial groups due to differences in impulsivity and [...] Read more.
Background: Socioeconomic status (SES) is traditionally viewed as a protective factor against impulsivity and subsequent tobacco use in youth. The prevailing model suggests that higher SES is associated with lower impulsivity, which in turn reduces the likelihood of future tobacco use. However, this pathway may not hold uniformly across racial groups due to differences in impulsivity and the phenomenon of Minorities' Diminished Returns (MDRs), where the protective effects of SES, such as educational attainment, tend to be weaker or even reversed for Black youth compared to their White counterparts. Objectives: This study aims to examine the racial heterogeneity in the pathway from childhood SES to impulsivity and subsequent tobacco use initiation during adolescence, focusing on differences between Black and White youth. Methods: Data were drawn from the Adolescent Brain Cognitive Development (ABCD) Study, which includes a diverse sample of youth aged 9 to 16 years. The analysis examined the relationship between baseline family SES (age 9), impulsivity (age 9), and subsequent tobacco use (ages 9 to 16). Impulsivity was measured using the Urgency, Premeditation (lack of), Perseverance (lack of), Sensation Seeking, and Positive Urgency Impulsive Behavior Scale (UPPS-P). Structural equation modeling (SEM) was employed, with analyses stratified by race to explore potential differences in these associations. Results: Overall, 6,161 non-Latino White and 1,775 non-Latino Black adolescents entered our analysis. In the full sample, higher family SES was linked to lower childhood impulsivity and, consequently, less tobacco uses in adolescence. However, racial differences emerged upon stratification. Among White youth, higher SES was associated with lower impulsivity, leading to reduced tobacco use, consistent with the expected model. In contrast, among Black youth, higher SES was not associated with lower impulsivity, thereby disrupting the protective effect of SES on tobacco use through this pathway. These findings suggest that racial heterogeneity exists in the SES-impulsivity-tobacco use pathway, aligning with the MDRs framework, which highlights how structural factors may weaken the protective effects of high SES among Black youth. Conclusions: These findings underscore the importance of considering racial heterogeneity in the relationships between SES, impulsivity, and tobacco use. The observed disparities suggest a need for targeted interventions that address the unique challenges faced by Black youth, who may not experience the same protective benefits of high SES as their White peers. These results carry significant implications for public health strategies aimed at reducing tobacco use in racially diverse populations.
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Open Access August 18, 2024

Extreme Heat Exposure Is Associated with Higher Socioeconomic Disadvantage and Elevated Youth Delinquency

Abstract Background: Climate change has led to an increase in the frequency and intensity of extreme heat events, a trend expected to continue. This poses significant health risks, particularly for vulnerable populations like children. While previous research has largely concentrated on the physical health impacts of extreme heat, less attention has been given to behavioral outcomes, such as [...] Read more.
Background: Climate change has led to an increase in the frequency and intensity of extreme heat events, a trend expected to continue. This poses significant health risks, particularly for vulnerable populations like children. While previous research has largely concentrated on the physical health impacts of extreme heat, less attention has been given to behavioral outcomes, such as delinquency. Objectives: This study investigates the association between extreme heat exposure and delinquency among children, utilizing data from the Adolescent Brain Cognitive Development (ABCD) study. It also explores the potential mediating roles of neighborhood socioeconomic status (SES; measured by median home value), puberty, peer deviance, and financial difficulties. Methods: Data from the national ABCD study were analyzed to assess the relationship between extreme heat exposure (exposure) and delinquency (outcome). Covariates included race/ethnicity, sex, and age. Mediators examined were neighborhood SES, puberty, peer deviance, and financial difficulties. Structural equation modeling (SEM) was employed for data analysis. Results: Overall, 11,878 children entered our analysis. The analysis revealed a significant association between extreme heat exposure and higher levels of delinquency among children. Children more exposed to extreme heat were more likely to be Black, reside in lower SES neighborhoods, experience greater financial difficulties, and have more advanced puberty status. The group facing the highest heat exposure was also economically disadvantaged. Conclusions: The findings suggest that children already disadvantaged by socio-economic factors are disproportionately affected by extreme heat, leading to increased delinquency. This highlights the need for targeted interventions to protect these vulnerable populations and address the mediators of extreme heat exposure. Future research should focus on longitudinal studies and evaluate the effectiveness of various mitigation strategies to address these disparities.
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Open Access August 17, 2024

Socioeconomic Status Partially Mediates the Effects of Structural Racism on Youth Tobacco Use Initiation

Abstract Background: Recent research has identified structural racism—systemic policies and practices that perpetuate racial inequalities—as a significant social determinant of population health. Studies utilizing data from the Adolescent Brain Cognitive Development (ABCD) study have shown an association between higher levels of state-level structural racism and increased tobacco use among youth in [...] Read more.
Background: Recent research has identified structural racism—systemic policies and practices that perpetuate racial inequalities—as a significant social determinant of population health. Studies utilizing data from the Adolescent Brain Cognitive Development (ABCD) study have shown an association between higher levels of state-level structural racism and increased tobacco use among youth in the United States. However, there has been limited exploration of the psychosocial mediators of this relationship, particularly in the context of youth aged 10-16 years. Objective: This study aimed to assess the roles of socioeconomic status (SES), tobacco susceptibility, and perceived discrimination as potential mediators in the relationship between state-level structural racism and youth tobacco initiation rates. Methods: We analyzed data from the ABCD study, a nationally representative longitudinal survey of 11,698 youth followed from ages 9/10 to 15/16. These data were combined with state-level indicators of structural racism. We employed structural equation modeling (SEM) to investigate the mediators of the association between structural racism and self-reported initiation of tobacco use, while controlling for individual and state-level covariates. Results: Our findings indicate that higher levels of structural racism were associated with increased rates of tobacco initiation among youth. This relationship was partially mediated by lower SES, but not by perceived discrimination or tobacco susceptibility. Conclusion: The association between structural racism and youth tobacco initiation appears to be influenced in part by the lower SES prevalent in states with higher levels of racism. These results highlight the need for addressing both racism and SES inequalities as key strategies for reducing tobacco disparities among youth.
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Open Access August 16, 2024

Race, College Graduation, and Time of Retirement in the United States: A Thirty-Year Longitudinal Cohort of Middle-Aged and Older Adults

Abstract Introduction: College education is typically associated with the ability to work in less physically demanding occupations, allowing for a later retirement age. However, research indicates that highly educated Black individuals often work in more demanding occupations, which affects their retirement age. Aim: Building on the Minorities’ Diminished Returns [...] Read more.
Introduction: College education is typically associated with the ability to work in less physically demanding occupations, allowing for a later retirement age. However, research indicates that highly educated Black individuals often work in more demanding occupations, which affects their retirement age. Aim: Building on the Minorities’ Diminished Returns (MDRs) literature, we tested whether the benefit of college education on delaying the time of retirement is weaker for Black compared to White middle-aged and older adults. Methods: We utilized data from the Health and Retirement Study (HRS), which includes a 30-year longitudinal follow-up of a nationally representative sample of middle-aged and older adults in the United States. Education levels at baseline were categorized as less than college graduate (some high school, GED, high school diploma, or some college) and college graduate. The outcome was the time to retirement, measured from wave 2 to wave 15 (baseline to 30 years later). We graphed survival curves and used independent samples t-tests to assess associations between college graduation and time of retirement, overall and by race. Results: Our analysis included 6,803 White and Black participants who were employed at baseline and followed for up to 30 years. Overall, there was a positive association between college graduation and retirement timing, with individuals with higher education retiring later. However, we found significant racial differences in the retirement age of college graduates, indicating notable racial disparities in the effects of college graduation on retirement timing, disadvantaging Black college-educated individuals. Specifically, among Whites, but not Blacks, college education was associated with later retirement. Conclusion: Consistent with Minorities’ Diminished Returns theory, the positive effect of college education on retirement timing are weaker for Black than for White middle-aged and older Americans. To address racial disparities, it is insufficient to focus solely on economic disparities. While closing the educational gap is important, we must also work to equalize labor market experiences for Black and White individuals with similar educational credentials. Structural factors contributing to the diminished returns of college education for Black populations must be addressed to effectively close racial disparities.
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Open Access August 14, 2024

Handing Money to the Poor Is Never Enough: The Impact of Marginalization-Related Diminished Returns

Abstract Recent US studies such as Baby’s First Years have again demonstrated that unconditional cash transfers and guaranteed income do not lead to significant improvements in the health, economic status, and well-being of individuals living in poverty. In this perspective article we review the emerging literature on this topic and offer explanations for the observed outcomes. We then apply the theory and [...] Read more.
Recent US studies such as Baby’s First Years have again demonstrated that unconditional cash transfers and guaranteed income do not lead to significant improvements in the health, economic status, and well-being of individuals living in poverty. In this perspective article we review the emerging literature on this topic and offer explanations for the observed outcomes. We then apply the theory and empirical evidence on marginalization-related diminished returns (MDRs) also called minorities diminished returns (MDRs) to elucidate the weak or null effects of cash transfers in the lives of marginalized populations. According to the MDR theory, marginalization not only reduces access to resources but also reduces their utility. Individuals who experience long-term poverty and marginalization exhibit smaller than expected benefits from new resources, such as cash, in adulthood. This is due to the deeply entrenched structural barriers and systemic discrimination that persist throughout their lives. The existing literature suggests that socioeconomic changes in adulthood have limited impact on the health and well-being of populations that have been raised in poverty. This is because the advantages of increased socioeconomic status (SES) are often undermined by ongoing marginalization and limited access to supportive resources and opportunities. As a result, simply providing cash transfers is insufficient to create substantial and lasting improvements in the lives of those living in poverty. To address these challenges, we recommend a multifaceted approach that includes childhood poverty prevention, interventions aimed at reducing marginalization, and comprehensive multi-sector strategies. By focusing on early intervention and addressing the root causes of poverty and marginalization, we can create more effective and sustainable solutions to improve health and well-being among disadvantaged populations. This holistic approach recognizes the complexity of poverty and the necessity of addressing both immediate needs and long-term structural barriers to achieve meaningful change.
Perspective
Open Access August 11, 2024

Walking the Divide: A Public Health Journey from Manhattan to Harlem

Abstract This perspective article discusses the striking contrasts and inequalities observed during a walk from Manhattan to Harlem in New York City, highlighting the significant social and economic differences that have profound implications for public health and social policy. Through this journey, we explore various aspects including racial segregation, the composition of shops, smoking habits, street [...] Read more.
This perspective article discusses the striking contrasts and inequalities observed during a walk from Manhattan to Harlem in New York City, highlighting the significant social and economic differences that have profound implications for public health and social policy. Through this journey, we explore various aspects including racial segregation, the composition of shops, smoking habits, street cleanliness, police presence, unemployment, real estate disparities, and the pervasive sense of insecurity. The transition from a predominantly White Manhattan to a predominantly Black and Hispanic Harlem underscores the historical and systemic inequalities that continue to shape the city's demographic and economic landscape. These disparities, rooted in discriminatory housing policies, economic disparities, and social exclusion, manifest in poorer health outcomes, higher rates of substance use, and limited economic opportunities for minority populations. By addressing these structural issues through targeted policies and sustained interventions, we can work towards reducing health disparities and promoting racial equity. This paper also highlights the concept of Minorities' Diminished Returns (MDRs), where the benefits of education and income are less pronounced for minority individuals compared to their White counterparts, further perpetuating cycles of disadvantage. Comprehensive efforts to dismantle systemic inequities are essential for fostering a more equitable and healthy society.
Perspective
Open Access August 09, 2024

A Hybrid Based Recommender System for Enhancing Data Availability on Crop Market

Abstract Smallholder farmers face challenges when they lack information on their agricultural activities. To address this, we suggest a web-based system that can be used by farmers to help them in decision making considering the fact that all necessary information is provided by the system. Farmers can input crop type they want to grow and area. This data will help to recommend them the best crops that are [...] Read more.
Smallholder farmers face challenges when they lack information on their agricultural activities. To address this, we suggest a web-based system that can be used by farmers to help them in decision making considering the fact that all necessary information is provided by the system. Farmers can input crop type they want to grow and area. This data will help to recommend them the best crops that are suitable to be grown in that area and the necessary growing practices that can be done to produce high yield and have maximum profits, considering the average rainfall of that year. A persistent issue we face in Zimbabwe is the lack of access to reliable agricultural data. In the agricultural sector, one major uncertainty for farmers is the outlook of their future harvest. Once their produce is ready for sale, the presence of other potential buyers compels traders to offer prices that align closely with those in the formal market. However, without timely information, traders can take advantage of the situation by purchasing crops at unfairly low rates. Having data that tracks prices across various markets in near real-time would enable farmers to have a precise and complete understanding of their selling choices to maximize their profits.
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Open Access August 08, 2024

Challenges and Strategies: Usage of Multimedia Resources in Teaching Social Studies Concepts in the Junior High Schools of Ghana

Abstract Access to and the availability of digital infrastructure remains the most significant issue influencing teachers' use of multimedia technology in teaching and learning processes. Qualitatively, the study focused on a case study research design. The study population consisted of five (5) Social Studies teachers at Presbyterian University College of Education Demonstration Junior High School in the [...] Read more.
Access to and the availability of digital infrastructure remains the most significant issue influencing teachers' use of multimedia technology in teaching and learning processes. Qualitatively, the study focused on a case study research design. The study population consisted of five (5) Social Studies teachers at Presbyterian University College of Education Demonstration Junior High School in the Akuapem North Municipality of the Eastern Region of Ghana. A purposive sampling technique was used to select all the Social Studies teachers for the study. The main instruments for data collection were an interview guide and observation protocols. The data was analysed using the interpretative method based on the themes arrived at during the data collection. The themes were related to the research question and interpreted on the number of issues raised by participants. The study indicated that more resources are needed to use multimedia resources effectively in social studies instruction. Limited access to computers and the internet, unreliable power supply, time constraints for teachers, and a lack of necessary competencies all contribute to this challenge. Although multimedia has become crucial to education, teachers often need more training to utilise these resources fully. The government must collaborate with other organisations to procure ICT resources to address these challenges rather than shouldering the sole responsibility for financing education. Establishing a school-based ICT policy framework to guide technology implementation in teaching and learning is essential.
Review Article
Open Access August 04, 2024

Blacks’ Diminished Returns of Parental Education on Household Income: A Study of College Students in the US

Abstract Background: Parental education is a key determinant of household income, but its benefits are not uniformly distributed across racial groups. According to the Minorities' Diminished Returns (MDRs) theory, the socioeconomic benefits of resources such as parental education are systematically lower for minority families, particularly Blacks who have been subjected to slavery, segregation, [...] Read more.
Background: Parental education is a key determinant of household income, but its benefits are not uniformly distributed across racial groups. According to the Minorities' Diminished Returns (MDRs) theory, the socioeconomic benefits of resources such as parental education are systematically lower for minority families, particularly Blacks who have been subjected to slavery, segregation, racism, and discrimination. Objective: This study aims to investigate the diminished returns of parental education on household income among Black college students in the US. Methods: Using data from the Higher Education Research Institute (HERI) Freshman Student Survey, we analyzed the associations between race, parental education, and household income. The sample included 2,235,733 students, comprising 2,191,543 White and 441,90 Black freshman college students. We conducted regression analyses to examine the association between parental education and household income, adjusting for relevant covariates. Results: Our findings indicated that higher parental education is associated with higher household income in the pooled sample. We also found a positive association between parental education and household income for both Black and White college students. However, the magnitude of this positive association was significantly smaller for Black students compared to White students, demonstrating diminished returns of parental education on household income for Black families. Discussion: The results support the theory of Minorities' Diminished Returns, highlighting the need for policies that address the systemic barriers contributing to sustained economic inequality. These barriers go beyond parental education, resulting in income differences between similarly educated White and Black families.
Review Article
Open Access July 31, 2024

Black-White Differences in The Effects of Parental Education on College Students’ Beliefs about Racial Discrimination

Abstract Background: Racial discrimination remains a significant issue in the United States, particularly affecting Black individuals. Understanding how beliefs about the persistence of racial discrimination are shaped by race and parental education among college students is crucial for developing strategies to address these inequities. Objectives: This study aims to examine the [...] Read more.
Background: Racial discrimination remains a significant issue in the United States, particularly affecting Black individuals. Understanding how beliefs about the persistence of racial discrimination are shaped by race and parental education among college students is crucial for developing strategies to address these inequities. Objectives: This study aims to examine the multiplicative effects of race and parental education on beliefs about the persistence of racial discrimination among Black and White college students. We hypothesize that Black students, particularly those with highly educated parents, will exhibit stronger beliefs in the persistence of racial discrimination as a significant issue compared to their White peers. Methods: Data were drawn from the Higher Education Research Institute (HERI) study, which includes a national sample of Black and White young adults on college campuses across the United States. We conducted statistical analyses to explore the influence of race and parental education on students' beliefs about racial discrimination. Results: Black students demonstrated stronger beliefs in the persistence of racial discrimination compared to White students. Additionally, students with higher parental education levels were more likely to recognize racial discrimination as a significant issue than those with lower parental education. The impact of parental education on these beliefs was more pronounced for Black students compared to White students. Discussion: Black college students, especially those from higher SES backgrounds, exhibit a heightened awareness of racial discrimination due to their lived experiences and educational exposure. High SES Black individuals often face increased visibility and prejudice in predominantly White environments, further reinforcing their beliefs about the persistence of discrimination. These findings highlight the need for targeted interventions to support Black students in higher education and promote awareness of racial discrimination. Policy solutions should include comprehensive anti-discrimination policies, increased diversity and inclusion efforts, and educational curricula that address systemic racism and social justice. The cross-sectional nature of the data limits causality inference, and self-reported measures may be subject to bias. Despite these limitations, the study's large and diverse sample enhances the generalizability of the findings. Race and parental education have multiplicative effects on college students' beliefs about the persistence of racial discrimination. Black students, particularly those from high SES backgrounds, are more likely to perceive racial discrimination as a continuing problem. Addressing these disparities through targeted policies and interventions is essential for creating equitable and inclusive educational environments.
Article
Open Access July 27, 2024

Paradoxical Effects of Income and Income Inequality on Racial Health Disparities

Abstract The intersection of race and place in shaping health disparities presents complex dynamics, as evidenced by studies in cities like Detroit, Baltimore, and Philadelphia, where predominantly Black and economically disadvantaged populations experience high overall rates of health problems. Surprisingly, these cities do not exhibit the most pronounced racial disparities. In contrast, areas with a [...] Read more.
The intersection of race and place in shaping health disparities presents complex dynamics, as evidenced by studies in cities like Detroit, Baltimore, and Philadelphia, where predominantly Black and economically disadvantaged populations experience high overall rates of health problems. Surprisingly, these cities do not exhibit the most pronounced racial disparities. In contrast, areas with a higher percentage of White residents, indicative of greater income inequality, show stark differences in health outcomes between Black and White populations. This disparity underscores how conditions diverge more sharply between Black and White individuals in wealthier urban areas. This phenomenon suggests a complex and sometimes counterintuitive relationship among race, place, income, and income inequality in shaping racial health disparities. These dynamics have significant policy implications. Addressing health disparities requires nuanced strategies that recognize the multiplicative effects of race and income inequality on health outcomes. Policies focusing on areas with a high disease burden, such as Detroit, Philadelphia, and Baltimore can effectively mitigate disparities both locally and more broadly. Conversely, interventions targeting regions with lower disease prevalence, but higher racial disparities must be approached carefully to avoid exacerbating inequalities. In conclusion, understanding and addressing the complex drivers of health disparities demand comprehensive approaches that acknowledge the intertwined influences of race, income, and place. By prioritizing interventions that address economic disparities alongside health initiatives, policymakers can foster more equitable health outcomes across diverse communities.
Perspective
Open Access July 24, 2024

Race by Sex Intersectional Differences in the Association between Allostatic Load and Depression in US Adults: 2005-2018

Abstract Objective: Previous research has underscored the link between allostatic load—a comprehensive indicator of the cumulative physiological burden of chronic stress—and depression. However, there remains a significant gap in understanding how this relationship may differ across race and sex intersectional groups. This study aimed to investigate variations in the association between elevated [...] Read more.
Objective: Previous research has underscored the link between allostatic load—a comprehensive indicator of the cumulative physiological burden of chronic stress—and depression. However, there remains a significant gap in understanding how this relationship may differ across race and sex intersectional groups. This study aimed to investigate variations in the association between elevated allostatic load (AL>4) and depression among different race-sex intersectional groups within the general population. Methods: This cross-sectional secondary analysis utilized data from the National Health and Nutrition Examination Survey (NHANES) spanning 2005-2018. The analysis included variables such as race, sex, age, socioeconomic status, depression (measured via the Patient Health Questionnaire - PHQ), and allostatic load. Linear regression analyses were conducted to examine the interactions between race and sex with allostatic load, focusing on the likelihood of high depression as the outcome. Results: Across the pooled sample, an allostatic load greater than 4 was significantly associated with increased depression. Notably, an interaction effect was observed between race and AL>4 on depression among women, indicating that non-Hispanic Black women with a high allostatic load exhibited more pronounced depressive symptoms (Beta: 1.09, CI: 0.02-2.61). Conversely, among men, allostatic load greater than 4 neither correlated with nor interacted with race to influence depression levels. Conclusion: The study highlights the critical need to consider allostatic load as a key target for interventions that aim to reduce depression among Black women. These findings underscore the necessity for customized intervention strategies that address the nuanced race-sex disparities in the impact of allostatic load on mental health across populations.
Article
Open Access July 21, 2024

Securing Pharmaceutical Supply chain to Combat Active Pharmaceutical Ingredient Counterfeiting

Abstract Pharmaceutical Product serialization aims to assign distinct serial numbers to items within a pharmaceutical supply chain. However, this process faces several security challenges like Theft of valid serial numbers may occur, enabling the labelling of counterfeit products. Therefore, it's essential to ensure the uniqueness of serial numbers can be verified at any point in the product's lifecycle [...] Read more.
Pharmaceutical Product serialization aims to assign distinct serial numbers to items within a pharmaceutical supply chain. However, this process faces several security challenges like Theft of valid serial numbers may occur, enabling the labelling of counterfeit products. Therefore, it's essential to ensure the uniqueness of serial numbers can be verified at any point in the product's lifecycle within the supply chain. Intimidatory nodes along the distribution network could corrupt planned changes of custody for products. Ensuring verifiability of compliance with these changes is crucial. Manufacturers and consumers need assurance that perishable goods with expired shelf lives are appropriately discarded. In this paper, we review a product serialization method leveraging blockchain technology to address these security concerns within a multi-party perishable goods supply chain. Blockchains offer potential solutions by providing a secure platform for data sharing in multi-party environments, enhancing security and transparency. Within Blockchain technology, each distribution partner is registered to uphold transparency regarding drug information. The system facilitates real-time transfer of ownership changes, recording them as blocks with date and time stamps. This ensures visibility to all partners in real time, maintaining the authenticity of drugs. This article aims to outline how Blockchain technology benefits the pharmaceutical industry by enhancing traceability and trackability of drugs throughout the entire pharmaceutical supply chain.
Review Article
Open Access July 18, 2024

Household Income and Offspring Education Explain Blacks’ Diminished Returns of Parental Education

Abstract Background: High parental education promotes various aspects of offspring well-being including reducing their risk of depression/anxiety, criminal justice involvement, and welfare reliance. However, according to minorities’ diminished returns, these benefits are not equal across racial groups, with Black families experiencing diminished returns of parental education compared to White [...] Read more.
Background: High parental education promotes various aspects of offspring well-being including reducing their risk of depression/anxiety, criminal justice involvement, and welfare reliance. However, according to minorities’ diminished returns, these benefits are not equal across racial groups, with Black families experiencing diminished returns of parental education compared to White families. This study explores the role of household income and offspring educational attainment as potential serial pathways that operate as mechanisms underlying diminished returns of parental education on offspring outcomes in Black families. Gender differences in these effects were also explored. Methods: Utilizing data from the Future of Families and Child Wellbeing Study (FFCWS) over a 22-year follow-up period (seven waves), we examined the serial mediation by household income and offspring educational attainment in explaining the relationship between parental education and offspring outcomes namely depression, anxiety, criminal justice involvement, and welfare reliance [Temporary Assistance for Needy Families (TANF) and Supplemental Nutrition Assistance Program (SNAP)]. We used structural equation modeling (SEM) with household income as the first mediator and young adult education as the second mediator. Multi-group models were used to explore gender differences in these paths. Results: The study confirmed the role of our proposed serial mediators for Blacks’ weaker effects of parental education on offspring outcomes. We observed weaker effects of first affects household income, with this effect being for Black families compared to White families, which then impacted educational attainment of the offspring. The findings indicate that household income plays a crucial mediating role, but its effect is weaker in Black families. Additionally, the educational attainment of offspring from highly educated Black parents is less effective in improving outcomes compared to their White peers, further contributing to diminished returns. Some gender differences were observed for the effects of educational attainment on economic and health outcomes of young adults. Conclusions: The study underscores the need to reconsider traditional assumptions about the comparability of family conditions and outcomes across racial groups with similar levels of parental education. The findings highlight the importance of targeted policies and interventions aimed at enhancing the economic stability and educational outcomes of Black families to address these disparities. Policies should focus on promoting the economic well-being of highly educated Black parents and improving the educational outcomes of their children.
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Open Access July 16, 2024

Management of Saltwater Intrusion in Coastal Aquifers: A Review and Case Studies from Egypt

Abstract Groundwater is undeniably crucial to people's lives, particularly in coastal regions. Therefore, it is imperative to address this vital water source strategically and implement a management plan to maintain its optimal state. The salinization of groundwater poses a significant challenge for coastal communities, stemming from factors like excessive groundwater extraction from coastal aquifers, [...] Read more.
Groundwater is undeniably crucial to people's lives, particularly in coastal regions. Therefore, it is imperative to address this vital water source strategically and implement a management plan to maintain its optimal state. The salinization of groundwater poses a significant challenge for coastal communities, stemming from factors like excessive groundwater extraction from coastal aquifers, reduced recharge, rising sea levels, climate change, and other causes. Saltwater intrusion (SWI) is a prevalent issue that needs attention, as it significantly threatens groundwater quantity and quality. SWI happens when saline water infiltrates coastal aquifers, contaminating freshwater supplies. This review article aims to define SWI, explore its causes and influencing factors, and discuss various monitoring techniques. Additionally, it examines different modeling methods and management tools, including remote sensing, field surveys, modeling approaches, and optimization techniques. To mitigate the adverse effects of SWI, several control measures are outlined, along with their pros and cons. The final section reviews previous SWI studies and case studies from the Nile Delta, Sinai Peninsula, and North-West coast in Egypt. These studies offer suggestions, adaptations, and mitigation measures for future research.
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Review Article
Open Access July 16, 2024

A Different Lens: Insights of Non-Nursing Students in Nursing Education

Abstract Background: In the landscape of education, the decision-making process that leads students to pursue or reject nursing as a career is a multifaceted phenomenon shaped by a plethora of influences ranging from personal experiences to societal norms. Aim: To explore non-nursing students' insights on nursing education, seeking to shed light on the considerations and challenges that [...] Read more.
Background: In the landscape of education, the decision-making process that leads students to pursue or reject nursing as a career is a multifaceted phenomenon shaped by a plethora of influences ranging from personal experiences to societal norms. Aim: To explore non-nursing students' insights on nursing education, seeking to shed light on the considerations and challenges that influence their views on nursing education. Materials & Methods: A qualitative approach using thematic analysis were utilized. Lincoln and Guba's framework for rigor and trustworthiness directed the validation process. Semi-structured interviews based on vetted questionnaires yielded the data. Results: Analysis of interviews with ten (10) non-nursing college students revealed three key themes: 1) initial insights, 2) factors influencing their insights, and 3) difficulty of nursing education. Non-nursing students view nursing education as multifaceted and rigorous, recognizing the profession's complexity but have reservations about the heavy workload, intense clinical demands, and health risks, particularly highlighted by the pandemic, which contributes to their reluctance to choose nursing as a career path. Implications: Addressing perceptions, enhancing curricula, offering mentorship, and providing emotional support, nursing education can be improved, steering more students towards a career in nursing. Conclusion: Non-nursing students respect the complexity of the nursing profession but are deterred by its demands and risks, indicating a need for educational reforms to better convey the role, value, and opportunities within nursing to encourage more students into the field.
Article
Open Access July 12, 2024

Race, Poverty Status at Birth, and DNA Methylation of Youth at Age 15

Abstract Epigenetic studies, which can reflect biological aging, have shown that measuring DNA methylation (DNAm) levels provides new insights into the biological effects of social environment and socioeconomic position (SEP). This study explores how race, family structure, and SEP (income to poverty ratio) at birth influence youth epigenetic aging at age 15. Data were obtained from the Future [...] Read more.
Epigenetic studies, which can reflect biological aging, have shown that measuring DNA methylation (DNAm) levels provides new insights into the biological effects of social environment and socioeconomic position (SEP). This study explores how race, family structure, and SEP (income to poverty ratio) at birth influence youth epigenetic aging at age 15. Data were obtained from the Future of Families and Child Wellbeing Study (FFCWS) cohort, with GrimAge used as a measure of DNAm levels and epigenetic aging. Our analysis included 854 racially and ethnically diverse participants followed from birth to age 15. Structural equation modeling (SEM) examined the relationships among race, SEP at birth, and epigenetic aging at age 15, controlling for sex, ethnicity, and family structure at birth. Findings indicate that race was associated with lower SEP at birth and faster epigenetic aging. Specifically, income to poverty ratio at birth partially mediated the effects of race on accelerated aging by age 15. The effect of income to poverty ratio at birth on DNAm was observed in male but not female youth at age 15. Thus, SEP partially mediated the effect of race on epigenetic aging in male but not female youth. These results suggest that income to poverty ratio at birth partially mediates the effects of race on biological aging into adolescence. These findings highlight the long-term biological impact of early-life poverty in explaining racial disparities in epigenetic aging and underscore the importance of addressing economic inequalities to mitigate these disparities. Policymakers should focus on poverty prevention in Black communities to prevent accelerated biological aging and associated health risks later in life. Interventions aimed at eliminating poverty and addressing racial inequities could have significant long-term benefits for public health. Future research should explore additional factors contributing to epigenetic aging and investigate potential interventions to slow down the aging process. Further studies are needed to understand the mechanisms underlying these associations and to identify effective strategies for mitigating the impact of SEP and racial disparities on biological aging.
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