Search Results (37)

Background/Objectives: The Supplemental Nutrition Assistance Program (SNAP) is the largest food assistance program in the United States providing income-eligible households with cash-like assistance to spend on food. In October 2021, a historic policy change permanently increased benefit amounts by 21 percent. This study assessed differences in diet quality and food security, supplemented by participant descriptions of using SNAP, among adults with low incomes residing in the state of Massachusetts from before (October 2020–January 2021) to after (December 2021–February 2022) the benefit increases. Methods: Derived from The Greater Boston Food Bank’s Annual Statewide Survey, our sample included adults with household incomes ≤300% of the federal poverty level who completed diet and food security measures. We calculated Prime Diet Quality Scores (PDQSs), with higher scores reflecting more nutritious diets on a scale of 0–70. Adjusted difference-in-difference regression models evaluated differences in PDQS and food security between SNAP participants and non-participants from before to after the benefit increases. Reflexive thematic analysis of write-in responses summarized experiences with SNAP. Results: Complete data were available for 1051 respondents before and 801 respondents after SNAP benefit increases. We found no significant differences in diet quality or household food security for SNAP participants, compared to non-participants, from before to after the benefit increases. In write-in comments, respondents expressed gratitude for increased benefits but also fear of them being rescinded. Increased benefits helped some better meet food needs, yet many noted rising costs of living prevented benefits from stretching as far. Conclusions: Increased SNAP benefits did not impact food security or diet quality among this sample. SNAP benefits may need to be further increased to meet the nutritional needs of families. Full article

Background/Objectives: Classism, or discrimination based on social class, is associated with higher levels of depression and anxiety symptoms. However, limited research has examined the psychological processes that may help explain these associations. The present study tested whether perceived stress statistically mediated the associations between experienced and anticipated classism and mental health symptoms. Methods: A U.S. census-matched sample on age, gender, race/ethnicity, income, and census region (n = 1993) was analyzed. Missing data were addressed using Bayesian multiple imputation, and mediation models estimated total, direct, and indirect effects. Results: Results indicated that perceived stress statistically accounted for the associations between both experienced and anticipated classism and higher depression and anxiety symptoms, even after adjusting for income and education. In exploratory analyses, individuals living at or below the federal poverty line reported a higher likelihood of experiencing classism, and perceived stress significantly mediated the association between experienced classism and mental health symptoms within this population. Conclusions: These findings provide preliminary evidence that perceived stress is a statistical mediator of the association between classism and mental health symptoms. Future prospective and experimental work is required to establish potential causal relationships between the constructs. Full article

While the association between food insecurity and adolescent obesity is well-established, the mechanisms through which these co-occurring public health crises are linked remain inadequately understood. Using the Social Ecological Model as a theoretical framework, this study examines how individual (physical activity), interpersonal (household food security), community (poverty level, residence), and societal (race/ethnicity) factors interact to influence adolescent weight outcomes. Cross-sectional data from 37,425 adolescents aged 12–17 years in the 2022–2023 National Survey of Children’s Health using weighted multinomial logistic regression with interaction terms were used. Adolescents experiencing nutrition insecurity (adequate quantity but poor-quality food) had 41% higher odds of obesity (adjusted odds ratio (aOR) = 1.41; 95% CI: 1.20–1.65), while those with food insecurity (insufficient quantity) had 48% higher odds (aOR = 1.48; 95% CI: 1.08–2.02) compared to food-secure peers. Significant effect modification emerged across ecological levels: poverty below the 200% federal poverty level (FPL) significantly amplified the food insecurity–obesity relationship (interaction p < 0.001), Hispanic and Black adolescents demonstrated 49% and 78% higher obesity odds, respectively, independent of household food and nutrition security status, and physical activity showed protective effects that varied by food security context (interaction p = 0.003). These findings underscore the necessity of multi-level interventions addressing structural inequities alongside individual behaviors to combat adolescent obesity in food-insecure populations effectively. Full article

Background/Objectives: The purpose of this article (a comparative analysis of state laws) is to thoroughly examine enacted state-level healthy universal school meals bills to summarize bill content and determine current practices for program implementation and long-term viability, with special attention to the Community Eligibility Provision (CEP). Methods: Bills enacted at the state level, as of 31 December 2025, were located electronically on state legislature websites and subsequently reviewed with rules, regulations, and implementation guidelines. Content analyses were conducted to identify patterns, themes, and key concepts pertaining to healthy universal school meals laws and program implementation guidelines to inform comparison policy analyses. Results: Nine states (California, Colorado, Maine, Massachusetts, Michigan, Minnesota, New Mexico, New York, and Vermont) have healthy universal school meals laws that include mandatory funding provisions for programming. Michigan is the only state that has a non-permanent law. Such laws eliminate requirements to certify individual students for free, reduced-price, or full-price meals based on their household income, and instead allow entire schools and/or school districts to offer all enrolled students no-cost meals. All states are funding healthy universal school meals programming by leveraging existing or new tax revenue to bridge the gap between the cost of school meals and federal meal reimbursements. Conclusions: State laws that leverage the Community Eligibility Provision (CEP) have become a key way to sustain universal school meal programs when federal funding falls short. States that direct resources to high-poverty schools, help districts determine the most accurate Identified Student Percentage, and reduce undercounting through strong direct-certification practices are better positioned to maintain universal meals over time. These strategies strengthen both child health and academic outcomes by ensuring stable access to no-cost, nutritious meals. Full article

Background/Objectives: Increasing popularity, convenience, and access to processed foods are shifting the composition of dietary intake from whole to ultra-processed foods (UPF). This study aimed to assess the association between periconceptional UPF consumption and the incidence of adverse pregnancy outcomes (APOs). Methods: This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b). Patients were excluded if they were missing periconceptional diet data or if their pregnancy ended before 20 weeks. Food Frequency Questionnaire items were categorized using the NOVA Scale to calculate the proportion of total energy intake comprised of UPF (% kcal/day). Bivariate and multivariate analyses examined the relationships between UPF intake and preterm birth, hypertensive disorders of pregnancy (HDP), gestational diabetes (GDM), small-for-gestational-age (SGA) infants, large-for-gestational-age (LGA) infants, and fetal or neonatal demise. Results: A total of 6693 participants were included in the analysis. The sample was predominantly White (78%) and not Hispanic (84%), and a majority of participants had commercial insurance (76%). UPF accounted for an average of 51.3 ± 12.7% of participants’ daily total energy intake. Mean UPF intake was higher among patients who identified as Black or non-Hispanic, patients with public insurance, less than a high school education, a household income below the federal poverty level (all p-values < 0.001), patients with chronic hypertension (p = 0.02), and patients who delivered vaginally (p = 0.002). Patients with preterm birth, HDP, SGA infants, and fetal or neonatal demise all had significantly higher proportions of daily UPF intake compared to patients without these adverse outcomes. After adjusting for potential confounders, higher UPF intake remained significantly associated with preterm birth (AOR 1.11, 95% CI 1.02–1.21) and HDP (AOR 1.05, 95% CI 1.001–1.11). Conclusions: On average, more than half of participants’ daily energy intake was from UPF, and higher UPF intake correlated with several adverse pregnancy outcomes. Future efforts should focus on improving nutritional literacy regarding UPF consumption in pregnancy. Full article

Background: Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are prevalent neurodevelopmental conditions in childhood. Beyond biological factors, social and environmental conditions influence developmental experiences and pathways to diagnosis. Nationally representative studies examining multiple social determinants in relation to ADHD, ASD, and comorbidity across recent years remain limited. Methods: We analyzed pooled cross-sectional data from six cycles (2018–2023) of the U.S. National Survey of Children’s Health, including 205,480 children aged 3–17 years. Parent-reported, clinician-diagnosed current ADHD and ASD were the primary outcomes; comorbid ADHD and ASD were examined secondarily. Social determinants included household income relative to the federal poverty level, parental education, health insurance type, food insecurity, and caregiver-reported neighborhood safety. Survey-weighted prevalence estimates and logistic regression models accounted for the complex sampling design and adjusted for demographic, family, regional, and temporal factors. Results: The weighted prevalence of ADHD was 9.7% and ASD was 2.9%; 1.1% of children had comorbid ADHD and ASD. Lower household income, food insecurity, unsafe neighborhood conditions, and lower parental education were associated with higher adjusted odds of both conditions. Boys had substantially higher odds of ADHD and ASD. After adjustment, non-Hispanic Black and Hispanic children had lower odds of ASD than non-Hispanic White children, consistent with differential identification rather than lower underlying prevalence. Comorbidity was concentrated among socially disadvantaged children. Conclusions: ADHD and ASD are socially patterned across U.S. children. Integrating developmental screening with assessment of social risks may support more equitable identification and intervention. Full article

Objectives: This study aims to explore the relationship between dental caries and unemployment among U.S. adults who have engaged in illicit drug use, such as cocaine, heroin, and methamphetamine. Methods: The National Health and Nutrition Examination Survey (2015–2018) data were analyzed. The independent variable was severe dental caries (defined as DMFT > 13.99), and the dependent variable was employment status. The sample was categorized into non-users, current users (used in the past year), and former users (used prior to the past year). Covariates included age, education, race, gender, smoking status, family income-to-federal poverty level ratio, and health insurance status. Logistic regression with survey weights was applied to assess associations between severe dental caries and employment status. Results: The total sample (n = 5476) represented 131,848,604 U.S. adults aged 18–59 years, with 4% current users and 12% former users of the specified drugs. Among current users, those with severe caries had higher odds of unemployment (OR = 2.6, p = 0.025) compared to those without severe caries. No significant association was found between severe caries and employment status among former users after controlling for covariates. Conclusions: The study underscores a significant association between severe dental caries and unemployment among U.S. adults who have used illicit drugs in the past year. These findings suggest a potential need for targeted oral health interventions in this population to improve economic well-being. Future research should focus on longitudinal studies to establish causality and explore mechanisms through which dental health may impact employment prospects. Full article

Fifty million Americans, nearly 15% of the population, live below the federal poverty level, often facing civil legal issues without representation. Historically Black Colleges and Universities (HBCUs) have long served as economic engines and vital resources for their communities. HBCU law schools uphold this legacy by preparing students for legal careers while instilling a commitment to service, particularly for underserved citizens who lack access to quality legal representation. This research examines the dual mission of HBCU law schools—educating students and serving local communities—through a systematic document analysis of publicly available materials and literature on law school clinical programs. The findings identify four key community performance indicators that define the community impact of HBCU law schools: advocacy, engagement, client outcomes, and representation. These indicators reflect a shared commitment across all institutions to addressing systemic inequities through clinical legal education, reinforcing the role of HBCU law schools as both training grounds for future attorneys and essential pillars of justice in their communities. Full article

Coal ash is a byproduct of coal-fired power plants, and the management and disposal of coal ash in coal ash pits is an environmental health concern. Evidence suggests that socioeconomically disadvantaged communities are more likely to bear the burden of these environmental hazards. However, limited studies have investigated the relationship between socioeconomic status and residential proximity to coal ash pits. We examined associations between census tract poverty and non-white race with the likelihood of having coal ash pits within the census tract. We obtained coal ash pit location and census tract-level data (2017–2021) of the percentage of the population living at or below the federal poverty level and the percentage of the population’s non-white race for 82,805 census tracts in the contiguous United States. We implemented multivariable logistic regression models to examine associations between non-white race, poverty, and the likelihood of having one or more coal ash pits in a census tract. Secondary analyses among tracts with at least one coal ash pit evaluated the associations between poverty, non-white race, and the likelihood of having multiple coal ash pits. Models additionally adjusted for census tract region. Census tracts in the highest quartile of poverty were over two times as likely to have one or more coal ash pits (OR = 2.23, 95% CI: 1.52, 3.25). Tracts in the highest quartile of the non-white population had 90% lower odds of having one or more coal ash pits as compared to the lowest quartile (OR = 0.10, 95% CI: 0.06, 0.17). Census tracts with higher levels of poverty were more likely to have one or more coal ash pits, and census tracts with higher non-white populations were less likely to have one or more coal ash pits, suggesting that these associations are complex and indicate an environmental justice issue. Full article

Pain is a prevalent issue among cancer patients, yet its link with socioeconomic status has not been thoroughly examined. This study investigated chronic pain (lasting ≥3 months) and high-impact pain (chronic pain limiting activities) among cancer survivors based on household income relative to the federal poverty level (FPL), using data from the National Health Interview Survey (2019–2020). Of the 4585 participants with a history of solid cancers, 1649 (36.3%) reported chronic pain and 554 (12.6%) reported high-impact chronic pain. After adjustment, participants with incomes < 200% FPL had significantly higher odds of chronic pain (adjusted odds ratio [aOR]: 1.60, 95% CI: 1.25–2.05) and high-impact chronic pain (aOR: 1.73, 95% CI: 1.09–2.74) compared to those with incomes ≥ 400% FPL. Opioid use for chronic pain was most prevalent among those with incomes < 200% FPL (28.3%) compared to those with 200–399% (21.3%) and ≥400% (19.0%). Higher-income participants reported greater use of alternative pain management methods such as yoga (50.5%), chiropractic care (44.8%), and physical therapy (44.3%). This study highlights the association between household income and chronic pain outcomes among cancer survivors, emphasizing the necessity for targeted interventions to mitigate healthcare access disparities and improve pain management for all individuals affected by cancer. Full article

The rising prevalence of CSHCN has led to significant challenges for caregivers, particularly mothers, who face difficulties from caregiving demands and managing complex healthcare interactions. The objective of this study was to examine the association between the medical complexity of CSHCN and the healthcare experiences of their mothers while exploring the influence of sociodemographic factors on these associations. The study utilized data from the 2016–2020 National Survey of Children’s Health (NSCH), involving 17,434 mothers of CSHCN. Mothers provided information on the medical complexity of CSHCN, healthcare experiences (care coordination, family-centered care, and shared decision-making), and sociodemographic information (race, community, insurance, child sex, age, and federal poverty level). Results from multiple regressions revealed that greater medical complexity was associated with more negative healthcare experiences. Minoritized mothers, those in rural areas, and families with lower income reported lower levels of family-centered care, indicating significant disparities. Additionally, the negative association between medical complexity and healthcare experiences was pronounced for White families and those with private insurance compared to minoritized families and those with public insurance. This study highlights the necessity for targeted interventions to improve care coordination, family-centered care, and shared decision-making, emphasizing the need for a comprehensive, family-centered approach to address healthcare disparities and promote health equity for CSHCN and their families. Full article

This study is the first to examine factors in the utilization of physician services, dentist services, hospital care, and prescribed medications focusing exclusively on insured children in the United States. Data describing 48,660 insured children were extracted from the 2021 National Survey of Children’s Health. Children in the present sample were covered by private health insurance, public health insurance, or other health insurance. Logistic regression results showed self-reported health to be negatively associated with physician visits, hospital-care use, and prescription use, but teeth condition to be positively associated with dentist visits. Physician visits were associated negatively with age, Hispanic ethnicity, Asian ethnicity, family income at or below 200% of the federal poverty level, and other health insurance, but positively with parental education and metropolitan residency. Dentist visits were associated positively with girls, age, and parental education, but negatively with Asian ethnicity and public health insurance. Use of hospital care was associated negatively with age and Asian ethnicity, but positively with parental education and public health insurance. Use of prescriptions was associated positively with age, Black ethnicity, parental education, and public health insurance, but negatively with Hispanic ethnicity, Asian ethnicity, and family income at or below 200% of the federal poverty level. Implications included the expansion of public health insurance, promotion of awareness of medicine discount programs, and understanding of racial/ethnic minorities’ cultural beliefs in health and treatment. Full article

This secondary data analysis of 1731 low-birth-weight children and their parents in the United States investigated children’s health and its associations with social disorganization, social structural factors, social relationships, health/mental health, and access to health insurance/services. The study drew on data from the 2021 National Survey of Children’s Health. Logistic regression yielded results showing low-birth-weight children’s excellent/very good/good health to be associated positively with parents’ education and health. In turn, child health was associated negatively with being Black, having a family income at or below the 100% federal poverty level, difficulty parenting the child, child chronic health condition(s), parent mental health, and substance use in the family. The implications of the present findings in terms of interventions promoting maternal and child health as well as participation in government assistance programs for low-income families are discussed. Full article

To evaluate associations between depression and/or anxiety disorders during pregnancy (DAP), delivery-related outcomes, and healthcare utilization among individuals with Michigan Medicaid-funded deliveries. We conducted a retrospective delivery-level analysis comparing delivery-related outcomes and healthcare utilization among individuals with and without DAP between January 2012 and September 2021. We used generalized estimating equation models assessing cesarean and preterm delivery; 30-day readmission after delivery; severe maternal morbidity within 42 days of delivery; and ambulatory, inpatient, emergency department or observation (ED), psychotherapy, or substance use disorders (SUD) visits during pregnancy. We adjusted models for age, race/ethnicity, urbanicity, federal poverty level, and obstetric comorbidities. Among 170,002 Michigan Medicaid enrollees with 218,890 deliveries, 29,665 (13.6%) had diagnoses of DAP. Compared to those without DAP, individuals with DAP were more often White, rural dwelling, had lower income, and had more comorbidities. In adjusted models, deliveries with DAP had higher odds of cesarean and preterm delivery OR = 1.02, 95% CI: [1.00, 1.05] and OR = 1.15, 95% CI: [1.11, 1.19] respectively), readmission within 30 days postpartum (OR = 1.14, 95% CI: [1.07, 1.22]), SMM within 42 days (OR = 1.27, 95% CI: [1.18, 1.38]), and utilization compared to those without DAP diagnoses (ambulatory: OR = 7.75, 95% CI: [6.75, 8.88], inpatient: OR = 1.13, 95% CI: [1.11, 1.15], ED: OR = 1.86, 95% CI: [1.80, 1.92], psychotherapy: OR = 172.8, 95% CI: [160.10, 186.58], and SUD: OR = 5.6, 95% CI: [5.37, 5.85]). Among delivering individuals in Michigan Medicaid, DAP had significant associations with adverse delivery-related outcomes and greater healthcare use. Early detection and intervention to address mental illness during pregnancy may help mitigate burdens of these complex yet treatable disorders. Full article

This study compared neurological complications among a national sample of United States children with or without sickle cell disease (SCD) and evaluated health status, healthcare and special education utilization patterns, barriers to care, and association of SCD status and demographics/socioeconomic status (SES) on comorbidities and healthcare utilization. Data was acquired from the National Health Interview Survey (NHIS) Sample Child Core questionnaire 2007–2018 dataset that included 133,542 children. An affirmation from the guardian of the child determined the presence of SCD. Regression analysis was used to compare the associations between SCD and demographics/SES on neurological conditions at p < 0.05. Furthermore, adjusted odds ratios (AORs) were estimated for having various neurological conditions. Of the 133,481 children included in the NHIS, the mean age was 8.5 years (SD: 0.02) and 215 had SCD. Of the children with SCD, the sample composition included male (n = 110), and Black (n = 82%). The SCD sample had higher odds of having neuro-developmental conditions (p < 0.1). Families of Black children (55% weighted) reported household incomes < 100% of federal poverty level. Black children were more likely to experience longer wait times to see the doctor (AOR, 0.3; CI 0.1–1.1). Compared to children without SCD, those with SCD had a greater chance of seeing a medical specialist within 12 months (AOR 2.3; CI 1.5–3.7). This representative sample of US children with SCD shows higher odds of developing neurological complications, increased healthcare and special education services utilization, with Black children experiencing a disproportionate burden. This creates the urgency to address the health burden for children with SCD by implementing interventions in healthcare and increasing education assistance programs to combat neurocognitive impairments, especially among Black children. Full article