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

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.

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.

Background: Nursing students are exposed to significant stress due to academic and clinical demands, which can adversely affect their mental health, academic performance, and future clinical competence. Despite the global acknowledgment of this issue, limited research has been conducted to explore the prevalence and determinants of stress among nursing students in Bangladesh. Methods: This cross-sectional study was conducted from December 2023 to February 2024 among 372 nursing students enrolled in selected nursing colleges in Bangladesh. A purposive sampling technique was used, and data was collected using a semi-structured questionnaire. The questionnaire assessed socio-demographic characteristics, academic challenges, and psychological symptoms, with mental health stress measured using a Likert scale. Descriptive statistics and Chi-square tests were used to analyze the data, with a 95% confidence interval applied to all analyses. Results: The findings revealed that 31.7% of nursing students experienced severe stress, 23.9% reported moderate stress, and 16.7% had mild stress. Age, academic semester, and course load difficulties were significantly associated with stress levels (p < 0.05). Psychological symptoms such as anxiety, difficulty concentrating, and loss of interest in activities were also significantly linked to higher stress levels. Notably, students in their first semester and those reporting harder course loads were more likely to experience stress. However, gender was not significantly associated with stress levels. Conclusions: This study underscores the high prevalence of stress among nursing students in Bangladesh, driven by academic and clinical challenges and psychological symptoms. The findings highlight the need for targeted interventions, such as stress management training, enhanced mental health support, and policies to alleviate academic pressures. Future research should explore longitudinal trends in stress and evaluate the effectiveness of interventions to support a resilient nursing workforce.

The concept of maternity care satisfaction focuses on women's expectations and results in women having a positive attitude about the care received during pregnancy, childbirth and after birth. The proportion of births to Ghanaian migrant mothers in China is increasing, and there is an increasing demand for information regarding their reproductive health. To reduce maternal and neonatal morbidity and death rates, it is crucial for foreign women who use maternity services to be satisfied with their care. Ghanaian women's birth experiences in China might be harmed by language and cultural disparities. Little is known about their experiences in China's homogeneous society. A survey of 317 postnatal Ghanaian foreigners in Zhenjiang, China provided the study's data and was analyzed using IBM SPSS Statistics 25. The results showed that (76%) of postnatal foreigners were satisfied with delivery care. Though the satisfaction level was high, respondents raised the issues of poor communication (62.8%) and high cost of delivery care (52.4%) as some of the general experiences they faced. Healthcare providers’ strengthening routine monitoring of maternal and newborn health programs will help deliver more woman-centered care.

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

Introduction: Stroke remains one of the leading causes of death and disability worldwide, with ischemic stroke accounting for most cases. Structural vascular factors such as carotid artery tortuosity have gained attention as potential markers of vascular aging and cerebrovascular risk. The carotid tortuosity index (CTI), defined as the ratio of actual vessel length to the straight-line distance between two fixed points, provides a quantitative measure of arterial curvature. A CTI value of ≥1.2 indicates pathological tortuosity. Although noninvasive modalities such as CTA and MRA are frequently used, digital subtraction angiography (DSA) remains the gold standard for evaluating vessel geometry due to its higher spatial precision. This study aimed to determine the association of age, sex, and hypertension with CTI measured by DSA. Methods: A cross-sectional study was conducted from November to December 2025 at the Neurointervention Clinic, RS Pelni Jakarta, Indonesia, involving 61 adult patients who underwent carotid DSA. CTI was measured bilaterally using digital imaging software and classified as <1.2 (non-tortuous) or ≥1.2 (tortuous). Clinical data, including age, sex, and hypertension status, were collected from medical records and analyzed using bivariate tests. Results: Older age (≥65 years), female sex, and hypertension were significantly associated with higher CTI values on both carotid sides. Tortuosity was more common among hypertensive patients and elderly females, indicating the influence of vascular remodeling and chronic hemodynamic stress. Conclusion: Carotid tortuosity increases with age, hypertension, and female sex. DSA-based CTI measurement provides a reliable and precise approach for evaluating vascular changes associated with cerebrovascular risk.

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.

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.

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.

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.

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.

Background: The Cingulo-Opercular Network (CON) is a crucial executive control network involved in regulating actions and facilitating higher-order cognitive processes. Resting-state functional connectivity between the CON and the Default Mode Network (DMN) plays a vital role in cognitive regulation, enabling the transition between internally focused and externally directed tasks. This study investigates whether resting-state functional connectivity between the CON and DMN mediates the effects of social determinants, such as educational opportunities and family structure, on cognitive outcomes in youth. Aims: This study aims to explore how CON-DMN connectivity influences the relationship between social gradients and cognition in youth. Specifically, it examines whether resting-state functional connectivity between these networks mediates the effects of educational opportunities and family structure on cognitive outcomes and seeks to uncover the neural mechanisms underlying these social gradients. Methods: Data were derived from the Adolescent Brain Cognitive Development (ABCD) study, a large longitudinal dataset of over 11,000 children aged 9–10 years. Cognitive outcomes were assessed using standardized NIH toolbox measures: Total Composite, Fluid Reasoning, Picture Vocabulary, Pattern Recognition, and Card Sorting. Social determinants were operationalized using indicators such as parental education, family composition, and neighborhood educational opportunities (COI). Resting-state functional connectivity (rsFC) between the CON and DMN was measured using functional magnetic resonance imaging (fMRI). Structural equation modeling (SEM) was employed to test whether CON-DMN rsFC mediated the relationship between social determinants and cognitive outcomes, adjusting for potential confounders such as age, sex, and race/ethnicity. Results: Stable family structure and greater educational opportunities were significantly associated with improved cognitive performance. These relationships were mediated by reduced functional connectivity between the CON and DMN. Conclusion: Reduced functional connectivity between the CON and DMN serves as a neural mechanism linking social gradients, such as educational opportunities and family structure, to better cognitive outcomes in youth.

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.

Objective: To examine racial/ethnic differences in the associations of family socioeconomic status (SES), neighborhood SES, and inhibitory control with body mass index (BMI) in 9-10-year-old children using data from the Adolescent Brain Cognitive Development (ABCD) study. Methods: This cross-sectional study included a diverse sample of children aged 9-10 years, representing non-Latino White, Black, Latino, Asian, and Other racial/ethnic groups. BMI was the primary outcome. Key predictors were family SES, neighborhood SES, and inhibitory control. Multivariable regression models were stratified by race/ethnicity to identify group-specific associations. Results: Race/ethnic groups differed in psychosocial correlates of childhood BMI at age 9 and 10. Among non-Latino White children, higher family income (B = -0.086, p < 0.001), higher parental education (B = -0.069, p < 0.001), and living in a married household (B = -0.079, p < 0.001) were associated with lower BMI. Additionally, the presence of healthy food options in the zip code (B = -0.030, p = 0.032) was linked to lower BMI, while lack of planning (B = 0.032, p = 0.030) was associated with higher BMI. For non-Latino Black children, positive urgency (B = -0.068, p = 0.022) was negatively associated with BMI, while other factors such as family SES and neighborhood SES did not show significant associations. For Latino children, higher family income (B = -0.093, p = 0.001) and parental education (B = -0.099, p < 0.001) were associated with lower BMI. In this group, male gender (B = 0.043, p = 0.033) was associated with higher BMI. Among Asian children, higher family income (B = -0.199, p = 0.006) and parental education (B = -0.144, p = 0.037) were significantly associated with lower BMI. For children in the "Other" racial/ethnic category, higher family income (B = -0.101, p = 0.023), living in a married household (B = -0.076, p = 0.026), and higher median income in the zip code (B = -0.083, p = 0.013) were associated with lower BMI. In this group, male children had lower BMI compared to females (B = -0.089, p = 0.001). Conclusion: The findings highlight substantial racial/ethnic differences in the psychosocial and socioeconomic correlates of BMI in children. There is a need for tailored interventions that target social determinants of childhood high BMI. One size does not fit all.

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 12^th 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.

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.

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

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

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.

Background: Although some neural mechanisms underlying socioeconomic status (SES) disparities are known, the role of brain-wide resting-state functional connectivity in these effects remains less understood. Aim: This study aims to identify brain-wide resting-state functional connectivity signatures that may mediate the effects of SES on body mass index (BMI) and blood pressure in children, using data from the Adolescent Brain Cognitive Development (ABCD) study. Methods: Data were drawn from the ABCD study, a large, diverse cohort of children aged 9-10. Pre-processed resting-state functional MRI data were used, and factor analysis was conducted to extract a whole-brain connectivity factor. The first factor, capturing the greatest variance in brain-wide resting-state connectivity, was selected for further analysis in a structural equation model (SEM). This connectivity factor was tested as a potential mediator of the relationship between SES (measured by parental education, family income, and neighborhood characteristics) and two indicators of cardiometabolic health: BMI and systolic blood pressure. Results: Factor analysis revealed a robust first factor that accounted for a significant proportion of variance in brain-wide resting-state functional connectivity. This factor was significantly associated with SES, indicating that children from lower SES backgrounds exhibited distinct connectivity patterns. Additionally, the factor was linked to both BMI and systolic blood pressure, suggesting its relevance to cardiometabolic health. Mediation analysis showed that this connectivity factor partially mediated the relationship between SES and both BMI and systolic blood pressure. Conclusions: Brain-wide functional connectivity may be a mediator of SES effects on BMI and blood pressure in children. The first connectivity factor provides a promising neural signature linking SES with cardiometabolic risk. Comprehensive brain-wide approaches to functional connectivity may offer valuable insights into how social determinants of health shape neural and physical development in childhood.

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

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

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.

Intersectionality has significantly enhanced our understanding of how overlapping social identities—such as race, ethnicity, gender, sex, class, and sexual orientation—interact to shape individual experiences. However, despite its theoretical importance, much of the existing literature has relied on qualitative approaches to define and study intersectionality, limiting its application in predictive modeling, comparative analysis, and policy development. This paper introduces the concept of Quantitative Intersectionality Scoring System (QISS), a novel approach that assigns numerical scores to intersecting identities, thereby enabling a more systematic and data-driven analysis of intersectional effects. We argue that QISS can substantially enhance the utility and predictive validity of quantitative models by capturing the complexities of multiple, overlapping social determinants. By presenting concrete examples, such as the varying impacts of socioeconomic mobility on life expectancy among different intersectional groups, we demonstrate how QISS can yield more precise and reliable forecasts. Such a shift would allow policymakers and service providers to dynamically assess economic and health needs, as well as the uncertainties around them, as individuals move through different social and economic contexts. QISS-based models could be more responsive to the complexities of intersecting identities, allowing for a more quantified and nuanced evaluation of policy interventions. We conclude by discussing the challenges of implementing QISS and emphasizing the need for further research to validate these quantifications using robust quantitative methods. Ultimately, adopting QISS has the potential to improve the accuracy of predictive models and the effectiveness of policies aimed at promoting social justice and health equity.

Background: Tobacco use among adolescents is a significant public health concern, with early initiation leading to long-term health risks. Understanding the factors that contribute to the initiation of tobacco use is crucial for developing effective prevention strategies. This study investigates the roles of substance use harm knowledge and tobacco susceptibility in mediating the relationship between social gradients (race, ethnicity, and socioeconomic status) and tobacco use initiation among adolescents. Methods: Data from the Adolescent Brain Cognitive Development (ABCD) study, comprising a racially, ethnically, and economically diverse sample of tobacco-naive adolescents aged 9 to 16, were analyzed. Structural equation modeling (SEM) was used to test whether substance use harm knowledge and tobacco susceptibility mediate the effects of socioeconomic status (SES) on the initiation of tobacco use. Results: Findings indicated that both substance use harm knowledge and tobacco susceptibility partially mediate the relationship between SES and tobacco use initiation. Adolescents from lower SES backgrounds exhibited lower levels of harm knowledge and higher levels of tobacco susceptibility, which increased their likelihood of initiating tobacco use. Conclusion: This study highlights the complex interplay between social determinants and individual cognitive and psychological factors in influencing tobacco use initiation among adolescents. Public health interventions that enhance harm knowledge and reduce susceptibility to tobacco use are crucial for preventing initiation, particularly among racially, ethnically, and economically diverse adolescents. These efforts can help reduce health disparities and promote health equity.

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

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

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.

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

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.

This integrative literature review aims to explore the pivotal role of dignity and respect in maternity care, focusing on their profound impact on the experiences of pregnant individuals. Emphasis is placed on cultural competence as a crucial factor in fostering understanding and respect for diverse backgrounds, promoting inclusive approaches to maternal care. The overarching goal is to underscore the significance of dignified and respectful care in enhancing maternal satisfaction, postpartum outcomes, and overall well-being. Methods: The review synthesizes existing literature (n=22) on maternity care, dignity, and respect, drawing insights from diverse sources to comprehensively analyze the multifaceted nature of this critical healthcare aspect. Cultural competence is explored as a key theme in understanding and appreciating the varied backgrounds of pregnant individuals. The analysis encompasses factors such as effective communication, healthcare provider attitudes, cultural competence, informed consent, and systemic considerations, shedding light on their collective influence on dignity and respect in maternity care. Principal Findings: The literature review reveals that providing dignified and respectful care significantly contributes to improving maternal satisfaction and postpartum outcomes. Cultural competence emerges as a crucial element, ensuring that care approaches are inclusive and tailored to diverse cultural backgrounds. Effective communication, positive healthcare provider attitudes, and considerations for systemic factors are identified as key determinants of the dignity and respect experienced by pregnant individuals. The findings underscore the interconnectedness of these factors in shaping the overall quality of maternity care. Practical Applications: Recommendations stemming from the literature review include interventions aimed at enhancing healthcare providers' communication skills, cultural competence training, and the promotion of patient-centered care models. Acknowledging the systemic factors influencing maternity care, the review calls for collaborative efforts among healthcare providers, policymakers, and researchers to create an environment that upholds pregnant individuals' autonomy and values. The practical applications emphasize the need for comprehensive and culturally sensitive approaches to ensure that all pregnant individuals receive dignified and respectful care. In summary, this integrative literature review provides a comprehensive understanding of the critical role of dignity and respect in maternity care, offering insights into effective strategies for improvement and emphasizing the importance of cultural competence and collaborative efforts in shaping the future of maternal healthcare.

This study was designed to assess how primary identification markers affected social tolerance in a multi-tribal setting among a heterogeneous population. A sample of 312 participants was selected using the purposive sampling technique. A search of the literary documentation yielded three modalities of the dependent variable. Thus, data were collected from the Feeling Thermometer, Affirmative Action, and Multiculturalism scales. We assessed participants' levels of identification with identity markers to determine their impact on social tolerance. The findings suggest that measures of social tolerance are somewhat significantly influenced by Cameroonians' levels of affiliation with their key identity markers. However, tolerance decreases when tribal identity becomes stronger. Conversely, the effect of linguistic and religious identification forces on social tolerance varies depending on the object to be tolerated. These findings contribute to a better understanding of the determinants that influence social tolerance in a tribal setting.

Background: Reproductive health is a critical component of overall health and development. Unmet contraceptive needs are one of the regularly cited measures of the efficacy of family planning (FP) initiatives. This study set out to determine the magnitude and associated factors of unmet need for FP among women of reproductive-aged (15-49 years) in the provincial areas of The Gambia. Methods: The study used a community-based cross-sectional analytical design. A multistage sampling strategy, comprising simple random and cluster sampling, was utilized to obtain a sample of 643 childbearing women (15-49 years) from rural Gambia's sampled clusters. Data collection was conducted using pre-tested structured interview questionnaires. The association was examined using chi-square/fisher's exact test with a significance level of p<0.05. Binary logistic regression analysis was performed to examine the effect of sociodemographic and cultural determinants on unmet FP need, with corresponding computed adjusted odds ratios (aOR). IBM SPSS version 24 was used for data entry and analysis. Results: The unmet need for FP among the study participants was 25.2%; unmet need for spacing and unmet need for limiting was 17.4% and 7.8%, respectively. The total demand for FP was 59.4%, while the satisfaction of demand for FP was 57.6%. The significant predictors of unmet need for FP were woman’s age at first pregnancy (aOR=0.899, p=0.033), LGA of origin (aOR=0.240, p=0.001) and frequency of using contraceptives (aOR=1.587, p=0.032). Conclusion: The present study demonstrated a high unmet need for FP among rural women in The Gambia, with the most often cited reason for non-use being fear of side effects. Hence, it is necessary to concentrate FP services for rural populations, stressing education regarding contraceptive side effects, service quality, and gender equality. Additionally, the study suggests that male participation and religious leaders' involvement in FP programs be strengthened and mainstreamed, as well as the establishment of a communication program that specifically promotes inter-spousal communication.

Background: Everyone, irrespective of age, sex, colour, ethnicity, or present overall fitness level, can benefit from regular exercise. To improve one's health, one must engage in regular physical activity. People with underlying illnesses like long-term impairment can benefit from regular physical activity at the individual level, especially young women. Thus, the current study aimed to assess the prevalence and determinants of physical activity among female school-aged adolescents in the West Coast Region of The Gambia. Methods: The present study used an institutional-based cross-sectional analytical study to collect quantitative data from 384 female high school students in The Gambia. The study used a content-validated, pretested structured questionnaire that consisted of both open and closed-ended questions on physical activity. The data were processed and analyzed using IBM SPSS version 26.0. Descriptive statistics and Chi-square and/or Fisher exact test were used with a p-value <0.15 for inclusion in the logistic regression model. Adjusted odds ratios (aORs) and 95% confidence intervals were calculated, while p-value <0.05 was considered for statistical significance. Results: The proportion of female students involved in physical activity was 37.5%. The mean age of students was 18.8 years with a standard deviation of 1.7 years. Factors such as female students between 17 – 20 years (aOR:3.05, 95% C.I. (1.807 – 5.138)), father never been to school (aOR: 2.82, 95% C.I. (1.495 – 5.334)), primary education (aOR: 2.15, 95% C.I. (1.027 – 4.493)), upper basic school (aOR: 2.31, 95% C.I. (1.055 – 5.074)) and science major students (aOR: 2.21, 95% C.I. (1.203 – 4.047)) had increased odds of involving in PA. Furthermore, students who knew that exercise would strengthen bones (aOR: 2.62, 95% C.I (1.444 – 4.739)), do a planned brisk walking (aOR: 19.16, 95% C.I. (6.698 – 54.811)), basketball/football (aOR: 29.76, 95% C.I. (10.004 – 88.512)) and skipping with rope (aOR: 29.15, 95% C.I. (9.726 – 87.333)) had increased odds to involved in PA after controlling for confounders. Other factors such as students whose mother never been to school (aOR: 0.31, 95% C.I. (0.140 – 0.674)), primary level (aOR: 0.25, 95% C.I. (0.123 – 0.518)), senior secondary level (aOR: 0.42, 95% C.I. (0.189 – 0.935)), nuclear family (aOR: 0.23, 95% C.I. (0.119 – 0.458)) and extended family (aOR: 0.45, 95% C.I. (0.225 – 0.915)) had reduced odds of involving in PA. Conclusion: There is low physical activity among female adolescents in schools. For this, it is imperative that suitable interventions be implemented to raise the level of physical activity among secondary school students. A future intervention for school-aged adolescents could benefit from these findings.

Background: Family planning (FP) methods have been found as an efficient approach of reducing fertility and are therefore widely supported in order to decrease population growth, particularly in poor nations. Promoting contraception availability among women (15 – 49) age has also been shown to be an efficient public health strategy for improving maternal and newborn health outcomes. This paper aimed at exploring the pooled prevalence of contraceptive uptake and its contextual determinants among women of childbearing age in The Gambia. Methods: The Gambia Demographic and Health Survey (GDHS) in both 2013 and 2019-20 was used for this study. Data were obtained from a pooled 22,098 women aged 15-49 (10,233 for 2013 and 11,865 for 2019-20) through a stratified two-stage cluster sampling approach. Percentages and chi-square tests were used and variables with p-value <0.05 were included into the model. A multivariable logistic regression model was used to assess the predictors of contraceptive usage at 95% confidence interval (CIs) with computed adjusted odds ratios (aORs). All the study data were analyzed using Stata version 15. Results: The weighted pooled prevalence of modern contraceptive utilization in The Gambia was 10.1%. Younger age, compared with women aged 25-29; 30-34; 35-39; 40-44; primary education (aOR=1.25, 95% CI=1.05-1.49); secondary education (aOR=1.57, 95% CI= 1.32-1.85); Higher education (aOR=1.90, 95% CI=1.34-12.69); living in urban areas (aOR=1.49, 95% CI= 1.25-1.79); parity 2-4 (aOR=1.21, 95% CI= 1.01-1.47); told about FP at health facility (aOR=2.97, 95% CI= 2.61-3.38), and no desire for many children (aOR=1.96, 95% CI= 1.62-2.37) were more like to use modern contraceptives among Gambian women. Conclusion: The programme certainly needs to consider improvements in the quality of care being offered to acceptors. Government agencies should target these programs and campaigns on regional FP demands and provide suitable culturally sensitive and regionally adaptive services to the communities' contexts. The programme should intensify its efforts in rural and urban settings to improve accessibility to and availability of FP services.

Background: Acute respiratory infections (ARIs) generally describe a group of infections caused by a range of organisms whose site of action includes the nostrils, through the pharynx to the alveoli. ARIs are reportedly key contributing factors to childhood morbidities and deaths, with a higher impact on children less than the age of five years. This paper aimed at exploring the prevalence of ARIs and their contextual determinants among children less than 60 months of age in the rural settings of the Gambia. Method: The Gambia Demographic and Health Survey (GDHS) in 2019-20 was used for this study. Data were obtained from 1364 rural women aged 15-49 with children less than 60 months through a stratified two-stage cluster sampling approach. Percentages and chi-square tests were used and variables with p-value <0.15 were included in the model. A multivariable logistic regression model was used to assess the predictors of acute respiratory infection at 95% confidence interval (CIs) with computed adjusted odds ratios (aORs). All the study data were analyzed using Stata version 17. Results: The weighted prevalence of ARIs among children under 60 months of age in the rural Gambia was 37.1% with 95% CI (34.5% - 39.6%). The magnitude of ARI was higher among children 25-60 months age group (38.6%), male children (38.9%) unvaccinated children (42.9%), and those whose fathers and mothers were not working at 60.5% and 38.7%, respectively. In the adjusted model, children whose mother had primary education (aOR=0.65, 95% CI= 0.46-0.91), currently non-breastfed children (aOR=1.40, 95% CI= 1.09-1.79) and those whose father were not working (aOR=2.65, 95% CI= 1.47-4.17) were found to be associated with ARIs among children less than 60 months in The Gambia. Conclusion: The prevalence of ARI was moderately high across children under 5 years of age in rural Gambia, low mother’s educational levels, and unemployed fathers. The program must consider improvements in the quality of care provided to children in both primary, secondary and tertiary healthcare levels in rural settings. Partner support and adapting community-based supporting systems on child health strategies should be strengthened especially in rural settings.

This study raises the problem of the non-repayment of agricultural credits by producers who are members of the Community Growth Mutual (MC²), in this period of COVID-19. It questions the economic mores in force in most member countries of the Organization for the Harmonization of Business Law in Africa (OHADA), where credit has become difficult for small rural farmers; And refers to the theory of the vicious circle of poverty, which advocates an indispensable recourse to foreign capital in the event of financial breakdown, as a means of increasing capital. Since the capital of rural producers remains insufficient and their possibility of reinvestment decreases, then becomes zero because of agricultural credit. To understand the factors of the non-repayment of these credits, data were collected from 100 agro-sylvo-pastoral producers of the Bayangam group (West-Cameroon) of both sexes, aged at least 18 years, having obtained an unpaid credit from the MC² since 2019, and a manager of this microfinance institution. After analysis, it appears that beyond overproduction and anti-COVID-19 measures that lead to the missale or fall in prices on the market, the conditions of access to credit, the non-possession of acceptable guarantees, the misuse of the object of credit and the practice of financial cavalry by the borrower, as well as the rigidity of the procedures for prosecuting debtors significantly explain this non-repayment. It is associated with determinants such as age, level of education, marital status, type of agricultural activity of the debtor. Hence the need for flexibility of microfinance institutions vis-à-vis rural agro-sylvo-pastoral producers, who are severely affected by the economic shock of the COVID-19.

Background: Family planning is one of the key cornerstones of safe parenthood and a reproductive rights issue. In underdeveloped nations, women experiencing unmet FP needs formed a considerable proportion of all women of reproductive age and are ongoing public health concerns in The Gambia. The study was set out to explore the influence of socio-demographic and cultural factors on contraceptive uptake among rural women in The Gambia. Methods: The study used a community-based cross-sectional analytical design. A multistage sampling strategy, comprising simple random and cluster sampling, was utilized to obtain a sample of 634 childbearing women (15-49 years) from rural Gambia's sampled clusters. Data collection was conducted using pre-tested structured interview questionnaires. The association was examined using chi-square/fisher's exact test with a significance level set at p<0.05. Binary logistic regression analysis was performed to examine the effect of socio-demographic and cultural determinants on uptake of contraceptives, with corresponding computed adjusted odds ratios (aOR). IBM SPSS version 25 was used for data entry and analysis. Results: The uptake of contraceptives among the study participants was 30.4%. The total demand for FP was 59.4% while the satisfaction of demand for FP was 57.6%. The significant predictors of FP uptake were the age of women (aOR=1.097, p=0.014), reason for using FP (aOR=1.139, p=0.011), use of contraceptives before (aOR=24.416, p<0.001) and reason for not discussing FP with a partner (aOR=1.787, p=0.029). Conclusion: The study showed low contraceptive uptake among women in rural communities. Thus, spousal communications on FP concerns are key intermediate steps towards eventual acceptance and sustained usage of FP services. The program should focus on improving access to and availability of FP services in rural areas. The program should prioritize addressing women's needs through consistent community-based interventions including targeted home visits.