Young adults attending vocational education and training schools often engage in various health risk factors, including poor dietary habits. School canteens are key settings that can promote students' healthy food choices. This study aims to enhance the skills of vocational school canteen staff in preparing healthy food, student-centered communication, and meal presentation. A mixed-methods approach incorporated participatory action research and grounded theory (GT) analysis. The participants included 17 staff members, aged 21 to 60 years, working at three canteens that serve 557 students. Over eight months, four workshops were conducted, with staff engaging in exploratory actions between sessions to enhance student interaction and create healthy meals accommodating student preferences. Data collected from observations, field notes, and interviews were analyzed using GT, while survey data on student meal preferences were described statistically. A one-week choice architecture intervention was implemented in one canteen, and receipt data were collected to assess the impact of the new meal presentations and assessed using binomial logistic regression. The GT analysis identified the core category: "A dialogical hospitality approach facilitates reassurance." The workshops enhanced the staff's skills in healthy food preparation, incorporating student preferences and boosting their confidence in employing a hospitality-based dialogical approach, reassuring students to make healthy food choices. The choice architecture intervention led to a significant increase in the sales of healthy meals. This study highlights the importance of involving staff in targeted training through participatory methods to promote students' healthier food options in vocational school settings.

Emerging adulthood is a critical developmental period characterized by physiological and psychosocial vulnerabilities that may increase susceptibility to gastrointestinal (GI) symptoms and disorders. Stress during this time can disrupt gut-brain communication, exacerbating GI distress and associated health risks. Gender and race/ethnicity are also associated with GI symptom presentation and pain perception, yet these factors remain understudied. This study examines GI symptoms (Gastrointestinal Symptom Rating Scale), GI-specific anxiety (Visceral Sensitivity Index), and adverse childhood experiences (ACEs) in a diverse, non-medical college sample, exploring discernable differences among gender and racial/ethnic identities for key variables. The study included 1364 participants who were on average approximately 20 years old, recruited from five four-year colleges within a large public university system in New York City, completed an online survey. Multiple correspondence analysis (MCA), a multivariate technique, was used to identify patterns across categorical variables. MCA results showed that all GI symptoms were associated with GI-specific anxiety but were mostly unrelated to ACEs. Males and transgender females had significantly less GI symptoms and GI-specific anxiety compared to females and gender non-conforming participants. Participants who identified as White had significantly more GI symptoms and GI-specific anxiety compared to those who identified as Black. This work underscores the need for better recognition and intervention given the substantial burden of GI discomfort experienced by a sizable portion of this emerging adult sample, the strong link between GI-specific anxiety and symptoms, and differences in burden by gender and race/ethnicity.

Obesity is a major global health issue, increasing morbidity and mortality through its association with noncommunicable diseases. Black African women experience disproportionately high obesity rates, reaching 37% in the UK, reflecting complex genetic, sociocultural, and environmental factors, with migration influencing dietary changes. This study explored factors shaping the dietary choices of Black African immigrant women with overweight and obesity in the UK, focusing on individual, sociocultural, and environmental influences. A qualitative design was employed, using semi-structured online interviews with 15 participants, analyzed thematically through reflexive thematic analysis. Participants were African immigrant women from sub-Saharan Africa, ages ≥18 years, first- or second-generation immigrants, with a BMI >25 kg/m. Recruitment and interviews occurred between March and May 2024. Findings revealed tensions between sociocultural food preferences and children's Westernized tastes. Cultural identity, food-related shame, and ambivalence about traditional diets in public or work settings shaped practices. Work demands and limited time constrained preparation of traditional meals, while economic pressures and high costs of culturally appropriate foods restricted choices. Psychological stress and reliance on convenience foods emerged as coping strategies, often undermining health intentions. These findings highlight the need for culturally tailored, community-based interventions addressing barriers of cost, access, and time as well as potential strategies to support dietary autonomy and cultural retention. Future research should adopt longitudinal approaches to examine how these dynamics evolve, informing sustainable interventions.

Factors such as structural racism and disinvestment in community mental health and social services have resulted in harmful interactions between law enforcement and individuals experiencing mental health crises. These harms are even more prevalent among racial and ethnic minorities, sexual and gender minorities, and individuals with a mental illness. Nationwide, municipalities are exploring ways to ameliorate the harms experienced during these interactions, with some implementing alternative crisis response units. In Durham, North Carolina, we conducted interviews with staff of one such program to better understand what aids and prevents successful program implementation. Participants reported that buy-in from program partners such as other first responders as well as from the broader community facilitated program operations. Barriers disclosed included inadequate funding of local social services and changing policies and procedures.

Recent research suggests that in addition to structural barriers (e.g., access), psychosocial factors like medical mistrust can influence uptake of COVID-19 tools and treatments. However, less is known about racial differences in how medical mistrust affects SARS-CoV-2 antibody testing. We evaluated whether medical mistrust alters receptivity to SARS-CoV-2 antibody testing, and whether this influence differs across race. African American ( = 298) and White American ( = 205) participants were recruited from a Midwest urban community for an online study about COVID-19 and SARS-CoV-2 antibody testing. Participants completed the Group-Based Medical Mistrust Scale and then viewed educational videos about the SARS-CoV-2 virus, antibodies, and antibody testing. Participants reported their receptivity to antibody testing using Theory of Planned Behavior (TPB) measures (attitudes, normative beliefs, perceived behavioral control, and intentions). Medical mistrust was significantly higher among African Americans than White Americans, although there were no race differences in receptivity to antibody testing. Multiple regression analyses showed that higher medical mistrust was associated with lower receptivity to antibody testing across all TPB measures. A significant race x medical mistrust interaction revealed that medical mistrust was more strongly associated with less favorable antibody testing attitudes among White Americans than African Americans. Results suggest that medical mistrust may be a psychosocial barrier to antibody testing. However, despite being higher among African Americans, mistrust may exert a stronger influence on receptivity toward antibody testing among White Americans, highlighting a need to consider medical mistrust as a barrier to health behavior responses across racial groups.

Studies estimating the associations of physical activity (PA) and sedentary behavior (SB) with cardiometabolic risk factors and related conditions among people living with HIV (PWH) are limited. Data from the National Health and Nutrition Examination Survey (NHANES) (2007-08 through 2017-18 cycles) ( = 23,810) includes 125 PWH (representing 742,174 PWH). Adults were classified based on life epoch: emerging (18-29 yrs), early (30-44 yrs) and middle (45-59 yrs) adulthood. Achieving aerobic (≥150 min/wk of moderate-vigorous intensity PA [MVPA]) was quantified from self-report data collected across three domains (transportation, occupation/household, and leisure-time). SB was self-reported time sitting (min/day), regardless of domain. Cardiometabolic conditions included blood pressure, body mass index (BMI), weight status, hypertension, and chronic kidney disease. Regression models estimated the differences in PA and SB by HIV status and among PWH we estimated the association of achieving with cardiometabolic conditions. We also investigated whether age modified these relations and explored differences in domain-specific PA across life epochs. These analyses indicate that not meeting the resulted in greater odds of obesity and higher diastolic blood pressure, which increases risk for poor health among PWH-an already high-risk group for cardiovascular disease. Future longitudinal studies are needed to establish temporality.

The coronavirus 2019 (COVID-19) pandemic escalated family stress and prompted interruptions of regular healthcare visits. Such pandemic-related disruptions may be particularly deleterious among Black youth with chronic health conditions, such as type 1 diabetes. The present study leveraged longitudinal data from a multi-center randomized clinical trial (Clinicaltrials.gov [NCT03168867]) and a follow-up ancillary study focused on effects of COVID-19 to examine blood glucose trajectories and diabetes family conflict among Black adolescents with type 1 diabetes and their caregivers. Throughout the primary and ancillary studies, both adolescents and caregivers reported on their experience of diabetes family conflict across seven study visits. At each of these visits, the adolescent's hemoglobin A1c (HbA1c) was measured as an indicator of their blood glucose levels; further, HbA1c data during the study window was also extracted from the electronic medical record. Results demonstrated that HbA1c among the sample was linearly improving prior to the pandemic, but improvement halted following the onset of COVID-19. Following COVID-19 onset, average HbA1c remained stable, but higher than the recommended level. Higher mean levels of diabetes family conflict across the study were associated with higher HbA1c on average. However, diabetes family conflict did not predict changes in HbA1c trajectories pre- or post-pandemic onset. These findings highlight the potential stagnation of improving health-related outcomes during the COVID-19 pandemic for Black adolescents with type 1 diabetes and the need for further longitudinal work examining the familial and systemic factors contributing to the negative health consequences of the COVID-19 pandemic.

Women in midlife (ages 40-60) are at elevated risk of developing cardiovascular disease (CVD), and daily experiences such as stress, physical pain, and poor sleep quality exacerbate this risk. Understanding the severity and temporal sequencing of these experiences as they occur in daily life will inform health promotion efforts for this vulnerable group. To achieve these goals, we used ecological momentary assessment to clarify the occurrence, severity, and temporal associations between momentary stress and pain, and tested for moderating effects of subjective sleep quality on these associations. Participants were 75 women in midlife with >1 risk factors for CVD (mean age = 52 years, mean BMI = 34.0 kg/m) who completed 10 days of assessment. Multilevel models showed considerable within-person variability in sleep quality and stress. Pain was reported at 32% of moments and showed within-person variability. Within-person, stress and pain were worse on days with poorer sleep; pain intensity was worse after times when stress was worse (vs. better), . Findings show that women experience considerable variability in their daily experiences of sleep quality, stress, and pain. Greater-than-usual stress may be a real-time marker of later pain, on days when sleep is worse than usual. This clarification of temporal sequencing in women's daily lives may inform just-in-time interventions to mitigate pain.

Previous studies have shown associations between individual health behaviors and mental health outcomes. However, the impact of the accumulation of such behaviors on mental health remains unclear. This study aimed to examine the association between an index of accumulated health behaviors and mental health in adolescents, using data from the Brazilian National School Health Survey (PeNSE), which included 4,361 schools and a sample of 124,898 students. Health behaviors were assessed across five domains: healthy diet, alcohol consumption, smoking, physical activity, and sedentary behavior, with scores ranging from 0 to 5. Mental health outcomes (anxiety, sadness, social isolation, stress, and depression) and self-rated health were evaluated based on students' responses about their feelings over the previous 30 days. Regression models were applied, adjusting for key sociodemographic variables. The majority of participants were female, aged 13-15 years, and from the Southeast region. The results showed that a higher accumulation of healthy behaviors was associated with better mental health and more favorable self-rated health. These associations remained consistent after controlling for potential confounders. The findings underscore the importance of promoting multiple healthy behaviors to support mental well-being and self-perceived health among Brazilian adolescents.

Diet and physical activity together affect health as important components of energy intake and energy expenditure, but few studies have considered the temporal interaction effect between them. Therefore, this study aimed to identify real-world 24-h physical activity intensity and energy intake trajectories and explore their associations with all-cause mortality. A total of 6389 participants from the 2003-2006 annual survey of the National Health and Nutrition Examination Survey (NHANES) were involved as baseline data in this study. Physical activity data was obtained from the physical activity monitor ActiGraph AM-7164. Energy intake data was collected by the Mobile Examination Center and telephone 3 to 10 days later. All-cause mortality data were obtained in 2019. The group-based trajectory model (GBTM) was used to identify trajectories of 24-h physical activity intensity and 24-h energy intake. Weighted Cox proportional hazard regressions were used to estimate the association between 24-h trajectory groups and all-cause mortality. The 24-h energy intake-physical activity intensity dual trajectories were divided into four groups, including group1 (46.9%): three meals and low active, group2 (36.2%): three meals and moderately active, group3 (8.8%): night eating and moderately active, and group4 (8.1%): three meals and highly active. The dual trajectories were associated with all-cause mortality. Compared to participants with three meals and low activity levels, participants with three meals and moderate activity had a reduced risk of all-cause mortality. In summary, this study found that participants with three meals and moderately active had a lower risk of all-cause mortality.

Mistrust of the health care system is associated with underutilization of medical services and poor self-reported health, which itself is an important indicator for future morbidity and mortality. This study examines how several factors influence the association between medical mistrust and self-rated health in a middle-aged socioeconomically diverse cohort over 16 years. Participants ( = 1673) from the Health Aging in Neighborhoods of Diversity over the Life Span Study formed the sample. Information was gathered on race (African American/White), sex, poverty status, health literacy, and two measures of perceived discrimination. Linear mixed model regression was used for several models to examine the independent and combined influence of these factors on how medical mistrust is related to self-rated health over time. Poverty status exhibited the greatest influence on longitudinal self-rated health. Poverty status and health literacy did not influence the association between medical mistrust and self-rated health but perceived discrimination did. Stratified analyses by race found that White participants exhibited greater influence from medical mistrust and perceived discrimination on self-rated health than African American participants. Increasing trust, improving communication, and reducing unfair treatment across vulnerable groups is likely to improve health in middle-aged adults, but reducing overall poverty is likely to have the greatest effect.

The US has seen a sharp increase in measles cases in recent years. The measles vaccines (MMR and MMRV) are highly effective at preventing measles infections; however, vaccine coverage varies between racial/ethnic categories. Our objective was to use Minnesota Department of Health data to examine the association between a child's birthing parent's race, ethnicity, and other sociodemographic characteristics, and receipt of the first dose of a measles-containing vaccine by age 24 months. Sociodemographic data came from Minnesota birth certificate records (from 2017 to 2022), which are unique among states in how detailed ethnicity is characterized. During this timeframe, only 80% of the study population received the first dose of a measles-containing vaccine by age 24 months. We identified vaccination inequities by ethnicity, which could not be fully explained by these ethnic groups' differing socioeconomic status. Two groups, Somali-Minnesotan and Ethiopian-Minnesotan (which are often aggregated into a "Black" race), had the lowest levels of on-time first dose coverage (Somali = 31%, Ethiopian = 64%). Other factors associated with a lower predicted probability of coverage by 24 months included receiving inadequate prenatal care and lower socioeconomic status. Our main findings demonstrate the importance of racial/ethnic disaggregation when studying vaccine inequities. Collapsing race/ethnicity into broad categories like "Black" or "Hispanic" obscures a great deal of variability in outcomes. Those who are identified as at-risk for missing vaccine doses, the causes for this, and the possible approaches public health agencies might consider in preventing outbreaks should all differ depending on who is most affected.

The present study examined the association between adverse childhood experiences (ACEs) and body mass index (BMI) status among children and youth with special health care needs (CYSHCN), and the role of health characteristics and lifestyle factors in predicting BMI. Data from the 2016-2020 National Survey of Children's Health were utilized. Key variables included: ACEs, BMI status, level of functional impairment, depression, weekly level of physical activity, and daily screen time. Multivariable ordinal logistic regression analyses were used to examine associations between selected variables and BMI status. The sample consisted of 19,743 CYSHCN. Respectively, CYSHCN with exposure to 1-2 ACEs (vs. none) and 3+ ACEs (vs. none), had a 22% and 32% increase in odds of a one-level increase in BMI status, controlling for sociodemographic characteristics, level of functional impairment, and depression. When lifestyle factors (i.e., physical activity and screen time) were included in analyses, CYSHCN with exposure to 3+ ACEs (vs. none) had a 27% increase in odds of a one-level increase in BMI status. Thus, we found that ACEs were significantly associated with BMI status. However, the strength of this relation changed when considering CYSHCN health characteristics and CYSHCN lifestyle factors. A higher weekly level of physical activity, in particular, seemed to play a significant role in reducing risk of higher BMI status among CYSHCN with exposure to 3+ ACEs (vs. none). Findings support the development of physical activity promotion programs and education regarding strategic utilization of screen time (e.g., educational apps and games) for CYSHCN and their families.

Several studies report significant changes in lifestyle habits during the COVID-19 pandemic, yet results are largely heterogeneous across populations. We examined changes in lifestyle and health behaviors during the first COVID-19 lockdown in Lebanon and assessed whether mental and physical health indicators and outbreak- and lockdown-related factors are related to these changes. Data come from a cross-sectional online survey (May-June 2020) which assessed changes in smoking, alcohol, diet, eating behavior, physical activity, sleep hours, sleep satisfaction, social media use, self-rated health, and life satisfaction ( = 494). We examined these changes' association with current depressive and anxiety symptoms, presence of physical and mental disorders, outbreak-related worries, and lockdown-related factors using regression models adjusted for sociodemographic and socioeconomic covariates. Most prevalent changes were increased social media use (63.2%) and decreased life satisfaction (54.9%) and physical activity (53.4%). Higher depressive and anxiety symptoms, higher daily life difficulties, and presence of diagnosed mental disorder were related to worsening of almost all behaviors. Participants with higher outbreak worries had less healthy diet and increased social media use. Higher adherence to lockdown and preventive measures were associated with increased social media use and lower life satisfaction, respectively. Results show a clear clustering of negative lifestyle and health behavioral changes with current mental health symptoms, existing mental health disorder, and daily life challenges during lockdowns. Findings highlight the importance of tracking higher-risk mental health subgroups to mitigate further adverse impact on mental and physical health.

In the United States, HPV vaccination is available for unvaccinated 27 to 45 year olds based on a shared clinical decision with a health care provider. Since the implementation of the guideline, little has been known about provider perceptions of this recommendation. The purpose of this study was to elucidate health care provider perspectives on HPV vaccination for 27 to 45 year olds in the United States. Semi-structured interviews were conducted virtually with 18 health care providers regarding current HPV vaccination practices for 27 to 45 year olds, perceptions of the guideline, and shared clinical decision-making needs. Thematic analysis was conducted using interview transcripts, and interrater reliability was achieved for >10% of the transcripts. Overall, most participants reported that they have recommended HPV vaccination to patients aged 27 to 45 year olds; however, they applied various criteria to guide these discussions. Some participants considered the patients' relationship statuses, sexual partnerships, past HPV infection history, and age. Potential needs to facilitate shared clinical decision-making processes included medical record prompts and brief educational materials. While most health care providers in this sample discussed HPV vaccination with their patients ages 27 to 45 years old, there were inconsistencies in the interpretation of the guideline. The lack of specificity in the recommendation will likely result in significant and potentially inequitable implementation difficulties.

Human papillomavirus (HPV) vaccination among males is poorly understood. We systematically reviewed individual socioeconomic/health-related characteristics associated with HPV vaccine initiation and vaccination series completion among males in the United States. We searched for literature up to August 1, 2023, and pooled appropriate multivariable-adjusted results using an inverse variance random effects model, with results expressed as odds ratios. Among pediatric males (<18 years old), we observed moderately increased odds of vaccine initiation in urban residence, with being a Black/Hispanic male versus White male, public versus private health insurance, and visiting a health care provider in the past year. Influenza vaccination in the past year strongly increased the odds. Further, urban residence and having a parent with lower/no education moderately increased the odds of vaccination series completion, whereas influenza vaccination strongly increased the odds. Among adult males (≥18 years old), we observed moderately increased odds of vaccine initiation in the US-born, unemployed, unmarried/separated/divorced/widowed; among the states in the Northern versus Western region; having had a sexually transmitted infection; and being gay/bisexual. Younger age, living in the states in the Northern versus Southern region, having health insurance, and having visited a health care provider in the past year strongly increased the odds. Further, higher education, unmarried/separated/divorced/widowed, being a White male versus Black male, living in the states in the Northern versus Western region, and having a primary care physician moderately increased the odds of vaccination series completion, whereas having health insurance and being gay/bisexual strongly increased the odds. These findings may inform age-targeted future vaccination program planning.

This study investigates the impact of internalized HIV stigma on sleep problems and depression in people living with HIV (PLWH) in Botswana. It also explores whether sleep problems mediate the relationship between internalized HIV stigma and depressive symptoms, given that sleep disturbance is a symptom of depression and often predates a depressive episode. Secondary analysis was conducted using baseline data from a pilot randomized controlled trial on 58 virally unsuppressed PLWH in Gaborone, Botswana. Internalized HIV stigma, sleep disturbance and daytime impairment, and depressive symptoms were assessed using validated scales. Multiple linear regression and simple mediation models with bootstrap procedures were employed. Covariates for the adjusted models were age and sex assigned at birth. One in five participants reported experiencing moderate to extreme sleep problems. Internalized HIV stigma was associated with greater nighttime sleep disturbance, but not with daytime impairments or depressive symptoms. An indirect effect between internalized HIV stigma and depressive symptoms via nighttime sleep disturbance was identified; however, this path was no longer significant after adjusting for covariates. No significant indirect effects were found via daytime impairments. The findings of this study extend the existing literature by exploring the interplay between internalized HIV stigma, sleep disturbances, and depression among PLWH in Africa. While internalized HIV stigma contributes to nighttime sleep disturbance, its indirect role in affecting depressive symptoms is less clear, potentially due to small sample size. The study suggests the need for targeted interventions addressing sleep disturbances to potentially mitigate the psychological impacts of internalized HIV stigma.

Nonadherence to antihypertensive medications is highly prevalent, driving cardiovascular risk. Chemical adherence testing (CAT) can detect the presence of medications or their metabolites in bodily fluid, though it is unclear if its use to date has been equitable. This review aimed to identify the demographics with hypertension in which CAT has been used previously, and to estimate the resulting prevalence of nonadherence. Multiple databases were searched from 2013 to February 2024. We included any published paper that reported CAT data in people with hypertension. Extracted data included: study design and setting, hypertension definition and type, participant sociodemographic factors, and prevalence of nonadherence. Data were synthesized using a random effects meta-analysis with meta-regression, or narrative synthesis. Seventy eligible papers were identified. Many papers did not present key participant sociodemographic data, including ethnicity or socioeconomic, educational or disability status. Most studies were completed in tertiary care settings, and in primarily White patients with apparent treatment-resistant hypertension. The estimated pooled prevalence of complete medication nonadherence was 15.0%, increasing to 33.0% when estimating any kind of nonadherence; heterogeneity was high in both analyses (I of 94.6% and 95.6%, respectively). Nonadherent patients had higher blood pressure and were prescribed more antihypertensive medications, whilst participant age showed an inverse relationship with prevalence of nonadherence. Key relevant sociodemographic factors were often not reported, limiting the understanding of CAT use in diverse populations. In order to support behavior change interventions to address medication nonadherence in underserved groups, future research should recruit diverse populations to inform equitable implementation. International Prospective Register of Systematic Reviews CRD42024505602.

Fluctuations in steroid sex hormones are associated with altered cardiac autonomic and affective functioning across the female lifespan. The neuroendocrine pathways which modulate sex hormone changes during the menstrual cycle have reciprocal interactions with the autonomic nervous system, an integral system for self-regulation and stress response. Cardiac autonomic activity is often imbalanced among individuals with mental and physical health conditions. However, it is unclear whether variations in female-typical sex hormones across the menstrual cycle significantly alter cardiac autonomic and affective stress reactivity, which may underlie menstrual-related mood and psychosomatic symptoms. The present systematic review aims to address this gap by characterizing patterns of cardiac autonomic activity at baseline, and cardiac autonomic and affective reactivity to laboratory stress tasks across the menstrual cycle in reproductive-aged women. The review was preregistered (https://doi.org/10.17605/OSF.IO/B2Y5Q) and conducted in line with PRISMA guidelines. Twenty studies and 28 records were identified and discussed. The study found modest support for increased cardiac sympathetic activation at baseline and in response to stress, and greater affective reactivity within the luteal phase of the menstrual cycle. These results expand upon prior research demonstrating cardiac autonomic imbalance and affective vulnerability within the luteal phase to show that these patterns also influence stress reactivity. Additionally, the review aims to identify notable methodological limitations and gaps within this body of literature and suggests areas of future research to clarify the role of cardiac autonomic and affective processes in steroid sex hormone-related symptomatology.

Eating and exercise habits established in adolescence are associated with immediate and long-term health outcomes. These habits may be influenced by adolescents' socioeconomic status (SES), such that low SES households often experience inequitable access to nutritious foods and opportunities for exercise. Emerging evidence suggests that social factors, such as social skills and social support may support adolescents' health behavior engagement. Thus, this study tested if social factors might be a viable target for interventions to reduce SES disparities in health behavior among adolescents. Using data from the Future of Families and Child Wellbeing Study, we examined (1) if household SES is associated with adolescents' self-reported frequency of healthy eating and exercise, and (2) if social factors (e.g., social skills, connectedness, social support) mitigate the negative association between SES and each health behavior. Regression analyses revealed that adolescents in lower SES households reported fewer days of healthy eating and exercise. Social skills and support were positively associated with exercise for all adolescents, but did not reduce the SES disparity. Social skills and support were only associated with healthy eating for adolescents with higher SES, but connectedness was associated with healthy eating for all adolescents. Even so, connectedness did not reduce the SES difference in healthy eating. These findings suggest that high quality social relationships and social skills may have a significant but small positive effect on health behavior for adolescents in low SES households, and that systemic change is needed to achieve health equity and improve health outcomes for all adolescents.

The increasing incidence of infertility has increased the cost of assisted reproductive techniques and raised serious concerns on fertilization worldwide. Age and smoking adversely affect the reproductive system. This study aimed to assess the in vitro fertilization (IVF) cycle characteristics and outcomes of smoking women ages over 35 years. The data of 329 women ages 20-35 who underwent frozen embryo transfer in IVF treatment were used in the study. The M2 number, pregnancy outcome, live birth rate, and embryo transfer day showed statistically significant differences according to age group. The 2PN rate, pregnancy outcome, and live birth rate were significantly higher in nonsmoking women with infertility than in smoking women. The effects of these factors, especially smoking behavior, which can potentially be modified to increase the chance of IVF success, on IVF cycle characteristics should be explained to patients.

Adverse childhood experiences (ACEs) significantly contribute to health disparities among minoritized populations. However, the characterization and impact of ACEs and the resilience of men who have sex with men (MSM) living with HIV remains under-examined. This study aimed to examine how the clustering profiles of ACEs and social support networks may affect psychosocial outcomes to elucidate ACEs resilience in relation to social support network among MSM living with HIV. Data (2019-2023) were obtained from a prospective cohort of MSM living with HIV from Hawaii and Philadelphia, USA ( = 261). Latent profile analysis and propensity score-weighted generalized estimating equations were used to estimate group-level differences in psychosocial trajectories over the one-year study period. An ACEs-resilient profile with intensified, poly-types of ACEs and a robust social support network was significantly associated with higher perceived social support from family, resilient coping, lower depressive symptoms, and perceived stress, compared to those with similarly heightened ACEs exposure and a less optimal social support network. Bolstering social support networks could potentially improve the holistic range of ACEs-psychosocial outcome resilience among MSM living with HIV with heightened histories of ACEs. Future studies should examine the more nuanced socio-ecological and intrapersonal pathways of ACEs resilience.

Stroke survivors experience physical and psychological symptoms. However, long-term symptom prevalence and symptom associations have not been extensively studied. The current study aimed to assess the prevalence of physical and psychological symptoms across four years after stroke and to evaluate the relationship between these symptoms. We conducted a secondary analysis of a prospective, clinical, observational study. Physical (pain, fatigue, and physical impairment) and psychological (loss of interest, depressed mood, anxiety, and worry) symptoms were assessed using the International Consortium for Health Outcomes Measurement Standard Set for Stroke and the Patient Health Questionnaire for Depression and Anxiety three months, one year, two years, three years, and four years after hospital admission. We evaluated the prevalence of these symptoms across time and conducted a network analysis using panel vector autoregressive modeling. Physical impairment and fatigue had the highest prevalence in the sample. Psychological symptoms were also consistently observed, however, at a lower prevalence. There was no reduction in any symptom's prevalence across the course of four years after stroke. Furthermore, psychological and physical symptoms were associated with each other. Physical impairment was most strongly associated with the other symptoms, and anxiety symptoms preceded depressive symptoms. Thus, despite established follow-up care in Germany, symptoms persisted for years after stroke. Further, the observed symptom associations suggest the need to investigate the impact of physical symptoms on psychological distress. Our findings emphasize the need to prevent and treat persisting physical and psychological symptoms after stroke.

Individuals with cerebral palsy (CP) often exhibit mental health problems, including depressive symptoms. This study investigated self-reported depressive symptoms in children and adolescents with and without CP and associated factors. Herein, 52 and 38 children and adolescents with and without CP were enrolled in the CP and typically developing (TD) groups. Depressive symptoms were assessed using the Birleson Depression Self-Rating Scale for Children. Parents of the participants completed the Strengths and Difficulties Questionnaire. Self-reported depressive symptoms were more severe in the CP group than in the TD group, which was primarily attributed to declining activities and enjoyment in daily life. Depressive symptoms in the CP group were not correlated with age, the severity of CP, or parent-reported behavioral features. However, in the overall cohort, the cluster with high levels of depressive symptoms had significantly higher proportions of individuals with CP and participants with conduct, emotional, and peer problems. Multivariate analyses revealed that only peer problems were associated with increased depressive symptoms. Furthermore, peer problems fully mediated the relationship between the presence of CP and depressive symptoms. Our study suggests that providing opportunities for activities involving social interactions with peers and offering support to enable the enjoyment of such activities from an early age are imperative to prevent an increase in depressive symptoms in children with CP.

Gulf War Illness (GWI) is a highly prevalent chronic, multisymptomatic condition associated with worsening physical health and quality of life among veterans. Specifically, GWI symptoms may disrupt physical functioning that negatively impacts overall health. Complementary and integrative health interventions that promote physical activity, such as Tai Chi, may be critical to addressing physical functioning in veterans with GWI. The present study is a secondary analysis of data from a randomized controlled trial comparing Tai Chi to a Wellness intervention on physical functioning outcomes in a sample of 53 veterans with GWI and pain. Gait speed, fast walking speed, lower body strength, and self-reported physical activity were assessed across four timepoints: baseline, posttreatment, 3-month follow-up, and 9-month follow-up. Treatments were delivered in a 60-minute group format twice a week for 12 weeks (24 sessions total). Results from multilevel regression models revealed that Tai Chi was related to greater increases in time spent on flexibility exercise whereas improvements in gait speed were associated with Wellness, though between-treatment differences were small. These findings are promising because they provide preliminary evidence for the utility of treatments that may improve specific physical functioning outcomes in veterans with GWI, especially in accommodating physical difficulties associated with the condition that few treatments have addressed.

Childhood obesity has been associated with high levels of systemic inflammation, increasing the risk of metabolic and cardiovascular diseases throughout life. Genetic and environmental factors, such as parental body mass index (BMI), can influence this relationship, impacting the inflammatory health of offspring from childhood. This study investigates the influence of parental BMI on the relationship between BMI and high-sensitivity C-reactive protein (hs-CRP) levels in offspring. A cross-sectional study was conducted with 423 children and adolescents from a municipality in southern Brazil. Offspring BMI was calculated using measured weight and height, while parental BMI was determined from self-reported measurements and classified based on World Health Organization cutoff points. hs-CRP levels were assessed using a high-sensitivity assay. The moderating effect of parental BMI on the relationship between offspring BMI and hs-CRP levels was analyzed through multiple linear regression models using the PROCESS macro extension for SPSS. Results indicated a direct association between offspring BMI and hs-CRP levels across all models, showing that hs-CRP levels increased linearly with BMI in offspring. A direct relationship between paternal obesity and offspring hs-CRP levels was observed, along with a significant inverse interaction between paternal BMI and offspring BMI with hs-CRP levels. Among schoolchildren with lower BMI, those with parents with obesity exhibited higher hs-CRP levels compared to peers with parents classified as eutrophic or overweight. These findings suggest that children of parents with obesity tend to have elevated levels of inflammation, regardless of their own BMI.

Cisgender women living with HIV experience elevated cardiovascular disease (CVD) risk that increases with age, a concern given extended life expectancies for people living with HIV. The CVD risk disparity among cisgender women aging with HIV is understudied and remains unclear. Taking a psychoneuroimmunology approach, given this group's intersecting marginalized identities, one potential driver of the disparity is intersectional stigma. Yet not all women living with HIV have coronary artery disease (CAD). Resilience to stigma may serve as a protective factor to CAD, as observed in other health issues. This study aimed to explore the relationship between intersectional stigma, resilience, "traditional" CVD risk factors, and objective indicators of CAD among women aging with HIV. A diverse sample of cisgender women aging with HIV (aged ≥ 35,  = 48) completed a cross-sectional survey, clinical health interview, blood sample, blood pressure, anthropometric measurements, and computed tomography angiography (CTA). CART-based machine learning models assessed the statistical importance of traditional CVD risk factors, intersectional stigma, and resilience for classifying individuals with coronary artery stenosis, calcification, and inflammatory markers associated with CAD. Of the  = 31 who completed CTA, 74% had detectable calcification and 39% stenosis. Intersectional stigma was identified as an important variable for explaining calcification, but not stenosis, and for explaining sCD163, an inflammatory biomarker associated with CAD. Results show a potential psychoneuroimmunology pathway to the CAD disparity among this group. Future longitudinal research should investigate the mechanisms of this pathway and consider stigma as target for intervention to improve cardiovascular health among women aging with HIV.

Pain is highly prevalent among emerging adults (18-25 years old), and rates of cannabis use are increasing among this population. Research indicates pain is a unique risk factor and motivator for substance use. However, evidence for pain-cannabis use relations among emerging adults is largely cross-sectional, and the only prospective evidence focuses on the frequency, quantity, and consequences of cannabis use, not initiation. Accordingly, this is the first study to examine pain as a prospective predictor of cannabis initiation among emerging adults. Data were drawn from five annual waves of the Population Assessment of Tobacco and Health Study. Emerging adults who denied cannabis use at baseline ( = 4,185) were included in the analysis. At baseline, a tenth of emerging adults reported moderate/severe pain (≥4/10). Adjusted Cox regression analysis revealed that emerging adults with moderate/severe baseline pain were more likely to initiate cannabis use, and did so earlier over the subsequent 4 years, than those with no/low baseline pain. These findings provide initial evidence for pain as a risk factor for cannabis initiation during emerging adulthood. Future research is needed to identify mechanisms by which pain motivates cannabis initiation and to examine the utility of pain-targeted content in cannabis use prevention and intervention efforts among emerging adults.

Respiratory Syncytial Virus (RSV) is a common respiratory pathogen with high morbidity and mortality, especially in children under two years of age. Severe RSV infection poses a significant threat to healthcare systems, making vaccination an utmost need. In August 2023, the U.S. FDA approved an RSV maternal vaccine to prevent lower respiratory tract disease (LRTD) in infants throughout their first six months of life. This cross-sectional survey was designed to evaluate pregnant women's willingness to receive the vaccine during pregnancy. An anonymous survey was administered from April 2023 to December 2023 to pregnant women aged above 16 years old attending gynecology wards of randomly selected public and private hospitals in Crete. The primary outcome was the intention to receive the vaccine. Univariable and multivariable analyses were carried out to identify factors associated with the intention to get vaccinated. Questionnaires were distributed to a sample of 335 pregnant females who agreed to participate in this study. The intention to get vaccinated against RSV was positively associated with educational level, the presence of school-age children, RSV infection awareness, intention to get routine pregnancy vaccines according to the National Immunization Program (NIP), and previous vaccination against COVID-19. The majority of pregnant females were not familiar with the term RSV and the upcoming vaccine. An educational campaign regarding RSV infection and its vaccine is required to improve women's perceptions and to support healthcare workers in promoting it upon its availability in Greece.

Perceiving ambiguity-a specific type of uncertainty-can lead to ambiguity aversion. In the context of vaccination, ambiguity aversion can manifest as vaccine hesitancy. We tested various correlates of ambiguity aversion in the context of COVID-19 vaccination to better understand how and why ambiguity about COVID-19 vaccines is associated with COVID-19 vaccine hesitancy. Two studies regarding beliefs about COVID-19 were conducted among 330 college students in the US and 204 college students in Israel during March to June 2023. Participants completed a survey assessing perceived ambiguity about COVID-19 vaccines, COVID-19 risk perceptions (i.e., likelihood, severity, and worry), emotions about COVID-19 vaccines, vaccination intentions, and information seeking about vaccination. Overall, key findings include higher levels of anger among individuals who report higher perceived ambiguity about COVID-19 vaccination, as well as possible engagement in motivated reasoning processes when considering COVID-19 vaccination. More specifically, consistent with motivated reasoning, Americans who perceived higher ambiguity about COVID-19 vaccines reported lower worry about and lower perceived severity of COVID-19, which were each associated with lower vaccination intentions and lower information seeking about COVID-19 vaccines. In line with the Appraisal-Tendency Framework, Americans who perceived higher ambiguity about COVID-19 vaccines reported higher anger about COVID-19 vaccines, which was associated with lower perceived severity of COVID-19. Consistent with conceptualizing ambiguity as an aversive experience, Americans who perceived higher ambiguity about COVID-19 vaccines reported lower happiness about COVID-19 vaccines, which was associated with both lower worry about and lower perceived severity of COVID-19. These relationships were not present in the Israeli sample. Further, both Americans and Israelis who perceived higher ambiguity about COVID-19 vaccines reported lower feelings of relaxation from the COVID-19 vaccine, which was associated with lower perceived severity of COVID-19. These results can improve our understanding of processes involved in ambiguity aversion. Findings also provide greater insight into vaccine hesitancy and have practical implications for creating culturally appropriate vaccine health communications and interventions that consider the phenomenon of ambiguity aversion. Indeed, if motivated reasoning does play a role in responses to ambiguity, incorporating strategies to reduce motivated reasoning may contribute to vaccine uptake.