Sexual and gender minority (SGM) older adults in rural areas face elevated cognitive health risks shaped by structural stigma, yet the pathways underlying these inequities are poorly understood. This study investigated how lifetime rural exposure, minority stress exposure, and community involvement influenced cognitive outcomes among SGM older adults in the U.S. South. Using data from a three-wave longitudinal panel of 1259 participants, we applied structural equation modeling (SEM) to examine direct, indirect, and total effects of these factors on cognitive change scores. We then specified a generalized structural equation model (GSEM) with a Poisson latent growth curve to model repeated cognitive problem counts over time, addressing the count distribution of the outcome. SEM results indicated that lifetime rural exposure, gender minority status, and higher educational attainment were associated with increased minority stress exposure, whereas racial minorities and older participants reported lower minority stress. Minority stress was positively associated with community involvement, reflecting adaptive coping response, and mediated the relationships between gender minority status, education, and community involvement. However, neither minority stress nor community involvement predicted cognitive change when modeled as a difference score. In contrast, the GSEM growth model demonstrated that higher minority stress exposure significantly accelerated cognitive problem growth over time, while chronic conditions exacerbated and higher education slowed decline. Findings highlight that minority stress exerts cumulative, longitudinal effects on cognitive trajectories among SGM older adults. Community participation may foster engagement but cannot offset the neurocognitive consequences of structural stigma.

Medical literature suggests that girls are affected by persistent pain disproportionately to boys especially following the onset of puberty. This article turns attention to how clinicians treating pediatric pain patients conceptualize the role of sex/gender in persistent pain and its care. Drawing on in-depth interviews with members of interdisciplinary pediatric pain care teams in Finland, we argue that sex/gender is an elusive object of alternating in/attention in pain care. We show that clinicians diverge in their views on the degree to which sex/gender matters in pediatric pain, and often express hesitance and ambivalence in their reflections on it. In the absence of clearly articulated conceptual tools for understanding sex/gender in pain, clinicians often fall back on either sociocultural clichés or reductionist biological explanations focusing on hormones. Such explanations present particularly girls' adolescence as a time of risk, a framing that is particularly prominent in accounts that foreground hormones. At the same time, critical voices within the field caution against stereotypical notions of 'typical patients' in pain care settings. By employing a social scientific perspective on persistent pain, the study extends existing interdisciplinary attempts to understand the complexities of sex/gender in pain and its care.

Although fruits are an important part of healthy diets, they are relatively expensive, so most individuals consume less than recommended. We use a randomized control trial to study a voucher program designed to improve the affordability of fruits in peri-urban and urban settings in Vietnam and Nigeria, and analyze whether vouchers can increase fruit consumption. The trial took place in 2021 among 601 households in Vietnam and 611 households in Nigeria. Vouchers were distributed between March and July in Vietnam and between June and November in Nigeria. In both contexts, a large majority of consumers who received vouchers used them. Following project conclusion, we find suggestive evidence of sustained increased fruit consumption only in Vietnam. In Nigeria, vouchers increased consumption of certain fruit categories during program implementation, but we find no evidence of sustained impacts. Fruit consumption is higher across the board in Vietnam, and the sample is wealthier overall, suggesting fruit affordability may not be a binding constraint for consumption. In Nigeria, the increase in consumption during the program along with a post-project decline suggest a lack of household resources to sustain consumption once the project concluded. The results suggest vouchers can improve consumption of healthy foods like fruits, but other actions are needed to make them more affordable in the longer term.

There are persistent inequalities in health-related behaviours in England which are stratified by region and deprivation. These are influenced by the interaction of people with places they live in, over and above individual risk factors. The amenities available on high streets is one such aspect of place but to date, its role in shaping health behaviours has been under examined. Our study presents a novel analysis into health-related amenities and change in availability between 2014 and 2024. We used geographic data analysis and statistical modelling of Ordnance Survey Points of Interest data to describe the association between health-related amenities, area level deprivation and region across England. We found that there were significant inequalities in amenity availability by deprivation over the past decade. The most deprived areas were more likely to gain a takeaway (OR1.56[1.28,1.91]), a bookmaker (OR2.14[1.64,2.79]), or a vape shop (OR2.11[1.68, 2.66] and more likely to lose a supermarket (OR1.95[1.62,2.35]) or a public toilet (OR1.34[1.12,1.62]), compared to the least deprived areas. These patterns were similar on a regional level - the North was more likely to gain a takeaway (OR1.65[1.44,1.90]), a bookmaker (OR1.40[1.18,1.66]), a pawnbroker (OR1.72[1.23,2.40]) or a vape shop (OR1.30[1.11,1.51]) compared to the South. Our findings indicate that the most deprived areas and regions are gaining potentially health-harming amenities and losing health-conducive ones. Through this analysis, we argue that amenities that facilitate health behaviours on high streets are influenced by political and economic drivers of health inequalities and therefore require political decisions to manage, rather than individual behaviour change.

Cesarean sections and inductions in low-risk pregnancies have risen dramatically in recent decades, yet the drivers of these trends remain debated. This study examines peer influence within physician networks as a contributing factor. Using 170,151 New Jersey low-risk births from 1997 to 2014, linked to hospital discharge and physician office location data, we examine whether physicians' practices are associated with their peers' recent behaviors. We define peer groups by geographic proximity, shared hospital affiliation, and co-attendance frequency, and estimate multilevel logistic and Poisson regression models. A physician's likelihood of performing an intervention increases as the number of interventions performed among their peers increases, especially when the expected probability of peer-physician interaction increases. After 2007, peer influence on C-section use declined, aligning with new professional guidelines and policy efforts intended to discourage elective C-sections, while peer effects for inductions persisted. We argue this pattern may suggest that peer influence is stronger under conditions of high clinical discretion and tends to weaken as professional standards become more clearly defined and actively enforced. Findings suggest that social influence within physician networks is a subtle yet significant driver of practice change, shaped by tie strength and institutional context. This study provides new evidence contributing to our understanding of the rise in elective obstetric interventions and the conditions of diffusion.

Chronic household water insecurity is consistently linked to distress and poor mental health, yet the social pathways remain under-tested. We examine multiple theorized socially situated mechanisms that may explain how household water insecurity translates into depressive symptoms, using population-representative 2024 survey-interview data (N = 685) from Sistan and Baluchestan, Iran. Household water insecurity (HWISE-12), depressive symptoms (PHQ-9), and five mechanisms-interpersonal conflict, distributive injustice, procedural injustice, institutional distrust, and water-labor burden-were measured with validated or locally developed scales. Structural equation modeling estimated direct and indirect effects, adjusting for gender, residence, age, education, income, and household size. Mean HWISE scores exceeded prior global benchmarks and mean PHQ-9 scores were higher than clinical cut-points for moderate depression, confirming both extreme insecurity and high levels of psychosocial distress. Findings suggest multiple nonmaterial mechanisms work simultaneously to link water insecurity to poor mental health. The model explained more variance in men's depression (R = .34) than women's (R = .14). Interpersonal conflict was the strongest and most consistent statistical mediator of PHQ-9 scores. Stronger effects for men (β = .47) than women (β = .22) are likely related to men's roles in local water governance. Perceived distributive injustice was associated with higher PHQ-9 scores across groups, while procedural injustice was significant only for men and in urban settings. Distrust of water-related institutions was significant only among women, while burdens of water labor were associated with PHQ-9 scores for both genders, particularly in rural settings. Household income did not account for these associations once social mechanisms were considered. We highlight the need for mixed-method research to refine theory and interventions that recognize the many ways water insecurity operates socially to shape distress and related mental health outcomes.

This study traces the evolution of the '(in)equality in health' concept in parliament debates in Denmark from 1998 until 2024, exploring how the social determinants of health framework has been translated into policy discourse. We analyzed all parliament speeches employing the (in)equality in health concept between 1998 and 2024, and other significant documents of political intent during this period, including government platform papers, party programs and major political agreements. We then quantified the relative dominance of two distinct framings of health inequality by coding the parliament speeches using a large language model. We show that while health inequalities have increasingly been framed 'broadly' as a complex issue that notes the importance of social determinants, the practical policy issues connected with health inequalities have increasingly 'narrowed' in on the issue of healthcare access and quality. In a paradoxical translation of the social determinants framework, policymakers increasingly frame health inequalities as a complex phenomenon to undermine the use of legislation for structural prevention. The Danish case is illustrative of a dilemma that warrants strategic consideration among proponents of the social determinants of health framework, namely how to simultaneously broaden the policy conversation on health inequalities and prevent this broadness from being instrumentalized against action. We argue that one element of this balancing act could be to engage in more context-specific arguments for particular leverage points and to challenge the pursuit of evidence on 'what works' within politically defined boundaries of social change.

Digital transformation is reshaping the pharmaceutical industry, but adoption remains fragmented due to regulatory constraints, organizational inertia, and unequal digital capabilities. This study investigates how the digital divide influences the implementation of new technologies across the pharmaceutical value chain. We combined a systematic literature review of 70 peer-reviewed studies with topic modeling (Latent Dirichlet Allocation) to provide an integrated overview of challenges, opportunities, and future research directions. Our analysis identified 16 thematic clusters consolidated into five strategic domains: Advancing Drug Discovery, Reinventing Organizational Strategies, Optimizing Manufacturing, Strengthening Supply Chains, and Developing Patient-Centric Models. The results show that digital transformation is not only a technical matter but also a systemic process shaped by regulation, governance, and socio-economic conditions. While artificial intelligence, blockchain, digital twins, and other technologies hold potential to accelerate innovation and improve patient outcomes, their benefits are distributed unevenly. Large multinational firms, advanced laboratories, and well-resourced health systems are better positioned to adopt these tools, while small and medium enterprises, emerging economies, and marginalized patient groups often face barriers in infrastructure, expertise, and compliance. From these findings, we developed a structured research agenda to bridge the pharmaceutical digital divide. Priorities include clarifying regulatory and institutional frameworks for digital technologies, identifying the organizational capabilities and governance models required for systemic adoption, and addressing equity implications to ensure inclusive access across geographies, firms, and patient populations. This study contributes methodologically by integrating systematic review and topic modeling, conceptually by framing digital transformation through a value-chain and digital divide perspective, and practically by offering a roadmap for managers, policymakers, and scholars.

The COVID-19 pandemic threatened to exacerbate housing insecurity among renters in the United States, with spillover effects on mental health and non-housing material hardships such as food insecurity. As one response to the potential crisis, the federal government implemented the $47 billion Emergency Rental Assistance Program (ERA) to stabilize rental housing through aid to vulnerable renter households. This study evaluates impacts of ERA on two non-housing outcomes, food insufficiency and psychological distress, using data from the Household Pulse Survey fielded by the U.S. Census Bureau. We created treatment and comparison groups from households that applied for rental assistance and either received aid (treatment) or were awaiting a decision (comparison), using coarsened exact matching to further improve validity. We first estimated bivariate probit models to examine the relationship between rental assistance and non-housing outcomes, then conducted mediation analyses to gauge the extent to which effects were associated with improved housing security. Rental assistance reduced probability of food insufficiency (average treatment effect -0.09), anxiety symptoms (-0.10) and depression symptoms (-0.08). Approximately half of these effects were mediated through improvements in housing security as measured by being in arrears, and larger fractions when housing security was represented using an index of depth of arrears and perceived risk of housing loss. Findings highlight public health benefits of pandemic rental assistance and the potential for housing policy to improve material and psychological wellbeing.

Treatments for mental health and substance use problems have historically been unintegrated, limiting co-occurring disorders treatment. Blending discrete payment models is one potential facilitator of integrated care. This study assesses the impact of one blended payment strategy on the diagnosis of co-occurring disorders in a community mental health system.

The purpose of this study was to examine the associations between marital status and marital transitions with psychological well-being among older adults in Taiwan, and the moderating effects of social support and social participation on these relationships. The Taiwan Longitudinal Survey on Aging data were analyzed to extend current understanding. Participants from eight waves from 1993 to 2019, in total 12,731 older adults, were included. Widowed, separated, or divorced older adults showed higher levels of depression and lower life satisfaction than married individuals. Remaining spouseless or losing a spouse between waves was also associated with lower life satisfaction and higher depressive symptoms. Receiving emotional support from family or friends demonstrated greater potential than social participation in mitigating the psychological impacts of spousal loss or absence, however, receiving negative support was significantly related to higher level of depressive symptoms and lower life satisfaction. Various social participation showed different effects for the never married, widowed, or separated/divorced older adults. The findings highlight the distinct role of limited family ties─spousal status in shaping psychological well-being in later life. Older adults without spouses require more individualized and culturally sensitive support systems.

Health and disease are understood in diverse ways, and im/migrants bring cultural backgrounds that shape explanatory concepts. These understandings influence health practices and may affect utilisation of healthcare institutions. Yet most research focuses on biomedical perspectives, offering limited insight into how alternative medical, and supernatural understandings shape im/migrants' health practices. This study examined im/migrants in two German urban neighbourhoods (Bonn-Tannenbusch and Cologne-Mülheim), using a practice-theory approach (Schatzki, 1996, 2002). Qualitative, semi-structured interviews revealed biomedical, alternative medical, and supernatural explanatory concepts that either travelled from countries of origin or were acquired after migration. We analysed the role of social groups, distinguishing between communities with shared migration backgrounds, other local communities, translocal communities, and healthcare institutions. From this, we developed a typology of four practice-shaping understandings of health and disease. We also examined medical diversity, defined as the blending of different understandings and practices, finding it to be a common rather than exceptional feature. These results highlight the diversity of im/migrants' health understandings and explain why individuals adopt some practices while rejecting others.

The advent of gene therapies such as Zolgensma, Libmeldy, and Luxturna has given rise to new treatment options for several rare conditions, drastically changing the expectations of affected patients. It has also significantly influenced hopes of medical treatment in general, with an emerging vision of widespread targeted personalised treatment of increasingly segmented conditions. Looking at a newspaper sample from the latest wave of developments in the field (from January 01, 2020 until April 30, 2023), our analysis of current media coverage however finds that this narrative of paradigmatic change operates mostly without regard to the present and its challenges, such as the prohibitive price tag of these treatments and unresolved questions about their accessibility and long-term effects. Drawing on expectations raised in the context of the completion of the Human Genome Project in 2000, the article compares these to current hopes of gene therapy's safety and effectiveness; profitability; and accessibility. Areas of tension are then interpreted as a guide to an emerging 'real-life' understanding of gene therapy's promise, which is, however, mostly visible in discussions of problems with gene therapy's accessibility. Similarly marginalised issues include for instance assumptions of effectiveness that do not acknowledge the long-term uncertainty of treatment outcomes; and assumptions of profitability that run counter to real-life examples of business failure. As a revolutionary future becomes reality for some patients, such questions are becoming harder to ignore - but are crucially often omitted from discussion about projected change.

Using an autoethnographic approach, this paper explores the phenomenon of shared rage between Alzheimer's patients and their informal family caregivers. Unlike previous analyses regarding dementia care, this work understands that rage within caregiving relationships is both dynamic and productive. Drawing broadly from social scientific studies regarding emotional labour and "feeling work," this work argues that Alzheimer's sufferers and their informal caregivers form two halves of a dyad, each of whom may use rage as a form of protection against loss of relational identity and pursuant grief, and to demand humane and dignified treatment from broken formal care systems. This individual rage simultaneously offers a point of connection between both halves of the caregiving dyad, which is otherwise torn asunder by interpersonal manifestations of the disease. Ultimately this paper argues for a brave, curious and compassionate response to caregiving dyads in which experiences of rage are not stigmatized, minimized or medicalized. Rather, this analysis suggests that experiences of anger are recognized as an often-excruciating form of emotional labour necessitated by an insidious disease and inadequate formal care systems.

Early studies of the parity-mortality relationship expected high parity to elevate mortality risk, but studies increasingly find that childless and high-parity women have higher post-reproductive mortality risk than moderate-parity women (U-shaped pattern). We investigate race-related differences in completed parity and parity-mortality associations, including attention to childlessness. We use a non-Hispanic Black and White sample of U.S. women born between 1920 and 1941 drawn from the REasons for Geographic And Racial Differences in Stroke (REGARDS, 2003-2007) dataset (N = 6542). Black women born in this period, compared to White women, reached higher parity (5+ children) and were more likely childless due, respectively, to greater exposure to southern Jim Crow-era agricultural arrangements (sharecropping) and poorer health. Identification of women's birthplaces in REGARDS allows us to link county-level measures from U.S. Plantation Censuses to women's records. We use count regressions to model completed parity and shared-frailty proportional hazards regressions to model all-cause mortality. We find Black but not White women's high-parity status associated with contextual exposure to plantation agricultural arrangements, and Black but not White women's childlessness primarily associated with perinatal child loss(es). We also find U-shaped parity-post-reproductive mortality patterns among all women, but especially among high-parity Black women born in plantation-holding counties. In the historical context of our study, women's childbearing careers and subsequent mortality risk reflected complex reproductive health histories (especially among the childless) and fertility control practices, which, in turn, reflected differential exposure to geographic, social, and political-economic contexts.

Social and structural determinants of health significantly impact well-being across the lifecourse and contribute to ethnoracial disparities in cognitive aging. Early-life exposure to parental disruption (i.e., death, divorce, or separation), which disproportionately affects ethnoracially diverse children, increases the risk of adverse brain health outcomes. Systemic inflammation, a key biological mechanism linking early stress to cognitive aging, affects neurocognitive pathways. However, little is known about how the relationship between parental disruption, inflammation, and cognition varies by ethnoracial group. This study examines the mediating role of systemic inflammation in the relationship between early-life parental disruption and late-life global cognition among non-Hispanic White (69.11 %), Black (16.45 %), and Hispanic (11.64 %) adults aged 55+ in the Health and Retirement Study (HRS). Data on systemic inflammation were obtained from the 2016 HRS Venous Blood Study, and early-life experiences from the 2015-2017 Life History Mail Survey. Using structural equation modeling (SEM), we constructed a latent variable of systemic inflammation based on Meier et al. (2023), incorporating CRP, IL-6, IL-10, IL-1RA, TNFR1, IGF-1, and the neutrophil-to-lymphocyte ratio. SEM with full information maximum likelihood (FIML) was used to address missing data and assess indirect effects. Inflammation was associated with lower cognition among non-Hispanic White and Hispanic participants, but not Black participants. Among non-Hispanic Whites, parental disruption was linked to higher inflammation, which in turn predicted lower cognitive performance. The pathway differed for Black participants, suggesting distinct psychosocial risk and resilience processes. Findings highlight the importance of lifecourse and culturally responsive approaches to addressing disparities in cognitive aging.

Access to care among older adults can help identify unmet health needs and increase the use of health care, though in some cases it may substitute some forms of health care. We argue that the balance between these two effects is largely gender dependent: female spouses are more likely to act as informal caregivers and, as a result, are more likely to have neglected their own health needs. To examine this hypothesis, we exploit the variation introduced by Scotland's Free Personal Care (FPC) programme, a government initiative implemented in 2002 that provides free personal care access to all eligible individuals regardless of their income. Using a Difference-in-Differences (DiD) framework comparing Scotland with the rest of the United Kingdom and a rich longitudinal dataset of men and women aged 65 and over, we first find that FPC significantly increased the uptake of home help services among women, with little change among men. Among women, adult care expansion led to a 3.5-percentage-point rise in inpatient admissions, whereas among men, we find evidence suggesting a modest substitution effect of care for health care. The effects are stronger among older adults who live alone, and those facing socioeconomic disadvantage, or high care needs.

Air pollution and noise exposure adversely affect individuals' physical and mental health. Static environmental exposure measurement methods lack accuracy and introduce estimation bias in the relationship between environmental exposure and health outcomes. Contextual factors and temporal effects play a significant role in influencing this association due to non-stationary effects. However, few studies have considered mobility-based exposure, contextual factors and temporality together in environmental health research. This study investigates the associations between noise and PM and momentary stress level (MSL) using a mobility-based measurement method, considering both contextual and temporal effects. It collected real-time exposure data from participants using mobile sensing technologies (e.g., GPS tracking) and geographic ecological momentary assessment (GEMA). The results show that daily routines and interactions with family or friends are linked to the highest PM exposure, whereas work/study contexts and settings spent with colleagues are associated with the lowest PM and noise levels. Travel is associated with the highest noise exposure. Further, travel and work/study contexts and being with colleagues are significantly and positively related to MSL compared to daily routines and being alone separately, while being with family members is related to lower MSL. The association between noise and MSL is significant (effect size: 0.003-0.008, temporal range: 1 minute-2 hours), particularly in entertainment, work/study, daily routines, when alone, with friends, or with family. PM's association with MSL becomes non-significant when contextual factors are included. This study highlights the importance of addressing temporal and contextual uncertainty in mitigating the uncertain geographic context problem.

This paper presents an economic evaluation of community-led and -owned organisations that deliver activities to support health and wellbeing. Because community-led organisations (CLOs) are a vital part of the social and solidarity economy, they increasingly feature in public health policies targeting disadvantaged populations. However, little is known about the value CLOs generate as few economic evaluations of them exist and those available focus on isolated activities (such as exercise classes) and/or specific populations (e.g., men-only collectives). The novelty of our work lies in the inclusion of multiple CLOs, comprehensive coverage of their activities, breadth of participants studied, and control group methodology applied in creating new knowledge of the health and wellbeing outcomes of CLOs and resources consumed to achieve them. We conducted cost-effectiveness and cost-consequence analyses of data collected via a 12-month longitudinal study. We compared 331 CLO participants in 14 UK-based CLOs to a 'do nothing' synthetic control group (n = 100). Health and wellbeing were measured using the ICECAP-A capability measure for adults, EuroQol EQ-5D-5L, Short-form Warwick Edinburgh Mental Wellbeing Scale and the Revised Social Connectedness Scale. Resource use data included health, social care, and other community sector resources. Data collection occurred at four-points over the study period supported by publicly available accounts and data provided by each CLO. We found an incremental cost per year in full capability of £35,813 and an incremental cost per quality adjusted life year of £29,827. Statistically significant improvement in both social connectedness, and mental wellbeing were observed over the 12 month follow up. This work supports CLOs as an intervention to improve health and wellbeing in disadvantaged communities and identifies challenges for traditional evaluation methodology with regards to costing and comparator groups.

Using a large administrative dataset, we explore intersectional effects in the risk of unplanned readmission after hospital discharge in England. We test whether the size and direction of these effects aligns with societal power dynamics that underpin theories of intersectionality.