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Open Access June 26, 2025

The Relationship Between Lymphocyte Count and Mortality in Patients with Dysphagia

Abstract Background: Dysphagia is a common functional impairment in elderly populations, often leading to severe complications such as malnutrition and aspiration pneumonia, significantly increasing healthcare burdens. Currently, effective prognostic assessment tools are lacking. The absolute lymphocyte count (ALC), a biomarker reflecting immune-nutritional status, has potential predictive value in this context, though its role in dysphagia prognosis remains unclear. Methods: This retrospective cohort study included 253 dysphagic patients who received percutaneous endoscopic gastrostomy (PEG) or total parenteral nutrition (TPN) between 2014 and 2017. Five patients with missing ALC were excluded. Cox regression models assessed the association between ALC and mortality. ALC was analyzed as both continuous variable (using restriocted cubic splines) and categorical tertiles, with additional threshold analyses to assess non-linearity. Kaplan–Meier survival curves and subgroup analyses were also performed. Results: Lower ALC was associated with poorer nutritional status, higher inflammatory markers, and greater comorbidity burden. Higher ALC was independently associated with reduced mortality (adjusted HR: 0.60; 95% CI: 0.44–0.83; p = 0.002). Patients in the highest tertile had significantly better survival than those in the lowest (HR: 0.37; 95% CI: 0.23–0.59; P < 0.001). A non-linear threshold effect was identified at ALC = 1.899×109/L (p for non-linearity = 0.009). Kaplan–Meier analysis confirmed improved survival with higher ALC (p [...] Read more.
Background: Dysphagia is a common functional impairment in elderly populations, often leading to severe complications such as malnutrition and aspiration pneumonia, significantly increasing healthcare burdens. Currently, effective prognostic assessment tools are lacking. The absolute lymphocyte count (ALC), a biomarker reflecting immune-nutritional status, has potential predictive value in this context, though its role in dysphagia prognosis remains unclear. Methods: This retrospective cohort study included 253 dysphagic patients who received percutaneous endoscopic gastrostomy (PEG) or total parenteral nutrition (TPN) between 2014 and 2017. Five patients with missing ALC were excluded. Cox regression models assessed the association between ALC and mortality. ALC was analyzed as both continuous variable (using restriocted cubic splines) and categorical tertiles, with additional threshold analyses to assess non-linearity. Kaplan–Meier survival curves and subgroup analyses were also performed. Results: Lower ALC was associated with poorer nutritional status, higher inflammatory markers, and greater comorbidity burden. Higher ALC was independently associated with reduced mortality (adjusted HR: 0.60; 95% CI: 0.44–0.83; p = 0.002). Patients in the highest tertile had significantly better survival than those in the lowest (HR: 0.37; 95% CI: 0.23–0.59; P < 0.001). A non-linear threshold effect was identified at ALC = 1.899×109/L (p for non-linearity = 0.009). Kaplan–Meier analysis confirmed improved survival with higher ALC (p < 0.0001). Subgroup analyses showed the protective effect of higher ALC was consistent across age, sex, BMI, PEG use, and comorbidity strata, with no significant interactions. Conclusions: ALC is an independent, non-linear predictor of mortality in older dysphagic patients and may aid clinical risk stratification across diverse patient subgroups.
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Open Access June 26, 2025

Mathematical modelling of the impact of HIV prevention strategies among female sex workers on public health in Burkina Faso

Abstract This article presents a mathematical model designed to simulate the impact of targeted interventions aimed at preventing HIV transmission among female sex workers (FSWs) and their clients, while also analyzing their effects on the health of the general population. The compartmental model distinguishes between high-risk populations (FSWs and their clients) and low-risk populations (sexually active [...] Read more.
This article presents a mathematical model designed to simulate the impact of targeted interventions aimed at preventing HIV transmission among female sex workers (FSWs) and their clients, while also analyzing their effects on the health of the general population. The compartmental model distinguishes between high-risk populations (FSWs and their clients) and low-risk populations (sexually active men and women in the general population), and links prevention efforts in high-risk groups to the evolution of the epidemic in the low-risk population. The fundamental properties of the model, such as the positivity of solutions and the boundedness of the system, have been verified, and the basic reproduction number R0 has been calculated. Finally, the stability of the model was studied using Varga’s theorem and the Lyapunov method. Simulation results show that targeted prevention among FSWs and their clients reduces HIV incidence in the general population. This framework provides a valuable tool for guiding policymakers in the design of effective strategies to combat the epidemic, especially relevant in the context of suspension of USAID funding.
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Open Access June 25, 2025

Performance and Validity of Knee Function Assessment Tools After Total Knee Arthroplasty: A Systematic Review

Abstract Objective: To identify and evaluate the main functional assessment tools applied in the postoperative monitoring of patients undergoing total knee arthroplasty (TKA), and to synthesize the functional outcomes reported through these instruments in the current scientific literature. Methodology: A structured review was conducted following PRISMA 2020 guidelines. [...] Read more.
Objective: To identify and evaluate the main functional assessment tools applied in the postoperative monitoring of patients undergoing total knee arthroplasty (TKA), and to synthesize the functional outcomes reported through these instruments in the current scientific literature. Methodology: A structured review was conducted following PRISMA 2020 guidelines. Thirty-one peer-reviewed studies were selected through a targeted manual search based on predefined eligibility criteria. Included studies evaluated functional recovery following TKA using validated outcome measures such as the WOMAC, KSS, KOOS, IKDC, SF-36, and SANE. Data extraction focused on the instruments used, patient population characteristics, and reported outcomes. A descriptive synthesis was compiled in Table 1. Additionally, 15 studies with quantitative data were analyzed using a forest plot to illustrate risk ratios (RR) and 95% confidence intervals (CI) for functional improvement. Risk of bias was assessed qualitatively based on methodological rigor, clarity of reporting, and validation of the outcome tools. Results: All included studies reported improvements in functional status following TKA. Most risk ratios ranged from 0.66 to 0.85, indicating a consistent reduction in the risk of postoperative functional limitation. High-quality studies demonstrated more precise effect estimates and greater internal validity. The SANE scale emerged as a valid and practical tool with high responsiveness, including in its culturally adapted Brazilian version. Despite heterogeneity in study design, the direction of effect remained consistent across all included studies. Conclusion: Validated functional assessment tools are essential for monitoring recovery after total knee arthroplasty. Instruments such as WOMAC and SANE demonstrate strong clinical utility and psychometric validity. Their systematic use enhances outcome comparability, supports individualized rehabilitation planning, and improves decision-making in orthopedic care.
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Systematic Review
Open Access April 30, 2025

Psychological Flexibility and Cardiovascular Health Behaviors Among Filipino Outpatients: A Correlational Study

Abstract (1) Background: Psychological flexibility, the ability to adapt to changing demands while staying true to personal values, is linked to better health behaviors. However, its relationship with cardiovascular health behaviors, particularly in Filipino populations, remains underexplored. (2) Aim: This study aimed to examine the relationship between psychological flexibility and [...] Read more.
(1) Background: Psychological flexibility, the ability to adapt to changing demands while staying true to personal values, is linked to better health behaviors. However, its relationship with cardiovascular health behaviors, particularly in Filipino populations, remains underexplored. (2) Aim: This study aimed to examine the relationship between psychological flexibility and cardiovascular health behaviors among outpatients in Rizal, Philippines, focusing on BMI, smoking, physical activity, and dietary habits. (3) Methods: A cross-sectional, descriptive-correlational design was used with 100 outpatient participants from selected hospitals. Psychological flexibility was measured using the Acceptance and Action Questionnaire-II (AAQ-II), and cardiovascular health behaviors were assessed using a modified version of the American Heart Association’s Life Simple 7 tool. Descriptive statistics and Pearson’s correlation were applied. (4) Results: The findings showed that respondents had neutral levels of psychological flexibility. While most exhibited intermediate BMI and physical activity, dietary habits varied. A significant positive correlation was found between psychological flexibility and whole grain consumption. However, no significant associations were found with BMI, smoking, or physical activity. (5) Conclusions: Psychological flexibility appears to influence specific health behaviors, such as dietary choices, but does not strongly correlate with other cardiovascular health behaviors. Further research is needed to explore its broader role in cardiovascular disease prevention.
Article
Open Access April 13, 2025

Respiratory Syncytial Virus Vaccines for the Elderly Population in Japan

Abstract Respiratory syncytial virus (RSV) is commonly known as a pathogen of the bronchiolitis in children, however, recently also as a pathogen of the severe virus pneumonia in adults, especially elderly persons, and vaccines for elderly persons have been developed. There are two vaccines, such as the vaccines targeted for subgroup A with the adjuvant, and that targeted for both subgroup A and B but not [...] Read more.
Respiratory syncytial virus (RSV) is commonly known as a pathogen of the bronchiolitis in children, however, recently also as a pathogen of the severe virus pneumonia in adults, especially elderly persons, and vaccines for elderly persons have been developed. There are two vaccines, such as the vaccines targeted for subgroup A with the adjuvant, and that targeted for both subgroup A and B but not included the adjuvant in Japan. Both vaccines are considered effective to prevent not only the incident of RSV infection/pneumonia, but also the exacerbations of the elderly persons with underlying diseases including chronic cardiopulmonary diseases.
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Mini Review
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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Article
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 07, 2025

Factors Affecting Pain Scale Preferences among Populations in Indonesia: Comparison Study between Suburban and Rural Areas

Abstract Introduction: Pain is considered as the fifth vital sign that should be considered in assessing patients. For clinicians to evaluate and determine the right pain interventions, there should be parameters such as pain scale. Our objective in this study is to determine factors affecting pain scale preferences in suburban and rural populations. The pain scales used in this study are FPS-R [...] Read more.
Introduction: Pain is considered as the fifth vital sign that should be considered in assessing patients. For clinicians to evaluate and determine the right pain interventions, there should be parameters such as pain scale. Our objective in this study is to determine factors affecting pain scale preferences in suburban and rural populations. The pain scales used in this study are FPS-R (Faces Pain Scale-Revised), VRS (Verbal Rating Scale), VAS (Visual Analogue Scale), and NRS (Numering Rating Scale). Method: This study uses observational design with an interview approach and a cross-sectional study. Areas covered are within Indonesia, which are marginal areas of Tangerang district border, and two rural areas in Serukam, West Kalimantan, and Soe, East Nusa Tenggara. Data collected will be analyzed using SPSS 25 software. Result: Populations within the suburban areas prefer NRS (52.08%) as their pain scale, and populations in rural areas prefer FPS-R 76.92%). Factors affecting pain scale preferences are location areas, as well as last education, with statistical significance of p<0.05. Discussion: Our study showed that the choice of several pain scales is not appropriate for specific demographics due to the complexity of these scales. Factors that should be considered are the location areas and education level, as some population in remote areas have better understanding of simpler pain scales. Conclusion: Complexity or simpler components may be an underlying reason for the preference of score selection to assess pain scales in some population. Therefore, the selection of pain scales should be adjusted to specific demographics so that clinicians can provide appropriate management with appropriate pain scales.
Article
Open Access January 04, 2025

Knowledge Level of Street Fruit Vendors on Food Hygiene in the Tamale Metropolis

Abstract This study aimed to assess the knowledge level of street food vendors on hygiene in the Tamale metropolis in the Northern Region of Ghana. The study employed the health belief model as the theoretical basis. Quantitatively, the study employed a descriptive cross-sectional study design to examine the microbial load of street-cut fruits and assess the knowledge and practice of vendors of cut fruits [...] Read more.
This study aimed to assess the knowledge level of street food vendors on hygiene in the Tamale metropolis in the Northern Region of Ghana. The study employed the health belief model as the theoretical basis. Quantitatively, the study employed a descriptive cross-sectional study design to examine the microbial load of street-cut fruits and assess the knowledge and practice of vendors of cut fruits on personal and food hygiene in the study setting. The population consists of cut and vented pawpaw, watermelon, and street fruit vendors registered with the health directorate in the Tamale Metropolis. A convenient sampling technique was used to select 113 respondents for the study. The Yamane formula was used to determine the sample size to select one hundred and thirteen participants (113) out of one hundred and fifty-eight street fruit vendors in the Tamale Metropolis. The main instrument for data collection was a questionnaire. A questionnaire had close-ended questions which were developed using a 'Yes' and 'No' response, and a four-point Likert-type scale ranging from 1=Strongly Disagree (SD), 2=Disagree (D), 3=Agree (A) and 4= Strongly Agree (SA). The data were analysed using descriptive statistics (frequency, percentages, means and standard deviation). The findings revealed that the overall knowledge level of respondents is low. The findings also indicate that vendors do not control the rate at which their customers touch their vended fruits. It is recommended that Street fruit vendors and handlers be educated on fruit hygiene practices through engagement by the Health Directorate Unit of Tamale Metropolis and the Ministry of Health. To keep consumers safe, the Tamale Metropolitan Assembly must strictly enforce compliance with regulations on operation permits and health clearance certificates. Metropolitan sanitation officers must regularly monitor fruit vendors to ensure compliance with goods.
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Open Access December 10, 2024

Psychological Corollaries, Self-Care and Coping Behaviors of Healthcare Workers During COVID-19 Pandemic: An Integrative Review

Abstract Background: The COVID-19 pandemic posed significant psychological challenges to frontline healthcare workers (HCWs), including anxiety, stress, and emotional strain. Aim: This study investigates the psychological impact on HCWs during the pandemic and explores coping strategies employed to manage distress. Methods: An integrative review was conducted using 24 studies published [...] Read more.
Background: The COVID-19 pandemic posed significant psychological challenges to frontline healthcare workers (HCWs), including anxiety, stress, and emotional strain. Aim: This study investigates the psychological impact on HCWs during the pandemic and explores coping strategies employed to manage distress. Methods: An integrative review was conducted using 24 studies published between January and December 2020. These studies were analyzed to identify common psychological outcomes and coping mechanisms among HCWs. Results: Healthcare workers experienced significant psychological distress during the COVID-19 pandemic, including anxiety, stress, insomnia, and depression. Anxiety was the most commonly reported issue, particularly among women, younger healthcare workers, and frontline staff. Stress levels were heightened by high workloads, exposure to COVID-19 patients, and inadequate protective measures. Coping strategies and self-care behaviors, such as seeking social support and utilizing institutional resources, varied in effectiveness across populations. Conclusion: The findings highlight the urgent need for targeted mental health support and resilience programs for HCWs, ensuring they are better equipped to face future health crises.
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Integrative 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 October 07, 2023

A Systematic Review of Observational Studies Focusing on Impact of Telehealth Consultation in Osteoporosis Management during the Pandemic

Abstract Background: The COVID-19 pandemic disrupted routine osteoporosis care due to clinic closures and limited in-person consultations. Telehealth emerged as an alternative model enabling remote care delivery and monitoring. However, previous reviews on telehealth either did not include the pandemic period or had a limited focus in scope. Evidence synthesized specifically for osteoporosis care [...] Read more.
Background: The COVID-19 pandemic disrupted routine osteoporosis care due to clinic closures and limited in-person consultations. Telehealth emerged as an alternative model enabling remote care delivery and monitoring. However, previous reviews on telehealth either did not include the pandemic period or had a limited focus in scope. Evidence synthesized specifically for osteoporosis care during the pandemic is needed but lacking. Methods: We systematically searched PubMed, MEDLINE, EMBASE, PsycINFO, Web of Science, and CINAHL for studies on telehealth for osteoporosis published between January 2021 and March 2023. Five studies met the inclusion criteria of: osteoporosis population, telehealth intervention, and COVID-19 pandemic timeframe. Data was extracted on study characteristics, COVID-19 outcomes, osteoporosis status, telehealth purpose, patient satisfaction, and clinical outcomes. Result: The five studies showed telehealth was used for monitoring data, delivering test results, adjusting medications, and assessments. Osteoporosis prevalence among telehealth users ranged 30-100%. High patient satisfaction was reported with telehealth versus in-person care. No major differences occurred in medication delays or fractures between telehealth and in-person groups. Conclusion: This review found telehealth enables effective osteoporosis care and monitoring during the pandemic, with high patient and provider satisfaction. However, more robust randomized controlled trials are needed to establish stronger evidence around telehealth's impacts on clinical osteoporosis outcomes. Implications: Though promising, further high-quality studies will help clarify telehealth's role in improving osteoporosis care and outcomes. Findings inform guidelines on integrating telehealth into routine management. Evidence on user perspectives optimizes telehealth implementation policies.
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Systematic Review
Open Access September 20, 2023

Group-specific Differences in Blood Lead Levels among Occupationally Exposed Workers in Greater Banjul Area, The Gambia

Abstract Occupational lead (Pb) exposure continues to be an important public health problem globally, yet data is lacking on the associated risks and resources available for the prevention of Pb related diseases in low middle income countries (LMICs) like The Gambia. In this study, we used a case-control design to compare blood lead levels (BLLs) between the exposed (auto repair workers) and unexposed [...] Read more.
Occupational lead (Pb) exposure continues to be an important public health problem globally, yet data is lacking on the associated risks and resources available for the prevention of Pb related diseases in low middle income countries (LMICs) like The Gambia. In this study, we used a case-control design to compare blood lead levels (BLLs) between the exposed (auto repair workers) and unexposed (healthcare workers) populations in The Greater Banjul Area. The data was analyzed using Chi square test of independence to determine the characteristic factors associated with BLL. Multivariate logistic regression was used to test the relationship between BLLs for auto repair and healthcare workers and their experiences. The results of this study indicated 82.1% of cases had higher BLLs compared to 52.9% of controls. Also, the proportion of workers with elevated BLLs was higher for certain factors including more than 80% of those with greater than 10 of years job experience, more than 70% of those who worked greater than 5 days a week, worked more than 8 hours per day, did not use personal protective equipment (PPE), were illiterate or had no formal education, and smoked or ate at work. The study results have implications for policies and practice in the auto repair industry and related workplaces in The Gambia and other LMICs with similar settings. Based on the findings of this study, it is essential to initiate discussions to establish national occupational health policies in The Gambia aimed at protecting workers and the general population.
Article
Open Access September 17, 2023

Knowledge and practice of diabetic foot prevention among diabetic patients attending Edward Francis Small Teaching Hospital, Banjul, The Gambia: an institutional-based cross-sectional study

Abstract Background: The increasing prevalence of Diabetes Mellitus (DM) is closely tied to complications, particularly diabetic foot ulcers, which significantly raise the risk of lower extremity amputations due to infected, non-healing ulcers. This study aimed to assess diabetic foot prevention knowledge, practices and associated factors among patients at the Edward Francis Small Teaching Hospital [...] Read more.
Background: The increasing prevalence of Diabetes Mellitus (DM) is closely tied to complications, particularly diabetic foot ulcers, which significantly raise the risk of lower extremity amputations due to infected, non-healing ulcers. This study aimed to assess diabetic foot prevention knowledge, practices and associated factors among patients at the Edward Francis Small Teaching Hospital (EFSTH), Banjul. Methods: In this cross-sectional study, we employed a convenience sampling technique to enroll 357 diabetic patients, both inpatients and outpatients, who were under the care of EFSTH. Data on diabetic foot prevention were collected through semi-structured interviews conducted by trained interviewers. Statistical analyses were carried out using SPSS, encompassing descriptive analysis, chi-square, Fisher exact tests, and logistic regression. Statistical significance was set at p<0.05, with a 95% confidence interval. Results: The mean age of the respondents was 47.3 years (±10.5), with women comprising 55.2% of the study population and 94.4% were married. About 73% demonstrated good knowledge of diabetic foot care and prevention, while 25.8% exhibited fair knowledge. A significant association was observed in bivariate analysis with patients’ educational level (P = 0.032). Specifically, patients with Madarasa (Arabic) education had a 68% lower likelihood 【aOR: 0.320, 95% CI: (0.103, 0.992), p = 0.048】 of practicing diabetic foot care and prevention compared to those with tertiary education. Conclusion: The study revealed that participants’ knowledge of preventing diabetic foot was high. However, the practice was poor. Therefore, there is a need for more health education on the practices that would emphasize diabetes management among diabetes patients.
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Article
Open Access March 27, 2023

Exploration and Practice of Health Communication in Hospital Under the Background of the Healthy China Initiative

Abstract Along with the increasing quality of human life, people pay more attention to healthcare. Public health and one's health have become daily issues. As a branch of communication, more and more scholars pay attention to health communication studies. Supported by the Healthy China Initiative, health communication study has ushered in a new development opportunity. This paper elaborates on the specific [...] Read more.
Along with the increasing quality of human life, people pay more attention to healthcare. Public health and one's health have become daily issues. As a branch of communication, more and more scholars pay attention to health communication studies. Supported by the Healthy China Initiative, health communication study has ushered in a new development opportunity. This paper elaborates on the specific practices of health communication in a provincial hospital from three dimensions: (1) how to empower communication with the Healthy China Initiative; (2) the effects of health communication; (3) health communication strategy analysis.
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Commentary
Open Access March 16, 2023

The Black-Scholes Exotic Barrier Option Pricing Formula

Abstract The paper considers a specific type of such financial instrument as an option, namely an exotic barrier call option of the European type. Exotic options are gaining popularity among ordinary investors due to the development of information and telecommunication technologies, thanks to which such specific financial instruments as options have become readily available. We investigate the hedging [...] Read more.
The paper considers a specific type of such financial instrument as an option, namely an exotic barrier call option of the European type. Exotic options are gaining popularity among ordinary investors due to the development of information and telecommunication technologies, thanks to which such specific financial instruments as options have become readily available. We investigate the hedging problem for such options with some restrictions on the payment function and the availability of dividend payment on a risky asset in the classical Black-Scholes model. An analogue of the Black-Scholes formula for the mentioned variant of the exotic barrier is proved. In the future, it is planned to generalize the obtained results for put options and for more general payment functions.
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 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 September 29, 2022

Anthyllis hermanniae L. subsp. brutia Brullo & Giusso (Fabaceae): population survey and conservation tasks

Abstract Anthyllis hermanniae subsp. brutia, is an Italian endemic shrub occurring just in one locality by the Calabrian Ionian coast in southern Italy. Objective of this study is to provide data on population numbers, demography and ecology, as well as to identify the main threats on the long term conservation of the target taxon. The survey has been carried out through field census work, sampling biometric and dendrometric data, and applying simple statistics. The population, counting totally 962 individuals, is divided in two stands concentrated in the central part of the distribution area. It is restricted to a narrow belt on the inland part of the dune slope encompassed between an artificial pine forest at the dune top, and the dune-specialized vegetation on the slope. Some biometric insights, such as stem diameter, plant height and number of annual rings, suggest the role of micro-ecology in individual shaping. The most relevant threating factor for the long term conservation of this rare taxon is the rapidly spreading Pinus halepensis subsp. halepensis. Local population of this invasive alien species, deriving from planted individuals, is now invading the A. hermanniae subsp. brutia [...] Read more.
Anthyllis hermanniae subsp. brutia, is an Italian endemic shrub occurring just in one locality by the Calabrian Ionian coast in southern Italy. Objective of this study is to provide data on population numbers, demography and ecology, as well as to identify the main threats on the long term conservation of the target taxon. The survey has been carried out through field census work, sampling biometric and dendrometric data, and applying simple statistics. The population, counting totally 962 individuals, is divided in two stands concentrated in the central part of the distribution area. It is restricted to a narrow belt on the inland part of the dune slope encompassed between an artificial pine forest at the dune top, and the dune-specialized vegetation on the slope. Some biometric insights, such as stem diameter, plant height and number of annual rings, suggest the role of micro-ecology in individual shaping. The most relevant threating factor for the long term conservation of this rare taxon is the rapidly spreading Pinus halepensis subsp. halepensis. Local population of this invasive alien species, deriving from planted individuals, is now invading the A. hermanniae subsp. brutia habitat. Chorological and ecological data here provided should hopefully steer further population dynamics investigation as well as any urgent environment management actions.
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Open Access June 23, 2022

Priority tree and shrubs for use in Landscape Architecture based on the dynamic states of native vegetation with the highest ecological value in mainland Portugal

Abstract The reduction of the native forests coverage in mainland Portugal increased in the past centuries, leading to a marked decrease in biodiversity in general, especially on typical species of mature forest environments. However, urban biodiversity seems to resist more effectively than rural to disturbances due to the lower incidence of fires, as well as to agriculture expansion. Thus, in this work, [...] Read more.
The reduction of the native forests coverage in mainland Portugal increased in the past centuries, leading to a marked decrease in biodiversity in general, especially on typical species of mature forest environments. However, urban biodiversity seems to resist more effectively than rural to disturbances due to the lower incidence of fires, as well as to agriculture expansion. Thus, in this work, we analyzed the dynamics of the natural vegetation potential in each biogeographic sector, and selected, based on the evolutionary stages of the vegetation, a set of priority taxa for conservation. The criteria used are intended to highlight plants with ornamental value, but at the same time, some of them have high patrimonial value, belonging to the Red List of Vascular Flora of Mainland Portugal or protected by Annexes II, IV and V of the Sectorial Plan of the Natura 2000 Network at the European level. Our analysis resulted in the identification of 62 plants that can be increased in public spaces in order to improve their conservation status. For each biogeographic sector, the plants best adapted to the local edaphoclimatic conditions are presented. Forest habitats can now, through micro-reserves in urban areas, ensure their long-term conservation and greater awareness among the population. An integrated planning, where the socio-ecological strategy is designed for the long term, will benefit the quality of life of citizens in an urban environment. Furthermore, the creation of micro-reserves in urban parks (gardens) can prevent the extinction of many botanical values in the landscapes of the western Mediterranean Basin.
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Open Access March 01, 2022

Nicotinic agonists promoted the activation of nicotinic acetylcholine α7 receptors (α7 nAChR) in neurons, but failed to activate these receptors in mouse peritoneal macrophages

Abstract Nicotinic acetylcholine receptor (nAChR) of subtypes said "neuronal" are expressed in epithelial and immune system cells and participate in acetylcholine signaling by neural or non-neural pathways. It has been shown in macrophages that activation of type α7 nAChRs inhibits the release of pro-inflammatory cytokines, but the ion channel function has not been recorded in these cells. The objective of [...] Read more.
Nicotinic acetylcholine receptor (nAChR) of subtypes said "neuronal" are expressed in epithelial and immune system cells and participate in acetylcholine signaling by neural or non-neural pathways. It has been shown in macrophages that activation of type α7 nAChRs inhibits the release of pro-inflammatory cytokines, but the ion channel function has not been recorded in these cells. The objective of this work was to clarify what are the molecular mechanisms of transduction of α7 nAChRs in macrophages. To this end, RAW 264.7 cells, mouse peritoneal macrophages and rat hippocampal neurons were used. Cells were submitted to electrophysiological studies and stimulated with brief applications of the agonists acetylcholine, choline and nicotine, associated or not with the allosteric modulator PNU-120596. Responses to ATP were recorded as a reference. Furthermore, macrophages were submitted to cytokine quantitation. The electrophysiological results showed that macrophages responded to ATP but did not show whole-cell current by stimulation with nicotinic agonists. However, hippocampal neurons stimulated in the same pharmacological conditions of the macrophages showed ionic currents typical of the α7 nicotinic receptors. No effect of nicotine was observed in the lipopolysaccharide-induced TNF-α release. These results suggest that the α7 nAChR in macrophages do not work as ion channels similar to those expressed in neurons.
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Open Access August 21, 2021

Global Analysis of Potential COVID 19 Transmission and Enabling Factors

Abstract Background: Coronavirus disease has caused global turmoil especially causing huge impact on human life all over the world. Current reports states more than 3 million people have lost life and more than 160 million people are known to be suspected with the SARS-CoV-2. Transmission and disease incidence rates are indicators to assess the seriousness of COVID-19 pandemic and studies to understand the factors that aid in this direction are very vital to curb the disease. Methods: The study intends to discover the relationship by performing statistical analysis using correlation and multiple linear regression analysis between the variable’s population density, temperature, relative humidity, and active time of virus and find out the parameters that predict the cases reported per million population in 83 countries. Results: Analysis indicates active time of virus in days is very positively associated with the COVID -19 cases in all the countries r = .604, p < .01. Active time of virus shows strong negative correlation with temperature r = -.930, p [...] Read more.
Background: Coronavirus disease has caused global turmoil especially causing huge impact on human life all over the world. Current reports states more than 3 million people have lost life and more than 160 million people are known to be suspected with the SARS-CoV-2. Transmission and disease incidence rates are indicators to assess the seriousness of COVID-19 pandemic and studies to understand the factors that aid in this direction are very vital to curb the disease. Methods: The study intends to discover the relationship by performing statistical analysis using correlation and multiple linear regression analysis between the variable’s population density, temperature, relative humidity, and active time of virus and find out the parameters that predict the cases reported per million population in 83 countries. Results: Analysis indicates active time of virus in days is very positively associated with the COVID -19 cases in all the countries r = .604, p < .01. Active time of virus shows strong negative correlation with temperature r = -.930, p < .01 revealing that rise in temperature will reduce the virus activity in the population. Together, these variables will account for 36.2% variance in the cases per million population with no significant prediction estimated from any factor. Conclusion: The study outcomes clearly state that population density alone is insufficient to estimate the extent of influence on COVID -19 cases as the number of persons living per sq. km of land is a dynamic quantity tend to fluctuate over time and space due to migration of population. In conjunction to the previous studies reported on the environmental and climatic factors influencing the cases reported, population dynamics does not show much significance on the disease spread and incidence. Contribution: The rise in confirmed cases and the high incidence rate reported in countries can be attributed to the active time of virus life expectancy as there is a positive correlation observed between the COVID-19 cases reported and the virus active time in the examined countries. Also, environment and climatic factors play a role in modulating the infection and transmission rate with less significant influence of population density on the COVID-19.
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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 June 08, 2021

The Influence of Emotional Intelligence on Leadership Style at Integrated Service Unit (UPT) Regional Revenue Management in Pematangsiantar

Abstract The purpose of this research is: 1. To determine the description of emotional intelligent and leadership style in the Integrated Service Unit (UPT) Regional Revenue Management in Pematangsiantar. 2. To determine the influence of emotional intelligent to leadeship style in the Integrated Service Unit (UPT) Regional Revenue Management in Pematangsiantar. The research uses literature research design [...] Read more.
The purpose of this research is: 1. To determine the description of emotional intelligent and leadership style in the Integrated Service Unit (UPT) Regional Revenue Management in Pematangsiantar. 2. To determine the influence of emotional intelligent to leadeship style in the Integrated Service Unit (UPT) Regional Revenue Management in Pematangsiantar. The research uses literature research design and field research. The population in this study were all administrative employee at in the Integrated Service Unit (UPT) Regional Revenue Management in Pematangsiantar, emounted to 42 employees. The type of data used are qualitative data and quantitative data. Sources of data used are primary and secondary. The data were collected through questionnaries, interviews and documentation. Test of instrument used with validity test and reliability test. The analysis technique used are normality test, qualitative descriptive analysis and quantitative descriptive analysis. The result of this study can be summarized as follows: 1. Emotional intelligent and leadership style are good. 2. Emotional intelligent have positive effect on leadership style. 3. Emotional intelligent heve moderately corelation with leadership style then the level of leadership style can be explained by emotional intelligent. 4. H0 is rejected, meaning that emotional intelligent has positive and significantly to leadership style. The suggestions of this research are: 1. To make leadership style, the leaders should be provided opportunities for employee to be more independently in making decisions both individually or in grups. 2. To enhance emotional intelligent, the leaders should record data of employee to know their skill, knowledge or work experience
Article
Open Access February 16, 2026

Tuberculosis among elderly patients: diagnostic and therapeutic challenges (2020-2024)

Abstract Background: Tuberculosis (TB) in the elderly poses significant diagnostic and therapeutic challenges due to immunosenescence, comorbidities, and atypical clinical presentation. This study evaluates the epidemiological and clinical characteristics of TB in patients aged ≥65 years. Methods: A retrospective descriptive study was conducted including all TB cases reported between 2020 and [...] Read more.
Background: Tuberculosis (TB) in the elderly poses significant diagnostic and therapeutic challenges due to immunosenescence, comorbidities, and atypical clinical presentation. This study evaluates the epidemiological and clinical characteristics of TB in patients aged ≥65 years. Methods: A retrospective descriptive study was conducted including all TB cases reported between 2020 and 2024. Data from the National Tuberculosis Program were analyzed for demographic characteristics, clinical form, bacteriological confirmation, comorbidities, and treatment outcomes. Results: Of 1,335 TB cases, 352 (26.4%) occurred in individuals aged ≥65 years. Pulmonary TB accounted for 80.7% of cases. Men represented 63.4% of patients, and 56.8% lived in urban areas. Bacteriological confirmation was achieved in 82% of pulmonary cases, and treatment success exceeded 85%. Diabetes mellitus (26.5%) and arterial hypertension (31%) were the most common comorbidities. An increase in TB cases was observed in the post-COVID-19 period. A significant association was found between age and clinical form of TB (p < 0.001). Conclusions: Elderly individuals constitute a substantial proportion of TB cases and frequently present with chronic comorbidities. Despite diagnostic challenges, favorable treatment outcomes were achieved, highlighting the need for integrated and early management strategies in this population.
Brief Report
Open Access December 30, 2025

Elimination of HIV Transmission Risks through Viral Suppression: Undetectable=Untransmittable and its Impact among People Living with HIV

Abstract The principle of Undetectable = Untransmittable (U=U) posits that people living with the human immunodeficiency virus (HIV) who are able to achieve and maintain a viral load of <200 copies/mL by regularly taking antiretroviral drugs (ARVs) are considered virally suppressed and cannot transmit the HIV virus to other individuals through sex. This groundbreaking message has emerged as a key HIV [...] Read more.
The principle of Undetectable = Untransmittable (U=U) posits that people living with the human immunodeficiency virus (HIV) who are able to achieve and maintain a viral load of <200 copies/mL by regularly taking antiretroviral drugs (ARVs) are considered virally suppressed and cannot transmit the HIV virus to other individuals through sex. This groundbreaking message has emerged as a key HIV prevention strategy for eliminating transmission risks and enhancing the quality of life of people living with HIV. This narrative review explores the clinical foundation of U=U, the level of awareness and acceptance of the message globally, and the psychosocial impact on people living with HIV. It has been discovered that this message minimizes stigma, improves mental health, promote treatment adherence and good disclosure behaviors among people living with HIV. Evidence has shown that despite the U=U revolution for HIV prevention, there are significant differences in awareness and acceptance of the message among different population groups. The challenges noted were poor communication by healthcare providers, limitations in the health system, and stigma issues. Nevertheless, the inclusion of U=U in mainstream HIV services has proven to increase awareness and enhance its adoption. The urgent need in the present review is to advocate for strategies to increase the equitable distribution of U=U to harness its full potential in public health.
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Review Article
Open Access November 06, 2025

Ventral Attention Network Resting State Functional Connectivity: Psychosocial Correlates among US Adolescents

Abstract Background: Resting-state functional MRI (rsfMRI) provides insights into large-scale brain network organization associated with cognitive control, emotion regulation, and attentional processes. The ventral attention network (VAN) is a key salience-driven network that supports attentional re-orienting to behaviorally relevant stimuli. However, little is known about how VAN [...] Read more.
Background: Resting-state functional MRI (rsfMRI) provides insights into large-scale brain network organization associated with cognitive control, emotion regulation, and attentional processes. The ventral attention network (VAN) is a key salience-driven network that supports attentional re-orienting to behaviorally relevant stimuli. However, little is known about how VAN resting state functional connectivity varies by demographic, socioeconomic, psychosocial, and behavioral factors during early adolescence. Objective: To examine associations between VAN rsfMRI connectivity and multiple demographic, socioeconomic, psychosocial, and behavioral characteristics. Methods: Data came from the baseline and early follow-up waves of the Adolescent Brain Cognitive Development (ABCD) Study. The analytic sample included youth with high-quality baseline rsfMRI data and complete socioeconomic and psychosocial measures. The primary outcome was mean resting-state functional connectivity within the VAN across subcortical and cortical regions of interest (ROIs). Bivariate correlations were computed between VAN connectivity and demographic (age, sex, puberty, race/ethnicity), socioeconomic (income, parental education, marital status, neighborhood income), psychosocial (trauma, discrimination, financial difficulty), trait (impulsivity), and behavioral variables (body mass index, depression, suicide, prodromal symptoms, and substance use). Unadjusted bivariate correlations and adjusted logistic regressions were used for data analysis. Results: VAN connectivity showed small but significant correlations with multiple contextual factors. Higher household income, parental education, and neighborhood affluence were associated with greater connectivity, whereas Black race and Hispanic ethnicity were related to lower connectivity. Youth reporting higher discrimination and financial difficulty exhibited weaker VAN connectivity. Greater VAN connectivity was negatively associated with impulsive reward-driven trait (drive), prodromal symptoms, BMI, and marijuana and alcohol use. Associations between VAN connectivity and suicide, depression, marijuana use, and alcohol use remained significant in age and sex adjusted models. Conclusions: VAN connectivity reflects subtle neural correlates of socioeconomic and psychosocial context in early adolescence. Our results underscore the importance of integrating structural and contextual factors in interpreting brain-behavior associations across diverse populations. These findings are suggestive of stable socioeconomic and psychosocial correlates of network efficiency.
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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Open Access October 17, 2025

Street Foods in Urban Spaces: Analyzing the Determinants of Consumer Patronage in the Koforidua Metropolis

Abstract Eating at home remains very much ingrained in Ghanaian culture but rapid urbanization coupled with busy lifestyle and advancement in technology has greatly changed the way of life of many Ghanaians. These changes have altered the tradition of cooking and eating at home. The study focused on the determinants of consumer patronage of street foods in the Koforidua Metropolis. The target population [...] Read more.
Eating at home remains very much ingrained in Ghanaian culture but rapid urbanization coupled with busy lifestyle and advancement in technology has greatly changed the way of life of many Ghanaians. These changes have altered the tradition of cooking and eating at home. The study focused on the determinants of consumer patronage of street foods in the Koforidua Metropolis. The target population comprised customers that patronize the street foods in Koforidua Metropolis. From the target population, 197 consumers were selected using convenience. A structured self-administered questionnaire was utilized to gather the required data. The data collected were coded and analyzed with the help of SPSS-23. The findings revealed that food characteristics and social status determines consumers patronage of street food. It became evident that age (r=0.261, p<0.01), age (r=-0.318, P<0.01), educational level (r=0.144, P<0.05) and occupation (r=-0.477, P<0.01) of consumers has a significant influence on the decision and patronage of street food. The study concluded that food characteristics and social factors are major determinants of consumers patronage of street foods. It is recommended that Food and Drug Authority (FDA), other stakeholders, and street food vendors work cooperatively to establish laws that capture the distinctive and diverse foods sold on the street and their various preparation, storage, and sale methods in order to ensure that food preparation and sales are safe and hygienic.
Article
Open Access October 04, 2025

Unequal Burden of Loss of a Loved One in Non-Hispanic Black and White Californians

Abstract Purpose: Although the effect of loss of a loved one on depression is well established, very limited knowledge exists on racial differences in this effect. Aim: In the current study we compared Non-Hispanic White (NHW) and Non-Hispanic Black (NHB) Californians for the effects of loss of a loved one on depression in a representative sample of adults in California. Methods: This cross-sectional study used data from the Survey of California Adults on Serious Illness and End-of-Life 2019. Overall, 1603 people entered our study. We compared 901 (56.2%) NHB and 702 (43.8%) NHW adults (age 18 and older). Race/ethnicity, demographics (age and gender), socio-economic factors (education, income, employment, and marital status), religiosity, and health (self-rated health and number of chronic medical conditions), and depression were measured. To perform data analysis, we used logistic regression models. Results: In the pooled sample, loss of a loved one was not associated with self-reported depression, net of all covariates. Race, however, interacted with loss of a loved one on depression, suggesting a larger association for NHBs compared to NHWs. In race-specific models, loss of a loved one predicted depression for NHBs (OR = 1.54) but not NHWs (OR [...] Read more.
Purpose: Although the effect of loss of a loved one on depression is well established, very limited knowledge exists on racial differences in this effect. Aim: In the current study we compared Non-Hispanic White (NHW) and Non-Hispanic Black (NHB) Californians for the effects of loss of a loved one on depression in a representative sample of adults in California. Methods: This cross-sectional study used data from the Survey of California Adults on Serious Illness and End-of-Life 2019. Overall, 1603 people entered our study. We compared 901 (56.2%) NHB and 702 (43.8%) NHW adults (age 18 and older). Race/ethnicity, demographics (age and gender), socio-economic factors (education, income, employment, and marital status), religiosity, and health (self-rated health and number of chronic medical conditions), and depression were measured. To perform data analysis, we used logistic regression models. Results: In the pooled sample, loss of a loved one was not associated with self-reported depression, net of all covariates. Race, however, interacted with loss of a loved one on depression, suggesting a larger association for NHBs compared to NHWs. In race-specific models, loss of a loved one predicted depression for NHBs (OR = 1.54) but not NHWs (OR = 0.99). Conclusion: There are differences between NHBs and NHWs in the effect of loss of a loved one on depression. NHBs show a stronger association between loss of a loved one and depression than NHWs. This result is not in line with the NHB mental health paradox or with NHB resilience but is consistent with the notion that social relations may be more salient for NHBs than for NHWs.
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 07, 2025

Beyond the Brain: Exploring the Future of Neural Technology with Neuralink

Abstract This paper is a general summary of Neuralink, a revolutionary technology set to elevate human life and neurology. Neuralink itself is a key testimonial to the evolution of neuroscience and even brain-computer interfaces, otherwise known as BCI. The original few BCI experiments were conducted on monkeys in the 1960s and 70s, in which the experiment itself narrowed down and understood brain function [...] Read more.
This paper is a general summary of Neuralink, a revolutionary technology set to elevate human life and neurology. Neuralink itself is a key testimonial to the evolution of neuroscience and even brain-computer interfaces, otherwise known as BCI. The original few BCI experiments were conducted on monkeys in the 1960s and 70s, in which the experiment itself narrowed down and understood brain function as a general concept [3]. More specifically, "Work on these technologies began in the early 1970s, led by computer science professor J.J. Vidal at UCLA" [12]. Science itself progresses day by day, growing rapidly in recent years, especially in neuroscience, something highlighted as a focal point in the previous statement. Moreover, recently we have seen technology go on a rampant rise in terms of popularity, inventions, and changes to the human lifestyle. The interactions humans had with technology initially developed with wearables or wearable technology, such as Apple Watches, AirPods, and Fitbits, and now they have even prompted advancements in brain-computer interfaces. Technology has had the power to advance science, but now it’s capable of changing the human mind. Going back to Neuralink, it’s a startup that began its initiative in 2016 and was approved by the FDA for clinical trials in May of 2023, ready to create a wave of change in the field of neuroscience [6]. The foremost baffling thing is how this chip plans on being placed in the somatosensory system. The somatosensory system is a part of the brain that deals with motor actions, recognition, and perception, and applying Neuralink in this area should supposedly allow for cures and treatment of amyotrophic lateral sclerosis, Parkinson’s disease, spinal cord injuries, epilepsy, autism, depression, schizophrenia, and possibly blindness [9]. Neuralink is deemed to lead to a life-changing future, and with co-founders and investors like Elon Musk, there is a lot to know about this piece of technology.
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Review Article
Open Access August 22, 2025

Status Epilepticus in Sub-Saharan Africa: A Literature Review on Epidemiological Challenges, Socio-Cultural Barriers, and Public Health Impact

Abstract This literature review delves deeply into the epidemiology, structural and cultural challenges, and management strategies of status epilepticus (SE) in sub-Saharan Africa (SSA). Incidence rates of SE vary significantly between countries, with notable disparities associated with socio-economic contexts, healthcare infrastructures, and cultural perceptions of epilepsy. The management of SE in this [...] Read more.
This literature review delves deeply into the epidemiology, structural and cultural challenges, and management strategies of status epilepticus (SE) in sub-Saharan Africa (SSA). Incidence rates of SE vary significantly between countries, with notable disparities associated with socio-economic contexts, healthcare infrastructures, and cultural perceptions of epilepsy. The management of SE in this region is often hindered by constraints in medical infrastructure, inadequate access to specialist diagnostics such as electroencephalogram, and limited availability of essential anti-epileptic drugs, which are frequently out of reach for rural populations. These challenges are further exacerbated by the social stigma and cultural beliefs surrounding epilepsy, impeding access to care and widening inequalities. Moreover, the scarcity of qualified medical personnel undermines the efficient and prompt management of this neurological emergency. The review underscores the pressing need to enhance healthcare infrastructures, boost the capabilities of healthcare professionals, and conduct community awareness initiatives to destigmatize epilepsy and lessen prejudice. Additionally, practical recommendations are put forward for enhancing local capacity, fostering equity in care access, and mitigating regional health disparities in SSA.
Literature Review
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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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 05, 2025

To Be Twice as Good to Get Half

Abstract “To Be Twice as Good to Get Half” is a common mindset among high aspiration and ambition Black individuals in the U.S., capturing the lived reality of Minorities’ Diminished Returns (MDRs). This paper explains that MDRs reflect how, even with high levels of ambition, self-efficacy, education, and income, Black individuals and other marginalized groups do not experience the same protective benefits [...] Read more.
“To Be Twice as Good to Get Half” is a common mindset among high aspiration and ambition Black individuals in the U.S., capturing the lived reality of Minorities’ Diminished Returns (MDRs). This paper explains that MDRs reflect how, even with high levels of ambition, self-efficacy, education, and income, Black individuals and other marginalized groups do not experience the same protective benefits for health and well-being as White populations. Systemic obstacles embedded within U.S. society weaken the expected returns on socioeconomic achievements for racialized individuals, creating a reality where “being twice as good” still results in lesser outcomes. High-SES Black individuals, for instance, continue to face significant risks for adverse outcomes, such as depression and chronic disease, due to structural inequities across domains like labor market discrimination, segregation, and accumulated disadvantage from childhood. Our analysis identifies key mechanisms—including interpersonal discrimination, lower-quality education, and structural racism in sectors like banking, policing, and real estate—that erode the protective effects of SES across racial lines. Mediating factors, such as chronic stress, allostatic load, and epigenetic changes over the life course, further compound these diminished returns, weakening the expected physical and mental health benefits. Drawing on extensive evidence from U.S. national and local datasets and corroborated by international studies, this paper underscores the necessity of policies that dismantle structural barriers rather than relying solely on SES improvements. Recommendations include implementing multi-sectoral policies, recognizing the unique challenges of middle-class non-White populations, and approaching policy with humility, acknowledging that achieving equity is a long-term endeavor. By challenging the “bootstraps” narrative, this paper advocates for structural interventions aimed at genuine health and economic equity for all racial and socioeconomic groups. While we provide an in-depth analysis of MDRs’ phenomena, mechanisms, mediators, and policy implications, the experience is often distilled as, “I have to be twice as good to get half.”
Article
Open Access April 09, 2025

Color of Poverty Matters: Socioeconomic Resources and Health of Mothers Giving Birth to Children into Poverty

Abstract Background: Childhood poverty is a critical determinant of developmental, health, and behavioral outcomes. However, racial and ethnic differences in how families experience and navigate poverty suggest that a one-size-fits-all approach may not be an effective approach for alleviating disparities. Understanding baseline demographic, socioeconomic, health, and behavioral characteristics among [...] Read more.
Background: Childhood poverty is a critical determinant of developmental, health, and behavioral outcomes. However, racial and ethnic differences in how families experience and navigate poverty suggest that a one-size-fits-all approach may not be an effective approach for alleviating disparities. Understanding baseline demographic, socioeconomic, health, and behavioral characteristics among families in poverty is crucial to designing equitable interventions. Objective: To examine racial and ethnic differences in baseline demographic, socioeconomic, health, and behavioral characteristics among families living in poverty, using data from the Baby's First Years (BFY:2018-2019) Study. Methods: This analysis used baseline data from the BFY study, a randomized controlled trial (RCT) designed to evaluate the effects of monthly cash assistance on children’s developmental outcomes. The sample included 1,050 children and their families, consisting of mothers and, when available, fathers. Descriptive analyses were conducted to compare demographic, socioeconomic, health, and behavioral outcomes across racial and ethnic groups, focusing on Black, Hispanic, and other mothers. Results: Significant racial and ethnic differences were observed. Regarding demographic factors, Hispanic mothers were older than White mothers. In terms of socioeconomic factors, Hispanic mothers had fewer years of education compared to White mothers, while Black mothers were more likely to receive food stamps than mothers from other groups. Regarding health and behaviors, Black mothers reported worse self-rated health but were less likely to plan for breastfeeding compared to White mothers. In contrast, Hispanic mothers reported lower levels of depression and were more likely to plan for breastfeeding. Conclusion: These findings highlight the heterogeneity of experiences among families living in poverty, with significant differences across racial and ethnic groups. Such disparities underscore the importance of tailoring anti-poverty policies to the unique needs of diverse populations. Future research should explore how the effects of interventions, such as cash assistance or guaranteed income, may differ across racial and ethnic groups to inform equitable and effective policy development.
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Open Access March 22, 2025

I Am My Peers: How Social Ties Influence E-Cigarette Attitudes, Policy Support, and Use

Abstract Background: Electronic cigarette (e-cigarette) use is increasingly prevalent among youth and young adults, particularly college and university students. This is a population for whom e-cigarette use is not recommended due to potential health risks, including nicotine addiction and long-term respiratory effects. Social networks play a crucial role in shaping attitudes toward [...] Read more.
Background: Electronic cigarette (e-cigarette) use is increasingly prevalent among youth and young adults, particularly college and university students. This is a population for whom e-cigarette use is not recommended due to potential health risks, including nicotine addiction and long-term respiratory effects. Social networks play a crucial role in shaping attitudes toward e-cigarettes and influencing use behaviors. However, the relative influence of different social ties—parents, siblings, and friends—on e-cigarette attitudes and use remains unclear. Objective: This study utilizes data from the SMOKES study to compare the influence of e-cigarette use within different social network sections—parents, friends, and siblings—on personal e-cigarette attitudes and use among college and university students. Methods: Using a cross-sectional survey of college and university students, we examined the associations between e-cigarette use within different social networks and individual e-cigarette attitudes and use. Multivariate regression models assessed the strength of these associations, adjusting for key demographic and behavioral covariates. Results: Findings indicate that among college and university students, the strongest influence on both e-cigarette attitudes and use comes from friends who use e-cigarettes. In contrast, parental and sibling e-cigarette use showed weak or non-significant effects. These results suggest that peer influence, rather than family influence, plays a dominant role in shaping e-cigarette-related behaviors and perceptions in young adults. Conclusion: This study underscores the importance of peer influence in e-cigarette uptake and attitudes among college and university students. Public health interventions aimed at reducing e-cigarette use in this population should consider targeting peer networks rather than focusing solely on family-based influences.
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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 09, 2025

Hippocampus Functional Connectivity, Impulsivity, and Subsequent Substance Use

Abstract Background: The hippocampus plays a critical role in memory and decision-making processes, with its resting-state functional connectivity (rsFC) linked to various behavioral outcomes. This study investigates whether baseline brain-wide rsFC of the hippocampus mediates the relationship between impulsivity and subsequent substance use, specifically tobacco and marijuana use, in adolescents. [...] Read more.
Background: The hippocampus plays a critical role in memory and decision-making processes, with its resting-state functional connectivity (rsFC) linked to various behavioral outcomes. This study investigates whether baseline brain-wide rsFC of the hippocampus mediates the relationship between impulsivity and subsequent substance use, specifically tobacco and marijuana use, in adolescents. Methods: Data were drawn from the baseline wave of the Adolescent Brain Cognitive Development (ABCD) study. Resting-state fMRI data were used to evaluate the functional connectivity of the hippocampus with key brain networks, including the cingulo-parietal network, visual network, sensory-motor network, and default mode network (DMN). Impulsivity was assessed using validated self-report measures, and substance use (tobacco and marijuana) was evaluated at follow-up. Mediation models were conducted to examine the extent to which hippocampal rsFC explains the association between impulsivity and substance use. Results: Baseline hippocampal rsFC with the cingulo-parietal network, visual network, sensory-motor network, and DMN showed marginal associations with future tobacco and marijuana use. Additionally, hippocampal rsFC was significantly associated with impulsivity, which, in turn, predicted higher substance use at follow-up. These findings suggest that hippocampal rsFC partially mediates the relationship between impulsivity and substance use behaviors. Conclusions: Hippocampal functional connectivity with brain networks may influence the pathway from impulsivity to future substance use in adolescence. These findings emphasize the importance of hippocampal connectivity in understanding the neural mechanisms underlying risk behaviors and may inform the development of targeted interventions to reduce substance use in this vulnerable population.
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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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Open Access February 27, 2025

Hopelessness and Smoking among Black Adults

Abstract Background: While the link between depression and smoking is known, less is known about the relationship between hopelessness and smoking in large national community-based sample of Black people. Aims: This study investigates the association between hopelessness and smoking status, using data from the National Survey of American Life (NSAL), which is the only ethnically [...] Read more.
Background: While the link between depression and smoking is known, less is known about the relationship between hopelessness and smoking in large national community-based sample of Black people. Aims: This study investigates the association between hopelessness and smoking status, using data from the National Survey of American Life (NSAL), which is the only ethnically diverse nationally representative sample of Black adults. Methods: Data from the NSAL were analyzed. Hopelessness and smoking status were assessed using structured interviews. Logistic regression was employed to assess the link between hopelessness and smoking status, controlling for potential confounders such as demographic factors and socioeconomic indicators as well as depression. Results: 4,939 participants entered our analysis. Hopelessness was significantly associated with higher odds of smoking status. This association remained robust after adjusting for confounders such as demographic factors, socioeconomic status, and depression. Conclusions: Hopelessness may be a critical risk factor for smoking in Black adults. Promoting hope as a component of targeted tobacco cessation programs may help reduce tobacco use of Black populations.
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 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 January 10, 2025

Extreme Heat Exposure is Associated with Lower Learning, General Cognitive Ability, and Memory among US Children

Abstract Background: The increasing frequency and intensity of extreme heat exposure is a significant consequence of climate change, with broad public health implications. While many health risks associated with heat exposure are well-documented, less research has focused on its impact on children’s cognitive function. Objectives: This study examines the [...] Read more.
Background: The increasing frequency and intensity of extreme heat exposure is a significant consequence of climate change, with broad public health implications. While many health risks associated with heat exposure are well-documented, less research has focused on its impact on children’s cognitive function. Objectives: This study examines the relationship between extreme heat exposure and various domains of cognitive function in children. Methods: Data were drawn from the Adolescent Brain Cognitive Development (ABCD) study. Key variables included race/ethnicity, age, gender, family socioeconomic status (SES), heatwave exposure, and multiple cognitive domains: total composite score, fluid composite score, crystallized intelligence, reading ability, picture vocabulary, pattern recognition, card sorting, and list recall. Structural equation modeling (SEM) was used for data analysis. Results: A total of 11,878 children were included in the analysis. Findings revealed significant associations between extreme heat exposure and lower cognitive performance across multiple domains. The strongest adjusted effects were observed in pattern recognition (B = −0.064, p < 0.001) and reading ability (B = −0.050, p < 0.001), both within the learning domain, as well as total composite cognitive ability (B = −0.067, p < 0.001), fluid composite (B = −0.053, p < 0.001), and crystallized intelligence (B = −0.061, p < 0.001), all within general cognitive ability. Weaker but still significant associations were found for list recall (B = −0.025, p = 0.006) and card sorting (B = −0.043, p < 0.001) within the memory domain, as well as picture vocabulary (B = −0.025, p = 0.008) within general cognitive ability. These associations remained significant after controlling for demographic factors, race/ethnicity, family SES, and neighborhood SES. Conclusions: This study underscores the impact of climate change on cognitive function disparities, particularly in learning and general cognitive ability among children exposed to extreme heat. Findings highlight the need for targeted interventions to mitigate the cognitive risks associated with heat exposure in vulnerable populations.
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Open Access February 10, 2025

Higher-than Expected Social Security Reliance Among Educated Black Americans: Minorities' Diminished Returns in National Health Interview Survey (NHIS) 2023

Abstract Background: While educational attainment is generally associated with reduced reliance on Social Security and disability benefits, Minorities' Diminished Returns (MDRs) theory suggests that the socioeconomic benefits of educational attainment are not equally distributed across racial groups and are weaker for minoritized populations. This study explores the association between educational [...] Read more.
Background: While educational attainment is generally associated with reduced reliance on Social Security and disability benefits, Minorities' Diminished Returns (MDRs) theory suggests that the socioeconomic benefits of educational attainment are not equally distributed across racial groups and are weaker for minoritized populations. This study explores the association between educational attainment and reliance on Social Security and disability benefits among Black and White adults in the United States. Objective: Building on the MDRs framework, we analyzed data from the National Health Interview Survey (NHIS) 2023 to examine how educational attainment impacts reliance on Social Security disability income, disability benefits, and public assistance for Black and White adults. Methods: We used a nationally representative sample of Black and White adults from the NHIS 2023 dataset. The outcomes assessed were reliance on three income sources: (1) Social Security disability income, (2) disability benefit income, and (3) public assistance disability income. Educational attainment was classified into three levels: less than high school (reference), high school diploma to some college, and college graduate or more. Logistic regression models assessed the relationship between educational attainment and reliance on each income source, with separate analyses for Black and White adults to evaluate differential effects. Results: Higher levels of educational attainment (high school diploma to some college and college graduate or more) were associated with lower odds of relying on Social Security disability, disability benefits, and public assistance. However, the protective effects of educational attainment were notably stronger for White adults than for Black adults. Among Black adults, even high educational attainment showed limited effectiveness in reducing reliance on these income sources, underscoring the Minorities' Diminished Returns (MDRs) phenomenon. Conclusions: Although educational attainment reduces reliance on Social Security and disability-related income sources, these protective effects are less pronounced for Black adults compared to White adults. The findings reveal persistent racial disparities in the economic returns of education, suggesting that structural factors may undermine the socioeconomic and health benefits of educational achievement for Black Americans. Targeted policy interventions may be needed to improve economic stability for Black adults, including those with higher educational credentials.
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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Open Access January 23, 2025

Population Diversity Matters: Heterogeneity of Biopsychosocial Pathways from Socioeconomic Status to Tobacco Use via Cerebral Cortical Volume in the ABCD Study

Abstract Background: Most neuroscience research has predominantly focused on White, middle-class populations, leading to gaps in understanding how socioeconomic status (SES) influences brain development and health behaviors in racially diverse groups. Tobacco use, a major public health concern, is influenced by both family and neighborhood SES, with early initiation during adolescence predicting [...] Read more.
Background: Most neuroscience research has predominantly focused on White, middle-class populations, leading to gaps in understanding how socioeconomic status (SES) influences brain development and health behaviors in racially diverse groups. Tobacco use, a major public health concern, is influenced by both family and neighborhood SES, with early initiation during adolescence predicting long-term health outcomes. The Adolescent Brain Cognitive Development (ABCD) study provides a unique opportunity to examine racial disparities in the pathways from SES to brain development and behavior, especially through the lens of Marginalization-Related Diminished Returns (MDRs), where the effects of SES are attenuated for minority groups. Objective: This study investigates racial variation in the associations between SES, cerebral cortical volume, and tobacco use initiation, comparing Black and White youth over 4-6 years of follow-up. Methods: Data from the ABCD study were analyzed to assess pathways from family income to adolescents’ cortical volume via the needs-to-income ratio, and from cortical volume to tobacco use initiation. Structural equation modeling was used to evaluate these pathways, stratified by race, with a focus on comparing Black and White participants. Covariates included family and neighborhood SES, demographic factors, and baseline behavioral measures. Results: We found that the positive association between income (via the needs-to-income ratio) and total cortical volume was significantly weaker for Black youth compared to White youth. Additionally, the link between larger total cortical volume and reduced risk of tobacco initiation was also weaker in Black adolescents. These findings were consistent over 4-6 years of follow-up, suggesting that Black youth experience diminished returns from higher SES in terms of brain development and behavioral outcomes. Conclusions: Our findings highlight significant racial disparities in the pathways from SES to brain development and tobacco use initiation, supporting the Marginalization-Related Diminished Returns (MDRs) framework. While higher SES is associated with larger cortical volumes and lower tobacco use risk in White youth, these associations are attenuated in Black adolescents.
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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 16, 2025

Extreme Heat Exposure and Adolescent Cognitive Function

Abstract Background: Extreme heat exposure is an increasing public health concern, particularly in the context of climate change. Limited research has explored its impact on children's cognitive outcomes. This study investigates the association between extreme heat exposure and cognitive function in 9–10-year-old children, using data from the Adolescent Brain Cognitive Development (ABCD) study. [...] Read more.
Background: Extreme heat exposure is an increasing public health concern, particularly in the context of climate change. Limited research has explored its impact on children's cognitive outcomes. This study investigates the association between extreme heat exposure and cognitive function in 9–10-year-old children, using data from the Adolescent Brain Cognitive Development (ABCD) study. Additionally, we assess whether this effect is independent of socio-demographic factors such as race, family socioeconomic status (SES), and neighborhood SES. Methods: Data were drawn from the ABCD study, comprising over 10,000 children aged 9–10 years. Cognitive function was assessed through standardized cognitive tests, while extreme heat exposure was estimated using geographic and climate data. Structural equation modeling (SEM) was employed to examine the direct effects of heat exposure on cognitive outcomes and to account for potential confounding variables, including race, family SES, and neighborhood SES. Results: Black families, low SES households, and children from low SES neighborhoods were disproportionately exposed to extreme heat. Extreme heat exposure was significantly associated with lower cognitive function in children, and this association remained robust even after adjusting for socio-demographic factors. Conclusions: Extreme heat exposure is linked to diminished cognitive function in children, particularly among socio-economically disadvantaged and marginalized populations. Given the increasing frequency of extreme heat events due to climate change, future research should further explore these implications for children’s cognitive outcomes. Policy interventions that improve access to cooling infrastructure, expand green spaces, and prioritize at-risk populations are critical to mitigating the adverse cognitive effects of extreme heat in low SES communities.
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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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Article
Open Access December 06, 2024

An Appraisal of Availability and Use of Protective Clothing for Workers in Ghana

Abstract The study aimed to examine the availability of protective clothing and its usage among workers at the University of Cape Coast in the central region of Ghana. It used the Accident-Proneness Theory and the Theory of Reasoned Action to achieve the study's objectives. The study adopted the positivist research paradigm. The study used a descriptive design with mixed methods. The study population [...] Read more.
The study aimed to examine the availability of protective clothing and its usage among workers at the University of Cape Coast in the central region of Ghana. It used the Accident-Proneness Theory and the Theory of Reasoned Action to achieve the study's objectives. The study adopted the positivist research paradigm. The study used a descriptive design with mixed methods. The study population comprised all workers and supervisors whose work demands the use of protective clothing at the University of Cape Coast. The study used multistage sampling techniques (stratified, purposive, proportional and Systematic random sampling techniques) to select one hundred and ninety-six departmental workers and five (5) supervisors in the University. The main instruments for data collection were a Semi-structured questionnaire and an unstructured interview guide. Mean and standard deviation, frequency count, and percentages were used to analyse the quantitative data. The qualitative data was analysed through the development of data categories and themes. The study concluded that “not all the protective clothing for the various departments were available. The University ensured that workers used what was in stock at the department. The protective clothing supplied to the various departments was insufficient, so their continuous use of the existing ones got them defaced, bringing about shortages. The study also revealed that workers used protective clothing most often, but not all used it because safety laws were relaxed. The study recommended that the University ensure a regular and adequate supply of PPC, insist on its usage, and enforce the use of PPC by all workers whose work demands it.
Article
Open Access November 27, 2024

Bead Jewellery Industry in Ghana: Problems and Solutions

Abstract Bead jewellery is common in all Ghanaian communities. Bead jewellers are well-known for their important bead jewellery production and have advanced to the Master craft level. The industry can be utilized if the industry's difficulties are discovered and remedied. The study area for the research includes Ghana's Eastern, Ashanti, and Greater Accra Regions. The study's population included bead [...] Read more.
Bead jewellery is common in all Ghanaian communities. Bead jewellers are well-known for their important bead jewellery production and have advanced to the Master craft level. The industry can be utilized if the industry's difficulties are discovered and remedied. The study area for the research includes Ghana's Eastern, Ashanti, and Greater Accra Regions. The study's population included bead jewellers, bead jewellery firms, bead dealers, bead aficionados, clients, and bead makers. With a sample size of 30, data was gathered mostly through direct observations, interviews, and document reviews. The study went over the procedure for securing land for a bead jewellery workshop. According to a survey conducted by the Ghanaian Chamber of Commerce and Industry (GCCII), Ghanaian bead jewellers should use qualified designers. Cost pooling in legal services, accounting, and consulting is likely to save money.
Case Study
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

Influence of Physical Features of Housing Environment on Students Halls of Residence

Abstract The purpose of the study was to examine the Influence of Physical Features of the Housing Environment on Students' Halls of Residence at the University of Cape Coast in the central region of Ghana. Quantitatively, a descriptive survey research design was adopted for the study. Housing Deficit Theory underpins the study. The study population comprised three hundred and eight one (381) level 100 [...] Read more.
The purpose of the study was to examine the Influence of Physical Features of the Housing Environment on Students' Halls of Residence at the University of Cape Coast in the central region of Ghana. Quantitatively, a descriptive survey research design was adopted for the study. Housing Deficit Theory underpins the study. The study population comprised three hundred and eight one (381) level 100 students in the Halls of Residence at the University of Cape Coast. Stratified proportionate random and simple random sampling techniques were used to select the eight (8) halls of residence and three hundred and eight one (381) level 100 students. The main instrument for data collection was a questionnaire. Cronbach's alpha was used in the study to assess the reliability of the variables. Descriptive statistics were used to analyse the data and show the direction of the responses. The study revealed that the students were satisfied with the physical features of the halls of residence, which influenced their contentment. Features such as recreational facilities, fire service systems, and relaxation facilities were vital in reaching such satisfaction. The study also indicated that the students were satisfied with how much their housing environment influenced their contentment. Students' relationship with their colleagues, the proximity of their halls of residence to the lecture halls and the serenity of the environment of the halls of residence all proved helpful in aligning the students' contentment to such an extent. It is recommended that the hall management should maintain the present physical features and facilities in the halls of residence for students' satisfaction. It is also recommended that the university management take into consideration the proximity of the halls of residence to the lecture theatres and the serenity of the environment of halls of residence in any future halls of residence construction.
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 14, 2024

When Common Becomes Normal: Weaker Association Between Neighborhood Stress and Body Mass Index Among Black Adolescents Compared to White Adolescents

Abstract Objective: This study explores the relationship between neighborhood stress and Body Mass Index (BMI) in adolescents, while also examining whether this association differs between Black and White adolescents. Methods: Data from the Adolescent Brain Cognitive Development (ABCD) Study were analyzed using linear regression models to examine the association between neighborhood stress [...] Read more.
Objective: This study explores the relationship between neighborhood stress and Body Mass Index (BMI) in adolescents, while also examining whether this association differs between Black and White adolescents. Methods: Data from the Adolescent Brain Cognitive Development (ABCD) Study were analyzed using linear regression models to examine the association between neighborhood stress (defined as a composite score based on three items measuring perceived safety and neighborhood fear) and BMI in adolescents, controlling for demographic and socioeconomic variables. We tested models both with and without interaction terms to assess whether race moderated the association. Stratified analyses were conducted to further explore potential differences between Black and White adolescents. Results: A positive association was observed between neighborhood stress and BMI across the overall sample. However, this association was weaker for Black adolescents compared to White adolescents, even after adjusting for potential confounders. Conclusions: The contribution of neighborhood stress to higher BMI in adolescents may vary by race. Our findings suggest that while neighborhood stress is associated with increased BMI, Black adolescents appear to be less affected by these stressors than their White peers. This weaker association could be due to the normalization of stress in environments where it is pervasive (what is common becomes normal) or the presence of other significant risk factors affecting BMI in Black youth, such as poverty, limited food access, food culture, and food deserts. Future research should explore processes of habituation, inoculation, or even sensitization to stress among Black populations, who are often exposed to a wide range of stressors throughout the life course.
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 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 04, 2024

In-Person versus Virtual CEASE Smoking Cessation Interventions

Abstract Background: Smoking cessation interventions are critical for underserved populations, particularly among low-income individuals who may benefit from tailored support. However, the effectiveness of different intervention formats remains unclear, particularly as virtual and hybrid models gain popularity. Aims: This study compares the effectiveness of three smoking cessation intervention [...] Read more.
Background: Smoking cessation interventions are critical for underserved populations, particularly among low-income individuals who may benefit from tailored support. However, the effectiveness of different intervention formats remains unclear, particularly as virtual and hybrid models gain popularity. Aims: This study compares the effectiveness of three smoking cessation intervention arms in a quasi-experimental design: Self-help group (Arm 1), In-person group (Arm 2), and Virtual/hybrid group (Arm 3). The primary outcome was the rate of successful quit across these different intervention modalities. Methods: The study utilized a community-based intervention approach, controlling for potential confounders. The communities were randomized, and this process was blinded. The effectiveness of the In-person group and the Virtual/hybrid group was compared to the Self-help group. The odds ratio (OR) for successful quit rates was calculated for each group, with corresponding 95% confidence intervals (CIs). Results: Participants included 50.4% of women, 82.8% were Black Americans, 11.6% Whites, and 3.4% other races. In-person group (Arm 2) showed a higher rate of successful quit compared to the Self-help group (OR = 2.67, 95% CI = 1.05, 6.79). Virtual/hybrid group (Arm 3) was not associated with a significantly higher quit rate compared to the Self-help group (OR = 1.48, 95% CI = 0.57, 3.83). Conclusion: The In-person group, which utilizes the CEASE curriculum and incorporates peer motivation, proved to be significantly more effective than both the Self-help and Virtual/hybrid groups. The findings suggest that low-income, underserved smokers may not be fully prepared to benefit from virtual interventions, or the current curriculum may need adaptation to better serve their needs in a virtual format.
Article
Open Access November 03, 2024

Students' Perceptions of the Usefulness of Formative Feedback in Mathematics Lessons

Abstract This study aimed to examine students' perceptions of the usefulness of formative feedback in mathematics lessons at Sagnerigu Municipality in the Northern Region of Ghana. Quantitatively, this study employed a descriptive non-experimental survey design. The population comprises all pupils of public Junior High Schools in the Sagnerigu Municipality. A purposive sampling technique was used to [...] Read more.
This study aimed to examine students' perceptions of the usefulness of formative feedback in mathematics lessons at Sagnerigu Municipality in the Northern Region of Ghana. Quantitatively, this study employed a descriptive non-experimental survey design. The population comprises all pupils of public Junior High Schools in the Sagnerigu Municipality. A purposive sampling technique was used to select the Junior High School students for the study. The criterion purposive sampling technique was used to select 518 final-year students for the 2022 Basic education certificate examination from 14 schools in Sagnerigu Municipality. The chosen schools comprised 291 students from high-performing schools and 227 students from low-performing schools. The primary tool for the study was the Student Feedback Perception Questionnaire (SFPQ), administered to the student participants. The Descriptive statistical tool was used to analyse the mean and standard deviation of the data. The study's examination of students' perceptions of feedback revealed a moderate level of perceived usefulness. This emphasises the importance of feedback as a tool for student growth and development. However, the findings also suggest the need for further support and guidance to optimise the impact of feedback on student learning outcomes. The findings also suggest that students value feedback that helps them improve their skills and strategies in Mathematics and keeps them on track to succeed. It also highlights the importance of providing different types of feedback to cater to the diverse learning needs of students. Educators can create a conducive environment that promotes student engagement and achievement by equipping teachers with effective feedback techniques, emphasising constructive comments and avoiding grades.
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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 30, 2024

Smokers with Multiple Chronic Disease Are More Likely to Quit Cigarette

Abstract Objective: This study aims to investigate the relationship between the presence of chronic medical conditions and cessation among U.S. adults who use combustible tobacco. We hypothesized that having chronic medical conditions would be associated with a higher likelihood of successfully quitting combustible tobacco. Methods: We utilized longitudinal data from the Population [...] Read more.
Objective: This study aims to investigate the relationship between the presence of chronic medical conditions and cessation among U.S. adults who use combustible tobacco. We hypothesized that having chronic medical conditions would be associated with a higher likelihood of successfully quitting combustible tobacco. Methods: We utilized longitudinal data from the Population Assessment of Tobacco and Health (PATH) Study, using data from Waves 1 to 6. Only current daily smokers were included in our analysis. The independent variable was the number of chronic medical conditions, defined as zero, one, or two or more. The outcome was becoming a former smoker (quitting smoking). Using multivariate regression analyses, we assessed the association between the number of chronic conditions and tobacco cessation over the six waves. We controlled for potential confounding variables, including demographic factors and socioeconomic status. Results: Our analysis revealed a significant association between the number of chronic medical conditions and the likelihood of quitting smoking. Specifically, individuals with two or more chronic conditions exhibited a greater probability of quitting smoking compared to those with no chronic conditions. The results remained significant after adjusting for potential confounders. Conclusions: Multiple chronic medical conditions may act as a catalyst for smoking cessation among U.S. adults. This suggests that the presence of multimorbidity, defined as multiple chronic disease diagnoses, may serve as “teachable moments,” prompting significant health behavior changes. These findings highlight the potential for leveraging chronic disease management and healthcare interventions to promote tobacco cessation, particularly among individuals with multiple chronic conditions.
Article
Open Access October 26, 2024

Exploring the Relationship between Teacher Training and Challenges in Delivering Effective Sex Education

Abstract This study aimed to explore the relationship between teacher training and challenges in delivering effective sex education in the Sagnarigu district in the Northern region of Ghana. The Social-cultural theory underpins the study. A descriptive survey research design was adopted for the study. The population of this study comprises teachers, head teachers and a School Improvement Support Officer [...] Read more.
This study aimed to explore the relationship between teacher training and challenges in delivering effective sex education in the Sagnarigu district in the Northern region of Ghana. The Social-cultural theory underpins the study. A descriptive survey research design was adopted for the study. The population of this study comprises teachers, head teachers and a School Improvement Support Officer (SiSo) in basic schools in the Gumani/Nyanshegu circuit in the Sagnarigu district of the Northern Region. This study adopted multi-sampling methods to select respondents. Random and purposive sampling techniques were used to select the study's 10 basic schools and 83 respondents. The main tools used for the data collection were the questionnaire and interview. The data was analysed using Statistical Package for Social Scientists (SPSS) software version 23 tools. Descriptive Statistical tools such as frequencies were used to gauge the number of occurrences of the studied variables. The qualitative data was also further analysed in line with the research questions to establish patterns of similarities and variations. These were then validated with the quantitative data for any possible contradictions in the findings. The study concludes that people's socio-cultural and religious beliefs and practices affect the teaching of sex education in school. It was observed that sex education could be misconstrued as an encouragement to young people to engage in early sexual promiscuity. Finally, the study concludes that there cannot be effective sex education without the appropriate logistics such as T.L.M.s, syllabus and time allocation for the subject. The study also acknowledges that the availability of these materials must go along with appropriate capacity building for teachers to be well-positioned to teach the subject. It is recommended that Sexuality education should be included in the curricular and academic calendar of basic schools, along with the provision of adequate T.L.M.s and the proper collaboration with appropriate agencies for the effective teaching of the subject. Sex education needs to be given maximum attention, just as any of the life skills subjects, with adequate investment and motivation to both teachers and pupils to ensure a meaningful impact. There should be regular monitoring, supervision, and assessment of the training of teachers and its influence on the teaching of the subject, as well as ensuring that ethical considerations regarding cultural and religious sensitivities and individual privacy issues are upheld.
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Open Access October 05, 2024

Symbolic Splendour: Integrating Adinkra Symbols in Ghana’s Most Beautiful Set Design

Abstract This study explores the integration of Adinkra symbols into the set design of Ghana’s Most Beautiful (GMB), a popular beauty pageant and reality TV show that has aired on TV3; a private television station in Ghana. GMB showcases beauty, intelligence, cultural knowledge, and traditional values, celebrating Ghana's rich cultural heritage through female contestants representing the country's diverse [...] Read more.
This study explores the integration of Adinkra symbols into the set design of Ghana’s Most Beautiful (GMB), a popular beauty pageant and reality TV show that has aired on TV3; a private television station in Ghana. GMB showcases beauty, intelligence, cultural knowledge, and traditional values, celebrating Ghana's rich cultural heritage through female contestants representing the country's diverse ethnic groups. In response to the lack of coherent Ghanaian artistic elements in previous set designs, this study employed an artistic methodology to incorporate four Adinkra symbols, Okɔdeɛ Mmɔwerɛ, Duafe, Dweninimmɛn, and Mate Masie, into the set design for the show’s eighth season. These symbols, signifying beauty, strength, wisdom, and unity respectively, were creatively integrated into a crown-like set design for the grand finale, harmonizing aesthetic trends with cultural significance. The design process was informed by rigorous research and stakeholder interviews, ensuring that the selected symbols conveyed the intended cultural messages. The results highlight the potential of traditional symbols to enhance both the cultural relevance and visual appeal of television productions. The project enriches the cultural depth of GMB production and offers a blueprint for incorporating indigenous symbols into contemporary set design. The study recommends that future productions continue exploring traditional symbols to deepen the appreciation of Ghanaian heritage and strengthen cultural identity through visual arts.
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Open Access September 30, 2024

A complication occurred fourteen days following the laparoscopic correction of pelvic organ prolapse using lateral suspension with mesh

Abstract This case report describes a postoperative complication following laparoscopic lateral suspen-sion with mesh for the treatment of pelvic organ prolapse (POP) in a 67-year-old woman. The pa-tient initially presented with grade III anterior vaginal prolapse and grade IV apical uterine pro-lapse. A laparoscopic lateral suspension procedure was successfully performed, and the patient was discharged on [...] Read more.
This case report describes a postoperative complication following laparoscopic lateral suspen-sion with mesh for the treatment of pelvic organ prolapse (POP) in a 67-year-old woman. The pa-tient initially presented with grade III anterior vaginal prolapse and grade IV apical uterine pro-lapse. A laparoscopic lateral suspension procedure was successfully performed, and the patient was discharged on postoperative day two without complications. However, two weeks later, she experienced pelvic discomfort, and examination revealed a recurrence of the prolapse due to the failure of the right lateral arm of the mesh. The mesh was successfully reattached via a second laparoscopic procedure, and the patient had an uneventful recovery. This case highlights the po-tential for mesh dislocation postoperatively, underscoring the importance of secure mesh attach-ment to prevent recurrence of prolapse.
Editorial
Open Access September 22, 2024

Societal Perception of New Religious Movements’ Televangelism: A Study of House of Power Ministry International and Gilgal Pentecostal Prayer Ministry International in Dunkwa-On-Offin in the Central Region of Ghana

Abstract This aimed to examine the societal perception of new religious movements' televangelism in Dunkwa-On-Offin, Ghana's Central Region. The study used a sequential explanatory mixed-methods design, using the mixed methods approach to research. The population of this study comprised Women, Regular churchgoers, believers, and those listening to televangelism services by new religious movements, as well [...] Read more.
This aimed to examine the societal perception of new religious movements' televangelism in Dunkwa-On-Offin, Ghana's Central Region. The study used a sequential explanatory mixed-methods design, using the mixed methods approach to research. The population of this study comprised Women, Regular churchgoers, believers, and those listening to televangelism services by new religious movements, as well as clergy, lay leaders, and other male worshippers. Random and purposive sampling techniques were used to select 200 women and 20 men from House of Power Ministry International and GILGAL Pentecostal Prayer Ministry International as the respondents for the study. The instruments used for data collection were questionnaires and interview guides. IBM SPSS statistics software version 23 was used to analyse the quantitative data, while qualitative data was analysed thematically with an interpretative lens. The study has revealed that society perceives the televangelism movements as helpful and encouraging but could also create trouble in fundamental Christian worship principles. The study also indicates that televangelists emphasise material things rather than spiritual matters. Other concerns included that televangelism brings about the separation of family and friends because they always inform members that their friends and family are evil. It is recommended that there is the need to change or improve the credibility perception among Christians in Ghana about televangelism. Televangelists must exhibit accountability and integrity to their worshippers by providing adequate information to encourage viewers to support their ministries.
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Open Access September 09, 2024

An Evaluation of Modal Verbs Teacher-Trainees Used in Writing Long Essays and Assignments

Abstract Qualitatively, the study adopted a case research design. The population of this study comprised the last batch of Diploma in Basic Education (DBE) and the current first-year students of the new programme (Bachelor in Basic Education) of Mount Mary College of Education. Simple random and stratified sampling techniques were used to select 15 long essays from the final year, while 30 assignments were [...] Read more.
Qualitatively, the study adopted a case research design. The population of this study comprised the last batch of Diploma in Basic Education (DBE) and the current first-year students of the new programme (Bachelor in Basic Education) of Mount Mary College of Education. Simple random and stratified sampling techniques were used to select 15 long essays from the final year, while 30 assignments were chosen from the first year. Nine (9) long essays from the English language, five (5) essays from Social Studies and one (1) essay from Mathematics. The main tools used for the study were students' assignment items and copies of long essays. Through an interpretative lens, the data were analysed into themes. The data and the analysis largely showed that students employed different kinds of modal verbs in their writing, including complete and periphrastic modal verbs. There was evidence that students have used these modal verbs in different ways that sometimes affected the intended meaning. These inappropriate choices are evident in both written texts and oral presentations. Findings showed that students employed modal verbs indiscriminately with little attention to contexts. It would be recommended that language teachers deal with the issue by giving written feedback on the use of modal verbs to students in their texts anytime they are given assignments.
Article
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 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 03, 2024

Facilities Audit in the Kindergarten Schools in Yendi Municipality of Ghana

Abstract This study aimed to examine the school facility quality on children's social achievement in Kindergarten in the Yendi Municipality of the Northern Region. The study adopted a mixed-method approach. The study population comprised twenty-five (25) teachers and five (5) head teachers from all kindergarten schools in five circuits in the Yendi municipality. A purposive sampling technique was used to [...] Read more.
This study aimed to examine the school facility quality on children's social achievement in Kindergarten in the Yendi Municipality of the Northern Region. The study adopted a mixed-method approach. The study population comprised twenty-five (25) teachers and five (5) head teachers from all kindergarten schools in five circuits in the Yendi municipality. A purposive sampling technique was used to select the study participants. The main instruments for data collection were structured questionnaires and observation checklists. The data were statistically analysed using simple frequencies and percentiles presented on a simple frequency table. The study reveals that inadequate access to essential resources, such as textbooks, teaching and learning materials, and proper classroom environments, adversely affects teacher effectiveness and student engagement. The findings indicate that while some facilities, such as restrooms and playgrounds, are available, many need to be updated or more to meet the needs of the children. To enhance the educational experience for young learners, stakeholders, including the government, educational authorities, and the community, must collaborate to improve the infrastructure and resources available in these schools.
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 25, 2024

Leadership Styles of Female Leaders in Management of Senior High Schools in the Central Region of Ghana

Abstract The role and contribution of women in modern organisations have been phenomenal. However, societal norms and other patriarchal values continue to stifle the progress of women leaders. The study's overall purpose was to examine the leadership styles of female leaders in managing senior high schools in the Central Region of Ghana. The study adopted non-numerical data and used a purely qualitative [...] Read more.
The role and contribution of women in modern organisations have been phenomenal. However, societal norms and other patriarchal values continue to stifle the progress of women leaders. The study's overall purpose was to examine the leadership styles of female leaders in managing senior high schools in the Central Region of Ghana. The study adopted non-numerical data and used a purely qualitative research approach. A phenomenological design supported the study framework, and the required data was collected through interviews. The target population for the study were female headmistresses and assistant headmistresses in the various Senior High Schools in the Metropolis. The study involved all six female headmistresses and eight assistant headmistresses in the Metropolis. The participants were sampled using the census to meet the study objectives. The data were analysed thematically. The study revealed that married couples use the participatory leadership style, but those who are single use the assertive style. The study also concluded that women leaders who are single and are farther from 60 years old are more likely to have problems in the discharge of their duties as leaders since men, per societal influence, will always try to resist the control of women leaders. The Ghana education service should package special incentives for women who aspire to achieve the utmost leadership role of becoming heads of senior high schools. It will motivate the young women generation. It is also recommended that women in leadership positions in the Ghana Education Service are advised to learn by updating their skills and competencies to grow in confidence and share ideas with colleagues in the same field to adopt and adapt leadership styles that have worked in other institutions to handle institutional challenges.
Review Article
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 June 30, 2024

Education as a health tool: Adulterations and falsifications in natural medicine

Abstract The teaching-learning relationship of natural medicine is key to avoid health problems in the population; adulterations and falsifications of frequently used plants are evident. The aim of this study is to raise public awareness and to urge institutions to incorporate contents in the student's curriculum. The curricula of different educational levels are analyzed to check the level of knowledge on [...] Read more.
The teaching-learning relationship of natural medicine is key to avoid health problems in the population; adulterations and falsifications of frequently used plants are evident. The aim of this study is to raise public awareness and to urge institutions to incorporate contents in the student's curriculum. The curricula of different educational levels are analyzed to check the level of knowledge on the use of medicinal plants, as well as some regulations on quality controls. Of the wide range of species that are consumed by the population, some are detected in which adulterations and falsifications occur, although there is no danger in some cases, such as chamomiles, if a falsification occurs when consuming the whole plant instead of the flowering tops, which is where the properties reside. In other cases, adulteration occurs, generally unintentional, but very dangerous to health, such as horsetail. For a more effective quality control, we need public awareness and highly specialized personnel, with the capacity to inspect crops, markets and companies.
Review Article
Open Access June 18, 2024

Concord Errors in Academic Writing: A Study of First-Year Students at Offinso College of Education and Strategies for Improvement

Abstract This study examines concord errors in academic writing among first-year students at Offinso College of Education in Ghana, aiming to identify common errors and propose remedial strategies for improvement. The population sample consists of first-year students at the college, reflecting a gender-sensitive distribution. The study adopts a mixed-methods research design, combining qualitative and [...] Read more.
This study examines concord errors in academic writing among first-year students at Offinso College of Education in Ghana, aiming to identify common errors and propose remedial strategies for improvement. The population sample consists of first-year students at the college, reflecting a gender-sensitive distribution. The study adopts a mixed-methods research design, combining qualitative and quantitative analyses to explore the effects of concord errors on academic writing. Sampling techniques include purposive, quota sampling, and simple random sampling methods. Research instruments include questionnaires, interviews, and writing assessments to evaluate students' language skills. Data analysis involves identifying concord errors in students' writing and assessing the impact on their academic performance. The study concludes by recommending strategies to mitigate concord errors, such as targeted language practice, timely feedback, and awareness of grammatical conventions, to enhance students' writing proficiency and academic success.
Article
Open Access June 17, 2024

Knowledge Level of Teachers on Inclusive Education in Tamale Metropolis in the Northern Region of Ghana

Abstract The study examined teachers' perception of inclusive education in the three educational circuits in Tamale Metropolis in the Northern Region of Ghana. Research paradigms underpinning the study are Positivism, Interpretivism, and Pragmatism. The study adopted a cross-sectional survey research design. The study population comprised 81 teachers from the Gumbihini Educational Circuit, 100 from the [...] Read more.
The study examined teachers' perception of inclusive education in the three educational circuits in Tamale Metropolis in the Northern Region of Ghana. Research paradigms underpinning the study are Positivism, Interpretivism, and Pragmatism. The study adopted a cross-sectional survey research design. The study population comprised 81 teachers from the Gumbihini Educational Circuit, 100 from the Hospital Educational Circuit, and 72 from the Salaga Road Educational Circuit. The study population was from a pool of two hundred and fifty-three (253) teachers. The census method was used as a sampling technique for three (3) educational circuits and two hundred and fifty-three (253) teachers. The main instrument for data collection was a questionnaire. The data were analysed with descriptive statistics to determine the frequencies, percentages, mean and standard deviation scores for the response from the questionnaire and hypothesis. On the level of knowledge teachers in Tamale Metropolis have about inclusive education, Even though the study revealed that teachers know how to meet the needs of learners with learning disabilities and use varied learning activities to engage a diverse range of learners, knowledge in meeting the needs of learners who are gifted most teachers do not know to meet the needs of learners with speech and language, or communication disorder. Again, the findings revealed that teachers need to learn about meeting the needs of learners who are seen as having behavioural difficulties. Teachers were also found to not know about meeting the needs of learners who are blind or have low vision. Furthermore, the study revealed that teachers do not know how to assess, test, or evaluate the learning of children with disabilities. In the statistical analysis, special educators were found to possess a higher level of knowledge among primary school teachers who were studied than their general/regular educators' counterparts, even though the difference was not statistically significant. On the level of knowledge teachers in Tamale Metropolis have about inclusive education, regular in-service education and refresher courses will help improve and reorient teachers' knowledge towards performing their duties in inclusive education. The study, therefore, recommends that the Tamale Metropolis Directorate of Ghana Education Service collaborate with bare school heads in assisting teachers through the implementation of professional development/training programmes to employ adaptive instructional strategies to help children with disabilities.
Article
Open Access June 01, 2024

An Assessment of Off-Season Vegetable Farming on Farmers in Savelugu Municipality in the Northern Region

Abstract The study aimed to assess the impact of off-season vegetable farming on farmers in the Savelugu Municipality in the Northern Region. The study population consisted of all respondents to off-season vegetable farming in the Savelugu Municipality in the five selected communities in the Northern Region. A purposive sampling technique was used for a sample size of fifty (50) off-season farmers in the [...] Read more.
The study aimed to assess the impact of off-season vegetable farming on farmers in the Savelugu Municipality in the Northern Region. The study population consisted of all respondents to off-season vegetable farming in the Savelugu Municipality in the five selected communities in the Northern Region. A purposive sampling technique was used for a sample size of fifty (50) off-season farmers in the selected communities. An interview guide and questionnaire were used to solicit data to conclude the findings. The data derived from the questionnaire were analysed in a step-by-step thematic analysis that included reading the transcriptions several times, coding, generating codes, and reviewing and naming themes. Afterwards, the questionnaire and interview guide responses were transferred into Microsoft Excel under assigned variable names. Descriptive statistics, namely frequency, means, and percentages, were used to analyse the data. Off-season vegetable production technology can be gained by using different agro-climatic regions, maintaining or adjusting planting time, selecting varieties, and creating artificial and controlled environments through tunnels, polytene houses, glass houses, hotbeds, etc. Moreover, Off-Season vegetables helped earn income and ranked highest with an overall mean score of 1. Nearly all the trained farmers said their primary constraint was the high incidence of pests and diseases. It is evident that off-season cultivation is profitable and significantly impacts the farmers' consumption expenditure and food security status. Therefore, providing improved and modern agricultural inputs to off-season farmers is essential for rural agricultural development.
Review Article
Open Access May 05, 2024

Challenges facing the Church in dealing with Moral Issues in Ghana: the way forward

Abstract The purpose of this study was to examine challenges facing the Church in dealing with Moral Issues and the way forward in Ghana. Qualitatively, the study sought to examine the Church's challenges in coping with Moral Issues and the way forward in Ghana. The study adopted a case study research design. The population of the study comprised leaders of Calvary Baptist Church – Adabraka and Shiashe. [...] Read more.
The purpose of this study was to examine challenges facing the Church in dealing with Moral Issues and the way forward in Ghana. Qualitatively, the study sought to examine the Church's challenges in coping with Moral Issues and the way forward in Ghana. The study adopted a case study research design. The population of the study comprised leaders of Calvary Baptist Church – Adabraka and Shiashe. These include the Vice President of the Ghana Baptist Convention and departmental heads at the Ghana Baptist Convention headquarters. Others included the Senior Pastor of Calvary Baptist Church – Adabraka with its satellite mission at Shiashe as well as a cross-section of pastors of these churches; the church administrator; the past and present directors of Baptist Relief and Development Agency (BREDA). The purposive sampling technique was specifically used to locate respondents for the study. The churches and participants were chosen because of their efforts in dealing with the causes of immorality confronting Ghanaian society. The main tool for data collection was a semi-structured interview guide. The data gathered was organised and analysed manually using emerging themes. The study revealed that the challenges which the Baptist Church encounters in its effort to deal with moral issues are the politicisation of statements made by the clergy, and inadequate trained personnel who are willing and ready to champion the agenda of the church in that respect. Financial difficulties were also mentioned. In this regard, specific reference was made to the effort made by the Ghana Baptist Convention to free the Trokosi girls. It was indicated that it takes a lot of financial resources to train and settle the freed girls. Regarding the way forward as far as these challenges were concerned, it was suggested that the church ought to speak more and do what it is mandated by Christ to do to bring about transformation. It is recommended that Churches should seriously intensify education on what constitutes human rights and freedom so that there would be a clear understanding of the concept that enables people to think through and adopt the good aspects to enhance their circumstances. Human rights defenders should exercise restraints when it comes to practices which are alien to Ghanaian values, laws and religious faith.
Review Article
Open Access May 03, 2024

Congruence Between Intended and Observed Transactions in the Implementation of the Senior High School (SHS) Social Studies Curriculum in Ghana

Abstract This study aimed to evaluate the Social Studies Curriculum for Senior High Schools in Ghana to determine whether the subject has attained its goal(s) or not, using Stake’s Countenance Evaluation Model. The study took place in the Asante Akim North District. The population for study were all Social Studies teachers and students in the district. The multi-stage sampling technique was adopted for the [...] Read more.
This study aimed to evaluate the Social Studies Curriculum for Senior High Schools in Ghana to determine whether the subject has attained its goal(s) or not, using Stake’s Countenance Evaluation Model. The study took place in the Asante Akim North District. The population for study were all Social Studies teachers and students in the district. The multi-stage sampling technique was adopted for the study and the sample size was 120, made up of 100 students and 20 teachers. The concurrent mixed method approach was adopted. The main instruments used for collecting data were questionnaires, interviews (focus group and unstructured interview), observation and documentary analysis. Quantitative data were tabulated, organised, analysed and interpreted to draw sound conclusions and generalisations. The data were presented in the form of tables and percentages. Words were used to interpret the tables and percentages for easy understanding. The qualitative data responses were described and explained in the form of themes. Sometimes responses were quoted verbatim to authenticate claims made. The study looked at the congruence between what was intended to occur and what was observed before and during the implementation of the curriculum in the Asante Akim North District. On the transactions, it was revealed that teachers in the district communicate the problem the topic seeks to address and the specific objectives to the learners during instruction. Also, teachers varied their teaching methods, techniques and strategies. However, teachers failed to take students out on field trips. Also, they failed to use video documentaries to deliver their lessons inhibiting students’ creativity as they are denied the opportunity to explore and get first-hand information to build up knowledge and develop the needed attitudes and values. From the findings, it is therefore recommended that the National Council for Curriculum and Assessment should increase the time allotted to the teaching of Social Studies at the SHS level from 3-periods of 40 minutes a week to 5-periods of 40 minutes a week to give teachers and learners ample time to discuss, debate, digest and solve problems during instructional hours to enable the goal of the subject attained.
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Open Access May 01, 2024

Challenges Affecting the Teaching and Learning of Social Studies in the Colleges of Education in Ghana

Abstract The purpose of this study was to examine the challenges affecting the teaching and learning of Social Studies in the Colleges of Education in the Ashanti Region. Qualitatively, the study adopted a case study research design. The population of the study comprised fifteen (15) Social Studies teachers in the Ashanti region of Ghana. A purposive sampling technique was used to select the colleges and [...] Read more.
The purpose of this study was to examine the challenges affecting the teaching and learning of Social Studies in the Colleges of Education in the Ashanti Region. Qualitatively, the study adopted a case study research design. The population of the study comprised fifteen (15) Social Studies teachers in the Ashanti region of Ghana. A purposive sampling technique was used to select the colleges and Social Studies teachers. The main instrument for data collection was an unstructured open-ended interview guide. Four criteria proposed by Lincoln and Guba in 1985 used to measure the trustworthiness of data collected are credibility, transferability, dependability and confirmability. Data obtained from the study were subjected to thematic analysis using themes developed from the data collected based on the research question. The findings of this study indicate that adequate textbooks, availability of teaching and learning materials such as projectors, the ability of tutors to engage in research, and the ability to vary teaching techniques are some factors that affect the teaching and learning of Social Studies in Colleges of Education. Students can remember a greater percentage of what was taught when techniques used by teachers are in their interest. It is recommended that T-TEL and Universities to which Colleges of Education are affiliated should continue to provide seminars and sessions to tutors in areas of material, resource development and research. This will continue to ensure that tutors are competent in their field of specialization. It is also recommended that the government should conduct a nationwide programme evaluation exercise on Social Studies to identify the loopholes needed to ensure the effectiveness of the subject.
Review Article
Open Access March 23, 2024

An Attitude of Staff and Students towards Littering in Second-Cycle Schools in Sefwi Wiawso Municipality in the Western North of Ghana

Abstract The growing unconcern and poor attitude of some Ghanaians towards environmental protection and sanitation practices has become very endemic in Ghanaian Societies. Littering especially is considered a major environmental problem within the setting of this study. This study employed the mixed-method approach in integrating qualitative and quantitative research data. The study adopted a convergent parallel research design. The population for this study consisted of all teaching staff and students of Sefwi Wiawso Senior High Technical School and St. Joseph Catholic Senior High School in Sefwi Wiawso municipality in the Western North Region of Ghana. Purposive, simple random, and convenient sampling techniques were used to select the schools, teachers and students for the study. A sample size of one hundred and ninety-eight (198) consisting of one hundred eighty-eight (188) students and ten (10) teachers were selected for the study. The two main instruments used for data collection were questionnaires and interview guides. The quantitative data obtained from the questionnaire were coded with numerical values and keyed into the data view of the SPSS version 23. The qualitative data was analysed through content analysis and was further transcribed into themes for analysis with a side-by-side comparison with the quantitative data. The qualitative data gathered and presented, were organised and analysed manually using emerging themes. The study revealed that littering is currently caused by irresponsible behaviour among some staff and students coupled with other factors such as lazy attitudes among people, inadequate waste bins on campus, and more seriously, less sensitization of people on littering in the various senior high schools. The study also indicated that provisions of adequate waste bins at vantage points in the various campuses, awarding prizes to individual students and groups with good waste management practices on campus, implementing rules and regulations on littering, as well as educating, and sensitizing students and staff on littering on campuses formed the possibilities on how schools can shape up staff and student’s attitudes towards healthy environment by avoid littering. It is recommended that Students with good waste management practices should be rewarded to encourage others in Senior High Schools. It is also recommended that sustainable waste management practices (collection, transportation, and treatment) should be employed in all the Senior High Schools [...] Read more.
The growing unconcern and poor attitude of some Ghanaians towards environmental protection and sanitation practices has become very endemic in Ghanaian Societies. Littering especially is considered a major environmental problem within the setting of this study. This study employed the mixed-method approach in integrating qualitative and quantitative research data. The study adopted a convergent parallel research design. The population for this study consisted of all teaching staff and students of Sefwi Wiawso Senior High Technical School and St. Joseph Catholic Senior High School in Sefwi Wiawso municipality in the Western North Region of Ghana. Purposive, simple random, and convenient sampling techniques were used to select the schools, teachers and students for the study. A sample size of one hundred and ninety-eight (198) consisting of one hundred eighty-eight (188) students and ten (10) teachers were selected for the study. The two main instruments used for data collection were questionnaires and interview guides. The quantitative data obtained from the questionnaire were coded with numerical values and keyed into the data view of the SPSS version 23. The qualitative data was analysed through content analysis and was further transcribed into themes for analysis with a side-by-side comparison with the quantitative data. The qualitative data gathered and presented, were organised and analysed manually using emerging themes. The study revealed that littering is currently caused by irresponsible behaviour among some staff and students coupled with other factors such as lazy attitudes among people, inadequate waste bins on campus, and more seriously, less sensitization of people on littering in the various senior high schools. The study also indicated that provisions of adequate waste bins at vantage points in the various campuses, awarding prizes to individual students and groups with good waste management practices on campus, implementing rules and regulations on littering, as well as educating, and sensitizing students and staff on littering on campuses formed the possibilities on how schools can shape up staff and student’s attitudes towards healthy environment by avoid littering. It is recommended that Students with good waste management practices should be rewarded to encourage others in Senior High Schools. It is also recommended that sustainable waste management practices (collection, transportation, and treatment) should be employed in all the Senior High Schools across the country.
Article
Open Access March 09, 2024

An Evaluation of Interventions to Promote Adolescent Gender Forgiveness

Abstract The purpose of this study was to examine indicators of forgiving behaviour and intervention among adolescent students in Junior High School in Bimbilla in the Nanumba North Municipality of Ghana. This study adopted the Pragmatist philosophy. The mixed methods experimental design was used for the study. The study population comprised all adolescents in Junior High Schools in the Nanumba [...] Read more.
The purpose of this study was to examine indicators of forgiving behaviour and intervention among adolescent students in Junior High School in Bimbilla in the Nanumba North Municipality of Ghana. This study adopted the Pragmatist philosophy. The mixed methods experimental design was used for the study. The study population comprised all adolescents in Junior High Schools in the Nanumba North Municipality of the Northern Region, Ghana. Purposive, random sampling techniques Krejcie and Morgan's table of determination of sample size were used for the schools and respondents for the study. Two major instruments were used for this study: a questionnaire and an interview guide. The interview schedule was used to gather the qualitative data whereas the quantitative data was gathered using the questionnaire. The study indicated that both the REACH model and Process model are efficacious in reducing the level of depression among adolescent students when their levels of forgiveness are increased through forgiveness counselling regardless of gender and age. The findings also revealed that both REACH and Process models were good interventions for the adolescents in showing greater emotional regulation (increased forgiveness, reduced anger and reduced depression, enhanced sense of well-being, positive feelings and positive thoughts towards the offender). It is recommended that counsellors organise training programmes with parents in conjunction with Non-governmental organisations on using the Process and REACH models. This will bring awareness of the interventions and encourage parents to seek assistance anytime their adolescents need assistance. It is once again recommended that teachers and school administrators consider forgiveness interventions (the Process model and REACH model) as a very effective strategy for treating unforgiveness to improve students' psychological well-being.
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