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Open Access February 06, 2026

Predictive Modeling of Public Sentiment Using Social Media Data and Natural Language Processing Techniques

Abstract Social media platforms like X (formerly Twitter) generate vast volumes of user-generated content that provide real-time insights into public sentiment. Despite the widespread use of traditional machine learning methods, their limitations in capturing contextual nuances in noisy social media text remain a challenge. This study leverages the Sentiment140 dataset, comprising 1.6 million labeled [...] Read more.
Social media platforms like X (formerly Twitter) generate vast volumes of user-generated content that provide real-time insights into public sentiment. Despite the widespread use of traditional machine learning methods, their limitations in capturing contextual nuances in noisy social media text remain a challenge. This study leverages the Sentiment140 dataset, comprising 1.6 million labeled tweets, and develops predictive models for binary sentiment classification using Naive Bayes, Logistic Regression, and the transformer-based BERT model. Experiments were conducted on a balanced subset of 12,000 tweets after comprehensive NLP preprocessing. Evaluation using accuracy, F1-score, and confusion matrices revealed that BERT significantly outperforms traditional models, achieving an accuracy of 89.5% and an F1-score of 0.89 by effectively modeling contextual and semantic nuances. In contrast, Naive Bayes and Logistic Regression demonstrated reasonable but consistently lower performance. To support practical deployment, we introduce SentiFeel, an interactive tool enabling real-time sentiment analysis. While resource constraints limited the dataset size and training epochs, future work will explore full corpus utilization and the inclusion of neutral sentiment classes. These findings underscore the potential of transformer models for enhanced public opinion monitoring, marketing analytics, and policy forecasting.
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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 February 21, 2025

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

Abstract Background: Maternity leave, whether paid or unpaid, is a critical resource that can significantly impact maternal well-being and newborn outcomes. However, its availability and utilization among mothers living in poverty remain understudied. Education is widely recognized as a key factor that increases access to both paid and unpaid leave. However, the theory of Minorities’ [...] Read more.
Background: Maternity leave, whether paid or unpaid, is a critical resource that can significantly impact maternal well-being and newborn outcomes. However, its availability and utilization among mothers living in poverty remain understudied. Education is widely recognized as a key factor that increases access to both paid and unpaid leave. However, the theory of Minorities’ Diminished Returns (MDRs) posits that structural racism, segregation, and labor market discrimination limit the benefits of socioeconomic resources, such as education, for Black and Latino individuals. This suggests that the effects of education on maternity leave may not be uniform across racial and ethnic groups. Objective: This study aimed to examine the MDRs of education on access to unpaid and paid maternity leave among Black and Latino mothers compared to White mothers giving birth while living in poverty. Methods: We utilized baseline data from the Baby’s First Years Study (BFY), a longitudinal investigation of the effects of poverty on child development. The sample consisted of 1,050 mothers living in poverty who had recently given birth. Maternity leave (paid and unpaid) was assessed via self-report, and educational attainment was measured in years of schooling. Structural equation modeling (SEM) and interaction terms were employed to analyze racial and ethnic differences in the relationship between education and access to maternity leave. Results: Educational attainment was positively associated with access to unpaid maternity leave for the overall sample of mothers giving birth in poverty, but this association was weaker for Black and Latino mothers compared to non-Latino White mothers. Education did not significantly increase the likelihood of paid maternity leave, and there were no group differences for this association. Conclusion: This study highlights the urgent needs to address structural racism, labor market discrimination, and residential segregation that diminish the impact of education on living conditions for Black and Latino mothers, compared to non-Latino White mothers, even for those living under poverty. Policymakers and practitioners should develop targeted interventions to reduce racial and ethnic disparities in access to paid and unpaid maternity leave and other critical resources, particularly for new mothers living in poverty. Addressing these inequities is essential for improving maternal and newborn health outcomes and promoting social justice.
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Open Access February 15, 2025

Knowledge related to umbilical cord care among mothers of neonates attending outpatient departments in Sherpur district, Bangladesh

Abstract Background: Proper umbilical cord care prevents neonatal infections and reduces neonatal mortality. Despite global recommendations for evidence-based cord care practices, traditional beliefs, and inadequate maternal knowledge often lead to unsafe practices, particularly in low-resource settings like Bangladesh. This study aimed to assess the understanding of umbilical cord care among [...] Read more.
Background: Proper umbilical cord care prevents neonatal infections and reduces neonatal mortality. Despite global recommendations for evidence-based cord care practices, traditional beliefs, and inadequate maternal knowledge often lead to unsafe practices, particularly in low-resource settings like Bangladesh. This study aimed to assess the understanding of umbilical cord care among mothers of neonates in Sherpur District, Bangladesh, and identify factors associated with knowledge levels. Methods: A descriptive cross-sectional study was conducted from July to October 2020 at Sherpur Sadar Hospital. A total of 193 mothers of neonates were recruited using a non-randomized purposive sampling method. Data was collected through a pre-tested, semi-structured, interviewer-administered questionnaire. Knowledge levels were categorized as "Good" (>6) or "Poor" (≤6) based on responses to 10 structured questions. Statistical analyses, including chi-square tests and crude odds ratios (COR), were performed to identify socio-demographic factors associated with knowledge levels. Results: Of the 193 participants, 48.7% demonstrated "Good" knowledge, while 51.3% had "Poor" knowledge. Education level (p = 0.01), occupation (p = 0.02), family type (p < 0.001), and family size (p = 0.04) were significantly associated with knowledge levels. Mothers with higher education and those from joint families exhibited better knowledge. However, 28.5% of respondents were unaware of the typical umbilical cord-shedding timeframe, and 44% could not identify signs of infection. Unsafe practices, such as using medications (14.5%) or hot compression (7.2%) for drying the cord, were reported. Conclusion: The study reveals significant gaps in maternal knowledge regarding umbilical cord care in Sherpur District, driven by socio-demographic disparities and cultural practices. Targeted health education programs, emphasizing evidence-based cord care practices and leveraging local social structures, are urgently needed to improve neonatal health outcomes in similar resource-limited settings. Future research should evaluate the effectiveness of these interventions to inform policy and practice.
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Open Access November 26, 2024

Impact of Classroom from the Primary Level of the Acquisition of English as a Second Language in Bangladesh

Abstract This paper examines the impact of primary level classroom environments on the acquisition of English as a second language (L2) in Bangladesh, comparing English-medium and Bangla-medium schools. The study investigates how different instructional approaches and early exposure to English influence language proficiency among students. Through a mixed-methods approach, including surveys, interviews, [...] Read more.
This paper examines the impact of primary level classroom environments on the acquisition of English as a second language (L2) in Bangladesh, comparing English-medium and Bangla-medium schools. The study investigates how different instructional approaches and early exposure to English influence language proficiency among students. Through a mixed-methods approach, including surveys, interviews, and proficiency tests, the research reveals significant differences in language acquisition outcomes between the two educational settings. Findings indicate that students in English-medium schools, who are exposed to Natural approach methods of language learning and immersive English-speaking environments, demonstrate higher proficiency in speaking and listening skills compared to their Bangla-medium counterparts, who primarily receive grammar-focused instruction. The study highlights the critical role of early exposure to English, with students who begin learning the language at a younger age showing better phonological and syntactic development. Additionally, the integration of technology in language teaching emerges as a valuable tool for enhancing language learning, particularly in contexts with limited classroom exposure. The research suggests that Bangla-medium schools could benefit from adopting more interactive, student-centered teaching methods and integrating digital tools to support practical language use. The study's findings have significant implications for educational policy, advocating for a shift towards more immersive and communicative teaching practices to improve English language acquisition in Bangladesh. This research contributes to the broader understanding of SLA and offers practical recommendations for enhancing language education in similar contexts.
Article
Open Access March 05, 2024

Culture Shock in Nursing: A Concept Analysis

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

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

Abstract The quality of communication between healthcare providers and pregnant women is a topic of paramount importance within the realm of maternal healthcare. It is not merely an aspect of medical interaction; rather, it is the prerequisite that influences various critical dimensions of maternal care, including maternal satisfaction, health outcomes, and shared decision-making. Effective communication [...] Read more.
The quality of communication between healthcare providers and pregnant women is a topic of paramount importance within the realm of maternal healthcare. It is not merely an aspect of medical interaction; rather, it is the prerequisite that influences various critical dimensions of maternal care, including maternal satisfaction, health outcomes, and shared decision-making. Effective communication between healthcare providers and pregnant women is essential for optimal maternal care during pregnancy and childbirth. Maternal satisfaction is a fundamental metric of patient-centered care, and improved communication, characterized by empathy, information sharing, and active listening, cultivates trust and enhances women's contentment with their care experiences. Positive provider-patient interactions are associated with improved emotional well-being, reduced stress levels, and increased adherence to prenatal recommendations, contributing to positive health outcomes for both mother and fetus. Shared decision-making is impacted by open and transparent dialogue between healthcare providers and pregnant women. Inclusive discussions about available interventions, risks, and benefits empower women to make informed choices aligned with their preferences and values. This shared decision-making promotes autonomy, self-efficacy, and a collaborative care partnership, potentially influencing the birthing experience and postpartum adaptation. However, challenges persist in communication quality, such as variability in healthcare provider communication styles, cultural considerations, and system-level factors. Addressing these challenges through targeted interventions, training, and policy implementation can further enhance the overall maternal care experience. Further research is needed to explore innovative strategies that optimize communication and promote positive outcomes throughout the continuum of maternal care.
Review Article
Open Access September 19, 2023

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

Abstract Background: The phenomenon of "empty nest youth" is becoming increasingly ubiquitous, capturing the attention of society at large. However, few studies have been conducted in recent years on this group, especially focusing on their family and mental health. As such, this study investigates the correlation between family health and well-being among "empty nest youth," as well as the function of social support and loneliness in this relationship. Methods: A cross-sectional survey was conducted from June to August 2022 across 32 provinces, municipalities, and autonomous regions in China, utilizing a multi-stage sampling technique. And we screened individuals who were unmarried, living alone, and between 22-44 years old, resulting in a valid sample size of 908 cases; multiple regression analysis, mediation effect testing, and moderation effect testing are used to examine research hypotheses. Results: The regression analysis results show that family health not only has a direct impact on well-being (β = 0.36, p < 0.001) but also indirectly affects well-being through social support [β = 0.23, 95% CI: 0.19 0.28]. Additionally, the loneliness moderates the predictive impact of not only family health on social support (β = -0.13, p < 0.001) but also social support on well-being (β = -0.06, p [...] Read more.
Background: The phenomenon of "empty nest youth" is becoming increasingly ubiquitous, capturing the attention of society at large. However, few studies have been conducted in recent years on this group, especially focusing on their family and mental health. As such, this study investigates the correlation between family health and well-being among "empty nest youth," as well as the function of social support and loneliness in this relationship. Methods: A cross-sectional survey was conducted from June to August 2022 across 32 provinces, municipalities, and autonomous regions in China, utilizing a multi-stage sampling technique. And we screened individuals who were unmarried, living alone, and between 22-44 years old, resulting in a valid sample size of 908 cases; multiple regression analysis, mediation effect testing, and moderation effect testing are used to examine research hypotheses. Results: The regression analysis results show that family health not only has a direct impact on well-being (β = 0.36, p < 0.001) but also indirectly affects well-being through social support [β = 0.23, 95% CI: 0.19 0.28]. Additionally, the loneliness moderates the predictive impact of not only family health on social support (β = -0.13, p < 0.001) but also social support on well-being (β = -0.06, p < 0.001). Conclusions: These findings underscore the significance of directing policymakers and healthcare professionals towards the "empty nest youth's" familial and social support systems. It underscores the need for the development of policies aimed at addressing their emotional and material requirements by leveraging these familial and social networks. This approach ultimately contributes to the enhancement of their overall psychological well-being, promoting a more coherent and logical pathway for intervention and support.
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Open Access January 14, 2023

Searching for What You Can’t See - Evaluation of Pesticide Residues in Grain Sold at Selected Markets of Southwest Nigeria

Abstract Studies on the use of pesticides in southwest Nigeria have revealed a substantial rise in a variety of pesticide-related illnesses, including mental impairment and reproductive problems. Those who work in agriculture and are regularly exposed to pesticides are the most impacted. The World Health Organization (WHO) predicts that three million severe pesticide poisoning episodes occur globally each [...] Read more.
Studies on the use of pesticides in southwest Nigeria have revealed a substantial rise in a variety of pesticide-related illnesses, including mental impairment and reproductive problems. Those who work in agriculture and are regularly exposed to pesticides are the most impacted. The World Health Organization (WHO) predicts that three million severe pesticide poisoning episodes occur globally each year, with at least 300.000 deaths and 99% of cases occurring in low- and middle-income nations. The effects of longer-term exposure to pesticides on health are not yet precisely estimated. Objectives: To this end, the objective of this study is to assess the knowledge of pesticide residues and common pesticides in grain-based food (brown and white beans, yellow and white maize, brown millet and rice) about pesticide use in selected markets of Southwest Nigeria. Methods: A total of 240 respondents were selected from four states (Ado-Ekiti, Ibadan, Osun and Ondo) with the aid of structured questionnaire and interview guide using purposive sampling technique. The markets were Oja-titun (market) Ile-Ife, Osun; Alesinloye Market Ibadan, Oyo; Oja Oba, Ado-Ekiti, Ekiti; and Oja Oba, Akure Ondo State. The identification and quantification of pesticide residues was done using a Varian 3800/4000 gas chromatograph mass spectrometer while 60 structured questionnaires were administered to respondents including food merchants, buyers/consumers as well as food vendors. Data were analysed using descriptive statistics. Results: The experiment was conducted from November 2020 to November 2021. Up to 50.4% never read instructions on pesticide application while a shared 24.8% read them always and occasionally. The number of respondents who never read the instructions were particularly high in Ekiti and Ondo, up to 52.5% of the respondents in Ekiti do not know whether or not they are exposed to pesticides during application. Also, majority of the respondents never attended any professional training on pesticide application, this amounted to 79.3%. Most people were not aware that unsafe pesticide application is harmful to human health. Similarly, a wide variety of symptoms were reported by respondents following pesticide application or consumption of grains, these included headaches and dizziness, itching and redness of the eyes, skin allergy, diarrhea, and stomach disorder, vomiting and loss of appetite, weakness of the body, asthma, permanent skin patches, shortness of breath, excessive sweating. Millet recorded the highest number of OCP residues while maize had the lowest. On the contrary, maize had the highest number of OPP and carbamate residues while millet had the lowest number of OPP residues. Meanwhile, maize, rice and beans had only one carbamate pesticide residue. Conclusions: According to the study's conclusions, farmers who can only get information from agricultural extension officials should receive urgent and immediate attention for raising awareness. Additionally, extensive IPM training programs must be created with the intention of disseminating precautions for protecting human health and a healthy agro-ecosystem. In order to find more effective pest management methods that utilize less pesticides, it is crucial to reevaluate the pesticide residues and common pesticides found in grains in the targeted markets. To reduce farmers' exposure to pesticides, it is also required to establish personal protective measures, special educational initiatives, and legislation promoting the use of safer pesticides. Significance and novelty: This study gives policymakers a comprehensive understanding of the ways that may be utilized to close the significant knowledge gap on pesticide residues in grains and provides an insight into the knowledge of pesticide residues and common pesticides in grains.
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Open Access May 06, 2022

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

Abstract Acute diarrhea is a common affection, among children under 59 months old in Sub-saharan Africa and Asia known to be a global public health concern. It is responsible for significant mortality in developing countries. The main purpose of this study was to identify drivers of acute diarrhea in mothers of children aged 6-59 months in Kinshasa households. This study was conducted in two health areas [...] Read more.
Acute diarrhea is a common affection, among children under 59 months old in Sub-saharan Africa and Asia known to be a global public health concern. It is responsible for significant mortality in developing countries. The main purpose of this study was to identify drivers of acute diarrhea in mothers of children aged 6-59 months in Kinshasa households. This study was conducted in two health areas in Kinshasa namely Centre Supérieur Militaire Mobikisi and Hopital Militaire Central. It is a cross-sectional study of analytical type having a correlational design. In fact, 114 mothers having children aged 6 to 59 months old who had experienced at least three diarrheal episodes were selected and this research was carried out in January 2020. Independent variables were socio-economic factors and dependent variables were biological factors. Descriptive statistical analyses of which frequency and percentage were performed to describe the sampling profile. To measure the strength of association between different variables, the Pearson's Chi-Square (X2) test was used. The findings showed that 57% live in a high socio-economic environment compared to 43% who have a low socio-economic environment responsible for the occurrence of acute diarrhea. It was observed that 67.7% of participants knew the importance of access to health care services, compared to 32.3% who did not know. Meanwhile, 50.8% lived in a healthy environment versus 49.2% who had an unhealthy environment. Furthermore, 53.8% were in an acceptable demographic and biological situation, compared to 46.2% who were in a precarious demographic and biological situation. Acute diarrhea in children aged 6-59 months is one of the causes of morbidity and mortality in Kinshasa city. Obstacles to effective care are related to the lack of quality service provision. Policy makers must therefore put in place interventions to address these challenges in order to reduce infant morbidity and mortality in this area.
Article
Open Access June 16, 2021

Impact of Pandemic Covid-19 on Higher Education-Indian Context

Abstract Education stratum of India as well as world are worst-hit by Covid-19 and has imposed lockdown originating deleterious effect on academic life. A sheer number of learners ceased moving educational institutions and all pedagogies halted in India. Catastrophe has behaved as a stimulant for the educational institutions to cultivate and choose for platforms with technologies which were previously [...] Read more.
Education stratum of India as well as world are worst-hit by Covid-19 and has imposed lockdown originating deleterious effect on academic life. A sheer number of learners ceased moving educational institutions and all pedagogies halted in India. Catastrophe has behaved as a stimulant for the educational institutions to cultivate and choose for platforms with technologies which were previously noviced. Education sector has been challenging to weather the crux with alternative strategy and digitizing the challenges to hoover the menaces of the pandemic. Hypothesis of digital study has prognosis to impact the ventures of higher education for eon. Findings evince that despite digital learning is a nice adventure for little skills, varying illiberalities partake. Learners are crunched and academy also exclusively in unstable job. It has yet to be established the scope whereupon digital study would climactically cover for conventional study. Covid-19 conundrum has divulged prefacing dilemma and disparities clamoring synergetic attempt to contemplate even so pandemic’s approach. This deliberate paper illuminates sparse impeccable education in India and has discussed the positive and negative impacts of Covid-19. The paper also contributes a methodical substantiation of the experience and lessons digested from the impact of the pandemic on the transitional education panorama, and the dissemination and acceptance of e-learning in education. To end, few suggestions along with policy recommendations have been made to meet didactics during the pandemic contingency.
Article
Open Access January 16, 2026

Evaluating the Effectiveness of Occupational Health and Safety Management Practices in Improving Workplace Safety in Nigerian Construction Sites

Abstract The construction industry remains one of the most hazardous sectors globally, with Nigeria experiencing a high incidence of workplace accidents despite the adoption of Occupational Health and Safety Management (OHSM) frameworks. This study evaluated the effectiveness of OHSM practices in improving workplace safety across construction companies in Nigeria’s coastal cities. A cross-sectional design [...] Read more.
The construction industry remains one of the most hazardous sectors globally, with Nigeria experiencing a high incidence of workplace accidents despite the adoption of Occupational Health and Safety Management (OHSM) frameworks. This study evaluated the effectiveness of OHSM practices in improving workplace safety across construction companies in Nigeria’s coastal cities. A cross-sectional design was employed, combining quantitative surveys of construction workers (n = 1,400) with qualitative interviews of 35 managers and supervisors. Quantitative data were analyzed using SPSS version 28, while thematic analysis was applied to qualitative responses. Findings revealed a generally positive perception of OHSM, with 54.4% of workers rating OHS policy effectiveness as “Good” and 52.0% rating health outcomes as “Good.” However, accident frequency remained a concern, with 46.4% reporting accidents occurred “Occasionally” and 31.9% acknowledging them as “Frequent” or “Very Frequent.” Comparative analysis showed indigenous firms were rated higher in policy effectiveness and health outcomes but also reported slightly higher accident frequencies than international firms. Thematic analysis identified five key monitoring and evaluation strategies including routine inspections, regular training, audits, behavioural reinforcement, and access control, Also, five measures of OHSM effectiveness, including compliance observation, incident tracking, KPIs, employee feedback, and benchmarking. OHSM was found to positively influence project outcomes by reducing compensation costs, enhancing reputation, and improving supervision and quality of work. OHSM practices in Nigeria’s construction sector are perceived as effective in policy and health outcomes, yet accident rates remain a critical challenge. The study underscores the importance of continuous training, stricter enforcement, behavioural reinforcement, and systematic performance evaluation.
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Open Access December 22, 2025

Reimagining Mathematical Modeling for a Responsive and Integrated Future in Infectious Disease Epidemiology

Abstract Mathematical modeling plays a central role in infectious disease epidemiology, shaping outbreak response strategies and informing public health policy. The COVID-19 pandemic demonstrated the value of these models but also exposed persistent limitations related to data fragility, lack of transparency, limited stakeholder engagement, and insufficient consideration of social and political contexts. [...] Read more.
Mathematical modeling plays a central role in infectious disease epidemiology, shaping outbreak response strategies and informing public health policy. The COVID-19 pandemic demonstrated the value of these models but also exposed persistent limitations related to data fragility, lack of transparency, limited stakeholder engagement, and insufficient consideration of social and political contexts. Rather than critiquing modeling as a discipline, this perspective argues for a reorientation of infectious disease modeling toward a more responsive, equity-centered, and participatory paradigm. We propose a conceptual framework built on three interrelated principles: adaptability through real-time data integration, transparency via open-source and reproducible practices, and relevance through interdisciplinary and co-produced model design. Drawing on illustrative examples from COVID-19 and dengue control efforts, we highlight how integrating behavioral dynamics, local knowledge, and policy feedback can improve model usefulness and public trust. Reconceptualizing models as dynamic systems of inquiry rather than static forecasting tools can enhance decision-making and promote more equitable and effective responses to future public health emergencies.
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Brief Review
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 14, 2025

Lifecycle Management as a Roadmap to the Tobacco Endgame

Abstract Background: Tobacco endgame, defined as elimination of commercial tobacco sales The U.S. tobacco control landscape is a complex, adaptive system shaped by diverse stakeholders, evolving products and regulations, shifting social norms, and the strategic countermeasures of a powerful industry. Managing such complexity requires more than isolated interventions—it demands a coordinated, [...] Read more.
Background: Tobacco endgame, defined as elimination of commercial tobacco sales The U.S. tobacco control landscape is a complex, adaptive system shaped by diverse stakeholders, evolving products and regulations, shifting social norms, and the strategic countermeasures of a powerful industry. Managing such complexity requires more than isolated interventions—it demands a coordinated, enterprise-wide approach that accounts for dynamic interactions, feedback loops, and emergent risks. Objective: Drawing on complex systems thinking, Zachman enterprise architecture model, and public health best practices, we conceptualize tobacco control as an evolving enterprise progressing through six interconnected phases: (1) Conception & Initiation, (2) Policy & System Design, (3) Implementation & Operation, (4) Evaluation & Adaptation, (5) Consolidation & Endgame Transition, and (6) Sustainment or Sunset. Each phase incorporates governance structures, performance benchmarks, and transition criteria designed to manage interdependence and reduce systemic vulnerabilities. Results: The lifecycle framing emphasizes how tobacco control in the U.S. can evolve as a complex, adaptive enterprise—integrating public health objectives with legal, operational, and cultural change processes. This model supports strategic sequencing, cross-sector alignment, and risk mitigation against emergent industry tactics, enabling a resilient and measurable pathway to the endgame. Conclusions: Seeing tobacco control as a complex enterprise that operates under a lifecycle model may offer a roadmap for achieving and sustaining the tobacco endgame. Using this approach may enhance policy coherence, resource efficiency, and adaptability, ensuring tobacco endgame is achieved.
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Open Access June 26, 2025

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

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

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

Abstract The Free Senior High School (FSHS) policy implementation in Ghana has garnered significant attention in academic research, with various studies delving into its advantages and implementation obstacles. Nevertheless, there has been a rise in school dropout rates among secondary school students amidst the programme implementation. There is therefore the need for a more localized scientific inquiry [...] Read more.
The Free Senior High School (FSHS) policy implementation in Ghana has garnered significant attention in academic research, with various studies delving into its advantages and implementation obstacles. Nevertheless, there has been a rise in school dropout rates among secondary school students amidst the programme implementation. There is therefore the need for a more localized scientific inquiry into the socio-economic factors contributing to school dropout among Senior High School (SHS) students in the Abofour community. The study employed a qualitative approach, using the case study design to conduct interviews with 22 students who had dropped out of SHS, to explore their experiences and identify key socio-economic factors influencing their decisions to leave school. Thematic data analysis revealed six main themes, namely, lack of parental support, peer influence, early marriage and pregnancy, economic conditions, and unsupportive school environment, as among the causative factors. The findings suggest that while the Free SHS policy has removed some direct financial barriers, other social, economic, and institutional factors continue to spur up dropout rates. The study concludes that addressing these underlying issues requires a multi-faceted approach that includes strengthening family support systems, improving school environments, and providing targeted interventions for at-risk students. In this regard, policymakers and other educational stakeholders are required to provide targeted supports to enhance student retention and reduce dropout rates in the Abofour community.
Article
Open Access 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 May 04, 2025

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

Abstract Background: High educational attainment is a well-recognized protective factor against health problems such as diabetes. However, the theory of Minorities' Diminished Returns (MDRs) suggests that this protective effect is weaker for ethnic minorities compared to non-Latino Whites. This diminished effect is thought to result from structural inequalities, such as lower-quality [...] Read more.
Background: High educational attainment is a well-recognized protective factor against health problems such as diabetes. However, the theory of Minorities' Diminished Returns (MDRs) suggests that this protective effect is weaker for ethnic minorities compared to non-Latino Whites. This diminished effect is thought to result from structural inequalities, such as lower-quality education and fewer occupational opportunities, faced by ethnic minorities. Objective: This study examined the protective effect of years of schooling—used as a proxy for educational attainment—on diabetes mellitus (DM), overall and by ethnicity. Based on the MDRs framework, we hypothesized that the protective effect of education would be weaker for Latino individuals compared to non-Latinos. Methods: Data were drawn from the 2012 wave of the Understanding America Study (UAS), a nationally representative, internet-based panel. The outcome of interest was self-reported doctor diagnosis of DM. Logistic regression models were used to assess the association between educational attainment and DM, with an interaction term to explore differences between Latino and non-Latino individuals. Models were adjusted for age, sex, employment, immigration status, and marital status. Findings were presented as adjusted odds ratios (OR), p-values, and 95% confidence intervals (CIs). Results: Higher educational attainment was associated with lower odds of DM in both Latino and non-Latino individuals (p < 0.001). An interaction between education and ethnicity (p < 0.05) indicated that the protective effect of education was weaker for Latino individuals compared to non-Latinos. Conclusion: The findings align with the MDRs framework, which suggests that the health benefits of education are not equally distributed across ethnic groups. For Latino individuals, structural barriers such as lower educational quality and labor market discrimination may limit the protective effect of education against DM. While education is a key determinant of health, its unequal returns contribute to ethnic health disparities. Policymakers must address structural inequalities in education and employment that disproportionately affect ethnic minorities. Tackling these disparities through multi-sector policy interventions will require bipartisan political support.
Article
Open Access April 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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Article
Open Access March 29, 2025

How Stigma Affects Patients Seeking Help for Drug Addiction

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

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

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

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

Abstract Background: The Motivational Theory of Life-Span Development suggests that individual aspirations are shaped by both internal and external resources. Parental education is a key determinant of educational aspirations, yet its effects may vary by geographic location, demonstrating spatial patterns of Minorities’ Diminished Returns (MDRs). Objectives: This [...] Read more.
Background: The Motivational Theory of Life-Span Development suggests that individual aspirations are shaped by both internal and external resources. Parental education is a key determinant of educational aspirations, yet its effects may vary by geographic location, demonstrating spatial patterns of Minorities’ Diminished Returns (MDRs). Objectives: This study examines the association between parental education and aspirations for graduate or professional education among non-Latino White adolescents, with a specific focus on urban-suburban versus rural differences. Methods: Using data from the 12th-grade cohort of the Monitoring the Future (MTF) 2024 survey, we conducted multivariate analyses to assess the relationship between parental education and aspirations for graduate or professional education. We further examined whether this association was moderated by geographic location (urban-suburban vs. rural) to identify place-based MDRs. Results: Higher parental education was associated with greater aspirations for advanced education; however, this effect was weaker in rural areas compared to urban and suburban settings. These findings highlight that even among non-Latino White adolescents, rural residence diminishes the benefits of socioeconomic resources, providing evidence of place-based MDRs. Conclusion: Rural residents face a dual disadvantage—both lower socioeconomic status and weaker returns on those resources—necessitating targeted interventions beyond resource allocation. To address disparities in educational aspirations in rural areas, policymakers should focus on improving equitable access to educational opportunities and ensuring that these resources translate into comparable outcomes across different social and geographic contexts.
Article
Open Access March 06, 2025

Tobacco-control policy support and tobacco use: SMOKES study

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

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

Abstract Background: Tobacco use remains a major global health concern, and understanding the factors that influence tobacco-related knowledge and support for tobacco control policies is critical for effective development of tobacco control policies that are accepted by the public. Objectives: This study introduces the rationale, design, methodology, and participants of the SMOKES Study [...] Read more.
Background: Tobacco use remains a major global health concern, and understanding the factors that influence tobacco-related knowledge and support for tobacco control policies is critical for effective development of tobacco control policies that are accepted by the public. Objectives: This study introduces the rationale, design, methodology, and participants of the SMOKES Study (Study of Measurement of Knowledge and Examination of Support for tobacco control policies), which is conducted to evaluate tobacco use, tobacco-related knowledge and attitude, as well as support for tobacco control policies among college and university students. Methods: The SMOKES Study was designed to address significant gaps in literature by focusing on college and university students in a non-Western context. A multi-center, cross-sectional design was employed to collect data from a diverse sample of college and university students across different geographical provinces in Iran. The survey instrument incorporated a range of measures covering socio-demographic characteristics, university-related variables, family tobacco use status, personal tobacco consumption behaviors (including detailed assessments of cigarette, hookah, and electronic cigarette use), and attitudinal as well as knowledge-based assessments related to vaping. Support for tobacco control policies is also measured. Data were collected using an online survey that included self-administered questionnaires, enabling access to a large diverse sample. This study may be used to determine the prevalence of ever and current use of cigarettes, electronic cigarettes, and hookah, as well as examining the correlates of single, dual, and poly-tobacco use. The study also aims to assess the role of social determinants, attitudes, and ethnic/geographic differences in shaping these outcomes. Results: The study sample consisted of 2403 college and university students, including undergraduates enrolled in different academic programs from all faculties and disciplines. Participants were drawn from universities across 15 provinces, and 11 ethnic groups, ensuring a heterogeneous sample with respect to socio-demographic background, ethnicity, and institutional affiliation. This diversity enhances the generalizability of the findings and allows for the exploration of subgroup differences in tobacco use patterns and policy support. Conclusions: The SMOKES Study offers a framework for examining tobacco-related knowledge and the acceptability of tobacco control policies among a key part of the population, being college and university students. By providing detailed insights into the prevalence and correlates of tobacco knowledge, attitude, use, as well as the tobacco control policy support, the study lays the groundwork for tailored public health interventions and more effective tobacco regulation strategies particularly for college campuses in a non-Western setting.
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Article
Open Access February 12, 2025

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

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

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 January 24, 2025

High Socioeconomic Status Black Adolescents Attend Worse Schools than Whites

Abstract Background: School characteristics — including poverty levels, teacher experience, graduation rates, and college enrollment — are essential determinants of students’ academic outcomes and long-term success. Families often use their socioeconomic resources, such as parental education and household income, to secure access to high-quality schools with favorable attributes. However, [...] Read more.
Background: School characteristics — including poverty levels, teacher experience, graduation rates, and college enrollment — are essential determinants of students’ academic outcomes and long-term success. Families often use their socioeconomic resources, such as parental education and household income, to secure access to high-quality schools with favorable attributes. However, Minorities’ Diminished Returns (MDRs) theory suggests that Black families may not experience the same benefits of high family SES due to structural barriers. This study examines the association between family SES and school characteristics, focusing on racial disparities in access to high-quality educational environments. Objective: To investigate the relationship between family SES (parental education and household income) and multiple school characteristics (poverty, teacher experience, graduation rates, and college enrollment), and to assess racial differences in these associations. Methods: Data from the Adolescent Brain Cognitive Development (ABCD) study, a national sample of US adolescents, was analyzed. We used multivariate regression models to examine associations between family SES and school characteristics and to test for interactions by race, specifically comparing Black and White adolescents. Results: Higher family SES was associated with positive school characteristics overall, including lower school poverty, greater teacher experience, and increased graduation and college enrollment rates. However, these positive effects of high family SES on school characteristics were significantly weaker for Black adolescents than for White adolescents. Black adolescents from high-income families were more likely than White adolescents from similar backgrounds to attend schools with higher poverty rates, less experienced teachers, and reduced graduation and college enrollment rates. Conclusion: Our findings highlight persistent racial inequities in access to educational opportunities, even among families with comparable socioeconomic resources. The diminished returns of family SES for Black adolescents underscore the role of structural barriers in limiting access to high-quality schools. These findings emphasize the need for policy interventions to address systemic inequalities that hinder Black families from fully leveraging their SES to access favorable educational environments.
Article
Open Access January 21, 2025

A Disaster Management Contingency and Training Plan for Nursing Service Personnel

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

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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Article
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 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 October 19, 2024

Quantitative Intersectionality Scoring System (QISS): Opportunities for Enhancing Predictive Modeling, Comparative Analysis, Health Needs Assessment, and Policy Evaluation

Abstract 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 [...] Read more.
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.
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Perspective
Open Access August 13, 2024

A Study of the Implementation of the Language-In-Education Policy in Three Primary Schools in Ghana

Abstract This study investigated the English-only language-in-education policy in three primary schools in Ghana: University Primary, OLA Presby Primary and Apewusika Primary School in the Cape Coast Metropolitan in the Central Region of Ghana. The study employed Coulmas’s (2005) eight-step language planning model as a conceptual framework for the study. Nine teachers were randomly selected from Basic One [...] Read more.
This study investigated the English-only language-in-education policy in three primary schools in Ghana: University Primary, OLA Presby Primary and Apewusika Primary School in the Cape Coast Metropolitan in the Central Region of Ghana. The study employed Coulmas’s (2005) eight-step language planning model as a conceptual framework for the study. Nine teachers were randomly selected from Basic One to Basic Three to respond to the selection and supply items. The selected items were analysed and put into frequencies and percentages, while the supply items were coded into recurrent themes. Findings from data indicate that most teachers preferred using the local language (Fante) as a medium of instruction in the lower primary. The study also revealed that code missing is a significant feature in teacher-learner interaction. It was also observed that teachers encountered little problems when using Fante as a medium of instruction. Finally, most teachers express a lukewarm attitude towards using English as a medium of instruction in the lower primary school.
Article
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 July 31, 2024

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

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

Paradoxical Effects of Income and Income Inequality on Racial Health Disparities

Abstract The intersection of race and place in shaping health disparities presents complex dynamics, as evidenced by studies in cities like Detroit, Baltimore, and Philadelphia, where predominantly Black and economically disadvantaged populations experience high overall rates of health problems. Surprisingly, these cities do not exhibit the most pronounced racial disparities. In contrast, areas with a [...] Read more.
The intersection of race and place in shaping health disparities presents complex dynamics, as evidenced by studies in cities like Detroit, Baltimore, and Philadelphia, where predominantly Black and economically disadvantaged populations experience high overall rates of health problems. Surprisingly, these cities do not exhibit the most pronounced racial disparities. In contrast, areas with a higher percentage of White residents, indicative of greater income inequality, show stark differences in health outcomes between Black and White populations. This disparity underscores how conditions diverge more sharply between Black and White individuals in wealthier urban areas. This phenomenon suggests a complex and sometimes counterintuitive relationship among race, place, income, and income inequality in shaping racial health disparities. These dynamics have significant policy implications. Addressing health disparities requires nuanced strategies that recognize the multiplicative effects of race and income inequality on health outcomes. Policies focusing on areas with a high disease burden, such as Detroit, Philadelphia, and Baltimore can effectively mitigate disparities both locally and more broadly. Conversely, interventions targeting regions with lower disease prevalence, but higher racial disparities must be approached carefully to avoid exacerbating inequalities. In conclusion, understanding and addressing the complex drivers of health disparities demand comprehensive approaches that acknowledge the intertwined influences of race, income, and place. By prioritizing interventions that address economic disparities alongside health initiatives, policymakers can foster more equitable health outcomes across diverse communities.
Perspective
Open Access July 15, 2024

The Role of Dignity and Respect in Maternity Care: An Integrative Literature Review

Abstract 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 [...] Read more.
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.
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Review Article
Open Access July 12, 2024

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

Abstract Epigenetic studies, which can reflect biological aging, have shown that measuring DNA methylation (DNAm) levels provides new insights into the biological effects of social environment and socioeconomic position (SEP). This study explores how race, family structure, and SEP (income to poverty ratio) at birth influence youth epigenetic aging at age 15. Data were obtained from the Future [...] Read more.
Epigenetic studies, which can reflect biological aging, have shown that measuring DNA methylation (DNAm) levels provides new insights into the biological effects of social environment and socioeconomic position (SEP). This study explores how race, family structure, and SEP (income to poverty ratio) at birth influence youth epigenetic aging at age 15. Data were obtained from the Future of Families and Child Wellbeing Study (FFCWS) cohort, with GrimAge used as a measure of DNAm levels and epigenetic aging. Our analysis included 854 racially and ethnically diverse participants followed from birth to age 15. Structural equation modeling (SEM) examined the relationships among race, SEP at birth, and epigenetic aging at age 15, controlling for sex, ethnicity, and family structure at birth. Findings indicate that race was associated with lower SEP at birth and faster epigenetic aging. Specifically, income to poverty ratio at birth partially mediated the effects of race on accelerated aging by age 15. The effect of income to poverty ratio at birth on DNAm was observed in male but not female youth at age 15. Thus, SEP partially mediated the effect of race on epigenetic aging in male but not female youth. These results suggest that income to poverty ratio at birth partially mediates the effects of race on biological aging into adolescence. These findings highlight the long-term biological impact of early-life poverty in explaining racial disparities in epigenetic aging and underscore the importance of addressing economic inequalities to mitigate these disparities. Policymakers should focus on poverty prevention in Black communities to prevent accelerated biological aging and associated health risks later in life. Interventions aimed at eliminating poverty and addressing racial inequities could have significant long-term benefits for public health. Future research should explore additional factors contributing to epigenetic aging and investigate potential interventions to slow down the aging process. Further studies are needed to understand the mechanisms underlying these associations and to identify effective strategies for mitigating the impact of SEP and racial disparities on biological aging.
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Open Access July 12, 2024

Racial Gap in Household Income Explains Black-White Disparities in the Intergenerational Transmission of Educational Attainment

Abstract Background: Racial disparities in educational outcomes persist in the United States, with Black individuals experiencing lower levels of educational attainment and a higher rate of school disciplinary actions compared to their White counterparts. Parental education is a known predictor of offspring educational attainment, but its effects may vary by race. Understanding the role of household [...] Read more.
Background: Racial disparities in educational outcomes persist in the United States, with Black individuals experiencing lower levels of educational attainment and a higher rate of school disciplinary actions compared to their White counterparts. Parental education is a known predictor of offspring educational attainment, but its effects may vary by race. Understanding the role of household income in mediating these effects is crucial for developing targeted policy interventions to reduce educational inequalities. Objectives: This study aimed to examine the role of household income in mediating the differential effects of maternal education on two youth educational outcomes (educational attainment by age 22 and school disciplinary action) in Black and White families. Methods: Data were drawn from the 22 years of follow-up of the Future of Families and Child Wellbeing Study (FFCWS), a longitudinal study following a cohort of children born in large U.S. cities between 1998 and 2000. Participants included 1,647 Black and 689 White young adults who were followed from birth to age 22. Maternal education, household income, family structure, and paternal incarceration were assessed at baseline (birth), and two youth educational outcomes, namely educational attainment and any school disciplinary action, were assessed at age 22 (emerging adulthood). Using structural equation modeling (SEM), mediation analysis was conducted to examine whether household income partially mediates the effects of maternal education on youth educational outcomes, with race (Black vs. White) as the moderator. Results: The results indicated that maternal education was positively associated with youth educational attainment and negatively associated with school disciplinary actions in the pooled sample that included both Black and White families. However, the effect of parental education on educational attainment at age 22 was weaker for Black than White families. Household income partially mediated racial differences in the effect of maternal education on youth educational attainment. The results suggest that lower household income in Black families is why we observe a weaker effect of parental education on youth educational attainment for Black youth compared to White youth. Conclusions: Findings suggest that the lower household income of families is one of the reasons high maternal education levels are associated with lower youth educational attainment in Black than White families. Addressing income disparities through tax policies may help reduce racial disparities in education and promote educational equity for Black youth.
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Open Access May 30, 2024

Assessing the Socio-Economic Implications of Free Senior High School (SHS) Policy on Tertiary Institutions in Ghana: A Case Study of the Western Region

Abstract Ghana's Free Senior High School (SHS) policy has been touted as one of the most significant educational reforms in recent years, fueling the nation's achievement of Goal 4 [...] Read more.
Ghana's Free Senior High School (SHS) policy has been touted as one of the most significant educational reforms in recent years, fueling the nation's achievement of Goal 4 of the United Nations Sustainable Development Goals (SDGs). While many studies have been conducted on the policy’s impact on beneficiaries, little is known about its impact on tertiary institutions. The purpose of this study is to evaluate the socioeconomic effects of the Free SHS policy on tertiary institutions in Ghana's Western Region. We also provide suggestions on how to improve the policy's efficacy and lessen any obstacles to its incorporation into higher education. Methodologically, 103 employees of Takoradi Technical University and the University of Mines and Technology were sampled using a purposive sampling technique. According to the report, despite the lack of adequate facilities such as lecture halls, dorms, and residence halls on campus, the Free SHS policy has increased enrollment at the postsecondary level. This has resulted in a high student-to-lecturer ratio, increased utility bills, a high cost of living on campus, and a rise in the opening of businesses on campus. To address some of these socioeconomic impacts, respondents proposed that the government should improve infrastructure in the country's higher institutions, hire more lecturers, boost incentives for lecturers, and foster partnerships with private institutions to support infrastructure development.
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Open Access September 18, 2023

An Empirical Study of Challenges and Management Supports in Teaching and Learning of Social Studies in the Public Senior High Schools of Ghana

Abstract The purpose of this study was to examine the challenges and management supports in teaching and learning of Social Studies in Public Senior High Schools in Akuapem South and North Districts in the Eastern Region of Ghana. Quantitatively, the study adopted a cross-sectional survey using a descriptive correlational research design to assess Challenges and Management Supports Teaching and Learning of [...] Read more.
The purpose of this study was to examine the challenges and management supports in teaching and learning of Social Studies in Public Senior High Schools in Akuapem South and North Districts in the Eastern Region of Ghana. Quantitatively, the study adopted a cross-sectional survey using a descriptive correlational research design to assess Challenges and Management Supports Teaching and Learning of Social Studies in Public Senior High Schools of Ghana. The population of the study comprised social studies teachers and students in the Akuapem South and Akuapem North Districts of the Eastern Region of Ghana. Purpose and probabilistic sampling procedures were used to select senior high schools, teachers and students for the study. The main instrument for data collection was a structured questionnaire (SQ). Data was collected from 261 final year students from five Senior High Schools and 33 Social Studies teachers using structured questionnaire. Data was analysed using SPSS Version 24. Descriptive statistics (mean, SD) was conducted to summarise the data and t-test was applied to establish if there is a statistically significant difference in the perceptions of students and teachers on the school-based drivers and effective teaching and learning of social studies. The results of the study revealed that the key school-based drivers influencing the teaching and learning of social studies in the two districts relate to classroom environment; lack of management supports in terms of resource provision for practical lessons, lack of supportive physical environment such as large class size (t = 32.881, mean difference = 6.2422, p<0.05)- thus preventing teachers from engaging students in practical work and individualising their assignments (t-statistics=37.563, mean difference= 3.0920, p<0.05); and teachers inability to use diagnostics assessment tools to unraveled students difficulties and support them. The conclusion is that, the key drivers influencing effective teaching and learning of social studies are school-based and policy driven. The study therefore recommends that the government should support the teaching of Social Studies through provision of adequate resources to help teachers improve their output. Again, the student-teacher ratio should be reduced.
Article
Open Access November 29, 2022

Leaving No One Behind: Can Rising Africa Beat the Odds Against Poverty?

Abstract The number of poor people continues to rise in Africa, despite a slow decline in the poverty rate. Africa with a population of 422 million poor people, representing about 70 per cent of the world's poorest people shows that the global burden of poverty has shifted from the rest of the world to Africa. This paper discussed the causes of poverty on the continent and various responses by stakeholders [...] Read more.
The number of poor people continues to rise in Africa, despite a slow decline in the poverty rate. Africa with a population of 422 million poor people, representing about 70 per cent of the world's poorest people shows that the global burden of poverty has shifted from the rest of the world to Africa. This paper discussed the causes of poverty on the continent and various responses by stakeholders toward accelerating its poverty reduction. It was found that with the available statistics and projections, Africa will still fall short of eradicating poverty by 2030, but it can bring it to a low level. The study, therefore, recommends that African policymakers should aim for growth that is inclusive and sustainable. International support from the world bank, ODA, G7, and others will play a vital role, especially through technology and resource transfers, also African continent need to improve its resource mobilization.
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Open Access November 08, 2022

An evaluation of Eating Pattern and Nutritional Status of Police Personnel in the Tamale Metropolis in Ghana

Abstract Police work is mentally demanding and stressful, which takes a heavy toll on the health of police personnel. This study was conducted to assess the eating pattern, physical activity and nutritional status of police personnel in the Tamale Metropolis. A cross-sectional research design was adopted for the study. The population of this study involved all the 1590 police personnel with two years [...] Read more.
Police work is mentally demanding and stressful, which takes a heavy toll on the health of police personnel. This study was conducted to assess the eating pattern, physical activity and nutritional status of police personnel in the Tamale Metropolis. A cross-sectional research design was adopted for the study. The population of this study involved all the 1590 police personnel with two years working experience within the Tamale Metropolis in the Northern Region of Ghana. Simple random sampling technique was used to select three hundred and eighty-four (384) respondents for the study. The main instrument for data collection was questionnaire. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 21.0. Chi-square and Fisher’s exact tests were used to test associations. Logistic modeling was used to test the strength of the associations. P<0.05 was used to denote significance. The study revealed that the police eat two main meals, skip breakfast or eat in between meals, consume alcohol, ate foods belonging to the meat, soft drinks, fish, grain and eggs groups and their diet were more moderately diverse. The study also concluded the police personnel had normal BMI while was overweight and obese respectively. It is recommended that the police department should institute health education programs on the benefits of good dietary practices to achieve optimal health, to avoid the practice of police eating two main meals, skipping breakfast, consuming more alcohol but rather consumes diet that is moderately diverse to sustain him or her. It is also recommended that police department should institute a health education and screening exercise policy to examine the personals periodically to warrant their good health in the service.
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