In order to combat the COVID-19 pandemic, policymakers around the globe have increasingly invested in digital health technologies to support the 'test, track and trace' approach of containing the spread of the novel coronavirus. These technologies include mobile 'contact tracing' applications (apps), which can trace individuals likely to have come into contact with those who have reported symptoms or tested positive for the virus and request that they self-isolate. This paper takes a critical public health perspective that advocates for 'genuine participation' in public health interventions and emphasises the need to take citizen's knowledge into account during public health decision-making. In doing so, it presents and discusses the findings of a UK interview study that explored public views on the possibility of using a COVID-19 contact-tracing app public health intervention at the time the United Kingdom (UK) Government announced their decision to develop such a technology. Findings illustrated interviewees' range and degree of understandings, misconceptions, and concerns about the possibility of using an app. In particular, concerns about privacy and surveillance predominated. Interviewees associated these concerns much more broadly than health by identifying with pre-existent British national narratives associated with individual liberty and autonomy. In extending and contributing to ongoing sociological research with public health, we argue that understanding and responding to these matters is vital, and that our findings demonstrate the need for a forward-looking, anticipatory strategy for public engagement as part of the responsible innovation of the COVID-19 contact-tracing app in the UK.

This paper draws upon the notion of as a framework to interpret ethnographic and qualitative findings on the challenges faced by Puerto Ricans with chronic conditions and health sector representatives throughout the island during and after Hurricane María. We conducted participant observation and qualitative interviews with chronic disease patients (n=20) health care providers and administrators (n=42), and policy makers (n=5) from across the island of Puerto Rico in 2018 and 2019. Many Puerto Ricans coping with chronic diseases during and after María experienced bureaucratic red tape as the manifestation of colonial legacies of disaster management and health care. They describe a precarious existence in perpetual "application pending" status, waiting for services that were not forthcoming. Drawing on ethnographically informed case examples, we discuss the effects of these bureaucratic barriers on persons with three chronic conditions: renal disease, opioid dependency, and HIV/AIDS. We argue that while emergency management approaches often presume a citizen-subject with autonomous capacity to prepare for presumably transient disasters and envision a 'post-disaster future' beyond the immediate crisis, Puerto Rican voices draw attention to the longer, sustained, slow emergency of colonial governance.

Research recruitment, eligibility, and who chooses to participate shape the resulting data and knowledge, which together inform interventions, treatment, and programming. Patterns of research participation are particularly salient at this moment given emerging biomedical prevention paradigms. This paper explores the perspectives of Black and Latino young men who have sex with men (BL-YMSM) regarding research recruitment and eligibility criteria, how their experiences influence willingness to enroll in a given study, and implications for the veracity and representativeness of resulting data. We examine inclusion and recruitment as a complex assemblage, which should not be reduced to its parts. From April-July 2018, we conducted in-depth interviews with 30 BL-YMSM, ages 18-29, in New York City. Interviews were recorded, transcribed, and analyzed using the constant comparative method. Black and Latino YMSM's responses unveiled tensions between researchers', recruiters', and participants' expectations, particularly regarding eligibility criteria (e.g., age, sex frequency), assumptions about 'risky behaviors,' and the 'target' community. Men preferred peer-to-peer recruitment, noting that most approaches miss key population segments. Findings highlight the need to critically examine the selected 'target' community, who sees themselves as participants, and implications for data comprehensiveness and veracity. Study eligibility criteria and recruitment approaches are methodological issues that shape knowledge production and the policies and programs deployed into communities. These findings can inform how future research studies frame recruitment and eligibility in order to better meet the needs of participants and ensure future engagement.

This paper argues for a rethinking of disease preparedness that puts incertitude and the politics of knowledge at the centre. Through examining the experiences of Ebola, Nipah, cholera and COVID-19 across multiple settings, the limitations of current approaches are highlighted. Conventional approaches assume a controllable, predictable future, which is responded to by a range of standard interventions. Such emergency preparedness planning approaches assume risk - where future outcomes can be predicted - and fail to address uncertainty, ambiguity and ignorance - where outcomes or their probabilities are unknown. Through examining the experiences of outbreak planning and response across the four cases, the paper argues for an approach that highlights the politics of knowledge, the constructions of time and space, the requirements for institutions and administrations and the challenges of ethics and justice. Embracing incertitude in disease preparedness responses therefore means making contextual social, political and cultural dimensions central.

Hypertensive disorders in pregnancy (HDPs) are the leading causes of maternal mortality and morbidity. This study explored whether micronutrient intake and psychological distress were associated with HDPs. Micronutrients include folate and vitamin B12. Psychological distress refers to perceived stress, prenatal distress, and prenatal depression. HDPs were defined as systolic blood pressure (BP) ≥ 130 mmHg or diastolic BP ≥ 80 mmHg. Data were collected at ≤ 17 weeks gestation (T1), 25-27 weeks gestation (T2), and 35-37 weeks gestation (T3). T-tests comparing those with and without HDP were performed to explore the associations. Results showed that folate and vitamin B12 were associated with HDPs at T1 and T2 (T1: = -0.41, = -0.52; T2: = -0.43, = -0.24). Psychological distress was positively associated with HDPs, but associations varied between timepoints and by measure - prenatal distress at all times (T1: = 0.26; T2: = 0.54, T3: = 0.40), perceived stress at T3 ( = 0.34), and prenatal depression at T2 and T3 (T2, = 0.47; T3: = 0.68). In summary, micronutrient intake and psychological distress are associated with HDPs but varied by construct and across gestational age.

One Health has gained global prominence in recent years. Alongside its emergence, there have been extensive social science critiques. In this contribution, we make the case for the value of recent theoretical discussions in the field of anthropology - sometimes referred to as an 'ontological turn'. We argue that taking theory seriously benefits One Health as an integrated approach that has interdisciplinary collaborations at its heart, but which encounters challenges when conversations based on different epistemological and ontological positions result in voices talking past each other. In this contribution, we offer two examples of what One Health specialists can gain from anthropologically-informed ontological thinking. Both require questioning ontological premises. Firstly, questioning assumptions about distinctions between animals and humans. Secondly, questioning the universality of biomedical knowledge. In the conclusion, we underline the importance of an ontological openness when it comes to the constitution and position of the actors as well as different bodies of knowledge that are involved in One Health and we show that talking to each other with awareness of different ontological positions is not impossible.

Funders increasingly encourage social and health service organizations to strengthen their impact on public health through the implementation of evidence-based interventions (EBIs). Local governments in the U.S. often utilize market-based contracting to facilitate EBI delivery via formal relationships with non-governmental community-based organizations (CBOs). We sought to understand how the discourses embedded within contracting to compete and perform influence how CBOs represent and accomplish their work. We draw on qualitative interviews conducted with government administrators (N=16) overseeing contracts for one child welfare EBI, SafeCare and the leaders (N=25) of organizations contracted to implement this program. Participants endorsed competition, capacity, and collaboration as ideals within marketized contracting. Yet they expressed doubt about marketplace meritocracy and described the costs incurred in building the necessary organizational infrastructure to deliver EBIs and compete for contracts. We discuss the implications of marketized EBI contracting for CBOs and the limitations it poses for evidence-based public health, especially in socially marginalized communities.

Concussion in sport is increasingly understood as a public health crisis. A key facet of this crisis concerns the claim that industry-funded research results in conflicts of interest that fundamentally compromise scholarship. This poses a particular problem for policymakers when adjudicating upon who counts as an expert and what to do with the evidence that they provide. In this paper, I explore these matters in relation to the 'Concussion in Sport' report produced by the UK's House of Commons's Digital, Culture, Media and Sport Committee. I ask, first, which stakeholders submit evidence to the Committee and, second, how evidence provided by those stakeholders is marshalled within the report itself. I show that, despite concerns about conflicts of interest, a significant body of interdisciplinary scholarship is submitted to the Committee. The report itself, however, understands academic scholarship as being both deficient and compromised, drawing exclusively upon epidemiological and neuroscientific work. I conclude by suggesting such an approach compromises the committee's own hope for an increasingly expansive notion of expertise.

Awareness months are used as promotion strategies to enhance public health through increasing knowledge and behavioral change, including suicide prevention. However, given epidemiologic evidence and the historical impact of awareness months on health behaviors, the purpose of this paper is to encourage reconsideration of the current timing of suicide prevention month. In the U.S., most suicide deaths occur in May. The original National Suicide Prevention Week was established in May 1974 by the American Association of Suicidology. In the early 2000s, this week was moved to September to align with a global effort by the International Association for Suicide Prevention and the World Health Organization, establishing September 10th as World Suicide Prevention Day and September as National Suicide Prevention Month. This commentary reviews evidence around awareness months/weeks/days and provides a brief history of suicide prevention awareness wee development, inviting a deeper consideration of the timing of National Suicide Prevention Week with epidemiologic trends in suicide attempts and deaths. Specifically, if calendar-anchored campaigns successfully increase awareness and behavior change, then perhaps the placement of National Suicide Prevention Month in September is not maximizing benefit in the U.S. because epidemiologic evidence suggests suicides peak in late spring/early summer, making this a potentially better time to increase awareness campaigns. By aligning the awareness month with the peak of the phenomenon, enhanced suicide prevention awareness could reduce suicide attempts and deaths. Re-scheduling this effort would require nationwide coordinated conversations with stakeholder groups, including non-profit advocacy organizations, loss survivors, researchers, prevention programs, and care agencies.

Personalised medicine is widely utilised in oncology, and healthcare personnel are its main gatekeepers and implementers. This scoping review provides insights into the knowledge and attitudes of healthcare personnel toward personalised medicine for cancer, barriers and challenges faced, and innovative practices employed for the provision of personalised medicine. Extensive database searches identified 19,972 studies, of which 50 studies were included in the final review. The data was charted by two reviewers and analysed thematically. The knowledge of healthcare personnel of personalised medicine was mixed, with some studies reporting overall good knowledge ( = 2) while some reported poor knowledge among healthcare personnel ( = 4). There was high interest (63-95%) in furthering education and training in personalised medicine ( = 6). The commonly reported barriers and challenges were: limited reimbursement and insurance coverage mechanism ( = 11); insufficient education and training ( = 10); and lack of trained personnel to provide the service ( = 7). The innovations identified emphasised enhancing the skills and capacity of the existing workforce as well as using technologies to assist in timely decision-making. Overall, gaps were identified at the human resource, institutional, and systemic levels, which will need to be addressed to improve the provision of personalised medicine and healthcare personnel's confidence levels.

Racist urban development policies and capitalist municipal management have continued the cycle of poverty experienced by many in the US. Modeling this disadvantage often relies on composite, or "umbrella", socioeconomic variables. We argue that this approach obfuscates the temporal nature of social determinants. We propose organizing downstream consequences of structural racism by exposure duration-historical disenfranchisement and contemporary disadvantage-to assess their differential effect on excess all-cause mortality in an U.S. urban environment during the COVID-19 pandemic.

Many academic and media conversations about COVID-19 vaccination center on lower uptake among racially minoritized individuals due to what is characterized as 'mistrust.' In 'Is trust enough? Anti-Black racism and the perception of Black vaccine hesitancy,' Wilson argues that questioning Black people's trust in the COVID-19 vaccine fails to 'understand Black people as rational, complex beings who are fit to make reasonable decisions guided by complex factors.' In this study, we explore what shapes Black women's COVID-19 vaccination choices using data from 20 qualitative interviews conducted March-April 2022 with a sample of predominantly Black women in Alameda County, CA. Findings provide empirical evidence to support Wilson's argument that a narrow view of 'trust' over-simplifies Black women's comprehensive thinking about health decisions. Participants triangulated COVID-19 information sources and vetted this material with specific consideration of factors highly relevant to Black women's day-to-day lives: evidence of systemic or interpersonal racism in healthcare settings, management of chronic health conditions, and the importance of family. Many participants indicated that it was common for people in their networks to hold different perspectives on vaccination and they normalized these differences of opinions, expressing understanding of the socio-structural factors affecting the impact of the COVID-19 pandemic and vaccination choices.

Through rapid ethnography undertaken in Vancouver, Canada's Downtown Eastside - one of Canada's overdose epicenters - this article examines how gendered expectations of labor shape overdose risk for structurally vulnerable women and gender diverse people who use drugs. Drawing on two participant narratives, we explore how structural, symbolic, and everyday violence frame the lives of women and gender diverse people who use drugs in ways that drive their overdose risk as they balance self-care with caretaking, paid work, and basic survival. This article underscores the need for structural reform of peer overdose response work and funding for gender-attentive harm reduction and ancillary supports to better mitigate overdose risk for these populations.

In 2021, the Centers for Disease Control and Prevention (CDC) proposed updated clinical practice guidelines for Pre-Exposure Prophylaxis (PrEP), marking a significant shift from risk-based screening to discussing PrEP with all sexually active adults. To ensure widespread adoption of new guidelines, this commentary posits that intentional de-implementation of the previous CDC guidelines is necessary to facilitate the adoption, implementation, and sustainment of new guidelines. Based on a review of the literature, the authors leveraged implementation science frameworks (i.e., CFIR, ERIC taxonomy, and RE-AIM) to map theoretical determinants, corresponding strategies, and outcomes in the context of de-implementing previous CDC guidelines for PrEP and simultaneously implementing the new guidelines. Potential barriers identified included resource constraints, staff capability, and structural characteristics of organizations that may impede de-implementation efforts. Potential facilitators included provider motivation and incentive systems that encourage providers to discuss PrEP with sexually active clients. Strategies like normalizing PrEP education and services, workflow redesign, and task-shifting could tackle workforce challenges. These strategies could aid in phasing out old guidelines, implementing new guidelines, increasing PrEP referrals, and reducing HIV incidence. Phasing out previous PrEP guidelines demands intentional (de-)implementation to enhance universal HIV prevention efforts and advance national plans for Ending the HIV Epidemic.

Training programs focused on developing the next generation of scholars with expertise in HIV and mental health are crucial for advancing health equity and cultivating a diverse workforce by supporting individuals with lived experience and a strong commitment to serving underserved communities. However, disparities persist in the workforce, particularly in the inclusion of professionals typically underrepresented in research. The aim of this commentary is to explore the strengths and challenges of a NIMH-funded training program (T32), Culturally focused HIV Advancements through the Next Generation for Equity (CHANGE), at the University of Miami, with the goal of providing a series of general recommendations. The program excels in leveraging Miami's unique context, recruiting a cohort of trainees committed to addressing HIV and mental health inequities, delivering a tailored curriculum, and providing strong leadership and mentorship networks to trainees. Additional opportunities for training programs that attract minoritized scholars to realize their vision include further increasing underrepresented scholars in health research, expanding federal funding and institutional investment in training programs, continuing to combat systemic inequities, fostering culturally-sensitive mentorship training, and building upon existing resources to provide trauma-informed support that acknowledges and addresses the unique, intersectional, and historical trauma experienced by trainees. We close with calls to action spanning institutional, community, and policy levels, urging scientists and decision-makers to actively address disparities in diversifying the HIV workforce, fostering equity, and creating inclusive training environments.

The use of policing to enforce public health guidelines has historically produced harmful consequences, and early evidence from the police enforcement of COVID-19 mandates suggested Black New Yorkers were disproportionately represented in arrests. The over-policing of Black and low-income neighborhoods during a pandemic risks increased transmission, potentially exacerbating existing health inequities. To assess racialized and class-based inequities in the enforcement of COVID-19 mandates at the ZIP-code-level, we conducted a retrospective spatial analysis of demographic factors and public health policing in New York City from March 12-May 24, 2020. Policing outcomes (COVID-19 criminal court summonses and public health and nuisance arrests) were measured using publicly available police administrative data. After controlling for two measures of social distancing compliance, a standard deviation increase in percentage of Black residents was associated with a 73% increase (95% CI: 35%, 123%) in the COVID-19-specific summons rate and a 34% increase (95% CI: 17%, 53%) in the public health and nuisance arrest rate. Percentage of Black residents and historical stop-and-frisk rates had stronger associations with COVID-19 summons rates than multiple measures of social distancing compliance. Findings demonstrate pronounced spatial and racialized inequities in pandemic policing of public health that mimic historical policing practices deemed racially discriminatory. If the field of public health supports criminalization and punishment as public health strategies, it risks reinscribing racialized health inequities.

Antimicrobial resistance (AMR) is often referred to as a complex problem embedded in a complex system. Despite this insight, interventions in AMR, and in particular in antibiotic prescribing, tend to be narrowly focused on the behaviour of individual prescribers using the tools of performance monitoring and management rather than attempting to bring about more systemic change. In this paper, we aim to elucidate the nature of the local antibiotic prescribing 'system' based on 71 semi-structured interviews undertaken in six local areas across the United Kingdom (UK). We applied complex systems theory and systems mapping methods to our qualitative data to deepen our understanding of the interactions among antibiotic prescribing interventions and the wider health system. We found that a complex and interacting set of proximal and distal factors can have unpredictable effects in different local systems in the UK. Ultimately, enacting performance management-based interventions in the absence of in-depth contextual understandings about other pressures prescribers face is a recipe for temporary solutions, waning intervention effectiveness, and unintended consequences. We hope our insights will enable policy makers and academics to devise and evaluate interventions in future in a manner that better reflects and responds to the dynamics of complex local prescribing systems.

Legal protections for people living with HIV (PLHIV) are important for protecting human rights, yet little research has examined how laws translate into awareness and understanding for key populations. The Philippines has recently revised their legal protections for PLHIV in response to its growing HIV epidemic, where HIV-positive gay, bisexual and other men who have sex with men bear the majority of cases. We present findings from interviews with 21 HIV-positive gay, bisexual and other men who have sex with men in Manila, Philippines regarding awareness, understanding, and needs regarding HIV-specific legal protections at the time just before new revisions to the omnibus HIV law were passed. Overall, there was no standardized way participants became aware of legal protections; few became aware through healthcare providers, while most learned through online resources, social media, and advocacy organizations. However, even after learning about HIV-specific legal protections, many found the law too complex to understand or did not understand how to use such protections. This led participants to preemptively take action to avoid HIV-related discrimination, even if they were protected by law. Participants demonstrated a strong desire for interventions and policies to improve legal awareness and understanding for PLHIV, government officials, and private businesses. This research demonstrates the value of increasing awareness and understanding in policy-specific interventions designed to improve quality of life for PLHIV. Interventions centered around legal protections are currently underdeveloped, providing a strong opportunity to integrate such interventions in existing practice or as stand-alone tools to decrease perceived stigmatization.

We examined the proportion of the low-income overweight or obese mothers meeting micronutrient recommendations, and whether race, education and body mass index category (BMIc) were associated with micronutrient intake. This analysis included 198 women who completed a validated food frequency questionnaire. Micronutrients were grouped: antioxidant (vitamins A, C, and E, as well as copper, selenium, and zinc), methylation (vitamins B2, B3, B6, B9, and B12, and choline), bone health (vitamins D and K, calcium, magnesium, and phosphorus) and others (vitamin B1, iron, potassium, and sodium). We performed descriptive analysis and generalized linear models. At least two-thirds of women met most antioxidant, methylation, and other micronutrient recommendations. Antioxidant: White reported lower intake of selenium than Black. There were negative associations between education and vitamin E intake and between BMIc and zinc intake. Methylation: White had lower intake of choline than Black, and BMIc was negatively associated with vitamin B12 intake. Bone health: White had lower vitamin K intake than Black. BMIc was negatively associated with magnesium intake. Others: White reported lower potassium and sodium intake than Black. Education was positively associated with iron intake. Nutrition education for the target population might consider tailoring intervention based on race, education, and BMIc.