Search Results (4,718)

Social–emotional competence (SEC) is an important factor contributing to students’ academic success and psychological well-being. While research on SEC is widespread, studies within the unique demographic and ethnic context of the Arab minority in Israel remain scarce. This study examined SEC levels across three distinct educational subsystems (General Arab, Druze, and Bedouin), alongside gender and socioeconomic status (SES). A sample of 852 fifth- and sixth-grade students was recruited from 15 elementary schools in northern Israel. SEC was evaluated using an adapted 40-item self-report online questionnaire split into emotional and social subscales. A 3 × 2 factorial ANOVA revealed a significant main effect of the educational subsystem, with post hoc pairwise comparisons showing that Druze students scored significantly higher than both General Arab and Bedouin students. Intriguingly, independent t-tests revealed no significant differences in SEC based on gender, grade level or SES. These results suggest that cultural–ethnic background and distinct institutional contexts serve as the primary sources of variance in SEC in this cohort. However, given the regional scope and cross-sectional design of the study, these findings should be interpreted with caution. Key explanatory mechanisms, such as intergroup contact and communal belonging, were not directly measured and remain theoretical interpretations. Overall, the results highlight the need to move away from “one-size-fits-all” approaches in favor of culturally sensitive, localized interventions Full article

Background/Objectives: Parental depressive symptoms are consistently associated with children’s emotional and behavioral functioning, yet research has predominantly emphasized parent-to-child associations. Less is known about child-to-parent pathways and reciprocal processes, particularly across socioeconomic contexts. This study examined within-person reciprocal associations between parental depressive symptoms and children’s emotional and behavioral functioning across Grades 3–5 and tested whether these associations differed by household income status. Methods: Data were drawn from 5320 children (Mage = 9.10 years at Grade 3) in the Early Childhood Longitudinal Study, Kindergarten Class of 2010–11 (ECLS-K:2011), a nationally representative U.S. longitudinal study. Parental depressive symptoms and teacher-rated internalizing and externalizing behaviors were assessed annually. Random-intercept cross-lagged panel models (RI-CLPMs) examined within-person reciprocal associations, and multigroup RI-CLPMs tested income-group differences. Results: In the overall sample, parental depressive symptoms did not significantly predict subsequent internalizing or externalizing behaviors, whereas both child behaviors predicted subsequent parental depressive symptoms. Both the parent-to-child and child-to-parent pathways for internalizing behaviors differed significantly by household income status. Among lower-income families, parental depressive symptoms and children’s internalizing behaviors were reciprocally associated, whereas neither direction was significant among relatively higher-income families. In contrast, the cross-lagged associations for externalizing behaviors did not differ by household income status. Conclusions: Within-person reciprocal associations between parental depressive symptoms and children’s internalizing behaviors emerged among lower-income families but not among relatively higher-income families, suggesting that parent–child mental health processes may be more interconnected under socioeconomic disadvantage. Full article

Obesity and hypertension are among the major contributors to the prevalence of non-communicable diseases in South Africa. The link between obesity and hypertension poses a major risk for mortality due to cardiovascular disease. This scoping review study set out to provide a mapping of the current literature on the link between obesity and hypertension among adult South Africans, comparing the applicability of BMI measurements against central adiposity indices (waist circumference and waist-to-height ratio) and considering potential moderators such as age, gender, and urbanization. A search for eligible studies was conducted on PubMed (n = 149), Google Scholar (n = 235), ScienceDirect (n = 55), Cochrane Library (n = 10), and Scopus (n = 5) up to 25 February 2026. The PCC (Population, Concept, Context) framework guided study selection: Population—adults (15–70 years) in South Africa; Concept—prevalence, association, and moderators of obesity and hypertension; Context—South African community and clinical settings. A total of 25 studies were included in the review. The prevalence of general and central obesity was found to be higher in females, with rates of 60% and 90–95%, respectively. The prevalence of hypertension varied between 18% and 70%. A stronger correlation was observed in the case of WHtR with systolic blood pressure (r = 0.209, P = 0.04) and diastolic blood pressure (r = 0.279, P = 0.006). 1.75-fold increased odds of having hypertension were observed with an elevated BMI. This scoping review maps evidence showing that South Africa faces high rates of both obesity and hypertension. In studies that directly compared adiposity measures, central adiposity measures (WC and WHtR) were more strongly associated with hypertension than BMI, although not all studies conducted direct comparisons. Sex, age, and urbanization showed consistent patterns of association with the obesity–hypertension relationship. Age showed the most consistent pattern across studies, but formal interaction testing was performed in only one study, and no study formally tested urban/rural residence as an effect modifier. Identified areas for further research include a lack of longitudinal research beyond major cities, a limited number of studies on the impact of socioeconomic status as a moderator of this relationship, and a lack of interventions to test causality. Full article

Introduction: North Atlantic hurricanes have intensified over recent decades, contributing to excess mortality, particularly among lower-income populations residing in coastal regions. However, the differential impact of hurricane intensity on mortality rates by income and education levels remains poorly understood. Methods: A population-based study was conducted using the North Atlantic Accumulated Cyclone Energy (ACE) index to assess associations with annual region- and sex-specific all-cause mortality rates (ages 20–84 years) across 279 counties in the southeastern United States from 2014 to 2022. The analyses were carried out for nine years; the total number of observations in the model for the 279 counties was 5022 (i.e., 279 counties × 9 years × 2 sexes). Associations were adjusted for covariates and were conducted using negative binomial regression, with autocorrelative residuals. Counties were stratified by pairs of income and education levels (i.e., low income–low education; high income–high education; low income–high education and high income—low education). ACE periods were classified as normal, above normal (≥126 × 10⁴ kt²), and extreme (≥160 × 10⁴ kt²). Results: The adjusted relationship between ACE and mortality was linear. Without stratification of income and education, extreme ACE periods were associated with increased all-cause mortality [rate ratio (RR) 1.056; p < 0.001] compared to normal ACE periods. Stratified analyses revealed that all income and education levels exhibited significant associations between extreme ACE and mortality, with the strongest for the high-income and high-education group (RR 1.097; p < 0.001). Insignificant associations were observed in counties with other income–education combinations. This pattern may reflect the coastal concentration of high-income, high-education counties, leading to greater hurricane exposure. Conclusions: Hurricane-related mortality varies by combined income and education levels, with elevated risk in coastal counties with higher socioeconomic status. Further research is warranted to explore cause-specific mortality and refine public health interventions based on socioeconomic vulnerability. Full article

Background. Adolescents from low socioeconomic status households experience increased emotional distress and barriers to mental health care. Real-time moderated digital emotional support (MDES) may offer a scalable and low-barrier complement to formal services. Objectives. This study focused on state-level sentiment changes among government plan-sponsored adolescents and young adults who accessed a no-cost, 24/7, anonymous, real-time MDES service. Methods. The retrospective analysis included 1005 moderated live chats between March and December 2024 from 663 users aged 13–20. Sentiments were scored using a few-shot learning approach with GPT-4o-mini, evaluating sadness, stress, insecurity, loneliness, anger, anxiety, and optimism. Sentiment trajectories were mapped as conversations progressed and assessed using Wilcoxon signed-rank tests and effect sizes. Results. Significant improvements were observed in all sentiments throughout the conversations (all p < 0.001), with the greatest reductions seen for anger (46.94%, r = 0.87), loneliness (31.99%, r = 0.79), and stress (31.02%, r = 0.82). Smaller but also significant reductions in anxiety (29.81%, r = 0.79), sadness (28.64%, r = 0.81), and insecurity (24.17%, r = 0.75) were observed, with a substantial improvement in optimism (47.69%, r = 0.70). Conclusions. Among government plan-sponsored adolescents and young adults, use of anonymous, real-time MDES was associated with reduced negative sentiment and increased optimism expression. Given the higher burden of mental health concerns and barriers in this population, this service may serve as a scalable approach to expand access to emotional support. Full article

Background: Cancer treatment impacts the economic stability and financial burden of adults in interior British Columbia. Objective: The aim is to examine the association of perceived economic burden, impact, and treatment barriers of adult cancer survivors in interior British Columbia. Methods: A descriptive, cross-sectional research approach was employed, utilizing a Cancer Supportive Care Questionnaire survey (37 items) measuring perceived Economic Burden of Cancer (13 items), Impact of Cancer (13 items), and Cancer Treatment Barriers (11 items). Participants were eligible to participate if they were 18 years and above and had been diagnosed and completed cancer treatment. Results: One hundred fifty-one participants completed the survey questionnaires. Thirty-six percent (36.4%) of the participants reported ‘total or partial work productivity loss days’ being extremely affected, while 29.1% of the participants reported ‘diminished all financial savings’ being extremely affected, and 22.5% of the participants reported being extremely affected by ‘loss of job or employment’. Eighteen percent (18.5%) of the participants reported being extremely affected by ‘return to work’, while 15.2% of the participants reported being extremely affected by ‘financial stability’ and 13.9% of the participants reported ‘quality of life being’ extremely affected. Conclusion: Ethnicity, educational level, and employment status were significant with economic burden, impact of cancer, and treatment barriers, which highlighted the role of socio-economic and financial burden. Full article

Background/Objectives: Congenital heart disease (CHD) is associated with altered brain development and an increased risk of neurodevelopmental difficulties, particularly in more severe forms of the condition. Although alterations in functional brain connectivity have been reported before and after the first corrective surgery in early infancy, as well as in adulthood, little is known about their presentation in early childhood and their association with neurodevelopmental outcomes. This study aimed to characterize resting-state functional connectivity in 3-year-old children with moderate-to-severe CHD and to examine its associations with neurodevelopmental outcomes, including cognitive, language, and motor abilities. Methods: Twenty-five 3-year-old children with moderate-to-severe CHD and 28 age-matched healthy controls completed resting-state functional near-infrared spectroscopy (fNIRS) analysis and a standardized neurodevelopmental assessment. Connectivity was compared across networks using a repeated-measures analysis of covariance (ANCOVA), then within each network separately, controlling for maternal socioeconomic status and with sex as a factor. Associations with neurodevelopmental measures were examined using hierarchical linear regressions adjusted for group, sex, and socioeconomic status, with connectivity-by-group interactions tested. Results: Children with moderate-to-severe CHD showed lower resting-state functional connectivity than controls specifically within the right fronto-temporal network, with no group differences in the four remaining networks, as well as poorer language performance. Greater inter-hemispheric functional connectivity was associated with fewer executive function difficulties and better overall motor performance across participants, and greater frontal connectivity with better motor coordination, with no significant differences in these associations between groups. Conclusions: Preschool-aged children with CHD show regionally circumscribed alterations in functional connectivity and language vulnerabilities, while the associations between connectivity and executive and motor functioning appear to extend across both CHD and typically developing children. Full article

Background/Objectives: Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory disorder imposing massive global mortality and socioeconomic burden, with disproportionately high prevalence and suboptimal diagnostic rates in rural China. This study aimed to identify factors associated with two-dimensional diagnostic adherence—operationalized as a cognitive/psychological dimension (knowledge of diagnostic guidelines, perceived value of early diagnosis, and psychological readiness) and a behavioral dimension (completion of standard diagnostic procedures)—among COPD high-risk populations based on the Health Belief Model (HBM), and to explore the statistical mediating roles of health beliefs and social support. Economic toxicity refers to the financial burden of healthcare, including direct costs (copayments, medications) and indirect costs (transport, lost wages). Methods: A cross-sectional survey was conducted among 248 COPD high-risk individuals recruited via stratified random sampling in Pingdu District, Shandong Province, eastern China. A two-stage screening procedure was employed: first-stage screening at township health centers using portable spirometry, followed by referral for standard diagnostic evaluation at secondary or higher-level hospitals. Validated scales were applied for data collection, including the European Health Literacy Survey Questionnaire-Short Form (HLS-EU-Q16). Analyses included descriptive statistics, reliability/validity testing, Pearson and point-biserial correlations, multiple linear regression (cognitive outcome), multivariable logistic regression (behavioral outcome), and Hayes’ PROCESS macro with 5000 bootstrap samples. Benjamini–Hochberg false discovery rate correction was applied to multiple comparisons. Results: The mean cognitive dimension score was 4.935 ± 2.512, and the behavioral diagnostic completion rate was 42.3%. Independent predictors of cognitive adherence included health literacy (β = 0.286), health beliefs (β = 0.252), COPD knowledge (β = 0.239), living alone (β = −0.157), and economic toxicity (β = −0.108). Predictors of behavioral adherence identified via logistic regression were health literacy (OR = 1.28, 95%CI: 1.15–1.42), social support (OR = 1.12, 95%CI: 1.04–1.21), economic toxicity (OR = 0.82, 95%CI: 0.72–0.94), and medical accessibility (OR = 1.85, 95%CI: 1.12–3.05). Health beliefs statistically mediated 31.4% of the knowledge → cognitive adherence association and 36.9% of the economic toxicity → cognitive adherence association (cognitive outcome; behavioral indirect associations are reported on the log-odds scale with bootstrap confidence intervals). GAD-7 anxiety score was weakly correlated with adherence but not an independent predictor. Conclusions: Health literacy, health beliefs, and COPD knowledge are associated with higher COPD diagnostic adherence in rural high-risk populations in eastern China, while economic toxicity and living alone are associated with lower adherence. Health beliefs mediate the statistical associations between knowledge and economic status and cognitive adherence. Given the cross-sectional design, these findings should be interpreted as associations rather than causal effects. Dual-target interventions covering both cognitive and behavioral barriers are proposed as future strategies to optimize early COPD diagnosis in rural primary care. Full article

People experiencing socioeconomic disadvantage are disproportionately affected by micronutrient deficiencies, but evidence concerning the barriers to micronutrient-rich diets among disadvantaged populations in European settings is limited. This qualitative study (eight focus groups) explored the experiences of 68 beneficiaries of charitable organisations in Trieste, Italy (n = 26), and Olsztyn, Poland (n = 42) (i.e., food-assistance recipients and refugees, including asylum seekers). Data were analysed using thematic analysis informed by an adapted Availability, Accessibility, Acceptability, and Quality (AAAQ) framework. Participants described intersecting economic, physical, temporal, informational, social, cultural, and organisational barriers to accessing and consuming micronutrient-rich foods. High food prices and competing household expenses constrained food choice and variety, while transport, work schedules, cooking and storage restrictions, culturally incompatible provision, social influences, and limited access to professional guidance created additional barriers. Availability and perceived quality differed between retail, food-assistance, and accommodation settings. Participants generally preferred obtaining micronutrients through food, expressed predominantly negative attitudes towards fortified foods, and reported divergent attitudes towards food supplements. The study did not assess dietary intake or micronutrient status but identified perceived barriers that might increase vulnerability to inadequate intake. The findings support context-sensitive, multilevel responses spanning food assistance, social protection, public health, organisational provision, and nutrition communication. Full article

Objectives: Previous research has consistently shown that children living in single-parent families are at greater risk of overweight and obesity. However, the mechanisms underlying this association remain insufficiently understood. Socioeconomic disadvantage may represent an important pathway linking family structure to children’s weight outcomes. This study examined whether socioeconomic status (SES) mediates the association between single-parent family structure and children’s BMI z-scores. Methods: Data were obtained from the Croatian Childhood Obesity Surveillance Initiative (CroCOSI) conducted during the 2021/2022 school year. The sample comprised 5425 children aged 6–10 years. Family structure was specified as the independent variable, BMI z-score as the outcome variable, and SES as the mediator. Age, gender, region, and urbanicity were included as covariates in the mediation model. Results: Children living in single-parent families had significantly lower SES than children living in two-parent families. Higher SES was associated with lower BMI z-scores. The indirect effect of family structure on BMI z-score through SES was statistically significant, whereas the direct effect was not statistically significant. These findings indicate that SES mediates the association between single-parent family structure and children’s BMI. Conclusions: The findings suggest that socioeconomic disadvantage is an important mechanism linking single-parent family structure to childhood weight outcomes. Efforts to reduce childhood obesity should therefore extend beyond individual behavioral interventions and address broader socioeconomic inequalities affecting families. Policies aimed at improving the socioeconomic conditions of single-parent families may contribute to reducing disparities in childhood obesity and promoting healthier developmental outcomes among children. Full article

Background/Objectives: Pain is a major public health burden shaped by social and structural factors, yet cross-national evidence on how social determinants influence pain prevalence across socioeconomically diverse European settings remains limited. This study aimed to examine the associations between social determinants and the prevalence of pain in four European countries, and to explore how these associations vary by national context. Methods: We conducted a multinational secondary analysis of cross-sectional data from the third wave of the European Health Interview Survey (EHIS), using Eurostat microdata for Serbia, Bulgaria, Norway and Finland (n = 34,882 respondents aged ≥15 years). Pain prevalence was examined in relation to sociodemographic characteristics, health status, chronic conditions and behavioural determinants. LASSO-selected logistic regression models were fitted separately for each country. Results: Pain prevalence varied markedly across countries, ranging from 35.4% in Serbia to 69.9% in Finland (p < 0.001). Musculoskeletal disorders showed strong associations with pain in countries where this factor was retained in the models (OR range, 3.40–4.26), while accidents/injuries (OR range, 1.43–2.66), greater daily life limitations (OR range, 1.55–2.52), poorer self-rated health (OR range, 1.66–2.22), and female gender (OR range, 1.38–1.91) were consistently associated with higher odds of pain in all countries. The associations of education, employment, income, household composition, and behavioural factors with pain varied across national contexts and may reflect country-specific socioeconomic conditions. Conclusions: Pain prevalence was associated with a broad range of social, demographic and health-related factors, with the magnitude and direction of associations varying across national contexts. Pain prevention and management strategies should address both clinical characteristics and the broader social determinants of health, tailored to the national socioeconomic environment. Full article

With an aging demographic and increasingly stretched care services in many countries, the issue of unpaid care for older adults is a growing concern for families and policy makers alike. Empirical evidence highlights how unpaid caregiving can be a stressful and challenging experience. In this paper, we draw from and build on the stress process model, which conceptualizes caregiver well-being and mental health as outcomes of primary and secondary stressors within social context, as well as relational framing from intersectional life course theory and feminist political economics. Based on 57 in-depth interviews with unpaid caregivers for older adults across Canada, we articulate two non-mutually exclusive themes that add nuance to understandings of caregiver stress. First, many caregivers describe their caregiving in “plateaus and peaks,” with minimal stress much of the time and spikes in stress at moments of crisis and transition. However, there are outlier cases of chronically stressed carers, with evidence that gender, socioeconomic status and complex care situations inequitably shape caregiver experiences. Second, some care journeys involve “loops,” with care for one senior ending, followed by care for another beginning shortly thereafter, a novel articulation of multiple care which was found to influence caregiver decisions and meaning-making about care. Full article

Objective: We aimed to evaluate the association between pre-pregnancy excess weight and the adequacy of the ω-6/ω-3 ratio using a directed acyclic graph (DAG) to guide the selection of potential confounders. Methods: We conducted a cross-sectional study with 89 lactating women visiting a breast milk bank in Rio de Janeiro, Brazil. Pre-pregnancy excess weight was assessed using the body mass index according to World Health Organization criteria. ω-6 and ω-3 levels were determined by gas chromatography, and their ratios were calculated and categorized, with a ratio of greater than 10 being considered inadequate in accordance with dietary intake recommendations for these fatty acids. A DAG was constructed to identify a minimally sufficient set of confounders, including maternal age, socioeconomic status, parity, interbirth interval and food consumption patterns. Prevalence ratios were estimated using Poisson regression with robust variance. Results: The mean ω-6/ω-3 ratio was 10.8. Prevalence of inadequate ω-6/ω-3 ratio was higher in women with pre-pregnancy excess weight compared to women with normal pre-pregnancy weight. After adjusting for the confounders identified by the DAG, prevalence of inadequate ω-6/ω-3 ratio was higher among women with pre-pregnancy excess weight (PR = 1.35; 95% CI: 1.02–1.78). Conclusions: Pre-pregnancy excess weight is associated with an unfavorable breast milk lipid profile characterized by an imbalance in the ω-3 to ω-6 essential fatty acid ratio. The use of a DAG-based approach enables parsimonious and theoretically grounded adjustment for potential confounders, contributing to greater robustness of the findings. Our results underscore the importance of nutritional care strategies during the preconception period to promote maternal and child health. Full article

The paper utilises everyday bordering scholarship to examine why Liberian refugees in Ghana deliberately sought exemption from the cessation of refugee status in 2012 and how they navigate everyday borders in Ghana. The paper is based on primary qualitative data collected through in-depth interviews and analysed using reflexive thematic analysis. The findings show that participants’ decisions to remain as refugees were influenced by multiple and interconnected factors, including unresolved trauma, fear of insecurity in post-conflict Liberia, fear of spiritual harm, loss of social networks and livelihoods, and concern about their children’s education and future. Although Ghana was regarded as more peaceful than Liberia, exemption holders still experienced structural, socio-economic, cultural, and social forms of everyday bordering, alongside psychological bordering associated with memories of violence and perceptions of insecurity in Liberia. Participants also demonstrated agency in navigating these everyday bordering processes through informal livelihoods, social networks, and transnational ties, among other means. The study argues that remaining a refugee was a deliberate, protective response to different forms of insecurity and uncertainty. By highlighting the experiences of exemption holders, the article contributes to scholarship on borders, refugee governance, and protracted refugeehood in the Global South. Full article