Sociology of health & illnessJinlong Lin, Weitao Li
Critical theory has provided important resources for understanding the social determinants of health (SDOH). Yet less is known about what happens to these explanatory resources as SDOH becomes increasingly institutionalised in research and policy. We examine this question through a scoping review of 298 peer-reviewed SDOH reviews published between 2005 and 2025, together with a close analysis of the 15 reviews with the highest annualised Web of Science citation rates. The findings show a pronounced and widening discursive asymmetry: mainstream, technically oriented reviews dominate the literature and have expanded substantially over time, whereas explicitly critical approaches have remained rare. At the same time, critical concepts such as class, exploitation and social reproduction have not disappeared. Instead, they are often retained in attenuated form, reframed as indicators of risk, vulnerability or group difference rather than as concepts for explaining how health inequalities are produced. This process is described here as explanatory marginalisation. Greater engagement with critical theory can therefore strengthen the capacity of SDOH research to explain, rather than merely describe, the structural production of health inequality.
JMIR formative researchKassandra I Alcaraz, Lensa S Keno, Brittany D Jenkins, Avonne E Connor
This pilot study provides evidence that multimodal online recruitment and engagement are feasible for mixed methods social determinants of health research with sociodemographically diverse Black breast cancer survivors.
Journal of medical Internet researchAtsushi Nakagomi
AI is increasingly embedded in the institutions and environments that shape health. Yet current frameworks for understanding its implications for health equity remain underdeveloped. The social determinants of health tradition provides a strong foundation, and recent work on digital determinants of health has begun to address the health implications of digital transformation. However, AI warrants distinct conceptual attention because of its triple role: it operates simultaneously as a determinant of health in its own right, as a mediator and moderator of existing determinants, and as an amplifier of advantage and disadvantage over time. This viewpoint proposes a redistribution-translation-accumulation framework for analyzing how AI may contribute to the reproduction of health inequity. The framework comprises 2 analytically distinct mechanisms and 1 cross-cutting temporal dynamic. Redistribution captures how AI reshapes the distribution of health-relevant resources and opportunities, including education, employment, and income, while AI itself becomes an unequally distributed determinant. Translation describes how AI changes the pathways through which social positions are converted into health outcomes. Proxy-based decision rules can formalize historical inequities, diagnostic algorithms may perform unevenly across populations due to unrepresentative training data, and AI-mediated information environments can alter institutional responsiveness. Accumulation is conceptualized not as a third parallel mechanism but as a temporal amplifier operating on both mechanisms: AI-driven feedback loops and institutional embedding can concentrate advantage and disadvantage over time, often without users' awareness. The framework is offered as a hypothesis-generating heuristic and is directionally neutral: under specifiable design, deployment, and governance conditions, the same mechanisms can narrow rather than widen health gaps in high-income and low- and middle-income settings alike. The framework has direct implications for governance. Current approaches such as the EU AI Act's Fundamental Rights Impact Assessment (FRIA) and Canada's Algorithmic Impact Assessment (AIA) advance AI accountability but assess systems largely before or at deployment and do not systematically track distributional health consequences. Building on this framework, I propose a distributional impact assessment as a complementary tool for equity-oriented AI governance. Structured around the 3 RTA dimensions, it asks whether an AI system alters the distribution of health-relevant resources across groups (redistribution), changes how social positions are converted into health (translation), and risks concentrating disadvantage over time through feedback and institutional embedding (accumulation). It is operationalized with candidate indicators, data sources, responsible actors, and reassessment triggers and is illustrated through a retrospective worked example of a biased care-management algorithm.
Global public healthMaría F Rivadeneira, Andrea Bravo-Díaz, José Cóndor, Philippe Belmont, María Sol Jurado, Ana L Torres-Castillo
The Waorani are a recently contacted indigenous group inhabiting oil extraction territories in the Amazon. This study aimed to analyse the prevalence of stunting and explore its association with health determinants in Waorani children under 5 years of age. A cross-sectional study was conducted with 102 children. Mothers were surveyed about biological, socioeconomic, environmental and health service determinants. Bivariate, multivariate and weight-adjusted logistic regression models were performed. A total of 39.2% of the children exhibited stunting. Health determinants such as male sex (OR = 2.73, 95% CI: 1.63-4.64), short maternal stature (OR = 4.96, 95% CI: 2.38-10.84), child age (OR = 1.04, 95% CI: 1.02-1.05), reduced dietary diversity (OR = 2.37, 95% CI: 1.27-4.53) were associated with a higher prevalence of stunting. Prenatal care was also associated with stunting (OR = 1.59, 95% CI: 1.16-2.21, for two or more checkups), with a potential reverse causality effect. Tall birth height (OR 0.28, 95% CI: 0.13-0.57) was associated with a lower prevalence of stunting. No socioeconomic differences were found related to stunting. The health determinants model may have limitations in socioeconomically homogeneous populations. Stunting prevention policies should take this model into account, contextualised to the specific territory.
Global public healthYusuf Hared Abdi, Sharmake Gaiye Bashir
Antimicrobial resistance (AMR) is one of the most consequential threats to global public health. In 2021, bacterial AMR was associated with an estimated 4.71 million deaths globally, including 1.14 million directly attributable to resistance. Yet, despite its designation as a global emergency, policy responses remain heavily focused on surveillance, antimicrobial stewardship, diagnostics, and pharmaceutical innovation. These interventions are necessary but insufficient without sustained action on the social and structural conditions shaping infection exposure, access to care, and antibiotic use. This commentary argues that the One Health framework, as currently operationalised, does not sufficiently centre poverty and structural inequality as core determinants of AMR. AMR is shaped by overcrowded living conditions, inadequate water and sanitation, disrupted health systems, weak diagnostic infrastructure, gender inequities, and unreliable access to quality-assured medicines, disproportionately affecting low- and middle-income countries (LMICs). We propose four linked policy directions: aligning national AMR action plans with the Sustainable Development Goals; integrating socioeconomic disaggregation into AMR surveillance; reforming international financing to expand fiscal space for health, WASH, and diagnostics; and embedding communities as co-designers of stewardship and governance. A justice-oriented One Health approach is essential to translate global AMR commitments into equitable and durable action.
American journal of public healthAvijit Mitra, Richeek Pradhan, Kirsha S Gordon, Haijuan Yan, Robert D Kerns, William C Becker, Hong Yu
Objectives. To examine associations between opioid overdose (OOD) deaths among veterans and natural language processing (NLP)‒enriched social determinants of health (SDOH). Methods. We conducted a nested case‒control study using a cohort (n = 6 854 031) from the US Veterans Health Administration database with any record of service between October 2017 and September 2021. Participants were followed for up to 2 years from cohort entry, ending in September 2021. An NLP system extracted 8 SDOHs from unstructured notes, while structured data captured 6, yielding 9 distinct SDOHs with 5 common to both. Results. A total of 5411 veterans experienced fatal OOD over 21 397 462 person-years of follow-up and were matched with 21 623 controls. NLP-extracted SDOHs captured 90.08% of structured and 97.28% of all SDOHs. All measured SDOHs were significantly associated with increased risk of fatal OOD. The strongest association was for housing instability (adjusted odds ratio [AOR] = 3.36; 95% confidence interval [CI] = 2.96, 3.81), followed by legal problems (AOR = 3.07; 95% CI = 2.55, 3.70) and financial problems (AOR = 2.63; 95% CI = 2.32, 2.98). Conclusions. NLP-extracted SDOHs were significantly associated with fatal OOD risks among veterans and exhibited comparable direction and magnitude of association to structured SDOHs. (Am J Public Health. 2026;116(10):1575-1585. https://doi.org/10.2105/AJPH.2026.308697).
Primary health care research & developmentAaron Switzer-Rodriguez, Jinfan Qiang, Barjot Gill, Natricha Levy McFarlane, Ellah San Antonio, Dana Howse, Itunuoluwa Adekoya, Alannah Delahunty-Pike, Leanne …
AIM: This study aimed to explore patient perspectives on standardized screening for social needs within the context of primary care in Canada. BACKGROUND: Social determinants of health significantly influence patient health outcomes. While standardized screening for patient social needs has gained momentum, patient perspectives on the utility of said screening, particularly within the Canadian context, remains underexplored. METHODS: Semi-structured interviews were conducted with participants aged 18 and older (n = 195), recruited from a larger multi-site study, using purposive maximum-variation sampling across four Canadian provinces (Ontario, Manitoba, Saskatchewan, and Newfoundland and Labrador). Questions asked during the interviews focused on financial well-being (ability to afford basic needs), housing status, social well-being, transportation, ability to afford utilities, and employment status. These interviews followed another study component where participants were asked to complete a short social needs questionnaire (the SPARK tool). Data was analysed using a thematic content analysis. Five themes were generated, including (1) openness to screening for social needs, (2) value in healthcare providers knowing patients' social needs, (3) overall scepticism and trust/distrust in the healthcare system and professionals; (4) potential for harm; (5) meaningful engagement and provider training on social needs. FINDINGS: Participants were generally comfortable being asked about their social needs but stressed the importance of privacy, especially regarding financial well-being (ability to afford basic needs and extended health-care related expenses), as well as clear usefulness of the data and building physician-patient trust. Participants were generally open to social needs screening, though discomfort emerged when discussing race, employment, housing, and financial well-being, largely driven by concerns about privacy, trust, and data use. These findings highlight the importance of transparent communication, robust data governance, and explicit informed consent to support acceptable and effective implementation of social needs data collection.
BACKGROUND: Social disparities in oral health persist, disproportionately affecting Indigenous populations. OBJECTIVE: This study aims to compare oral health status, dental care access, treatment needs, and social determinants between Mapuche and non-Mapuche older adults in the La Araucanía Region of Chile, within a hybrid dental care model, and to explore whether ethnicity is associated with these outcomes, guided by the World Health Organization (WHO) Commission on Social Determinants of Health (CSDH) framework. METHODS: We conducted a cross-sectional exploratory analytic study using data from 480 adults aged 60 years or older who received dental care through a hybrid teledentistry and mobile clinic model (Geriatric Dental Specialties Tele-Platform [TEGO]) in 4 municipalities of La Araucanía. The analytic sample was restricted to community-dwelling, functionally independent older adults. Outcomes included oral health status (nonfunctional dentition, edentulism, cavitated caries, and periodontitis), dental care access (fixed prosthetic rehabilitation and unmet denture need), and dental treatment needs (restorative and prosthetic). Structural (sex, age, education, rurality, and ethnicity) and intermediary determinants (behavioral, biological, psychosocial, and health system access) were analyzed following the WHO-CSDH framework. Bivariate analyses compared outcomes between Mapuche and non-Mapuche participants. Multivariable logistic regression models examined associations between determinants and outcomes. RESULTS: A total of 471 older adults (mean age 72.8, SD 7.7 years) were included; 76.9% (362/471) had nonfunctional dentition, 18% (85/471) were edentulous, 25.6% (98/383) had cavitated caries, and 46% (154/335) had periodontitis. In bivariate analyses, Mapuche participants showed lower educational attainment, higher rural residence, poorer oral health, more behavioral risk factors (eg, infrequent toothbrushing and higher sugar intake), greater restorative needs, and reduced access to complex dental care compared with non-Indigenous peers. In multivariable analyses, female sex was associated with increased odds of edentulism but lower odds of periodontitis. Lower education was associated with nonfunctional dentition (odds ratio [OR] 4.28, 95% CI 2.34-7.88; P<.001) and edentulism (OR 3.04, 95% CI 1.52-6.09; P=.002). Mapuche ethnicity was associated with higher prevalence of cavitated caries (OR 2.40, 95% CI 1.25-4.63; P=.009) and periodontitis (OR 2.43, 95% CI 1.21-4.88; P=.01). Dental care access was associated with behavioral factors (brushing, interproximal hygiene, and sugar intake) and structural determinants (age, sex, and rurality), while restorative and prosthetic needs were linked to sugar consumption and tobacco use, respectively. CONCLUSIONS: Oral health inequalities among older adults in La Araucanía were associated with both structural and behavioral determinants. Although Mapuche participants exhibited poorer oral health, higher restorative needs, and reduced access to complex dental care in bivariate analyses, ethnicity remained associated only with cavitated caries and periodontitis in adjusted models. These findings underscore the importance of incorporating social determinants into oral health planning for underserved older adults and highlight the potential utility of data generated through digitally supported territorial care models for informing equity-oriented oral health strategies.
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in CancerIngrid Jacobson, Abigail Swenson, Zachary Schroeder, Emily McGovern, Gillian Northrup, Wade Swenson
BACKGROUND: Loneliness is a social determinant of health linked to downstream health consequences, but little to no research has examined the association between loneliness and cancer mortality at the community level. This study evaluates whether loneliness functions as a population health indicator associated with variation in cancer mortality rates. METHODS: We analyzed county age-adjusted cancer mortality rate data from the National Cancer Institute (5-year estimates, 2018-2022) merged with 2022 County Health Rankings data on sociodemographic and health behavior covariates (N = 1303). Loneliness was measured as the percentage of adults reporting subjective feelings of loneliness; the outcome was age-adjusted all-site cancer mortality per 100,000 population. General linear models assessed associations between loneliness and all-site cancer mortality, adjusting for sociodemographics, health behaviors, and rurality. RESULTS: In unadjusted analyses, county-level loneliness was positively associated with cancer mortality rates (β = 1.88, p < 0.001). Fully adjusted models showed loneliness's association with cancer mortality rates remained significant (β = 0.88, p < 0.001). Sociodemographic and health covariates were differentially associated with cancer mortality rates. DISCUSSION AND CONCLUSIONS: Higher-loneliness counties exhibit higher cancer mortality rates, suggesting that monitoring county-level social indicators may inform public health surveillance and guide future research on social determinants of cancer outcomes.
European journal of nutritionMarkus Mattila, Lazarus K Mramba, Sari Niinistö, Iris Erlund, Xiang Liu, Ulla Uusitalo, Carin Andrén Aronsson, Sandra Hummel, Brigitte I Frohnert, Hemang M Par…
PURPOSE: We explored the associations between vitamin C intake and the risk of islet autoimmunity (IA) and/or type 1 diabetes in genetically at-risk children. Furthermore, we explored associations between vitamin C metabolism-related single nucleotide polymorphisms (SNPs) and type 1 diabetes outcomes. METHODS: The current study within Environmental Determinants of Diabetes in the Young (TEDDY) cohort included 8478 children followed up every 3-6 months for relevant autoantibodies and diet. Dietary vitamin C intake was assessed longitudinally throughout childhood using age-specific dietary assessment methods and analysed using repeated measurements. Cox regression was used for the primary analyses and Bayesian joint longitudinal-survival models as sensitivity analyses. RESULTS: A total of 777 (9.2%) children developed IA, including 292 (3.4%) with IAA-first and 337 (4.0%) with GADA-first autoimmunity; 319 (41.0%) progressed to type 1 diabetes. Mean (SD) vitamin C intake was 60.7 (38.8) mg/1000 kcal. Higher vitamin C intake was associated with an increased risk of IAA-first autoimmunity (adjusted hazard ratio 1.04; 95% confidence interval 1.00-1.07, per 10 mg/1000 kcal increase) while lowest and highest tertiles of intake were associated with increased risk of GADA-first autoimmunity as compared to mid-tertile [(1.65; 1.20-2.27) and (1.42; 1.02-1.98), respectively]. Sensitivity analyses using Bayesian joint longitudinal-survival models supported the primary findings and suggested nonlinear associations between vitamin C intake and the risks of IA and multiple IA. Associations between vitamin C-related SNPs and study outcomes did not withstand correction for multiple testing. CONCLUSION: Vitamin C intake was not consistently associated with IA or progression to type 1 diabetes. However, the observed nonlinear association, with lowest risk for moderate intakes, merits further investigation. TRIAL REGISTRATION: NCT00279318, 06/09/2004.
Journal of the American Heart AssociationItsuki Osawa, Yuichi J Shimada
BACKGROUND: Oral anticoagulant (OAC) prescriptions recommended by atrial fibrillation guidelines to prevent stroke may be influenced by social determinants of health (SDOH). We aimed to uncover patient and institutional SDOH associated with failure to prescribe guideline-directed OAC and to develop an SDOH-based scoring system to predict failure to prescribe OAC. METHODS: We analyzed the nationwide, 249-hospital American Heart Association GWTG-AFib (Get With The Guidelines-Atrial Fibrillation) registry. We included adult patients hospitalized for atrial fibrillation with class I indication for OAC and no contraindications. Using a logistic regression model, we identified patient and institutional SDOH of failure to prescribe OAC, adjusting for the other SDOH. Next, we developed a machine learning-based prediction model in a training data set and examined the relative contribution of each SDOH. We then compared the risk of failure to prescribe OAC in an independent test data set for validation. RESULTS: Among 68 628 eligible patients, 1345 (2.0%) patients did not receive guideline-directed OAC prescription. The guideline-directed OAC prescription was influenced by both institutional SDOH (eg, hospital region, hospital size, the absence of a cardiology team) and patient SDOH (eg, sex, insurance). The absence of a cardiology team was the most important predictor (adjusted odds ratio [OR], 3.72 [95% CI, 3.20-4.32]). Patients with the higher-than-Youden-index-cutoff prediction score had higher risk of failure to prescribe OAC than those with the lower-than-cutoff prediction score (OR, 3.11 [95% CI, 2.67-3.63]). CONCLUSIONS: We identified both institutional and patient SDOH of guideline-directed OAC prescription failure. We further developed and validated a SDOH-based scoring system to predict failure to prescribe OAC.
American journal of Alzheimer's disease and other dementiasC Vanessa Tumbajoy-Arango, Natalia Trujillo, Juan Pablo Sánchez, Diego Camilo Díaz, Stella Valencia, Sandra Trujillo, Diana Gómez
Social determinants of health (SDOH), including education, socioeconomic status, place of residence, genetic risk, and perceived stress, influence brain health and Alzheimer's disease (AD), yet their role in genetically at-risk populations remains underexplored. This study examined the influence of SDOH on early brain health, specifically its cognitive dimension, in Colombian individuals from the world's largest kindred with autosomal dominant AD (ADAD) caused by the PSEN1 E280A mutation. Participants included 86 mutation carriers and 71 non-carriers. Brain health was assessed using the BHA_CS index from the TabCAT battery, and perceived stress using the PSS-14. Carriers showed significantly lower brain health and higher perceived stress than non-carriers. Multiple regression analyses identified genetic status, age, education, and place of residence as significant predictors of brain health, with higher education and urban residence associated with better performance. These results demonstrate that SDOH contribute to early cognitive variability even decades before clinical onset in ADAD.
ObjectiveOral pain is a common and clinically relevant symptom that reflects unmet oral health needs and may be shaped by broader social and healthcare access-related factors. The study aimed to investigate the association between a composite Social Determinants of Health (SDoH) score and oral pain among U.S. adults.MethodsThis cross-sectional secondary analysis included 14,245 adults aged 30 years and older who participated in the National Health and Nutrition Examination Survey during 2011-2018. Weighted binary logistic regression models were used to evaluate the association between SDoH score and oral pain. Receiver operating characteristic curves were used to evaluate the discriminatory performance. Mediation analyses were performed to quantify the indirect associations.ResultsParticipants with oral pain had significantly higher and more adverse SDoH scores compared with those without oral pain (2.94 ± 0.08 vs. 1.94 ± 0.05, P < 0.001). In fully adjusted logistic regression models, participants in the highest SDoH burden category had 2.79-fold higher odds compared with those in the lowest burden category (P < 0.001). All eight individual SDoH components were independently associated with oral pain (all P < 0.001). The addition of SDoH components significantly improved model discrimination for oral pain compared with a demographic-only model (AUC 0.654 vs. 0.574, Z test P < 0.001), although the overall discriminatory ability remained limited. Mediation analyses showed that cost-related barriers to dental care accounted for 31.0% of the observed association between SDoH score and oral pain (P < 0.001).ConclusionsHigher social disadvantage, as captured by a composite SDoH score, is associated with increased odds of oral pain among U.S. adults. Cost-related barriers to dental care may partly explain this association, suggesting that dental affordability and access should be considered in efforts to reduce oral pain disparities.
Frontiers in public healthLining Xi, Junli Wan, Qifang Liu, Jingyan Liu, Huidan Yu, Xianwu Luo
BACKGROUND: Dementia is one of the most urgent public health challenges globally. Early screening is indispensable for timely identification and intervention. However, early dementia screening among community-dwelling older adults remains low, and the mechanisms underlying screening barriers remain insufficiently understood. METHODS: A qualitative study involving semi-structured interviews was conducted with 23 older adults who were purposively recruited from three communities in Wuhan, China. Interviews were transcribed verbatim and analyzed using thematic analysis that combined deductive coding guided by the social determinants of health framework with inductive coding to capture themes emerging from the data. RESULTS: Five themes and 12 subthemes were identified: (1) economic stability, comprising economic burden concerns and the lack of material incentives; (2) education access and quality, comprising limited disease-related knowledge, the double effect of educational level, and fixed beliefs about dementia risk; (3) social and community context, comprising perceived stigma, result-related anxiety and family concerns, and late-life values; (4) health care access and quality, comprising insufficient medical trust and service assurance, limited information accessibility, and symptom-oriented healthcare-seeking behavior; and (5) neighborhood and built environment, comprising limitations in convenience and accessibility. CONCLUSION: Low uptake of early dementia screening among community-dwelling older adults in China reflects a system-level behavioral dilemma shaped by social determinants of health. Future screening programs should build integrated, community-embedded pathways that make screening affordable, understandable, trustworthy, connected, and convenient, thereby strengthening the acceptability, equity, and sustainability of dementia prevention and early detection.
Frontiers in public healthMariola A Busquets, Ibrahim D Ali, Andrea N Ponce, Jeremy D Keenan, Luma Al-Attar
INTRODUCTION: Social determinants of health (SDoH) are increasingly recognized as drivers of population health, but their association with severe vision impairment has not been examined in Puerto Rico, a U. S. territory with a particularly high reported prevalence of severe vision impairment. METHODS: We conducted a population-based, cross-sectional analysis of 4,558 noninstitutionalized adults aged ≥18 years who participated in the 2023 Behavioral Risk Factor Surveillance System (BRFSS) in Puerto Rico. Responses were dichotomized into five SDoH exposure variables representing Healthy People 2030 domains: economic instability, low educational attainment, insufficient social support, limited health care access, and unstable built environment. These were summed to construct a cumulative Social Risk Index (range, 0 to ≥4). Modified Poisson regression with robust variance estimation was used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for the association between each exposure variable and self-reported severe vision impairment, adjusted for age, sex, marital status, and insurance coverage. Analytic weights were incorporated to account for the complex survey design. RESULTS: Among 4,558 respondents (mean age, 50 years; 53.3% female), 880 reported severe vision impairment (survey-weighted prevalence, 19.8%). After adjustment, severe vision impairment was more prevalent among individuals experiencing an unstable built environment (aPR, 2.02; 95% CI, 1.70-2.40), limited health care access (aPR, 1.95; 95% CI, 1.53-2.50), economic instability (aPR, 1.68; 95% CI, 1.40-2.01), insufficient social support (aPR, 1.33; 95% CI, 1.10-1.61), and low educational attainment (aPR, 1.30; 95% CI, 1.06-1.60). A graded increase in prevalence was observed with higher cumulative Social Risk Index scores, from aPR 1.28 (95% CI, 1.03-1.59) for one social risk factor to aPR 3.00 (95% CI, 2.13-4.23) for four or more factors. DISCUSSION: Self-reported severe vision impairment in Puerto Rico was associated with multiple individual social determinants and increased monotonically with cumulative social risk. Identifying social risk factors associated with severe vision impairment may help direct eye health resources toward the populations in which it is most prevalent. Further research is needed to clarify the mechanisms linking social determinants to vision loss.
BMJ openAnna Fäldt, Natalie Durbeej, Anton Dahlberg
PURPOSE: Social inequalities in child health persist even in high-income welfare states with universal child health services, yet large-scale longitudinal resources capturing early life exposures, family context and service delivery during the preschool years remain scarce. The Alma cohort was established to identify risk and protective factors for children's health and development during the first 5 years of life, with a particular focus on social determinants of health and the delivery and impact of proportionate universalism within the Swedish child health services. PARTICIPANTS: The Alma cohort is a population-based register cohort comprising all children born in Sweden between 2018 and 2023, together with their parents and siblings, totalling 2 169 423 unique individuals. Of these, 690 589 are index persons (children). Individual-level data are linked across multiple national registers using the unique Swedish personal identity number, including the Total Population Register, the Medical Birth Register, the National Patient Register, the Prescribed Drug Register, the Swedish Child Health Services Register (BHVQ), sociodemographic registers, registers on out-of-home placements and the Cause of Death Register. The cohort captures substantial variation in perinatal characteristics, family structure, socioeconomic conditions and geographical context. Data are retrieved in three waves up to 2030 to enable longitudinal follow-up from birth into school age. FINDINGS TO DATE: The cohort is broadly representative of Swedish children and families. Among index persons, 51.4% are boys and 48.6% are girls. Approximately 40% have at least one parent born outside Sweden, 63.5% have at least one parent with a college or university education and 78.0% reside in urban areas during their first year of life. The BHVQ subcohort, covering 458 724 index persons from 13 Swedish regions, provides data on child health and development and service delivery within the child health services. Several studies are currently ongoing, addressing topics such as language screening, enhanced support from child health services, parental mental disorders, out-of-home care and the consequences of parental loss. FUTURE PLANS: Planned data extractions will extend follow-up through early school age, including linkage to the National School Register for data on school performance. The cohort is open to collaboration with researchers interested in child health, service evaluation and policy-relevant analyses.
Archives of gerontology and geriatricsXue Wang, Min Li, Wendie Zhou, Jiaqi Yu, Hejing Chen, Xuan Yang, Cuili Wang
OBJECTIVES: To characterize long-term profiles of subjective memory ratings and examine their associations with cumulative, domain-specific, and individual social determinants of health (SDoH) among middle-aged and older adults. METHODS: We analyzed six waves of the China Family Panel Studies (2012-2022) comprising 14,938 adults aged ≥45 years. Group-based trajectory modeling was used to characterize longitudinal profiles of subjective memory ratings. Logistic regression estimated associations with baseline SDoH, with restricted cubic splines assessing dose-response shape and false-discovery-rate correction addressing multiple testing. Sensitivity analyses incorporated baseline memory, prospective follow-up, objective cognition, missing data, attrition, and complex sampling. A binary Ising network was estimated as a secondary analysis. RESULTS: Two profiles were identified and differed predominantly in their overall subjective-memory rating levels, with similar rates of change over time. Each additional adverse SDoH was associated with higher odds of the persistently lower subjective-memory rating profile after multivariable adjustment (OR, 1.23; 95% CI, 1.20-1.25), with attenuation after additional adjustment for the 2012 memory rating (OR, 1.16; 95% CI, 1.13-1.19). The association persisted when profile classification was restricted to 2014-2022 (OR, 1.15; 95% CI, 1.13-1.18). The cumulative association was nonlinear (P < 0.001), and one of 10 cross-domain interactions remained after false-discovery-rate correction. Subjective memory ratings correlated weakly with objective cognitive measures. In the network analysis, lower education had the largest expected influence estimate, although bootstrap comparisons did not support a statistically distinct hierarchy among the highest-ranking nodes. CONCLUSIONS: Greater social disadvantage was associated with persistently lower subjective memory ratings, highlighting enduring differences in subjective-memory rating levels over time. These findings indicate enduring social patterning of subjective memory from midlife into later life while underscoring the distinction between subjective ratings and objective cognitive performance.
Women's health (London, England)Amanda Gilbert, Bria Lee-Robinson, Cindy Schwarz, Teresa W Very, Allison Kemner, Debra Haire-Joshu, Rachel G Tabak, Sarah S Farabi
BackgroundSocial determinants of health (SDOH) and related social needs (e.g., food insecurity, financial strain) are major drivers of maternal health disparities. Pregnant women of color and those with low socioeconomic status (SES) experience a disproportionate burden of social needs, which are associated with adverse pregnancy outcomes and increased risk of chronic disease for both mothers and children. Home visiting programs represent a promising, community-based platform for identifying and addressing social needs; however, little is known about how these processes occur in practice or how they can be strengthened.ObjectivesExplore how social needs are identified and referred for intervention within the Parents as Teachers (PAT) home visiting model.DesignQualitative.MethodsWe conducted semi-structured interviews with supervisors, parent educators (home visitors), and pregnant women of color and low SES participating in PAT across seven U.S. states. Interview guides and analysis were informed by the Consolidated Framework for Implementation Research (CFIR) and the Healthy People 2030 SDOH framework.ResultsParticipants (25 PAT providers; 15 pregnant women) described social needs as pervasive and central to maternal well-being, with limited and variable community resources. Determinants spanned multiple CFIR domains. In the outer setting, availability of community resources and interorganizational partnerships shaped referral success. In the inner setting, time constraints, inconsistent resource tracking systems, and variable infrastructure posed barriers. At the implementer level, educators reported role strain and uncertainty regarding scope of practice, while noting that trusting relationships facilitated disclosure of sensitive needs.ConclusionHome visiting programs are uniquely positioned to identify and address social needs through longitudinal, relationship-based engagement. Findings highlight the need for brief assessment processes; enhanced training and role clarity for home visitors; and systems to support resource management and partnerships. These insights can inform scalable social needs interventions within home visiting to advance maternal health equity.
Journal of global healthImran A Chauhadry, Sajid Bashir Soofi, Muhammad Atif Habib, Arjumand Rizvi, Ahmad Khan, Kanza Naqvi, Henry D Kalter, Robert E Black, Zulfiqar A Bhutta
BACKGROUND: Reducing newborn, child, adolescent, and maternal mortality is a global priority, yet Pakistan continues to bear a high burden of preventable deaths. Routine civil registration does not capture causes or social determinants for most of these deaths. The verbal and social autopsy (VASA) methodology fills this gap by combining symptom-based identification of the cause of death with structured assessment of social and care-seeking factors. Here we describe the methodological framework of a national VASA study conducted using the Pakistan National Nutrition Survey 2018 sampling frame, designed to estimate cause-specific mortality and social determinants of stillbirths and neonatal, post-neonatal, adolescent, and maternal deaths. METHODS: We used the sampling frame of the Pakistan National Nutrition Survey 2018 and employed VASA techniques to identify biological causes and social determinants of stillbirths, neonatal, child, adolescent, and maternal deaths. By utilising adapted VASA tools and rigorous analytical methods, we sought to bridge the gap between health systems and mortality data by examining deaths that occurred in and outside of healthcare facilities. Our aim was to provide insights into preventable deaths to guide public health interventions and policymaking, such as integrating VASA into the national survey and building the capacity of community-level healthcare workers to conduct VASA. CONCLUSIONS: This study provides a vital contribution to improving health outcomes and reducing mortality in low- and middle-income countries by integrating sociocultural and systemic factors into mortality analysis. KEYWORDS: verbal and social autopsy, cause of death, VASA methodology, Pakistan.
Clinical interventions in agingLinxin Jiang, Simin Li, Zhihao Liao, Daniel R Reissmann, Deborah Kreher, Gerhard Schmalz, Jianbo Li
PURPOSE: This study aims to identify distinct oral multimorbidity subtypes among Chinese older adults and to examine the structural and intermediary social determinants associated with subtype membership. PATIENTS AND METHODS: This cross-sectional study analyzed 423 adults aged 65-74 years recruited from 39 communities at 13 disease surveillance sites in Guangdong Province, China, within the 2021 key population oral health surveillance project. Oral health indicators, including caries, periodontal status, and tooth loss, were subjected to latent class analysis (LCA). The Bolck-Croon-Hagenaars (BCH) three-step approach was employed to examine associations between latent class membership and covariates organized within Solar and Irwin's social determinants of health framework (SDH). RESULTS: Three subtypes were identified: Class 1 (lower disease burden, 23.9%), preserved dentition with moderate periodontal involvement; Class 2 (periodontal-dominant subtype, 41.6%), severe periodontal destruction, substantial tooth loss, and high rates of unrestored missing teeth; and Class 3 (caries-tooth loss dominant subtype, 34.5%), elevated crown caries burden and tooth loss but relatively preserved periodontal status. Compared with Class 1, Class 2 was significantly associated with older age, smoking, and dental visit. Class 3 was significantly associated with older age, females, urban residence, and dental visit. CONCLUSION: Oral multimorbidity among Chinese older adults is heterogeneous. These findings may support the design of, subtype-specific rather than uniform oral health management strategies for older adults. Longitudinal validation and replication in other Chinese populations are required before wider generalization.
INTRODUCTION: Explore association between a weighted social determinants of health (SDOH) score and incident dementia in adults with and without type 2 diabetes (T2D). METHODS: Among 10,071 UK Biobank adults with T2D and 11,780 euglycemic individuals, SDOH indicators were weighted using elastic net and categorized as favorable, medium, or unfavorable. Sex- and T2D-stratified associations with incident dementia were estimated using multivariable Cox models and validated in All of Us. RESULTS: Over 14 years of follow-up in UKB, 247 T2D and 149 euglycemic participants developed dementia. In T2D, higher SDOH score was significantly associated with increased risk of all-cause dementia. Comparing unfavorable vs. favorable SDOH, hazard ratios (HRs) were 2.4 (95% CI: 1.7-3.6) overall, 1.7 (1.1-2.6) in men, and 5.4 (2.0-13.9) in women (Sex-interaction p 0.009). In euglycemic, corresponding HRs were 2.4 (1.4-3.8) overall, 2.4 (1.3-4.3) in men, 2.9 (0.9-8.9) in women. Stratified by SDOH category, T2D (vs. euglycemia) was significantly associated with higher dementia risk in the unfavorable/medium SDOH group: 2.9 (1.8-4.6) in all,1.7 (0.8-3.6) in men, and 3.1 (1.1-8.7) in women. CONCLUSIONS: Adverse SDOH was associated with higher dementia risk, with stronger T2D-related risk among medium/unfavorable SDOH groups, especially in women with T2D.
INTRODUCTION: Emerging evidence supports the relationship among social determinants of health, depression symptoms, and cardiovascular health. Veterans have a disproportionate prevalence of cardiovascular disease and depression, social determinants of health concerns related to socioeconomic status, and challenges with access to healthcare. This study aimed to examine associations of social determinants of health and depression symptoms with cardiovascular health among civilians and veterans and assessed whether these associations differed between the 2 groups. METHODS: Our cross-sectional analysis used 2013-2018 and 2021-2023 National Health and Nutrition Examination Survey data on participants aged 20 years or older without cardiovascular disease. Social determinants of health included demographic characteristics, socioeconomic factors, and access to health care. We used the Patient Health Questionnaire-9 to assess the severity of depression and dichotomized scores as 0 to 5 symptoms (no depression) or 5 or more symptoms (mild to severe depression). We quantified cardiovascular health using Life's Essential 8 scoring metric (scored from 0 to 100, with higher scores indicating better health status). We applied sample weights in multiple linear regressions. RESULTS: Among 11,396 participants, 10,470 were civilians (mean age, 46 y; 55% female) and 926 were veterans (mean age, 56 y; 10% female). Mean cardiovascular health score was 71 among civilians and 67 among veterans. Veterans were more likely to have some college, higher financial status, and access to health care. Among both civilians and veterans, poorer cardiovascular health was associated with older age, identifying as non-Hispanic Black or as "other" or multiracial, lower education, lower financial status, and depression symptoms. These associations were more pronounced among veterans who identify as members of racial and ethnic minority populations or have lower financial status. CONCLUSION: The magnitude of the links between cardiovascular health and some social determinants of health varied by veteran status, indicating that varied factors may influence health disparities in each group and underscoring the need for tailored strategies to address them.
Clinics in geriatric medicineElizabeth Sheridan, Jessica M Wiseman, Jessica L Krok-Schoen, Holly I Dabelko-Schoeny, Shannon E Jarrott
Falls are a leading cause of injury and death among older adults, yet a persistent gap exists between available evidence-based prevention strategies and their real-world uptake. Social determinants of health shape fall risk as well as the accessibility and effectiveness of prevention interventions. Cohort evidence demonstrates that disparities in outcomes are intersectional and emerge at the community level, challenging current risk assessment tools and one-size-fits-all prevention approaches. Closing this gap requires further research, validated equity-informed assessment tools, and interventions matched to patients' social circumstances.
Archives of gerontology and geriatricsYa Li, Tianyue Li, Xi Jin, Banghua Liao, Kunjie Wang
BACKGROUND: Urinary incontinence (UI) affects a substantial proportion of middle-aged and older adults worldwide. We examined the associations of social determinants of health (SDOH) and lifestyle-related factors with incident UI in three national aging cohorts to identify factors associated with UI risk. METHODS: We analyzed longitudinal data from the Health and Retirement Study (HRS; United States), the English Longitudinal Study of Ageing (ELSA; England), and the China Health and Retirement Longitudinal Study (CHARLS; China). Composite SDOH scores and healthy lifestyle indexes were constructed from five harmonized domains or factors, each ranging from 0 to 5. Incident UI was the primary outcome. Cohort-specific survey-weighted Cox proportional hazards models were fitted, and estimates were pooled using random-effects meta-analysis. RESULTS: The analysis included 11,126 participants aged 50 years or older, with follow-up ranging from 8 to 10 years. Weighted UI incidence was 28.6% in HRS, 23.1% in ELSA, and 19.7% in CHARLS. The composite SDOH score was not consistently associated with incident UI (HR = 0.97, 95% CI: 0.92-1.01). A higher healthy lifestyle index was associated with lower UI risk (HR = 0.87, 95% CI: 0.81-0.92). Sleep problems (HR = 1.43, 95% CI: 1.31-1.55), higher body mass index (BMI; HR = 1.02, 95% CI: 1.01-1.03), and postsecondary education (HR = 1.37, 95% CI: 1.17-1.61) were associated with higher UI risk, whereas regular physical activity was associated with lower risk (HR = 0.78, 95% CI: 0.70-0.87). Mediation analyses suggested that sleep problems partially mediated the association between physical activity and incident UI. CONCLUSION: In this multi-cohort longitudinal study of adults aged 50 years and older, the composite SDOH score showed no consistent association with incident UI, whereas a higher healthy lifestyle index was associated with lower UI risk. Physical activity, BMI, and sleep problems may help identify individuals at higher UI risk, although sleep problems may also reflect underlying health conditions. These findings support lifestyle management as a potential target for UI prevention.
Journal of the American Heart AssociationElizabeth Adamson, Haoyang Li, Zhenxing Xu, Darren Tanner, Wodan Ling, Youran Qi, Chengyuan Liu, Ryan Zhenqi Zhou, Peter Speyer, Anna-Maria Volkmann, Bilal Sha…
BACKGROUND: New York City (NYC) launched the HealthyNYC initiative in 2025, aiming to reduce cardiovascular disease and diabetes deaths by 5% by 2030. Effective place-based interventions require evidence to address social risk factors associated with hypertension and diabetes. This study aims to identify key social determinants of health (SDoH) associated with variation in hypertension and diabetes prevalence across census tracts in NYC. METHODS: This retrospective cohort study analyzed clinical data on 3.2 million NYC residents integrated with SDoH data at the census tract level. Using Extreme Gradient Boosting, we identified the top 10 SDoH most strongly associated with both age-adjusted and unadjusted prevalence across all census tracts in the city and neighborhood-specific SDoH for census tracts in the highest prevalence quintile for hypertension and diabetes. RESULTS: SDoH explain 70% to 80% of the cross-tract variation in hypertension (R2=66.2%-79.5%, root mean square error=2.6-3.2) and diabetes (R2=72.9%-79.3%, root mean square error=2.1-2.2) prevalence in NYC. Normalized mean absolute Shapley Additive Explanations values showed that the top 10 SDoH contribute to most of the model's prediction: 73% (age adjusted) and 70% (unadjusted) for hypertension prediction and 73% (age adjusted) and 71% (unadjusted) for diabetes prediction. The top 10 SDoH with the highest Shapley Additive Explanations values center on domains like socioeconomic disadvantage, built environment, and commute time. The neighborhood-specific SDoH varied across census tracts and boroughs. CONCLUSIONS: This study provides robust evidence that SDoH are strongly associated with prevalence of hypertension and diabetes and identifies neighborhoods where targeted, place-based approaches could be prioritized for implementing and testing.
Frontiers in public healthJoachim P Sturmberg, Carmel M Martin, Stewart W Mercer, Mark J DeHaven, Holger Pfaff, Jeanette M Bennett
The social determinants of health (SDOH)-including socioeconomic position, education, housing, and social networks-are fundamental drivers of health inequalities worldwide. These inequalities persist because social determinants interact dynamically across time and context, with health emerging from the interplay of social, political, environmental, and biological processes in which determinants act simultaneously as causes and consequences. Early-life exposures and historical conditions produce enduring physiological vulnerability through biological embedding, encompassing stress dysregulation, inflammation, and epigenetic modifications. Feedback loops, non-linearity, and path dependence stabilise disadvantage across the life course and across generations-mechanisms that explain why interventions targeting isolated risks or single factors often yield modest or context-dependent effects. A complex adaptive systems perspective reconceptualises health inequalities as emergent outcomes of these interacting social-biological processes and identifies leverage points where systemic, multi-level interventions can shift trajectories. Promising approaches include coordinated, place-based strategies, relational continuity in primary care, and strengthened social infrastructure.
European journal of orthopaedic surgery & traumatology : orthopedie traumatologieDavid Dallas-Orr, Jessica Valdez, Shannon Tse, Mark A Lee, Megan R Terle, Gillian L S Soles, Ellen P Fitzpatrick, Sean T Campbell, Barton L Wise, Augustine M S…
PURPOSE: To determine whether community socioeconomic distress, measured by the Area Deprivation Index (ADI), is associated with worse short-term clinical outcomes in orthopaedic polytrauma patients treated at an academic level I trauma center. METHODS: We performed a retrospective cohort study of polytrauma patients treated for orthopaedic injuries at an academic level I trauma center (2014-2019). State ADI scores were used to classify patients as residing in a distressed community (ADI > 8; DC) versus non-distressed community (NDC). Collected variables included demographics, injury characteristics including the Injury Severity Score (ISS), insurance status, and outcomes. Primary outcomes were malunion, nonunion, and unplanned return to the operating room; secondary outcomes included disposition at discharge and follow-up duration. RESULTS: Among 348 patients, 193 (55.5%) resided in DC. Compared with NDC, a higher proportion of DC patients identified as Black or American Indian/Pacific Islander (p < 0.002), and DC patients more frequently had a prior smoking history (57.4%) and psychiatric illness (19.7%; both p < 0.001) and carried public insurance (p = 0.003). Mechanisms of injury differed (p = 0.045). Mean ISS was similar between DC and NDC (18.8 vs. 19.8; p = 0.435), and patients from DC were less likely to be discharged home (48.9 vs. 62.0%; p = 0.021). Rates of malunion, nonunion, and reoperation were similar between groups. CONCLUSIONS: Our findings indicate that orthopaedic polytrauma patients from distressed communities are disproportionately affected by factors that complicate recovery, including smoking history, psychiatric comorbidities, and insurance status. Despite these associations, ADI was not associated with short-term outcomes in our polytrauma patient population.
Medical careGabrielle Jutras, Andrea Huerta, Chetana Bisarya, Noelle Ebel, Joshua Gossett, George Mazariegos, Vicky L Ng, Emily R Perito, James E Squires, Sharad I Wadhwani
BACKGROUND: Social adversity contributes to poor health outcomes for children after liver transplantation (LT), including greater morbidity and mortality. Although social risk screening is standard practice in pediatric primary care, its adoption in pediatric LT (pLT) remains limited, despite the significant prevalence of social risks among these families. OBJECTIVES: To evaluate barriers and facilitators to social risk screening implementation in pLT settings across a multicenter learning health network. RESEARCH DESIGN: A mixed-methods study utilizing surveys and semistructured interviews. SUBJECTS: Health care practitioners involved in pLT care across North American centers in the Starzl Network for Excellence in Pediatric Transplantation (SNEPT) Network. Participants included multidisciplinary team members, notably transplant physicians, social workers, and research coordinators. MEASURES: We surveyed center leads to identify center-level implementation challenges. We conducted 1-on-1 interviews with transplant team members to identify barriers and facilitators. We analyzed qualitative data using the Capability, Opportunity, Motivation-Behavior model, an implementation science model for developing targeted interventions. RESULTS: We surveyed 10 centers, of which 40% of liver transplant clinics reported actively screening patients for Social Determinants of Health (SDoH). Most practitioners indicated reliance on social workers and cited limited resources as barriers to implementation. We also conducted interviews with 18 practitioners across 11 centers. Reported barriers included uncertainty about the tool's added value, time and space constraints during patient encounters, and challenges with data entry and sharing across a multicenter network. Facilitators included institutional support, interdisciplinary collaboration, and integration into electronic health records. CONCLUSION: Efforts to increase adoption should focus on improving practitioners' experiences with the tool as well as further assessing and disseminating its potential value in improving outcomes. Strategies for addressing logistical challenges to adapting workflows and simplifying network data management should be considered. This study establishes a foundation for improving screening rates and data capacity.
BACKGROUND: The COVID-19 pandemic led to economic and policy changes that increased Medicaid enrollment and reduced disenrollment. Tracking the impact of these changes on the composition of enrollees is crucial for resource allocation and program evaluation. However, Medicaid data currently lack the necessary demographic, social, and economic information about enrollees. OBJECTIVE: Enhance Medicaid enrollment data by linking it with nationally representative survey data to compare the composition of enrollees across various social determinants of health characteristics before and after the COVID-19 pandemic. RESEARCH DESIGN: We utilize individual-level Medicaid enrollment records (TAF, 2018-2021) before and during the pandemic, linked to restricted American Community Survey (ACS, 2021) microdata. RESULTS: Almost 95% of enrollees in our analytic sample received an anonymous identifier (Protected Identification Key), and nearly 1% were found in ACS data. By comparing Medicaid enrollees in different enrollment cohorts, we find that the pandemic caused significant compositional changes, particularly among the newly enrolled. Our findings indicate that those experiencing a major health or economic shock, either directly or through a family member, relied on Medicaid, likely as a temporary source of health insurance during the pandemic. CONCLUSIONS: Linking individual-level records between Medicaid and ACS data effectively addresses a crucial gap in current data capacity. The integrated data can be utilized, repurposed, and expanded by incorporating additional survey and administrative records to enhance the utility of Medicaid data for future research.
Revista espanola de salud publicaMyrian Pichiule-Castañeda, Honorato Ortiz-Marrón, Ana Gandarillas Grande, María-Felícitas Domínguez-Berjón
OBJECTIVE: Childhood obesity is a Public Health problem that is unequally distributed across the population. The aim of this paper was to assess baseline socioeconomic determinants (ages four or six) and their association with obesity during follow-up up to age fourteen. METHODS: Participants from the ELOIN cohort (Estudio Longitudinal de Obesidad Infantil) with four standardized weight and height measurements at ages four or six, nine, twelve, and fourteen years old (follow-up 2012-2024) were included. Obesity was defined as BMI (Body mass index) greater than 2 standard deviations according to World Health Organization 2017 growth charts. Socioeconomic variables included: Family Affluence Scale (FAS-II), occupational social class, age, country of birth, and parental educational level. The prevalence of obesity was estimated with 95% confidence intervals (95% CI) and crude (cPR) and adjusted prevalence ratios (aPR) (95% CI) were estimated by socioeconomic factors using Poisson regression models. RESULTS: Among 2,124 participants (51% girls), 19.8% had at least one parent born outside Spain and 15.6% reported low family affluence. The highest point prevalence of obesity was observed at age nine (14.7%). Overall, 20.1% (95% CI:18.4-21.8) were classified in obesity in at least one of the four assessments. Higher obesity prevalence was observed in socioeconomically disadvantaged groups. Obesity was associated with being a boy (aPR:1.40; 95% CI:1.17-1.68 vs. girls) and low family affluence (aPR:1.36; 95% CI:1.03-1.80 vs. highest affluence). CONCLUSIONS: A positive association between childhood obesity and being male, as well as, lower socioeconomic status was confirmed. Strategies for prevention and intervention should de prioritised for these groups.
Home healthcare nowSusan Burt, Kathleen Eid-Heberle, Mary Frances Stapleton
Home care nurses occupy a unique position in the health care system, observing patients in their living environments and coordinating care across multiple delivery sites. Social determinants of health (SDoH), encompassing economic stability, education, health care access, neighborhood conditions, and social context, account for an estimated 30% to 90% of health outcomes, far exceeding the contribution of medical care alone. This article examines the historical, organizational, and clinical foundations of SDoH within the context of home care nursing, underscoring the critical need for systematic assessment in patient care to ensure positive health outcomes. Drawing on the upstream, midstream, and downstream framework, this article describes how home care nurses can intervene at multiple levels: advocating for systemic change, connecting patients to community resources, and managing individual clinical and behavioral needs. The article also examines evolving policy and documentation requirements, including mandatory SDoH screening and the underutilized ICD-10-CM Z-codes, while highlighting gaps in social work utilization. The article further explores emerging models such as social prescribing as promising multilevel approaches to meeting patients' social needs. Ultimately, addressing SDoH is both a professional and ethical obligation for nurses, one that demands interdisciplinary collaboration and sustained commitment across all levels of care.
Clinics in geriatric medicineSiobhan K McMahon, Hiroko Kiyoshi-Teo, Rajean Moone
Falls among older adults remain a major public health issue despite strong evidence supporting prevention strategies. Rising mortality and costs highlight a gap between knowledge and implementation. This gap is partly driven by ageism, which operates at structural, interpersonal, and individual levels, influencing how fall prevention is implemented, received, and adopted. Factors such as underreporting, environmental barriers, and internalized stigma reduce effectiveness. The article argues for a holistic, multilevel approach that integrates social determinants of health, especially ageism. Using frameworks like Reframing Aging, it recommends systemic, clinical, and communication changes to improve prevention, engagement, and safe mobility for older adults.
Rhode Island medical journal (2013)Philip A Chan, Natalie Fenn, Yelena Malyuta, Maximillian Erbe, Morgan Leonard, Daniel McGuire, Sussy Santana, Katherine Westrom, Alexi Almonte, Peter Salhaney,…
BACKGROUND: In the United States, significant disparities exist in preventative health among underserved communities, including African American/Black (AA/B), Hispanic/Latino (H/L) and lesbian/gay/bisexual/transgender/ queer (LGBTQ+) individuals. We explored the influence of social determinants of health (SDOH) on preventative health outcomes in these groups. METHODS: We conducted a comprehensive cross-sectional needs assessment at safety-net health clinics in Providence, Rhode Island, from June to September 2022. RESULTS: Of N=1,017 individuals, 67% identified as H/L, 16% identified as AA/B, and 19% identified as LGBTQ+. The most common diagnosed health conditions were anxiety (26%), depression (23%), hypertension (20%), and diabetes (15%). People reported most commonly needing help with food (31%), housing (25%), and utilities (22%). More social needs were associated with reductions in COVID-19 booster vaccination (p<.01) and higher mental health diagnoses (p<.01). AA/B individuals with higher health literacy were also less likely to be diagnosed with a mental health condition (p=.02). LGBTQ+ individuals were more likely to report a history of mental health illness, tobacco use, hazardous alcohol use, other substance use, and more sexual partners (p<.05). CONCLUSIONS: Addressing health literacy and other social determinants of health is important to address disparities and achieve health equity among marginalized communities.
Journal of primary care & community healthShujie Chen, Farzana Yeasmin, Hai Phung, Nicola Wiseman
Background & ObjectivesWith the global increase in refugee displacement, countries such as Australia, Canada, and Germany continue to resettle the largest numbers of refugees. Resettled refugees face complex health challenges, including trauma recovery, mental distress, and barriers to healthcare access. Delivering effective health interventions is a critical public health priority. This scoping review examines recent health promotion interventions targeting refugee-background people in major resettlement countries: Australia, Canada, Germany, the US, and Sweden. It seeks to identify the scope of recent focus and the characteristics associated with intervention effectiveness.MethodsFollowing the PRISMA guideline, seven databases were searched for studies published between 2020 and 2024. Data on study design, intervention types, and outcomes were extracted and synthesised narratively.SynthesisThirty-three studies met the inclusion criteria. Mental health was the predominant focus (20 studies), followed by health literacy (6), social determinants (4), physical activity (3), maternal and infant health (2), and chronic pain (1). Effective interventions consistently featured community engagement, cultural sensitivity, and strong cross-sector collaboration, alongside engaging activities and accessible, safe environments. Applying the socioecological framework, this review also identified an overrepresentation of operating at individual level among recent refugee-targeted health interventions.ConclusionMental health emerged as the prioritised focus of refugee health interventions in major resettlement countries. However, this review identified a limited number of interventions that operate at socioecological levels beyond the individual level. Strategies that foster trust, safety, engaging activities, cultural relevance, program sustainability, and collaborative partnerships are essential for intervention success. Future research could employ robust designs and objective measures to strengthen evidence and inform scalable models for refugee health equity.
The Medical journal of AustraliaNikkita Joshua, Emma L Smith, Eunice Cheeky Love, Christopher P Lowbridge, Nicole Tukana, Amy Bowden, Megan A Campbell, Dawn Casey, James Ward
Tuberculosis is often perceived as a disease of the past in Australia, yet ongoing transmission persists in some jurisdictions and Aboriginal and Torres Strait Islander peoples continue to experience a disproportionate burden. Drawing on lived experience and community perspectives, we highlight challenges navigating tuberculosis care and opportunities to strengthen prevention and care. Achieving tuberculosis elimination requires more than biomedical tools alone. Earlier diagnosis, culturally responsive and community-led approaches, strengthened Aboriginal health workforces and action on social and structural determinants are needed to ensure tuberculosis is addressed rather than forgotten in Australia.
Clinical transplantationMansi K Shah, Zara Latif, Carolina Lemos, Adi Hertz, Elena Donald, Byron Fuselier, Jordan Lindekens, Fabian Vargas, Afsana Rahman, Farhana Latif, Kevin J Clerk…
BACKGROUND: Over 4,500 individuals undergo heart transplantation (HT) in the United States every year. Limited qualitative data exist evaluating challenges and barriers in the evaluation and post-transplant process and their association with primary language spoken. METHODS: We conducted semi-structured interviews with individuals who received HT at a high-volume urban academic medical center between 2015 and 2024. Primary English and Spanish speaking patients were included; interviews were conducted by a certified Spanish speaker. Interviews were audio-recorded and transcribed for thematic analysis. Themes were compared based on primary language spoken. RESULTS: 34 HT recipients (median age 61 years, 38% women) participated in this study. Forty-one percent (n = 14) identified Spanish as their primary language. Three key thematic differences emerged based on primary language spoken: (1) perception of the transplant process and emotional needs, (2) financial concerns while awaiting transplant, and (3) methods of communication. Spanish speaking patients more commonly relied on family support, faith, and public assistance programs to navigate the transplant process. English speaking patients, on the other hand, more frequently struggled with the morality of accepting a transplant. Additionally, English speaking patients more commonly had increased financial resources, highlighting the intersection with education and other social determinants of health (SDOH). CONCLUSION: This study identifies key differences in the experiences of HT recipients based on the patient's primary spoken language and inter-related SDOH. This study can inform future studies focused on the impact of health policy changes and the expansion of social support systems on transplant allocation among linguistically diverse communities.
Advances in health information science and practiceRachel Landauer, Erika Hanson, Kathryn Garfield, Sara Raza, Carmel Shachar
BACKGROUND: Social determinants of health (SDOH) are increasingly recognized as vital factors shaping health outcomes in the United States. With escalating integration of SDOH data into health information platforms, questions arise about appropriate regulation to both enable data-driven care and protect against potential harms. This article reviews the current regulatory landscape governing SDOH data within the US health care system, with an emphasis on identifying critical tensions, policy strategies, and gaps salient for policymakers, practitioners, and researchers. METHODS: We conducted a scan to identify federal and state regulatory activity pertaining to SDOH data within the health care contexts. We synthesized these sources to map the current landscape and tease out emerging themes. RESULTS/DISCUSSION: We identified 3 core areas of relevant regulation: (1) data standardization, interoperability, and exchange; (2) information privacy and security; and (3) oversight of advanced analytics, including artificial intelligence applications. Authorities actively wrestle with several key regulatory design questions, including: (1) whether to treat SDOH data created, collected, maintained, and used in or by health care settings in the same way as any other type of health information; (2) effective levers to promote desired policy outcomes; and (3) the rightsized jurisdictional balance between federal and state enforcement. Variations in decisions at these crossroads are entrenching the health care system in a scenario in which SDOH data exchange is more clearly part of the new standard of care in some states than others, and in which SDOH data is more protected in some states than others. CONCLUSION: Findings speak to the importance of cultivating a regulatory environment for SDOH data within the health care sector that is not only responsive to the current realities of the field but also responsive to rapid evolution and resilient to future challenges.
Health promotion and chronic disease prevention in Canada : research, policy and practiceGyselle de Geus, Jean-Philippe Chaput, Rita Al Kazzi, Claire N Tugault-Lafleur
INTRODUCTION: Limited evidence is available on the eating behaviours of Canadian adolescents. We examined how eating behaviours vary by social factors in a large nationwide sample of Canadian adolescents. METHODS: This cross-sectional study used data from the 2019 Canadian Health Survey on Children and Youth (n = 13 605 adolescents aged 12-17 years). Gender-stratified multivariable regression models were used to test for differences in the likelihood of breakfast consumption, evening family meals, sugar-sweetened beverages (SSB) intake and restrictive eating by gender, age, racial/cultural background, parental education, household income, and food security status. RESULTS: Compared to boys, girls were more likely to consume breakfast infrequently, have fewer evening family meals, engage in restrictive eating, but were less likely to consume SSB frequently. Adolescents aged 14 to 17 demonstrated a higher likelihood of infrequent breakfast consumption, reduced participation in family meals, engagement in restrictive eating behaviours, and frequent consumption of SSB compared to those aged 12 to 13. Black adolescents were more likely to report infrequent breakfast, lower participation in evening family meals and frequent SSB consumption compared to their White peers. Adolescents whose parents had a high school degree or lower education were more likely to report infrequent breakfast consumption and frequent SSB consumption compared to adolescents whose parents had a college degree or higher. Lower household income and food insecurity were linked to adolescents' frequency of breakfast consumption, evening family meals, and SSB intake, but showed no association with restrictive eating behaviours. CONCLUSION: Disparities in eating behaviours exist among Canadian adolescents, underscoring the need for social policies that address structural determinants shaping dietary behaviours in this population.
Developmental psychobiologyBerenice Anaya, Rachel E Lean, Anna Constantino-Pettit, Christopher D Smyser, Cynthia E Rogers
The current study examines trajectories of caregiver psychosocial stress in a large (N = 288) and representative longitudinal sample of families impacted by very preterm (VPT) birth, including a group of VPT infants with white matter injury (WMI) and a group of term control (TC) families followed from birth to age 9/10. We examine trajectories of caregiver psychosocial stress as a function of caregiver race, the extent to which social determinants of health (SDoH) factors mitigate or exacerbate differences in caregiver psychosocial stress trajectories, and whether these trajectories relate to child psychopathology outcomes. Using multigroup (birth group: TC, VPT, and WMI) latent growth models, we show that trajectories of caregiver anxiety and total stress, but not depression, varied across birth groups. Specifically, caregivers of VPT and WMI infants reported higher levels of early anxiety and total stress (birth and 2 years postpartum) compared to TC caregivers, but these early high levels of anxiety and stress significantly decreased over time. We also show distinct trajectories of anxiety in Black VPT caregivers compared to White VPT caregivers as a function of health insurance status, such that White VPT caregivers using public insurance experienced more persistent anxiety levels over time while Black VPT caregivers seemed to leverage both public and private insurance. We also found longitudinal associations between caregiver depression and child psychopathology in all birth groups, reiterating the critical need for care and intervention during the postpartum period.
Health promotion internationalToby Freeman, Connie Musolino, Fran Baum
World Cafés are a method to promote inclusive, constructive dialogue to identify solutions to large scale problems. These attributes make World Cafés a potentially valuable tool for multi-sectoral dialogue to identify solutions to health promotion issues such as addressing social determinants of health inequities. However, there are few accounts of World Cafés being used to bring disparate sector knowledges together to address common problems. We sought to test how the World Café method could aid bringing together multi-disciplinary and multi-sector expertise to identify solutions to reduce increasing health inequities in Australia. We conducted World Cafés in each Australian state and territory (N = 8) with a total of 162 participants from academia, government, and civil society. Participants were drawn from sectors including health, education, housing, urban planning, economics, and employment, and from organizations representing Aboriginal and Torres Strait Islander peoples, people with a disability, multicultural communities, youth, and older people. We found different sector participants readily found common ground and collaborated to identify potential public policy solutions to health inequities, generating deep discussion on structural drivers that would not be possible without bringing together these sector knowledges. This upstream focus is likely to identify opportunities to make meaningful changes to create healthier, more equitable societies. Participants reported valuing participation in the World Cafés, making the research more of an exchange compared to other data collection methods. We would suggest World Cafés are a valuable addition to a research toolkit for seeking structural solutions to health promotion issues.