Search Results (15,627)

Background and Objectives: Despite substantial advances in treatment strategies for patients with type 2 diabetes mellitus (T2DM), its complication, particularly sarcopenia, has emerged as a global healthcare challenge. Pay-for-performance (P4P), an incentive-based payment scheme, has long been used to improve the quality of care; however, few studies have explored its effect on sarcopenia prevention. Therefore, we conducted a nested case–control study to investigate the association between P4P participation and the risk of sarcopenia among patients with T2DM. Materials and Methods: Using a large claims dataset, we identified individuals aged 20–70 years with newly diagnosed T2DM between 2001 and 2010 in Taiwan. All enrollees were followed up until 2013 to determine the occurrence of sarcopenia. For each case, we randomly matched two controls without sarcopenia. The risk of sarcopenia in relation to P4P participation was estimated by fitting conditional logistic regression to yield the adjusted odds ratio (aOR) and corresponding 95% confidence interval (CI). Results: A total of 3475 individuals with sarcopenia and 6948 matched controls were included. Patients enrolled in the P4P program had a lower risk of sarcopenia than their matched counterparts (aOR = 0.66; 95% CI: 0.61–0.74). Earlier P4P enrollment (within 1 year of T2DM diagnosis) and high-intensity P4P participation were associated with additional reductions in sarcopenia risk. Conclusions: Integrating P4P into routine T2DM care may help prevent sarcopenia, highlighting the importance of interdisciplinary collaboration and timely program implementation. Full article

Objectives: to assess the safety profile of Gastrointestinal (GIT), renal, and pancreatic effects of GLP-1 and dual receptor agonists. Methods: Disproportionality analyses were performed on FDA Adverse Event Reporting System (FAERS) data following each drug’s approval for weight management. Signals were identified using Proportional Reporting Ratio (PRR) and Reporting Odds Ratio (ROR) with 95% confidence intervals (CIs). Results: Among GIT AEs, semaglutide (n = 12,321; 1.65%) showed the strongest signals (PRR 3.97, ROR 14.21), exceeding liraglutide (n = 5972, 0.45%, PRR 2.76, ROR 5.01) and tirzepatide (n = 4056, 3.48%, PRR 1.64, ROR 1.90). For renal and pancreatic outcomes, liraglutide demonstrated the highest overall signal (PRR 4.91, ROR 5.35), particularly for acute pancreatitis (PRR 18.9, ROR 19.4) and pancreatic carcinoma (PRR 18.6, ROR 19.5). Semaglutide showed stronger associations with diabetic ketoacidosis (DKA) (PRR 5.86, ROR 5.9) and acute kidney injury (AKI) (PRR 1.25, ROR 1.25). Tirzepatide demonstrated weaker or absent signals across most outcomes. Conclusions: This study revealed that semaglutide was most associated with GIT events, while liraglutide showed stronger renal and pancreatic signals. Novel associations with DKA and AKI were observed, warranting clinical vigilance. Findings should be cautiously interpreted given surveillance limitations, emphasising the need for large-scale real-world studies to confirm safety profiles. Full article

Background & Objectives: Periodontal disease (PD) is a common oral disease that affects the supporting structures of the teeth and is a leading cause of tooth loss worldwide. This study aimed to estimate the prevalence of PD among 9th-grade teachers in the northern West Bank and examine its association with key behavioral and socioeconomic factors. Methods: A cross-sectional study was conducted among 920 teachers selected through proportional stratified random sampling from governmental and private schools. Periodontal health was assessed using the WHO Community Periodontal Index for Treatment Needs (CPITN), and oral hygiene status was measured with the Simplified Oral Hygiene Index (S-OHI). A structured questionnaire was administered to collect data on socioeconomic status, oral hygiene practices, dietary habits, and smoking behaviours. Data was analysed using descriptive statistics, bivariate and multivariate logistic regression. Results: Only 11.8% of participants exhibited completely healthy gingiva, with the mean condition ranging between calculus and shallow pockets. Oral hygiene practices were the strongest predictors of periodontal outcomes: frequent tooth brushing (Adjusted Odds Ratio: AOR = 0.015), morning brushing (AOR = 0.015), and regular toothbrush replacement (AOR = 2.514) were protective. Higher red meat intake was negatively associated with periodontal health (AOR = 0.032), while frequent nut consumption was protective (AOR = 0.227). The number of cigarettes smoked per week was positively associated with PD (AOR = 1.085). Conclusions: PD is highly prevalent among Palestinian adults, with significant behavioural and lifestyle-related determinants. Targeted oral health interventions are urgently needed to improve adults’ oral health. Full article

Background and Objectives: Vaginal natural orifice transluminal endoscopic surgery, vNOTES, has become an increasingly preferred minimally invasive option for benign hysterectomy. General anesthesia is still the routine choice, yet regional methods such as combined spinal epidural anesthesia may support a smoother postoperative course. Although the use of vNOTES is expanding, comparative information on anesthetic approaches remains limited, and its unique physiologic setting requires dedicated evaluation. To compare combined spinal epidural anesthesia with general anesthesia for benign vNOTES hysterectomy, focusing on postoperative nausea and vomiting, recovery quality, and intraoperative physiologic safety. Materials and Methods: This retrospective cohort study was conducted in a single center and identified women who underwent benign vNOTES hysterectomy between March 2024 and August 2025 from electronic medical records. Participants received either combined spinal epidural anesthesia or general anesthesia according to routine clinical practice. All patients were managed within an enhanced recovery pathway that incorporated standardized analgesia and prophylaxis for postoperative nausea and vomiting. The primary outcome was the incidence of postoperative nausea and vomiting during the first day after surgery. Secondary outcomes included time to discharge from the recovery unit, pain scores at set postoperative intervals, early functional recovery, patient satisfaction and physiologic parameters extracted from intraoperative monitoring records. Analyses were performed according to the anesthesia group documented in the medical files. Results: One hundred forty patients met inclusion criteria and were included in the analysis. Combined spinal epidural anesthesia was linked to a lower incidence of postoperative nausea and vomiting, a shorter stay in the post-anesthesia care unit, and reduced pain scores in the first 24 h (adjusted odds ratio 0.32, ninety five percent confidence interval 0.15 to 0.68). Early ambulation and oral intake were reached sooner in the combined spinal epidural group, with higher overall satisfaction also noted. Adherence to ERAS elements was similar between groups, with no meaningful differences in early feeding, mobilization, analgesia protocols or PONV prophylaxis. During the procedure, combined spinal epidural anesthesia produced more episodes of hypotension and bradycardia, while general anesthesia was linked to higher airway pressures and lower oxygen saturation. Complication rates within the first month were low in both groups. Conclusions: In this observational cohort study, combined spinal epidural anesthesia was associated with lower postoperative nausea, earlier recovery milestones and greater patient comfort compared with general anesthesia. Hemodynamic instability occurred more often with neuraxial anesthesia but was transient and manageable. While these findings point to potential recovery benefits for some patients, the observational nature of the study and the modest scale of the differences necessitate a cautious interpretation. They should be considered exploratory rather than definitive. The choice of anesthesia should therefore be individualized, weighing potential recovery benefits against the risk of transient hemodynamic effects. Larger and more diverse studies are needed to better define patient selection and clarify the overall risk benefit balance. These findings should be interpreted cautiously and viewed as hypothesis-generating rather than definitive evidence supporting one anesthetic strategy over another. Full article

Background: Incarcerated men experience disproportionately high levels of health inequities shaped by social determinants, including poverty, violence, family adversity, trauma, and limited access to healthcare. These long-standing disadvantages, added to the adverse conditions experienced in prisons, may be associated with elevated rates of suicidality in this population. This study examined the prevalence of suicidal ideation and lifetime suicide attempts among men deprived of liberty in Southern Brazil and investigated the role of cumulative adversities and current protective factors in these outcomes. Methods: A cross-sectional study was conducted with 496 incarcerated men. Participants completed a sociodemographic and background questionnaire assessing lifetime adversity (e.g., hunger, homelessness, sexual abuse, domestic violence, family substance dependence) and current protective factors in prison (e.g., family visits, education, leisure, physical activity, religion, positive self-perception). Cumulative adversity and protective factors were operationalized as composite indices. Logistic regression models tested whether cumulative adversities and protective factors were independently associated with suicidal ideation and suicide attempts. Results: Lifetime prevalence was 9.6% for suicidal ideation and 10.8% for suicide attempts. Cumulative adversities were associated with higher odds of both suicidal ideation (OR = 1.43; 95% CI = 1.11–1.84; p = 0.006) and suicide attempts (OR = 1.94; 95% CI = 1.50–2.52; p < 0.001). Protective factors were associated with lower likelihood of suicidal ideation (OR = 0.74; 95% CI = 0.58–0.96; p = 0.020) but were not significantly associated with suicide attempts. No significant interaction effects were observed, indicating that protective factors did not moderate the impact of adversity. Conclusions: Suicidal tendencies among incarcerated men were associated with cumulative structural and psychosocial adversities. Protective factors in prison were associated with lower odds of ideation but not attempts. These associations may inform person-centered and equity-oriented approaches and are consistent with the relevance of social determinants to mental health, although causal inferences are not supported by this project. Full article

Background/Objective: This study investigated the associations between dietary patterns and subjective cognitive function among older Japanese adults and examined whether these associations differed according to sleep duration. Methods: This longitudinal cohort study was conducted using data from the Community Empowerment and Care study (2017–2020). Data were obtained from the Community Empowerment and Care Study of the T-Village, Aichi Prefecture, Japan. Latent class analysis was used to identify dietary patterns based on the intake frequencies of seven food groups. Logistic regression models assessed the associations between dietary patterns and subjective cognitive function stratified by sleep duration (optimal: 7–8 h; unfavorable: <7 or >8 h). Results: Three dietary patterns were identified (diverse, balanced, restricted). Compared with the restricted pattern, the diverse (odds ratio = 0.13, 95% confidence interval: 0.07–0.26; p < 0.0001) and balanced patterns (odds ratio = 0.33, 95% confidence interval: 0.18–0.62; p = 0.0006) were associated with lower odds of poor subjective cognitive function. Associations were broadly similar across sleep groups, and interaction testing was not significant. Conclusions: Dietary quality was associated with better subjective cognitive function, particularly among older adults with unfavorable sleep duration. The study findings underscore the need for integrated lifestyle interventions that target both nutrition and sleep in aging populations. Full article

This study investigates how master’s student teachers (MSTs) conceptualize and integrate programming and computational thinking within mathematics education. Grounded in the Anthropological Theory of the Didactic, and specifically its notion of praxeology, the study analyses 39 written reflections produced by MSTs who completed a compulsory programming-based mathematics task. The analysis identifies both mathematical and didactic praxeologies, revealing how MSTs’ engagement with programming reflects their development both as learners and as future teachers. The findings demonstrate that MSTs’ personal learning strategies, such as exploration, iteration, and productive struggle, closely parallel their envisioned classroom practices. The findings also show that many participants framed programming itself as the central learning object, highlighting a need to develop confidence and competence before applying programming as a tool for mathematical inquiry. The study argues that programming tasks provide a productive arena for bridging theory and practice in teacher education by fostering an interplay between praxis (know-how) and logos (know-why). Finally, the results indicate that MSTs require institutional support specifically aimed at developing basic programming fluency (e.g., handling syntax, debugging, and programming environments), so that computational thinking can be mobilized for mathematical exploration rather than being overshadowed by technical challenges. Full article

Background/Objectives: The Lancet Commission proposes a new obesity definition that combines body mass index (BMI) with anthropometric measurements to distinguish adipose tissue excess more effectively. This study aims to determine the prevalence of obesity based on the new definition and to examine cardiometabolic risk factors and lifestyle habits across different obesity phenotypes in the urban population of Lithuania. Methods: This study was conducted among residents of Kaunas city from 2020 to 2024. A total of 3426 adults aged 25–69 years (57.1% of the random sample) were participated. Three individuals were excluded due to missing anthropometric data. Participants were categorized into three phenotypes: (1) no obesity (BMI < 30 kg/m² and no or one elevated anthropometric measure, (2) anthropometric-only obesity (BMI < 30 kg/m² and at least 2 elevated anthropometric measures), and (3) BMI-plus-anthropometric obesity (BMI ≥ 30 kg/m² plus at least one elevated anthropometric measure or BMI ≥ 40 kg/m²). Standardized anthropometric, biochemical, and clinical measurements were collected, along with self-reported dietary habits and leisure-time physical activity. Results: Anthropometric-only obesity was highly prevalent, affecting 36.1% of males and 22.7% of females (p < 0.05). The prevalence of BMI-plus-anthropometric obesity was 24.1% among males and 21.4% among females. Individuals with anthropometric-only obesity had significantly higher odds of metabolic syndrome (OR 8.64; 95% CI 6.97–10.71), diabetes (OR 3.01; 95% CI 1.72–5.25), coronary heart disease (OR 1.48; 95% CI 1.12–1.97), and several lipid abnormalities compared with those without obesity. The highest cardiometabolic risk was observed in the BMI-plus-anthropometric obesity group. Greater adiposity was associated with higher intake of red meat, junk foods, and sugary drinks, while physical activity levels declined across obesity categories. Conclusions: Anthropometric-only obesity is a common and metabolically adverse phenotype that cannot be detected using BMI alone. A new obesity definition enhances identification of high-risk individuals and supports targeted prevention strategies. Full article

Background and Objectives: Sleep disruption and reduced physical activity are common in pregnancy and may impair sexual function through mood, body-image, and relational pathways. We prospectively examined whether sleep quality and physical activity predicted third-trimester sexual function in a Romanian antenatal cohort, and explored psychosocial correlates. Materials and Methods: In a single-center cohort, 102 pregnant adults were enrolled ≤ 20 weeks and followed to the third trimester. Sleep (Pittsburgh Sleep Quality Index, PSQI), sexual function (Female Sexual Function Index–Romanian version, FSFI-RO), physical activity (IPAQ-SF), depressive symptoms (PHQ-9), body-image avoidance (Body Exposure during Sexual Activities Questionnaire, BESAQ), and perceived social support (MSPSS) were assessed. Groups were defined by mid-/late-pregnancy sleep (good, PSQI ≤ 5; poor, PSQI > 5). Analyses used t-tests, Pearson correlations, multivariable linear regression for FSFI-Total, and logistic regression for FSFI-Total < 26.55. Results: Compared with good sleepers (n = 56), women with poor sleep (n = 46) had lower third-trimester FSFI-Total (24.4 ± 3.9 vs. 27.9 ± 4.3; p < 0.001) and higher odds of FSFI-defined dysfunction (adjusted OR 121.1; 95% CI 19.2–763.0; p < 0.001). FSFI-Total correlated with worse sleep (PSQI r = −0.42), depressive symptoms (PHQ-9 r = −0.36), social support (MSPSS r = 0.40), body-image avoidance (BESAQ r = −0.34) and physical activity (IPAQ-SF r = 0.24; all p ≤ 0.015). In adjusted models (R² = 0.42), higher MSPSS (β = 0.26; p = 0.004) was protective, whereas PSQI (β = −0.24; p = 0.008), ΔPHQ-9 (β = −0.19; p = 0.023), BESAQ (β = −0.17; p = 0.031), and higher BMI (β = −0.14; p = 0.049) predicted lower FSFI-Total. Conclusions: In this antenatal cohort, poor sleep was strongly and independently associated with lower sexual function, with meaningful contributions from social support, mood, body-image cognition, and physical activity, highlighting sleep as a clinically actionable target for preserving sexual well-being in pregnancy. Full article

Objective: Current data on the association between attention-deficit/hyperactivity disorder (ADHD) and essential hypertension (EH) in pediatric populations are very limited, as most research has focused on adults. This study investigated the long-term prevalence of EH in Israeli youth aged 5–18 years with ADHD, examining also trends in antihypertensive medication use. Methods: A retrospective cohort study was conducted using data from Leumit Health Services. The ADHD cohort (N = 18,558) was compared in a 1:2 ratio to controls (N = 37,116), who were strictly matched for age, gender, birth year and quarter, socioeconomic status (SES), sectors, region, and cumulative years of LHS membership up to the index date. Diagnoses of ADHD and EH were identified using ICD-9/10 codes, depending on the year of diagnosis. Logistic regression analyses were used to assess the associations between ADHD, EH and the use of antihypertensive medications over a 20-year follow-up. Results: ADHD-diagnosed children had a higher prevalence of EH, with odds ratios (ORs) of 3.17 (95% CI: 1.46–7.16, p = 0.0017) at 5 years, 2.94 (95% CI: 1.45–6.09, p = 0.0013) at 10 years, and 1.92 (95% CI: 1.26–2.93, p = 0.0015) at 20 years. ADHD patients showed a greater use of antihypertensive medications, including calcium channel blockers (OR 1.85, 95% CI: 1.02–3.35, p = 0.035), renin angiotensin system blockers (OR 2.20, 95% CI: 1.15–4.25, p = 0.013), and diuretics (OR 1.77, 95% CI: 1.21–2.60, p = 0.0028). Conclusions: These findings highlight an association between ADHD diagnosis and EH, suggesting regular cardiovascular monitoring of children with ADHD. Further studies are needed to uncover the role of stimulant medications and shared biological and behavioral factors involved in the pathogenesis. Full article

Background/Objectives: Isotretinoin remains an essential therapy for severe acne, yet its safety profile continues to raise concerns. This study analyzed adverse event reporting patterns for isotretinoin versus topical retinoids using EudraVigilance data. Methods: Aggregated ADR data for isotretinoin and four topical retinoids (tretinoin, adapalene, tazarotene, trifarotene) were retrieved from the EMA ADRreports portal (April 2025). Disproportionality was assessed using reporting odds ratios (RORs) with 95% confidence intervals at the MedDRA system organ class (SOC) level. Significant demographic differences (age and sex; both p < 0.001) justified stratified ROR analyses for SOCs showing positive signals. Results: Among 35,030 isotretinoin and 3795 topical retinoid reports, isotretinoin showed strong over-reporting in six SOCs: psychiatric disorders (ROR 11.96; 95% CI 10.11–14.14), gastrointestinal disorders (3.88; 3.50–4.31), musculoskeletal and connective tissue disorders (2.89; 2.50–3.35), surgical and medical procedures, social circumstances, and ear and labyrinth disorders. Fourteen SOCs demonstrated significant under-reporting, including neoplasms, immune system disorders, cardiac disorders, and blood/lymphatic disorders. Stratified analyses confirmed the robustness of the positive signals. Psychiatric disorders exhibited the highest disproportionality in males (22.10; 16.11–30.31) and adolescents aged 12–17 (25.85; 13.32–50.19). Gastrointestinal and musculoskeletal signals remained significant across all age and sex strata. Conclusions: Isotretinoin presents a distinct safety profile characterized by consistently elevated reporting of psychiatric, gastrointestinal, and musculoskeletal adverse events, independent of age and sex. These results refine the comparative safety landscape of systemic versus topical retinoids and support focused pharmacovigilance monitoring. Full article

(1) Background: Neonatal sepsis continues to be one of the leading causes of mortality and morbidity, particularly in underdeveloped countries. We aimed to compare laboratory parameters between clinical early-onset sepsis (clinEOS) and NNNon-clinEOS groups and to evaluate the association between TLR2-Arg753Gln, TLR4-Asp299Gly, IL6-174G/C, and IL10-1082G/A gene single-nucleotide polymorphisms and clinical EOS susceptibility in preterm newborns. (2) Materials and Methods: Genotyping of the TLR2, TLR4, IL6, and IL10 polymorphisms was performed in 36 preterm neonates with polymerase chain reaction (PCR) and restriction fragment length polymorphism analysis (RFLP). Logistic regression analysis was used to test the associations between the studied gene polymorphisms and EOS susceptibility. (3) Results: Statistically significant differences in gestational age and birth weight were observed between the two groups, with preterm neonates with clinical EOS having a lower mean gestational age (mean (SD): 29.4 (2.8) weeks vs. 32.6 (1.1); p = 0.00002) and a lower mean birth weight (1342.1 (446.5) gr. Vs. 1984 (376.9)) than preterm neonates without clinical EOS. C-reactive protein (CRP) values measured on the first day significantly increased in the clinEOS group compared with the non-clinEOS group (median, 95% CI: 0.80 [0.40, 1.15] vs. 0.30 [0.02, 0.50]). The mean number of neutrophils significantly decreased in the preterm neonates with clinical EOS (mean difference: 17.3%; 95% CI: [4.0%, 30.5%]; p = 0.0126) and non-clinEOS group (mean difference: 20.8%; 95% CI: [1.8%, 39.9%]; p = 0.0354) between the first and seventh hospitalization days. In the dominant model, the A/G + A/A variant genotype of the IL10-1082G/A polymorphism significantly increased the odds of clinical EOS compared with the GG genotype (OR = 5.25; p = 0.0322), but the gestational-age-group adjusted model yielded p = 0.0752. (4) Conclusions: The results of the current study suggest that IL10-1082G/A gene polymorphism is a significant risk factor for clinical early-onset sepsis development in preterm neonates, but there was no evidence of a gestational age-group independent direct effect of IL10-1082G/A gene polymorphism on clinical EOS susceptibility. The results should be considered as exploratory. Full article

Objective: This systematic review and meta-analysis aims to investigate the association between hearing loss (HL) and incident cardiovascular disease (CVD), a composite of stroke and myocardial infarction (MI), and to explore the specificity of the underlying pathophysiology and the consistency of this association across key demographics and HL types. Methods: Adhering to PRISMA and MOOSE guidelines, we searched PubMed and Web of Science for studies published in English over the past 16 years. The analysis encompassed the spectrum of HL types. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for CVD (a composite of stroke and MI) and for each outcome separately. Extensive subgroup and sensitivity analyses were performed to assess robustness amid heterogeneity. Results: The analysis included 15 studies (12 cohort, 3 cross-sectional/case–control). HL was significantly associated with a high incidence of CVD (pooled OR = 1.31, 95% CI 1.05–1.65). A significant association was found for stroke (OR = 1.41, 95% CI 1.07–1.85) but not for MI (OR = 1.15, 95% CI 0.88–1.50). A consistent pattern of elevated risk was observed across all subgroups, and the primary findings remained robust in sensitivity analyses. Conclusion: Our meta-analysis indicates that HL, across its various types, is significantly associated with incident stroke, but not MI. This differential risk profile is compatible with a pathophysiology that may involve the cerebrovascular system more prominently than systemic coronary arteries. The findings highlight the potential of HL as a cost-effective indicator meriting further investigation for targeted cerebrovascular risk assessment in prevention strategies. Full article

Social media addiction (SMA) and social phobia (SP) are significant adolescent mental health concerns. In Saudi Arabia, despite high social media penetration, the association between these two constructs remains under-researched, particularly in the Aseer region. This cross-sectional study, conducted from January to March 2025, recruited 384 Saudi adolescents aged 11–19 from schools in the Aseer region using multistage cluster sampling. Participants completed validated self-report measures, including the Social Phobia Inventory (SPIN) and the Al-Menayes Social Media Addiction Scale. A refined “Core SMA” subscale was created based on expert consensus criteria to enhance measurement precision. The prevalence of moderate-to-severe social phobia was 15.6%. A significant, moderate positive correlation emerged between SP and SMA (Spearman’s ρ = 0.294, p < 0.001). After adjusting for age, gender, and family income, adolescents with moderate social phobia had 2.15 times the odds of probable SMA compared to those with no SP (adjusted odds ratio [AOR] = 2.15, 95% CI: 1.15–4.04, p < 0.05), and this effect was more pronounced for those with severe social phobia (AOR = 2.56, 95% CI: 1.04–6.30, p < 0.05). This study demonstrates a clear relationship between social phobia severity and social media addiction among Saudi adolescents in the Aseer region. These findings support the urgent need for integrated mental health and digital literacy interventions that proactively screen for both conditions. Full article

Background: Personal protective measures help prevent infection and disease transmission during health crises such as Coronavirus disease 2019 (COVID-19). Populations facing barriers to adhering to these measures are more vulnerable to the health crisis. This study investigated the association of social drivers of health (SDoH), self-efficacy, and adverse substance use behavior changes with ability to practice COVID-19 personal protective behaviors among persons who inject drugs (PWID) with hepatitis C virus (HCV) infection history. Methods: This study used the Hepatitis C Real Options (HERO) study’s COVID-19 survey data (n = 157). The association of inability to practice COVID-19 personal protective behaviors (hand washing, social distancing, etc.) with (a) SDoH difficulties (employment, housing, etc.); (b) adverse substance use behavior change (overdose, injecting behavior, etc.); and (c) self-efficacy was tested using logistic regression. Results: Inability to practice any personal protective behaviors was more likely among those experiencing any vs. no SDoH difficulties [adjusted odds ratio (aOR) (95% confidence interval (CI))] = 4.57 (1.57, 16.40); p = 0.003] but less likely for those with higher overall self-efficacy [aOR (95% CI) = 0.55 (0.32, 0.93); p = 0.025] and self-efficacy for setting goals [aOR (95% CI) = 0.63 (0.40, 0.96); p = 0.031]. The association between adverse substance use behavior changes and the outcome was not significant. Conclusions: Greater SDoH difficulties and lower self-efficacy were associated with greater inability to practice COVID-19 personal protective behaviors. Interventions to meet SDoH-related challenges and increase self-efficacy could help encourage practice of personal protective behaviors and economically reduce disease burden during health crises. Full article