Search Results (742)

Background/Objectives: Pacifier use in infants has both beneficial and harmful implications, and dipping pacifiers in sweeteners is used by some parents to soothe infants. This study aimed to assess pacifier usage among mothers in Jeddah, Saudi Arabia, and to examine its association with child demographics, maternal socioeconomic status (SES), and maternal knowledge of the risks associated with dipping pacifiers in sweeteners. Methods: A cross-sectional study was conducted among mothers of healthy children aged 2 to 4 years during community-awareness events in Jeddah. Participants completed a validated Arabic questionnaire covering pacifier use patterns, feeding practices, SES background, and knowledge regarding the adverse effects of pacifier sweetening. Results: A total of 1438 mothers participated. The mean age of children was 34.3 ± 10.7 months, with 441 children (30.7%) reported as pacifier users. Among them, 202 (45.8%) used pacifiers both during the day and at night. Most children (35.6%) discontinued use between 4 and 6 months of age. Only 6.1% of mothers reported adding sweeteners to pacifiers. Pacifier usage was significantly higher among first-born children (37.6%, p < 0.001), those who received both bottle- and breastfeeding (65.5%, p < 0.001), and children enrolled in nursery (62.1%, p = 0.007). Most mothers (75.6%) were aware of the link between sweetened pacifiers and dental caries, and 69.4% of those who had this knowledge avoided giving their child a pacifier (p = 0.077). Conclusions: Birth order, feeding practices, and nursery attendance are key predictors of pacifier use. Enhancing parental awareness and education may support early interventions to promote healthier oral and feeding habits in young children. Full article

Tuberculosis (TB) remains a leading cause of death in Bangladesh, disproportionately affecting low socio-economic status (SES) populations. This review, guided by the WHO Social Determinants of Health framework and Rockefeller-Lancet Planetary Health Report, examined how social, economic, and ecological factors link SES to TB burden. The first literature search identified 28 articles focused on SES-TB relationships in Bangladesh. A second search through snowballing and conceptual mapping yielded 55 more papers of diverse source types and disciplines. Low-SES groups face elevated TB risk due to smoking, biomass fuel use, malnutrition, limited education, stigma, financial barriers, and hazardous housing or workplaces. These factors delay care-seeking, worsen outcomes, and fuel transmission, especially among women. High-SES groups more often face comorbidities like diabetes, which increase TB risk. Broader contextual drivers include urbanisation, weak labour protections, cultural norms, and poor governance. Recommendations include housing and labour reform, gender parity in education, and integrating private providers into TB programmes. These align with the WHO End TB Strategy, UN SDGs and Planetary Health Quadruple Aims, which expand the traditional Triple Aim for health system design by integrating environmental sustainability alongside improved patient outcomes, population health, and cost efficiency. Future research should explore trust in frontline workers, reasons for consulting informal carers, links between makeshift housing and TB, and integrating ecological determinants into existing frameworks. Full article

Identifying predictors of pro-environmental behaviors (PEBs) can not only figure out who concerns about the environment most but also inform possible pathways that advance or inhabit such prosocial actions. Most past studies and theories focus on factors that reside within personal characteristics or sociopsychological mechanisms rather than taking a holistic view that integrates these two elements into a framework. This study investigates how socioeconomic status (SES) correlates with PEBs, integrating both structural and psychological mechanisms. Drawing on the Stimulus–Organism–Response (SOR) theoretical framework, this paper examines the paradox whereby individuals with higher SES exhibit more frequent environmental actions yet demonstrate lower willingness to pay (WTP)—a form of economic sacrifice. Using nationally representative data from the 2021 Chinese General Social Survey (CGSS), our structural equation modeling reveals that adulthood SES positively correlates with environmental values and behaviors but negatively correlates with WTP. This challenges the traditional linear assumption that greater willingness necessarily leads to greater action. Additionally, while childhood SES predicts adult SES, it shows no direct effect on environmental engagement. These findings highlight multidimensional pathways by which SES shape environmental actions, necessitating differentiated policy approaches to build a sustainable world. Full article

Due to technological advancements such as generative artificial intelligence (AI) and large language models, chatbots enable increasingly human-like, real-time conversations through text (e.g., OpenAI’s ChatGPT) and voice (e.g., Amazon’s Alexa). One AI chatbot that is specifically designed to meet the social-supportive needs of youth is Snapchat’s My AI. Given its increasing popularity among adolescents, the present study investigated whether adolescents’ likelihood of using My AI, as well as their positive or negative emotional experiences from interacting with the chatbot, is related to socio-demographic factors (i.e., gender, age, and socioeconomic status (SES)). A cross-sectional study was conducted among 303 adolescents (64.1% girls, 35.9% boys, 1.0% other, 0.7% preferred not to say their gender; M_age = 15.89, SD_age = 1.69). The findings revealed that younger adolescents were more likely to use My AI and experienced more positive emotions from these interactions than older adolescents. No significant relationships were found for gender or SES. These results highlight the potential for age to play a critical role in shaping adolescents’ engagement with AI chatbots on social media and their emotional outcomes from such interactions, underscoring the need to consider developmental factors in AI design and policy. Full article

The changes in adolescents’ visions for the future are important to adolescents’ developmental trajectories, motivation, and educational outcomes, yet understudied. This study examined the change in possible selves and its association with grit during school closure and life interruption during COVID-19. We conducted a school-based longitudinal survey among 1577 students (Mage = 13.05, SD = 0.86) from 12 secondary schools at the start and end of an academic year prior to and during the COVID-19 pandemic with a 9-month interval. Demographic, grit, socioeconomic status (SES), self-control, and possible selves were measured. Paired t-tests indicated a significant decrease in academic possible selves and strategies. Hierarchical regression analysis results show that participants with higher grit scores reported higher academic and life possible selves; in particular, the effect of grit–perseverance was stronger than grit–passion after controlling self-control. SES moderated the effect of grit–passion on academic possible selves. The current longitudinal study provides important implications for education and youth social work practice for young people growing up with the influence of the pandemic. Full article

Background: Childhood hearing loss is a public health problem of critical importance associated with speech development, academic achievement, and quality of life. Parents’ awareness and knowledge about risk factors contribute to early detection and timely intervention.  Objective: This study aims to examine Jordanian mothers’ knowledge of childhood hearing loss risk factors and investigate the impact of education level and socioeconomic status (SES) on the accuracy and comprehensiveness of this knowledge with the moderating effect of health literacy. Material and Methods: The approach employed an embedded mixed-methods design with a dominant quantitative strand supported by qualitative data, utilizing quantitative surveys (n = 250), analyzed using structural equation modeling (SEM) in SmartPLS, and qualitative interviews (n = 10), analyzed thematically to expand upon the quantitative findings by exploring barriers to awareness and healthcare-seeking behaviors. Results: The accuracy and comprehensiveness of knowledge of hearing loss risk factors were also positively influenced by maternal knowledge of hearing loss risk factors. Maternal knowledge was significantly associated with both education level and socioeconomic status (SES). Furthermore, maternal knowledge and accuracy were significantly moderated by health literacy, such that mothers with higher health literacy exhibited a stronger relationship between knowledge and accuracy. Qualitative findings revealed that individuals encountered barriers to accessing reliable information and comprehending medical advice and faced financial difficulties due to limited options for healthcare services. Conclusions: These results underscore the need for maternal education programs that address specific issues, provide simplified healthcare communication, and enhance access to pediatric audiology services. Future research should explore longitudinal assessments and intervention-based strategies to enhance mothers’ awareness and detect early childhood hearing loss. Full article

Background: In rapidly aging societies like Japan, socioeconomic status (SES) plays a critical role in shaping older adults’ health behaviors. Disparities in SES influence access to healthcare, engagement in health-promoting activities, and the adoption of digital health technologies. This narrative review synthesizes current evidence on how SES affects health behaviors among older adults and highlights challenges in promoting equitable and sustainable healthcare in aging populations. Methods: A PubMed search was conducted for English-language articles published up to May 2025 using the keywords “socioeconomic status”, “older adults”, and terms related to health behaviors. Studies were included if they focused on individuals aged 65 or older and examined associations between SES and healthcare use, digital health, complementary and alternative medicine (CAM), supplements, or lifestyle behaviors. Results: A total of 24 articles were identified. Higher SES—typically measured by income, education, and occupation—was consistently associated with an increased use of preventive services, digital health tools, CAM, and healthier lifestyle behaviors such as diet, physical activity, and sleep. In contrast, lower SES was linked to healthcare underuse or overuse, digital exclusion, and less healthy behaviors. Structural and regional disparities often reinforce individual-level SES effects. Comorbidity burden and shifting health perceptions with age may also modify these associations. Conclusions: SES is a key determinant of health behavior in older adults. Policies should focus on redistributive support, digital inclusion, and SES-sensitive health system strategies to reduce disparities and promote healthy aging in super-aged societies. Full article

Background: Subjective socioeconomic status (SES) is a powerful determinant of health and well-being, capturing individuals’ perceptions of their material conditions and security. While higher perceived financial and basic needs security are generally linked to better health outcomes, little is known about how these associations differ across global contexts. Drawing on data from 23 countries, this study tests whether these relationships are systematically weaker in Global South countries. Methods: Cross-sectional data from Wave 1 of the Global Flourishing Study (n = 207,000) were used to examine associations between subjective SES indicators—financial security and security in basic needs (food, housing, safety)—and two outcomes: self-rated physical health and mental health. All variables were measured on 0–10 scales. Linear regression models were estimated separately by Global South and Global North country status, adjusting for age and sex. Global South classification was based on standard development and geopolitical frameworks. Results: In both global regions, individuals with higher perceived financial and basic needs security reported significantly better mental and physical health. However, the strength of these associations was consistently weaker in Global South countries. Interaction terms confirmed that Global South status moderated the association between subjective SES and health outcomes. Conclusions: These findings suggest global-scale “diminished returns” of subjective SES on health, echoing patterns previously observed within countries. Structural inequalities, weaker public systems, and contextual adversity may dilute the health benefits of perceived security in Global South settings. Global health equity efforts must therefore move beyond individual-level interventions to address the broader systems that constrain the translation of socioeconomic resources into health. Full article

Background: A national study from China in 2023 predicted that the prevalence of overweight and obesity among children aged 7–18 will increase from 23.4% in 2019 to 32.7% by 2030. Objectives: This study aimed to investigate the longitudinal association between parental feeding practices and children’s body composition and weight status, and to assess the mediation effect of parental feeding practices in the relationship between socioeconomic status and childhood body composition. Methods: This longitudinal observational study was conducted between September and November 2021 in eight primary schools located in Luohu District, Shenzhen. Baseline and two follow-up surveys were administered annually during the same period from 2021 to 2023 (with one-year intervals). A total of 620 third-grade students (aged 8–10 years at baseline) and their parents were ultimately included in the study. Associations between parental feeding practices and children’s weight status and body composition were analyzed using mixed-effects models. The mediation effect of parental feeding practices on the relationship between socioeconomic status and childhood body composition was assessed through bootstrapping analysis. Results: At follow-up, a significant upward trend in the prevalence of central obesity among children was observed. Among all parental feeding dimensions, perceived child weight (PCW) demonstrated a strong association with central obesity after Bonferroni correction (OR = 1.33, 95% CI = 1.16, 1.51); similarly, monitoring (MN) and concern about child weight (CN) were both significantly associated with central obesity as risk factors for central obesity (OR = 1.14, 95% CI = 1.06, 1.23; OR = 1.16, 95% CI = 1.07, 1.27), both p < 0.001. These associations were modified by baseline child sex, parental BMI, and maternal and paternal education levels. However, restriction (RST) was not significantly associated with either body composition or weight status. The relationship between family socioeconomic status (SES) and childhood overweight and obesity was mediated by pressure to eat (PE) (p < 0.05). Conclusions: MN, PCW, and CN are associated with an increased risk of obesity in children. However, no significant association was found between parental feeding practices and changes in children’s body composition. Full article

Mississippi has long been one of the most obese states in the U.S., with its obesity rates consistently exceeding the national average. The state’s severe obesity rate is also among the highest in the nation. This study utilized the 2011 to 2021 data from the Mississippi Behavioral Risk Factor Surveillance System (BRFSS) to conduct a comprehensive analysis of obesity and severe obesity trends in Mississippi by sex, age, and race and ethnicity. The data set included a BMI variable calculated by using self-reported height and weight, which the authors categorized into two obesity classification groups—obesity (BMI: 30.00 to 39.99) and severe obesity (BMI: 40.00 or greater)—and demographic characteristics such as sex, age, race and ethnicity. The data were analyzed using SAS 9.4 software to account for the complex design. Weighted prevalence estimates and associated standard errors (SEs) for obesity and severe obesity were calculated. Changes in the prevalence over time were assessed using logistic regression models. The prevalence estimates and SEs were exported to Joinpoint software to calculate the annual percentage change (APC) and associated 95% confidence intervals (CIs) and p-values for the trends. Our analysis of the data revealed a consistent increase in severe obesity, regardless of age, sex, or race. A concerning trend exists where individuals are moving from the obese category to the severely obese category, indicating a worsening trend in overall weight status. This is likely to accelerate the development of chronic disease and, hence, place additional strain on an economically disadvantaged state. Future research should explore the underlying drivers of this shift, including biological, behavioral, and socioeconomic factors, while also evaluating the effectiveness of existing obesity prevention and treatment programs. Full article

Introduction: This study aimed to explore the clinical and psychosocial characteristics associated with functional non-remission in young adults involuntarily hospitalized for a first episode of psychosis (FEP), focusing on the role of duration of untreated psychosis (DUP) and contextual vulnerabilities. Material and method: We conducted a retrospective monocentric study including 123 patients aged 18–30 who were involuntarily admitted between 2013 and 2023 for a first psychotic episode. Sociodemographic, clinical, and care-related data were extracted from medical records. Functional remission was defined as a Global Assessment of Functioning (GAF) score ≥70 at discharge. Univariate and multivariate logistic regressions were used to identify predictors of functional non-remission. Results: Only 48.8% of patients achieved functional remission at discharge. Social isolation, low socioeconomic status, unemployment, lack of structured activities, and a DUP ≥ 4 weeks were significantly associated with functional non-remission. After multivariate logistic regressions, DUP ≥ 4 weeks remained an independent predictor of functional non-remission. Conclusions: Involuntary admission per se was not a direct predictor of poor outcome. Our findings highlight the critical role of prolonged DUP and psychosocial vulnerability in the trajectory of early psychosis. Early detection strategies, psychosocial support integration, and individualized care planning are essential to improve outcomes among young people experiencing FEP under compulsory admission. Full article

Ensuring equitable access to higher education (HE) is not only a matter of social justice, but also a critical component to enhancing the long-term sustainability of modern societies. This study contributes to existing knowledge on socio-economic disparities in HE participation in Australia by identifying the extent to which key factors at the family, school, and individual levels mediate the relationship between socio-economic status (SES) and university enrolment. In doing so, it extends existing knowledge by simultaneously considering multiple factors at each ecological level, which enables us to disentangle their independent and joint influences on the SES differential in HE enrolment. To accomplish this, we analysed longitudinal data from the 2009 cohort of the Longitudinal Survey of Australian Youth (LSAY) using event-history models. Our findings reveal that students from lower-SES backgrounds are significantly less likely to enrol in university than their higher-SES peers, with persistent barriers emerging across multiple levels of influence. Indeed, after adjusting for cognitive skills, HE expectations, parental support, school climate, and access to learning resources, the estimated SES effect on HE participation was reduced by 68.6%. By systematically disentangling the relative contributions of these factors, this study provides critical insights into how sustainable education policies can be designed to mitigate social inequalities and promote inclusive growth. Intervention areas are discussed accordingly. Full article

Background: The present study seeks to examine how social disparities relate to the prevalence of poor glycemic control (HbA1c ≥ 7%), comorbidities such as hypertension and dyslipidemia, and diabetes-related complications (microvascular or macrovascular) among Saudi patients diagnosed with type 2 diabetes. Methods: A cross-sectional study was conducted among 574 patients with type 2 diabetes mellitus (T2DM) attending family medicine clinics at King Saud University Medical City in Riyadh. Participants were selected using a simple random sampling technique and interviewed via phone using a validated questionnaire. Data collected included demographic and clinical variables. Descriptive statistics and multivariate logistic regression analyses were performed to assess the association between socioeconomic status (SES) and cardiovascular complications, including stroke, dyslipidemia, hypertension, and acute coronary syndrome. Result: The analysis revealed that certain socioeconomic factors significantly increased the odds of cardiovascular complications among patients with T2DM. Being female was associated with higher odds of hypertension (OR = 2.29, p = 0.014), dyslipidemia (OR = 2.59, p = 0.012), acute coronary syndrome (ACS) (OR = 2.35, p = 0.001), and stroke (OR = 2.17, p = 0.003). Divorced or widowed participants had significantly increased odds of ACS (OR = 2.91, p = 0.001) and stroke (OR = 2.83, p = 0.002). A lower educational level (secondary school or less) was significantly associated with increased odds of hypertension (OR = 2.64, p = 0.031), dyslipidemia (OR = 2.22, p = 0.005), and stroke (OR = 2.88, p = 0.042). Monthly income between 3001 and 6000 SAR was significantly associated with higher odds of ACS (OR = 2.61, p = 0.003) and stroke (OR = 2.64, p = 0.012). Participants with diabetes duration >15 years had higher odds of dyslipidemia (OR = 2.86, p = 0.004) and stroke (OR = 2.89, p = 0.005). Being retired or not working increased the odds of all four cardiovascular outcomes, with stroke showing the highest risk (OR = 3.18, p < 0.001). Living outside the Riyadh region was also associated with elevated risk across outcomes, notably stroke (OR = 1.52, p = 0.046). Conclusions: The study concluded that notable social disparities exist among diabetic individuals affected by cardiovascular conditions, such as stroke and acute coronary syndrome (ACS), as well as risk factors for cardiovascular disease like dyslipidemia (DLD). These findings can inform targeted cardiovascular risk reduction strategies and address health inequities among diabetic populations in Saudi Arabia. Full article

Background and Objectives: Breast reconstruction following mastectomy improves quality of life and psychosocial outcomes, yet it is not consistently performed despite multiple federal mandates. Current data shows decreased reconstruction in minority races, those with a low socioeconomic status, and those holding public health insurance. Many barriers remain misunderstood or unstudied. This study examines barriers to post-mastectomy breast reconstruction to promote a supportive clinical climate by addressing multifactorial obstacles to equitable access to care. Materials and Methods: The California Cancer Registry Data Surveillance, Epidemiology, and End Results (SEER) database and California Health and Human Services Agency Cancer Surgeries Database (2013–2021 and 2000–2021, respectively) were used in this retrospective observational study on mastectomy with immediate breast reconstruction (IBR), delayed breast reconstruction (DBR), or mastectomy only (MO) rates. Data were collected on age, sex, race, insurance type, hospital type, socioeconomic status, and residence. Pearson’s chi-square analysis was performed. Results: We found that 168,494 mastectomy and reconstruction surgeries were performed (82.36% MO, 7% IBR, 10.6% DBR). The 40–49 age group received significantly less MO (38.1%) compared to the 70–74 age group (94.8%, (p = <0.001). Significantly more reconstruction was carried out in patients with private, HMO, or PPO insurance (IBR 75.86%, DBR 75.32%, p = <0.001). Almost all breast surgeries were in urban areas as opposed to rural/isolated rural areas (96.02% vs. 1.55%, p = <0.001). There was no significant difference between races. Of all surgeries, 7.46% were completed in a cancer center with significantly higher rates of IBR. LA County, San Luis Obispo/Ventura County, and Northern CA had significantly more MO than other regions (p = <0.001). Conclusions: Reconstruction rates after mastectomy are low, with only 17.64% of patients undergoing reconstruction. Nationally, 70.5% of patients received MO, with 29.6% undergoing reconstruction. Significant factors positively contributing to reconstruction were private insurance, high SES, cancer center care, and urban residency. Identified barriers include public health insurance enrollment, rural or non-urban residence, older age, low SES, and non-white race/ethnicity, indicating potential monetary influences on care. Full article

Strong emotional bonds within families are foundational to children’s academic, psychological, and social development. While family cohesion is widely recognized as a protective factor across these domains, there remains a need to understand the specific mechanisms and interventions that foster such cohesion, particularly in diverse socioeconomic and cultural contexts. This systematic review examines global evidence on factors influencing family cohesion and evaluates intervention strategies designed to strengthen familial relationships. Drawing on 41 peer-reviewed studies published between 2015 and 2023, this review adheres to PRISMA guidelines and applies the Mixed Methods Appraisal Tool (MMAT) to assess methodological quality. The findings are organized around four core dimensions of family cohesion—emotional bonding, adaptability, communication, and support—and highlight both common patterns and culturally specific mechanisms. Studies were drawn from a range of settings including North America, sub-Saharan Africa, Latin America, East and Southeast Asia, and Europe, enabling a cross-cultural analysis of how family cohesion operates under different social, cultural, and economic conditions. Intervention strategies are reviewed separately following the synthesis of correlations, with attention to their effectiveness, cultural relevance, and contextual adaptability. Community-based programs, trauma-informed therapies, and parenting interventions emerge as key approaches, though their success has varied by regional and structural context. Studies consistently demonstrate that higher family cohesion correlates with improved academic outcomes, as supportive home environments promote motivation, reduce stress, and enhance learning. Mental health benefits are also evident, with cohesive and adaptable families mitigating risks of anxiety and depression through open communication and emotional availability. Social competence is fostered through observed and practiced interpersonal skills within family settings. Socioeconomic status emerges as both a challenge and a moderating factor, with lower-SES families facing greater barriers to cohesion but also displaying notable resilience when supported through external interventions. Effective strategies identified include family therapy, parenting education, community-based programs, culturally sensitive approaches, and socioeconomic policy supports. Family cohesion and adaptability are critical to nurturing children’s academic success, emotional well-being, and social development. This review contributes to a more culturally nuanced and policy-relevant understanding of family cohesion by integrating empirical findings across global contexts and identifying both shared and differentiated pathways to resilience. The results inform future program design and suggest priorities for cross-cultural family research and intervention development. Full article