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

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.

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

“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.”