Search Results (37)

Objectives: We aimed to examine associations between social marginalization, defined by the Ontario Marginalization Index (“ON-Marg”), and overall survival (OS) in epithelial ovarian cancer (EOC). Methods: This was a population-based retrospective cohort study using linked administrative data in Ontario, Canada, including adults ≥ 18 years diagnosed with stage II-IV EOC (2010–2022). ON-Marg dimensions included Material Resources (economic disadvantage), Households and Dwellings (housing type/density), Age and Labour Force (workforce participation), and Racialized and Newcomer Populations (recent immigrants/visible minorities), and were categorized into quintiles (Q1 least marginalized, Q5 most marginalized). The primary outcome was OS. Multivariable Cox models estimated adjusted hazard ratios (aHR) for each ON-Marg dimension. Wald χ² statistics identified the dimension most strongly associated with OS. Results: Material Resources was most strongly associated with OS. Compared with Q1 (least marginalized), higher mortality was observed in Q3 (aHR 1.10; 95%CI 1.02–1.19), Q4 (aHR 1.13, 95%CI 1.05–1.22), and Q5 (aHR 1.25, 95%CI 1.15–1.35). Greater marginalization in the Racialized and Newcomer Populations dimension was associated with improved OS (Q5 aHR 0.87, 95%CI 0.80–0.94). The association between Material Resources and OS persisted in patients undergoing cytoreductive surgery with chemotherapy, but not among those receiving chemotherapy alone or no treatment. Conclusions: Material Resources is an independent predictor of survival in EOC within a universal, publicly funded healthcare system, with greatest impact among patients undergoing multimodal oncologic care. Residence in highly racialized or newcomer communities was associated with improved survival. Material marginalization is highlighted as a key driver of inequity, supporting targeted system-level interventions to address financial and logistical barriers to care. Full article

Recent studies suggest that prolonged participation in formal music programs may be associated with the cultivation of resilience and locus of control (LoC) in music students. Brazilian musicians, who were attending or had attended community-based music programs, and a group of matched, untrained individuals from disadvantaged, urban communities completed the Connor–Davidson Scale of Resilience (RISC), the Craig Locus of Control Scale, and the ABEP 2022—Brazilian Criteria of Economic Classification questionnaire. Results suggested that while musical participation alone was not associated with resilience and LoC scores (model 1), a conditional restriction of the same model (model 2) showed a significant interaction between musical participation, age, and RISC and LoC scores, after controlling for SES. Among musicians, higher age was associated with higher resilience scores and internal LoC. Findings from this exploratory study are discussed in light of the multifaceted nature of community-based music programs, the building blocks of resilience and LoC. We also comment on the potential links between resilience and LoC in relation to musical participation and well-being. Limitations of this study are discussed alongside implications for future research. Full article

Communities that have been structurally and historically marginalized continue to face barriers rooted in practices of exclusion and segregation. These structural constraints often persist within the entrepreneurial sphere, limiting opportunities for Indigenous entrepreneurs to establish and consolidate their businesses. This study examines the sales gap between Indigenous entrepreneurs (IEs) and non-Indigenous entrepreneurs (NIEs) in Mexico. The analysis employs a dual methodological approach based on Oaxaca–Blinder (OB) mean decompositions and recentered influence function (RIF) regressions applied across income deciles. Findings reveal a persistent and significant sales disparity: on average, Indigenous entrepreneurs sell 42.5% less than their non-Indigenous counterparts. Approximately 18% of this difference is explained by observable characteristics such as education and experience, 20.8% by differences in returns to these characteristics, and 5.8% by interaction effects. By distinguishing between gaps driven by endowment differentials and those arising from differential returns, the study highlights the potential role of structural or discriminatory mechanisms underpinning Indigenous disadvantage in the Mexican entrepreneurial ecosystem. Full article

Childhood immunization is one of the most effective public health measures, yet inequities remain in marginalized populations across Asia, where parental adherence is essential to sustaining the Expanded Program on Immunization. This narrative review examines determinants of adherence among under-five children in disadvantaged communities. Following PRISMA guidelines, searches of PubMed, Scopus, and Google Scholar identified studies published between 2015 and 2025, with earlier key works included as relevant. Twenty-one studies from South, Southeast, and East Asia were analyzed. Five domains were associated with adherence: socioeconomic and access factors, where maternal education, household income, and possession of immunization cards were positive predictors, while remote residence was a barrier; trust, cultural beliefs, and social norms, with misinformation and vaccine controversies reducing uptake, and provider trust and supportive norms improving it; migration and mobility, as migrant, stateless, and left-behind children had lower coverage due to weak registration and disrupted caregiving; household and caregiver dynamics, where decision-making by family or community members shaped uptake, while large family size and maternal employment limited adherence; and health system capacity, with inadequate infrastructure and follow-up hindering coverage and integration with maternal–child health services facilitating it. Addressing these intersecting barriers through equity-focused strategies is critical to achieving universal immunization coverage. Full article

Palestinian female students from East Jerusalem face multiple forms of discrimination as Palestinians in Israeli universities, as women in traditional society, and as residents of a politically contested area. These intersecting challenges create unique difficulties that traditional educational systems cannot adequately address. Despite worldwide higher education expansion, severe inequalities persist, particularly affecting students with multiple disadvantaged identities who face institutional barriers designed to maintain disparities. This study examines how Palestinian women transform structural challenges into opportunities for empowerment within Israeli higher education. This qualitative research used in-depth semi-structured interviews with 40 Palestinian female students from East Jerusalem enrolled in Israeli institutions. Participants were recruited through snowball sampling until data saturation was achieved. An interview analysis examined educational choices, institutional navigation strategies, experiences of discrimination, cultural identity preservation, and career planning approaches using a thematic methodology. Seven interconnected themes emerged, highlighting empowerment strategies: strategic educational choice-making, institutional navigation skills, academic resilience development, cultural identity preservation, intercultural bridge-building, community-oriented career planning, and the development of critical political consciousness. The findings demonstrate how these women utilize community cultural strengths to succeed in environments not designed for their advancement, positioning themselves as institutional change agents rather than passive recipients of support. This research contributes to diversity science by revealing how intersectional marginalization creates distinctive forms of empowerment, providing insights for developing antiracist teaching approaches that recognize the cultural assets that multiply-marginalized students bring to higher education. Full article

In socio-economically disadvantaged communities, the challenges faced by children with special needs are often overshadowed by more visible issues such as poverty, family instability, and substance abuse. Children, especially those with special needs, are particularly vulnerable in these settings as they are disproportionately impacted by intersecting adversities, including neglect, exploitation, and limited access to education and healthcare. These adversities create a vicious cycle, where disability exacerbates financial hardship, and in turn, economic deprivation negatively impacts early childhood development, further entrenching disability. Conventional models, which require physical presence and focus primarily on diagnosis and treatment within clinical settings, often fail to address the broader social, environmental, and contextual complexities of disability. We propose an Information Technology-based Exit Pathway as an innovative, scalable solution to disrupt this cycle. Anchored in the five pillars of the Community-Based Rehabilitation (CBR) matrix of Health, Education, Livelihood, Social, and Empowerment, the model envisions a multi-level digital platform that facilitates coordinated support across individual, familial, educational, community, regional, and national levels. By improving access to services, fostering inclusive networks, and enabling early intervention, the proposed approach aims to promote equity, social inclusion, and sustainable development for children with special needs in marginalized communities. Full article

Preterm birth is a leading cause of perinatal morbidity and mortality and is particularly prevalent among socially disadvantaged female populations. This quantitative, cross-sectional study aimed to explore the prevalence of preterm birth in three segregated Roma communities in Hungary and to identify health behavior and care factors associated with its occurrence. In our study, preterm birth was defined as delivery before 37 completed weeks of gestation (i.e., <259 days). Data were collected from 231 Roma women living in three municipalities of Szabolcs-Szatmár-Bereg County, one of Hungary’s most disadvantaged regions, using a structured interview questionnaire. The participants were women aged 18–65 years. Of these, 209 had been pregnant at least once in their lifetime. The questionnaire covered socio-demographic characteristics (age, level of education, employment status, housing conditions, marital status), health behaviors (smoking, alcohol consumption, drug use, vitamin supplementation, other substance use), antenatal care attendance, and birth outcomes (preterm birth, gestational age, low birth weight, newborn status). Statistical analyses included descriptive statistics, chi-square tests, and binary logistic regression with significance set at p < 0.05. Preterm birth was significantly more common among women who smoked, consumed alcohol or drugs during pregnancy, or had vaginal infections. Drug use showed the strongest association with a 22-fold increase in risk, followed by alcohol (nearly fivefold), smoking (over threefold), and infections (threefold). Although non-attendance at antenatal care was associated with increased risk, this relationship was not statistically significant. In the multivariate logistic regression model, alcohol consumption (OR = 1.744, p < 0.01), smoking (OR = 2.495, p < 0.01), drug use (OR = 25.500, p < 0.001), and vaginal infections (OR = 4.014, p < 0.01) during pregnancy were independently associated with an increased risk of preterm birth, whereas folic acid supplementation (OR = 0.448, p < 0.05) showed a significant protective effect. These findings highlight that preterm birth is intricately linked to socioeconomic disadvantage and adverse health behaviors. Culture-specific, community-based prevention strategies are essential to reduce perinatal risks in marginalized populations. Full article

This study explores digital inequality as a socio-spatial phenomenon within the context of smart inclusion, focusing on the Regional Unit of Xanthi, Greece—a region marked by ethno-cultural diversity and pronounced urban–rural contrasts. Using a mixed-methods design, this research integrates secondary quantitative data with qualitative insights from semi-structured interviews, aiming to uncover how spatial, demographic, and cultural variables shape digital engagement. Geographic Information System (GIS) tools are employed to map disparities in internet access and ICT infrastructure, revealing significant gaps linked to geography, education, and economic status. The findings demonstrate that digital inequality is particularly acute in rural, minority, and economically marginalized communities, where limited infrastructure intersects with low digital literacy and socio-economic disadvantage. Interview data further illuminate how residents navigate exclusion, emphasizing generational divides, perceptions of technology, and place-based constraints. By bridging spatial analysis with lived experience, this study advances the conceptualization of digitally inclusive smart regions. It offers policy-relevant insights into how territorial inequality undermines the goals of smart development and proposes context-sensitive interventions to promote equitable digital participation. The case of Xanthi underscores the importance of integrating spatial justice into smart city and regional planning agendas. Full article

Background: Caregivers in urban settings often face unique challenges in providing nurturing care. This qualitative study explores the complex realities of caregiving among mothers and grandmothers in urban poor neighbourhoods of Bangalore, South India. Grounded in Bronfenbrenner’s ecological systems theory, this is the first study in urban India that examines how caregivers’ perceptions, along with individual and systemic factors, shape caregiving practices in this setting. Methods: In-depth interviews (IDIs) were conducted with 22 mothers and grandmothers of 4–6-year-old children from the urban MAASTHI cohort in Bangalore, South India. Topic guides were developed, pre-tested, and piloted. IDIs were conducted in local languages (Kannada and Hindi). Transcripts were coded using NVivo 12 plus and analyzed via a thematic analysis approach using Bronfenbrenner’s ecological systems framework to organize themes. Findings: At the microsystem level, caregivers engaged with children through storytelling and play, though competing demands like household chores often constrained these interactions. Disciplining techniques varied, and the absence of fathers placed additional burdens on mothers. The mesosystem revealed the critical role of extended family in providing support. At the exosystem level, unsafe neighbourhoods limited children’s opportunities for outdoor play. The macrosystem highlighted how religious values provided moral frameworks for parenting and the presence of stigma against single mothers. The chronosystem explored declining social support over time and challenges. Conclusions: These findings emphasize that caregiving inequities are not isolated but structurally embedded, demanding interventions that address sociocultural, economic, and spatial barriers to equitable support for caregivers, particularly those in disadvantaged settings. It calls for context-sensitive interventions, including community-based parenting programmes including maternal well-being, strengthening community and public support systems, improving safe play spaces, and longitudinal research. By amplifying marginalized caregivers’ voices, this research highlights the need for policies that support nurturing care in low-resource settings to break intergenerational cycles of disadvantage. Full article

Background: Increasing evidence shows that the COVID-19 pandemic has disproportionately impacted certain populations, particularly those facing structural marginalization, such as immigrants and refugees. Additionally, research highlights that structurally marginalized populations living with chronic conditions, such as cancer and/or mental health and addiction (MH&A) disorders, are more vulnerable to the adverse effects of COVID-19. These individuals face higher susceptibility to infection and worse health outcomes, including increased rates of hospitalization, severe illness, and death. To better understand the challenges faced by people living at the intersection of social and clinical disadvantages, we organized a series of Think Tank sessions to engage stakeholders in exploring barriers and identifying community-based solutions for immigrants and refugees living with cancer and/or MH&A disorders during the current and future pandemics. Objectives: Our main objectives were to gauge how earlier findings resonated with stakeholders, to identify any gaps in the work, and to co-develop actionable solutions to safeguard health and well-being during COVID-19 and future crises. Methods: Two virtual Think Tank sessions were held in September 2023 as integrative knowledge exchange forums. The Cancer Think Tank was attended by 40 participants, while the MH&A disorders Think Tank included 41 participants. Each group comprised immigrants and refugees living with or affected by cancer (in the Cancer Think Tank) or MH&A disorders (in the MH&A disorders Think Tank), alongside service providers, policymakers, and researchers from Ontario. This paper presents the key discussions and outcomes of these sessions. Results: Participants identified and prioritized actionable strategies during the Think Tank sessions. In the Cancer Think Tank, participants emphasized the importance of leveraging foreign-trained healthcare providers to address workforce shortages, creating clinical health ambassadors to bridge gaps in care, and connecting immigrants with healthcare providers immediately upon their arrival in Canada. In the MH&A disorders Think Tank, participants highlighted the need to remove silos by fostering intersectoral collaboration, empowering communities and building capacity to support mental health, and moving away from one-size-fits-all approaches to develop tailored interventions that better address diverse needs. Conclusions: The Think Tank sessions enhanced our understanding of how the COVID-19 pandemic has impacted immigrants and refugees living with cancer and/or MH&A disorders. The insights gained informed a series of actionable recommendations to address the unique needs of these populations during the current pandemic and in future public health crises. Full article

Effective wildfire smoke risk and evacuation communication is urgently needed to avert unnecessary deaths as wildfires increase in frequency and intensity. Human exposure to wildfires has doubled in the last two decades. Low-income, marginalized communities are the most disadvantaged in their ability to respond. A systematic literature review of wildfire and wildfire smoke risk communication research between 2014 and 2024 was conducted. Web of Science and Scopus databases were searched using the keywords “wildfire”, “communication”, “wildfire smoke”, “risk”, and “public health”, resulting in 23 studies. The findings revealed marginalized communities were ill-prepared to respond to wildfires and take protective action against wildfire smoke. The findings were summarized across eight areas: the needs of marginalized communities to respond to wildfires, the role of trusted messengers to disseminate wildfire and smoke risk messaging, using diverse channels, timing and frequency considerations for disseminating messages, time-sensitive evacuation versus wildfire smoke risk messaging, targeted messaging for subgroups, the importance of coordinating messages across agencies and local government, and government perspective. Theory did not guide these research efforts with the exception of one study, and most studies were qualitative. The literature did not report on distinguishing indoor from outdoor protective action against smoke risk, reaching vulnerable communities such as nursing and older adult facilities, and postfire messaging. Evidence is needed on these fronts, along with experimental messaging studies to determine the most persuasive messages for motivating protective actions against wildfire and smoke risk. Full article

Being both a driver and a manifestation of the current ecological, climate, and social crises, urban sustainability has become a major contemporary issue. Rather than framing the challenges that populations are confronted to as external factors, especially in deprived and segregated neighborhoods, we collected narratives about their experience of their living environments. Our work assumed an innovative interdisciplinary perspective in response to the complex interconnexions of the issues at stake. We aimed to highlight the significance of a situated perspective and an experience-based approach to fully embrace the idea of a research engaged with and for the communities, especially those suffering from marginalization and social deprivation. Our empirical results, rooted in expressions of place attachment (or not), in four disadvantaged neighborhoods in France, are presented in the form of a heuristic device, a non-normative framework that iteratively produced a representation with six dimensions that we called feelings. Together, they can be used to explore the manifestations of well-being, through place attachment related to one’s living environment, in a relational and open way, as people make sense of their place and possibly engage in its defense. We suggest further attention should be directed to concepts such as agency, freedom, and social recognition, as major conditions of the possibility of well-being or leading a good life. These dimensions could be major targets for policies trying to respond to the current sustainability challenges, such as social and environmental justice in the face of an unequal and changing world. Full article

Chronic hepatitis B (HBV), alongside hepatitis D virus (HDV) super-/co-infection and chronic hepatitis C (HCV), are major contributors to cirrhosis, end-stage liver disease, hepatocellular carcinoma (HCC), and liver-related mortality. Despite significant progress in antiviral treatments and HBV vaccination, viral hepatitis remains a global health burden. Vulnerable populations, such as those experiencing homelessness, migrants, and economically disadvantaged groups, are disproportionately impacted by these infections, often facing barriers to care and exclusion from traditional health systems. This leads to undiagnosed cases and ongoing transmission, undermining global efforts to eliminate HBV and HCV by 2030, as outlined by the World Health Organization (WHO). Recent studies highlight the importance of tailored interventions to address health inequalities. For instance, on-site community-based screening initiatives targeting marginalized groups have shown promise, achieving higher linkage to care rates without monetary incentives. These approaches not only enhance diagnosis but also facilitate integration into healthcare systems, addressing both public health and social disparities. This review underscores the need for targeted strategies to promote the early detection and management of HBV and HCV in underserved populations. Such efforts are critical to advancing the WHO’s elimination goals, improving health outcomes, and addressing the broader social determinants of health. Full article

Mitigating human–wolf conflict is crucial, yet conventional approaches often overlook the broader socioeconomic challenges faced by farming communities. Wolves frequently become scapegoats for deeper rooted issues such as economic disadvantages, policy deficiencies, and rural depopulation. We conducted semi-structured interviews with 118 livestock farmers to examine (a) farmer profiles and wolf-related interactions, (b) professional challenges and proposed solutions, (c) reasons for perceiving wolves as a major problem, and (d) the impact of wolf presence on job dissatisfaction. Farmers reported low specialized education and job satisfaction, particularly regarding income. Many struggled to afford or find shepherds, especially sheep/goat farmers. Guardian dog poisoning incidents and dissatisfaction with the damage compensation system were prevalent. Key challenges included economic marginalization, wolf presence, climatic factors, inadequate grazing policies, infrastructure deficits, distrust in policy, rural depopulation, and a lack of services. Farmers who perceived wolves as a major problem implemented weaker preventive measures and moved herds seasonally over longer distances. Job dissatisfaction was linked to wolf presence, livestock type, and economic marginalization. Our findings emphasize that while wolves impact farmers, economic and policy-related factors play a greater role. Educational initiatives, supportive policies, effective depredation mitigation, and fair compensation systems are essential for sustainable livestock farming and coexistence with wolves. By tackling socioeconomic challenges, enhancing policies, and supporting farmers to adapt to evolving circumstances, the livestock farming sector can thrive while minimizing conflicts associated with wolves. Full article

This study presents new empirical findings on the multidimensional barriers that disadvantaged communities must overcome to equitably access quality education and health services. Equitable access to education and health services in disadvantaged communities requires comprehensive public policies that address multidimensional barriers. Through an innovative econometric analysis of primary data collected in 50 rural communities, the most influential factors hindering access to these basic services are identified. This article discusses the most effective public policy strategies for improving access to and the quality of education and health services in disadvantaged communities, and outlines how to implement them sustainably and equitably. The results reveal that a lack of adequate infrastructure, a shortage of qualified personnel, and socioeconomic and cultural barriers are the main obstacles. Based on these findings, a new comprehensive intervention model is proposed, which simultaneously addresses these interconnected barriers. These strategies contribute directly to the Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being) and SDG 4 (Quality Education), by addressing critical barriers to equitable access to essential health and education services in marginalized communities. These strategies are based on theories that highlight the importance of investing in education and health for human and economic development, and support the fact that investments in these sectors boost productivity, income, well-being, and equity. The study concludes with practical and applicable recommendations for public policymakers, emphasizing the importance of adapting them to the local context and ensuring the active participation of the beneficiary communities. Full article