Search Results (1,120)

Background: Older adults (aged 65 and older) faced a disproportionate burden of mortality during the COVID-19 pandemic, yet substantial geographical and sociodemographic disparities in vaccine uptake persisted within this vulnerable population. Objective: To examine the temporal dynamics of COVID-19 vaccination rates among older adults and investigate the association between vaccination uptake and neighborhood-level social determinants of health (SDOHs), including disability and poverty. Methods: COVID-19 vaccination data for older adult residents in Jefferson County, Kentucky, were obtained from the Kentucky Immunization Registry (KYIR). ZIP-code-level vaccination rates were calculated at three time points: 28 February 2021 (Q1), 31 May 2021 (Q2), and 31 May 2022 (Q6). The rates were linked to 2021 American Community Survey (ACS) ZIP code-level estimates of disability, poverty, and household composition. Two-dose COVID-19 vaccination rates stratified by race, ethnicity, and geographic region were used as outcome measures. Pearson correlation coefficients, bivariate, and multivariate linear models were used to estimate the association between COVID-19 vaccination rates and the SDOHs at the ZIP code level. Results: Among the estimated 139,222 older adults, overall two-dose vaccination rates rose from 22.4% in Q1 to 77.5% by Q6. Significant regional disparities were observed early in the campaign, with Q1 rates ranging from 12.6% in the Southwest to 35.4% in the Inner East county regions. Bivariate analyses showed ZIP-code-level disability and poverty rates were negatively associated with ZIP-code-level vaccination uptake in Q1 (disability slope: −0.38; 95% CI, −0.63 to −0.13; poverty slope: −0.36; 95% CI, −0.65 to −0.07). By Q6, the negative association between disability and vaccination had weakened significantly and was no longer statistically significant, while the negative association between poverty rate and vaccination rate remained persistent across all time points. Conclusions: The disability-associated gaps in older adults’ vaccination rates were dynamic and narrowed over time, whereas the poverty-associated gaps remained persistent and static. The low uptake observed among Black and Hispanic older adults in historically underserved areas suggests that understanding the specific factors that most negatively associate with vaccination rates in these populations, such as specific disabilities, may mitigate structural barriers. Future public health interventions should prioritize socioeconomically disadvantaged neighborhoods and account for the evolving association of functional impairments and healthcare access. Full article

Introduction: Low back pain (LBP) is the leading cause of disability worldwide, with substantial variation in prevalence across regions. It is associated with a wide range of biophysical, psychological, social, and lifestyle factors, as well as comorbid conditions. Given its high impact, identifying population-level correlations of LBP is essential for informing prevention strategies. This study aimed to assess demographic, socioeconomic, lifestyle, and health-related factors associated with LBP in Hungary. Methods: A repeated cross-sectional analysis was conducted using secondary data from three waves of the European Health Interview Survey (EHIS) carried out in Hungary in 2009, 2014, and 2019. Results: The prevalence of LBP increased over the study period. Female sex, higher educational attainment, normal body mass index, non-smoking status, abstaining from alcohol, and good self-perceived health were associated with lower odds of LBP. In contrast, older age (≥65 years), unfavorable financial status, residence in socioeconomically disadvantaged regions, use of over-the-counter medications, and several chronic conditions were associated with higher odds. Conclusions: Reducing the impact of low back pain requires its integration into comprehensive public health frameworks that combine chronic disease management with consideration of socioeconomic inequalities at the population level. Full article

A sense of school belonging predicts NEET outcomes for adolescents. However, young people from marginalized groups often have a lower sense of school belonging than their majority peers. Emerging understandings of belonging as a complex, agentic process shaped by multiple relational, contextual, cultural and structural factors have posed problems for real-world applications of belonging. NEET young people tend to be viewed through a lens of risk factors, with a lack of research accounting for their experiences and feelings. While recent research recognizes the intersectional effects of disadvantage, or ‘compound disadvantage’, on NEET outcomes for young people from certain social groups, there is a lack of viable alternatives for educators and policymakers to account for these differential experiences of belonging in order to be able to respond to them. Connected Belonging is a relational and identity-building approach to enhancing young people’s wellbeing through supporting their connectedness and sense of self across the eight social domains of their lives. This paper outlines the development and validation of a young people’s survey, which enables education professionals to attend to and respond to the differing belonging experiences of diverse groups, operationalizing an intersectional lens on school belonging. After introducing the views of young people about systemic priorities to better support their engagement in education, training or work (EET), gathered through a youth voice event as part of a parallel research project, the paper outlines the process of developing, piloting and validating the tool. We argue that this survey tool has the potential to support improved attention to the views and experiences of diverse young people in a systematic, regular fashion. Furthermore, it offers potential for the evaluation of supportive actions grounded in youth voice. Full article

In August 2022, the Pearl River flooded portions of Jackson, Mississippi and temporarily closed the city’s water treatment plant, leaving most citizens without access to safe drinking and potable water for more than a month. This event punctuated an ongoing water crisis that had lingered for decades in this predominately African American city. We employ a social production of disaster approach to reveal aspects of slow violence perpetrated against disadvantaged peoples that increased their collective vulnerability to flood risks and limited their access to safe water. Using survey data collected one year after the flood, we examine event-related psychosocial stress as measured by the Impact of Event Scale and associated risk factors related to Conservation of Resources Theory. Multivariate analysis indicates that resource losses from the flood, health concerns about water quality, and trust in government were significantly related to elevated levels of psychosocial stress. Although the 2022 Pearl River flood can be treated as a discrete event, a social production of disaster perspective situates the flood in terms of its cascading effects and cumulative impacts on the city’s water infrastructure and citizens who depend on it. Full article

Background: Disparities in esophageal cancer (EC) outcomes persist, partially due to inequitable access to high-quality surgical care, particularly for socioeconomically disadvantaged populations. This study evaluates the impact of social determinants of health (SDHs) on achieving textbook oncological outcomes (TOOs) and survival in operable EC patients. Methods: Using the National Cancer Database (2010–2021), we analyzed 26,367 stage I–IV A esophageal adeno- and squamous cell carcinoma patients undergoing esophagectomy after neoadjuvant chemoradiation. An SDH score (0–4) was derived from income, education, rurality, and hospital type. TOOs were defined as R0 resection, ≥20 lymph nodes examined, no 30-day mortality, and no prolonged hospitalization. Multivariable logistic and Cox regression models assessed predictors of TOOs and survival. Results: Overall, 19% achieved TOOs. Median survival time was 6.4 years for TOO+ versus 3.2 years for TOO−. Patients with favorable SDH had longer survival than those with unfavorable SDHs (median 4.0 vs. 3.5 years), but this disparity was largely confined to TOO− patients. Across stages II–III, low income and treatment at community hospitals were consistently associated with higher mortality among TOO− patients (HRs ~1.08–1.21), whereas SDH factors were largely attenuated among TOO+ patients. Stage-stratified analyses demonstrated that SDH effects were minimal in stage I and IV disease but pronounced in intermediate stages, especially in TOO− patients. Conclusions: TOOs are a powerful modifier of survival disparities in esophageal cancer. While SDH strongly influences outcomes among patients with suboptimal care pathways, achieving high-quality, textbook oncologic care attenuates these effects. Efforts to improve TOO achievement and expand access to high-quality centers may reduce socioeconomic inequities in survival. Full article

Social determinants of health (SDoH) are non-medical factors shaped by the socioeconomic status of individuals or communities that influence the onset and progression of diseases and affect their outcomes. We have narratively analyzed the most important findings relating chronic kidney disease (CKD) and SDoH, evaluating the following items: (i) medical care and social determinants of health, (ii) socioeconomic risk for kidney disease at the individual level and (iii) socioeconomic risk for kidney disease at the population level. SDoH can be categorized by how they influence a person’s daily life. Individual factors include personal lifestyle choices such as smoking habits, alcohol consumption, and how a patient spends their non-working time. Community factors include structural elements such as average household income, educational attainment, employment rates, and the quality of the surrounding physical environment. Research consistently shows that a low socioeconomic status is a primary driver of poor clinical outcomes. While healthcare systems vary globally, the negative impact of socioeconomic deprivation on CKD patients remains a constant. Disadvantaged patients experience a faster loss of renal function, and there is a significantly higher incidence of cardiovascular events and mortality compared to those with financial stability. Financial hardship often leads to a “double burden,” where the struggle to afford care triggers a decline in both physical health and mental well-being. To improve patient care, it is essential to raise awareness among healthcare providers regarding the profound impact of these social factors. More precise data and thorough research are needed to fully understand these associations and develop targeted interventions. Full article

The ambition of policymakers to ‘raise aspirations’ among young people from disadvantaged backgrounds as a means for improving social mobility in Britain has been a mainstay of political rhetoric for the last three decades. Reports such as Higher Education in the Learning Society in 1997, Unleashing Aspiration in 2009, and Success as a Knowledge Economy in 2016 are all underpinned by an ideology of neoliberal meritocracy that has transcended political parties and governments since the Thatcher administration. Even those who lean more to the left of the Labour Party within contemporary Britain have perpetuated this narrative by reframing it as ‘working-class ambition’. This paper advances an alternative view which reconceptualises the way in which young people from non-privileged backgrounds experience and perceive the world, and their place within it. Drawing upon our work on Connected Belonging in 2025 and our research on the From the Centre to the Periphery project in 2025, we suggest that ‘hopeful optimism’ offers a more realistic lens through which to understand what is needed to address the ‘personal troubles and public issues’ that young people face. Unlike aspiration, which has an inherently individualistic and future-orientated framing, with value systems directed by dominant hegemonic notions of ‘success’ that are commonly positioned in economic terms, we recognise optimism as being a holistic and relational process that resides in the present as well as looks to the future. Optimism, grounded within principles of hope, allows young people the freedom to be and to dream; by celebrating who they are and their interconnectedness, it protects them from fears of failure; by reimaging what success might mean, it liberates them as creators. Full article

This study explores the lived experiences of pregnant women in rural Nepal navigating maternal healthcare amidst intersecting structural barriers. Using the Social Determinants of Health framework and intersectionality, we examine how geographic isolation, inadequate infrastructure, and economic hardship compound risks to timely and safe maternal care. Twenty in-depth interviews were conducted at a district hospital in the eastern region of Koshi Province, Nepal. Four major themes were identified through inductive thematic analysis. These are: geographic vulnerability and transport challenges; gaps in rural maternal health provision; accommodation and institutional support deficits; and economic vulnerability and hidden costs of care. Findings reveal that poor road conditions, unreliable transport, and limited diagnostic services force women to undertake long, costly journeys, often requiring temporary relocation without institutional accommodation support. Despite policies such as the Safe Motherhood Programme, implementation gaps persist, leaving women to bear significant financial and emotional burdens. These experiences underscore systemic inequities in resource distribution and highlight the compounded disadvantage faced by women from rural and marginalised communities. To ensure equitable maternal healthcare, this study advocates for the decentralisation of health services and the implementation of inclusive financial protection policies tailored to the needs of women from rural and marginalised communities. To promote equitable maternal healthcare, we recommend strengthening rural health infrastructure, implementing maternity waiting homes, and expanding financial protection schemes tailored to vulnerable populations. This research offers critical insights for policymakers to address maternal health inequalities and advance Nepal’s progress toward Universal Health Coverage and Sustainable Development Goal 3 (Ensure healthy lives and promote well-being for all at all ages). Full article

Uneven urbanization can lead to significant quantities of vacant and abandoned land while exacerbating urban heat island (UHI) effects and simultaneously adversely affecting socioeconomically disadvantaged communities. This study examines the correlation between land surface temperature (LST) and urban vacant and abandoned land in socially vulnerable neighborhoods in Houston, TX, USA, where extreme heat can present significant environmental and public health challenges. Six critical study locations exhibiting a social vulnerability index (SVI) over 0.7 and average land surface temperature (LST) values surpassing 82 °F (27.8 °C) are analyzed through spatial analytics and drone footage. Findings indicate that vegetated vacant spaces help mitigate urban heat by decreasing land surface temperature, but abandoned structures exacerbate temperatures due to heat retention from non-permeable surfaces. Findings suggest that elevated socioeconomic vulnerability correlates with increased land surface temperature, exacerbating heat-related hazards in at-risk communities. In this six-site sample, the abandonment rate exhibited a positive correlation with the site mean land surface temperature (exploratory linear fit: +2.42 °F [0.74, 4.11]/+1.35 °C [0.41, 2.28] per +1% increase in abandonment; to be interpreted as exploratory and potentially confounded). Results provide critical insights for climate resilience planning and urban heat reduction through high-resolution thermal and geographical analysis, highlighting the impact of vacant and abandoned land on LST. Such findings endorse certain urban cooling techniques, including land reutilization and green infrastructure, to enhance environmental equality and adaptation. Full article

Background/Objectives: Maternal diet during pregnancy may influence neonatal outcomes, but dietary behaviours are socially patterned and were measured differently across cohorts. We therefore evaluated whether cohort-specific, partially harmonized maternal dietary patterns were associated with adverse birth outcomes after accounting for maternal and socioeconomic characteristics in two Italian birth cohorts. Methods: We analyzed 3234 mother–infant dyads from Piccolipiù (2011–2015) and 1564 from MAMI-MED (2020–ongoing). Maternal diet was captured by cohort-specific food questionnaires and grouped into food categories. Principal component analysis identified dietary patterns; pattern scores were categorized into tertiles and combined into five joint-adherence profiles. Logistic regression estimated odds ratios (OR) for preterm birth (PTB, <37 weeks), low birth weight (LBW, ≤2500 g), macrosomia (≥4000 g), and small/large for gestational age (SGA/LGA), with progressive adjustment for maternal age, pre-pregnancy body mass index (BMI), education, employment, and (Piccolipiù) income. Results: Two comparable patterns emerged in both cohorts: Western (processed foods, fried items, snacks/sweets, sugar-sweetened beverages) and Prudent (fruit, vegetables, fish, whole grains/yogurt). Western adherence was more common among younger women and those with disadvantage, whereas Prudent adherence tracked higher education, employment and income. After full adjustment, dietary profiles were not consistently associated with PTB, SGA or LGA in either cohort. In Piccolipiù, preferential Prudent adherence was associated with lower odds of LBW (OR 0.49; 95% CI 0.24–0.92) and higher odds of macrosomia (OR 1.56; 95% CI 1.06–2.30). Across cohorts, higher pre-pregnancy BMI predicted macrosomia/LGA, while lower education increased the probability of PTB and LBW. Conclusions: Across two Italian birth cohorts, maternal dietary patterns were socially stratified, whereas pre-pregnancy BMI and maternal education were more consistently associated with birth outcomes than dietary-pattern adherence per se. Full article

Background: As China enters the digital era and actively promotes an active aging strategy, smart wearable devices have become increasingly prevalent among older adults; however, their impact on health inequality remains unclear. This study investigates the association between smart wearable devices and health, as well as health inequality, among Chinese older adults, and further examines the mediating roles of joy of living and social participation. Methods: Data were derived from two waves (2018 and 2020) of the China Longitudinal Aging Social Survey (CLASS), with a final sample of 7098 adults aged 60 and above. A two-way fixed-effects model, propensity score matching–difference-in-differences (PSM-DID) approach, and mediation analysis were employed. Results: Smart wearable devices were significantly positively associated with both health and health inequality among older adults in China. Mediation analysis revealed that joy of living and social participation played an intermediary role. Conclusions: This study provides preliminary evidence that smart wearable devices are associated with health and health inequality among Chinese older adults. Policy efforts should focus on developing more user-friendly devices, promoting digital literacy among older adults, and supporting disadvantaged groups. Furthermore, the mediating effects suggest that fostering joy of living and encouraging active social participation may serve as effective pathways to improve health. Full article

Urban playgrounds are vital public spaces that support children’s play, social interaction, and well-being. However, many playgrounds in socially disadvantaged or aging urban areas experience physical deterioration, limited play diversity, and declining use. Although corporate social responsibility (CSR) initiatives have increasingly supported playground regeneration, many projects continue to emphasize short-term physical improvements rather than participatory processes and social value creation. This study conceptualizes CSR-supported, child-participatory playground regeneration as a social value creation process and examines how CSR enables process continuity through a structured six-stage participatory approach spanning planning, design, construction, and post-opening use. Two cases were selected from the “Save the Playground” program in Seoul, Korea: Saerok Children’s Park in a stable residential neighborhood and Mukjeong Children’s Park in a high-mobility, multicultural commercial district. Using a qualitative multiple-case study design, the study triangulates workshop outputs, observational records, facilitator field notes, and official program documents through thematic and cross-case analyses. The findings indicate that CSR support primarily ensured process continuity and facilitated multi-actor coordination across project stages. By securing implementation continuity and stabilizing governance arrangements, CSR support allowed participatory outputs to be iteratively translated into design development and post-opening evaluation. Post-opening outcomes differed by urban context; nevertheless, both cases showed social value creation through strengthened place attachment, responsibility-oriented use, and inclusive mixed-group play. This study advances a cross-case analytical framework linking urban context, participatory mechanisms, and post-opening social value outcomes, contributing to a more context-sensitive understanding of CSR-supported participatory design processes and their implications for sustainable urban public space development. Full article

The aim of this study was to explore and describe how a recent public health emergency affected the management of community sport organisations (CSOs) in favelas and how the crisis management strategy shaped community resilience. We relied upon the stakeholder theory of crisis management, which posits that during crises, organisations should adopt management practices that address the needs of multiple stakeholders rather than merely focusing on organisational survival. We conducted 13 interviews with sport managers of CSOs located in favelas in four different regions of the city of Rio de Janeiro, Brazil. The findings show that managers respond to the crisis by focusing on community support and resilience. Three factors informed the relationship between management practices and community resilience: sense of leadership and responsibility, filling the gaps of the public sector, and equality, diversity, and inclusion practices. Our study extends the application of stakeholder theory of crisis management to suggest the importance of considering the inclusion of stakeholders (e.g., government, sport managers) who have been ignored in the proposition of the theory and in the sport management literature. Theoretical and practical implications are discussed. Full article

The environmental and social problems caused by overfishing and unsustainable aquaculture practices make it necessary to implement the principles of the circular economy to steer the sector towards sustainability and responsible use of resources. The objective of this study was to assess the sustainability of the aquaculture sector in the context of current environmental and social concerns in the fisheries sector and to understand the state of research in terms of implementing circular practices, providing a comprehensive mapping of scientific articles focusing on circular practices adopted in the aquaculture sector over the last ten years, describing them and identifying their potential advantages and disadvantages. A bibliometric analysis was conducted using the Scopus database to obtain a clear picture of the sustainable innovations carried out in the aquaculture sector over the last ten years. The analysis focused on the terms ‘aquaculture’ and ‘circular economy’. The results indicate a rising trend in the number of studies on the circular economy in aquaculture from 2020 onwards, which can be attributed to an escalating awareness of environmental concerns. Subsequently, the analysis carried out by the VOSviewer software allowed the articles to be classified in four clusters, according to the relevance of the different adopted circularity practices. A particular focus was placed on the significance of practices minimising environmental impact, optimising resources and pursuing innovative strategies to ensure sustainability. Full article

Background: Mental health problems in childhood and adolescence constitute a major public health concern, influencing developmental trajectories, educational outcomes, and long-term well-being. This study aimed to assess developmental and socioeconomic gradients in perceived mental health and mood disorder risk among children and adolescents, integrating parental evaluations, symptom-related indicators, and sociodemographic correlates. Methods: A cross-sectional survey was conducted among 1177 parents or legal guardians of children aged 6–18 years in Poland. Data were collected via a structured questionnaire assessing perceived physical and mental health, socioeconomic characteristics, and seven symptom-based items aligned with the Children’s Depression Inventory 2 (CDI-2) diagnostic framework. Nonparametric tests (χ², Spearman’s ρ, Kruskal–Wallis H) were applied to examine age-related differences and socioeconomic gradients in perceived mental health and mood disorder risk. Results: Parental evaluations indicated a consistent discrepancy between physical and mental health, with psychological well-being rated less favorably and exhibiting greater variability. Both perceived mental health and mood disorder risk showed strong age-related differentiation, revealing declining scores with increasing age (ρ < 0, p < 0.001). Family financial situation demonstrated the strongest association with mental health outcomes (H = 71.39, p < 0.001), while parental occupational status exerted moderate effects and educational attainment showed no significant influence. Concentration difficulties, affective distress, and somatic symptoms such as fatigue and sleep disturbance were commonly reported. Conclusions: Findings indicate that child and adolescent mental health is shaped by interacting developmental and socioeconomic determinants. Adolescence and financial disadvantage represent key vulnerability factors associated with poorer psychological outcomes. The results highlight the need for developmentally targeted and socially equitable mental health strategies within pediatric and preventive healthcare systems. Full article