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The health of incarcerated populations is intertwined with the health of security staff, but the social mechanisms, and especially the specific interventions, that might mitigate these health harms are underexplored. We examine one possible mechanism of interrelated health harms: whether and how jail security staff are willing and able to care for mentally ill detainees. We hypothesize that the attitudes of security staff towards care affect the well-being of everyone in a jail setting-staff, as well as detainees. Analyzing 539 anonymous respondent surveys administered to a stratified cluster sample of security staff working in a large U.S. county jail system, we (1) describe the prevalence of a perceived duty to care and availability of caring resources among security staff and (2) analyze whether variations in a duty to care and caring resources predict outcomes associated with staff and detainee well-being. Across five maximum likelihood models estimated, both perceived duty to care and availability of caring resources are significantly associated with collaborative relationships with medical staff, increased perceptions of personal safety, decreased frequency of hostile encounters, and better self-reported health outcomes. Our models explain 20 percent of the variation in self-reported health outcomes (R2 = .20), a meaningful effect of care on security personnel's well-being. Our findings suggest security staff have an often-overlooked duty to care akin to that experienced by healthcare staff. Among healthcare staff, dual loyalty trainings have successfully amplified caring duties relative to security duties; similar trainings for security staff might better leverage their caring duties to improve both staff and detainee well-being.

ObjectivesLatinos are about twice as likely to develop cognitive impairment. Culturally, filial support and familismo are expected within Latino families. Yet approximately twenty percent of Latinos live alone in the United States. The purpose of this study is to explore the concerns and priorities of older Latinos living alone with cognitive impairment, using a precarity framework.MethodWe conducted 22 in-home interviews with older Latinos living alone with cognitive impairment, and we supplemented the interviews with interviews with members of the older adults' social circle and providers. Themes influencing the precarity of Latino older adults living alone were organized through the major areas of the precarity lens; 1) Limited awareness of cognitive impairment; 2) Self-management of cognitive impairment; and 3) Lacking tailored services for cognitive impairment.ResultsLatino culture permeated and intersected across the lived experiences of participants living alone with cognitive impairment. Precarity was prevalent in all participants' lives and was exacerbated by familismo combined with cognitive impairment.ConclusionFindings showed precarity in the experiences the participants shared. Participant narratives reveal how the Latino culture intersects with the experience of precarity while living alone with cognitive impairment, especially in reference to the role that family plays through the expectation of familismo. However, given the difficult demands of employment and raising their own families, familismo can become more like a goal than a practice. Further research is needed to better understand how to bridge the gap between the needs of these older Latino adults living alone with cognitive impairment, their families, and formal services.

IntroductionContraceptive counseling during the perinatal period is an important component of comprehensive perinatal care. We synthesized research about contraceptive counseling during the perinatal period, which has not previously been systematically compiled.MethodsWe developed search criteria to identify articles listed in PubMed, Embase, and Popline databases published between 1992 and July 2022 that address patients' preferences for, and experiences of, perinatal contraceptive counseling, as well as health outcomes associated with this counseling. Search results were independently reviewed by multiple reviewers to assess relevance for the present review. Methods were conducted in accordance with PRISMA guidelines.ResultsThirty-four articles were included in the final full text review. Of the included articles, 10 included implementation and evaluation of a contraceptive counseling method or protocol, and 24 evaluated preferences for or experiences of existing contraceptive counseling in the perinatal period. Common themes included the acceptability of contraceptive counseling in the peripartum and postpartum periods, and a preference for contraceptive counseling at some point during the antenatal period and before the inpatient hospital experience, and direct provider-patient discussion instead of video or written material. Multiple studies suggest that timing, content, and modality should be individualized. In general, avoiding actual or perceived directiveness and providing multi-modal counseling that includes both written educational materials and patient-provider conversations was desired.DiscussionThe perinatal period constitutes a critical opportunity to provide contraceptive counseling that can support pregnant and postpartum people's management of their reproductive futures. The reviewed studies highlight the importance of patient-centered approach to providing this care, including flexibility of timing, content, and modality to accommodate individual preferences.

BackgroundYoung adult (18-30 years) people who inject drugs (PWID) face high hepatitis C virus (HCV) prevalence. In San Francisco, where >60% of PWID lack stable housing, barriers hinder HCV treatment access. We assessed progress towards the World Health Organization's (WHO) HCV elimination goal of an 80% reduction in incidence over 2015-2030, focusing on young (YPWID) and unstably housed PWID in San Francisco.MethodsWe developed a dynamic HCV transmission model among PWID, parameterized and calibrated using bio-behavioural survey datasets from San Francisco. This included 2018 estimates for the antibody-prevalence among PWID (77%) and care cascade estimates for HCV for YPWID (72% aware of their status and 33% ever initiating treatment). Based on programmatic data, we assumed a 53.8% reduction in testing and 40.7% decrease in treatment from 2020 due to the COVID-19 pandemic, which partially rebounded from April 2021 with testing rates then being 31.1% lower than pre-pandemic rates and treatment numbers being 19.5% lower. We simulated different scenarios of how services changed after the pandemic to project whether elimination goals would be met.ResultsContinuing post-pandemic rates of testing and treatment, the model projects an 83.3% (95% credibility interval [95% CrI]:60.6-96.9%) decrease in incidence among PWID over 2015-2030 to 1.5/100pyrs (95% CrI:0.3-4.4) in 2030. The probability of achieving the elimination goal by 2030 is 62.0%. Among YPWID and unstably housed PWID, the probability of achieving the elimination goal by 2030 is 54.8 and 67.6%, respectively. Importantly, further increasing testing and treatment rates to pre-pandemic levels by 2025 only results in a small increase in the probability (67.5%) of the elimination goal being achieved among all PWID by 2030, while increased coverage of medication for opioid use disorder among YPWID and/or housing interventions results in the probability of achieving elimination increasing to over 75%.ConclusionThe COVID-19 pandemic impeded progress toward achieving HCV elimination. Our findings indicate that existing partial rebounds in HCV testing and treatment may achieve the elimination goal by 2030, with an additional scale-up of interventions aimed at YPWID or unstably housed PWID ensuring San Francisco is likely to achieve elimination by 2030.

Primary care is at the forefront of healthcare delivery. It is the site of disease prevention and health management and serves as the bridge between communities and the health care system As ethnographers of primary care, in this article we discuss what is gained by situating anthropological inquiry within primary care. We articulate how anthropologists can contribute to a better understanding of the issues that emerge in primary care. We provide a review of anthropological work in primary care and offer empirical data from two ethnographic case studies based in the United States, one focused on social risk screening in primary care and the other examining the diagnosis and care of people with dementia in primary care. Through these cases, we demonstrate how research of and within primary care can open important avenues for the study of the multidimensionality of primary care. This multidimensionality is apparent in the ways the medical field addresses the social and structural experiences of patients, scope of practice and disciplinary boundaries, and the intersection of ordinary and extraordinary medicine that emerge in the care of patients in primary care.

RationaleHIV and cardiometabolic disorders including hypertension and diabetes pose a serious double threat in Malawi. Supportive couple relationships may be an important resource for managing these conditions. According to the theory of communal coping, couples will more effectively manage illness if they view the illness as "our problem" (shared illness appraisal) and are united in shared behavioral efforts.MethodsThis study qualitatively investigated communal coping of 25 couples living with HIV and hypertension or diabetes in Zomba, Malawi. Partners were interviewed separately regarding relationship quality, shared illness appraisal, communal coping, and dyadic management of illness.ResultsMost participants (80%) were living with HIV, and more than half were also living with hypertension. Most participants expressed high levels of unity and the view that illness was "our problem." In some couples, partners expected but did not extend help and support and reported little collaboration. Communal coping and dyadic management were strongly gendered. Some women reported a one-sided support relationship in which they gave but did not receive support. Women were also more likely to initiate support interactions and offered more varied support than men. In couples with poor relationship quality and weak communal coping, dyadic management of illness was also weak. Partner support was particularly crucial for dietary changes, as women typically prepared meals for the entire family. Other lifestyle changes that could be supported or hindered by a partner included exercise, stress reduction, and medication adherence.ConclusionWe conclude that gendered power imbalances may influence the extent to which couple-level ideals translate into actual communal coping and health behaviors. Given that spouses and families of patients are also at risk due to shared environments, we call for a shift from an illness management paradigm to a paradigm of optimizing health for spouses and families regardless of diabetes or hypertension diagnosis.

Southeast Asia (SEA) is a key producer and exporter of rice, accounting for around 28% of rice produced globally. To effectively mitigate greenhouse gas (GHG) emissions in SEA rice systems, field methane (CH4) and nitrous oxide (N2O) emissions have been intensively studied. However, an integrated assessment of system-level GHG emissions which includes other carbon (C) balance components, such as soil organic carbon (SOC) or energy use, that can positively or negatively influence the net capacity for climate change mitigation is lacking. We conducted a systematic review of published research in SEA rice systems to synthesize findings across four main components of net system emissions: (1) field GHG emissions, (2) energy inputs, (3) residue utilization beyond the field, and (4) SOC change. The objectives were to highlight effective mitigation opportunities and explore cross-component effects to identify tradeoffs and key knowledge gaps. Field GHG emissions were the largest contributor to net system emissions in agreement with existing scientific consensus, with results showing that practices such as floodwater drainage and residue removal are sound options for CH4 mitigation. On the other hand, increasing SOC potentially provides a large GHG mitigation opportunity, with long-term continuous rice cropping and practices such as residue incorporation and biochar application promoting SOC increase. A reduction in energy inputs was mainly achieved by optimizing agrochemical use, especially N fertilizers. For residue utilization beyond the field, GHG emission mitigation mainly came from preventing open field burning through residue removal. Removed residue can subsequently be used for producing energy that offsets GHG emissions associated with conventional fuel sources (e.g. fossil fuel-based electricity generation) or substituting material used in other production systems. Integrating all four components of net system emissions into one analysis underscores the following two main takeaways. First, the components of field GHG emissions and SOC change are the biggest opportunities for reducing net system emissions and need to be considered for effective climate change mitigation. Second, the reduction of C inputs through residue removal and increased soil aeration through multiple drainage will lower CH4 emissions but may also potentially decrease SOC stocks over time. Hence, we argue that future research needs to consider cross-component effects to optimize net system emissions, specifically the “stacking” of best management practices for mitigation related to field GHG emissions or SOC change in long-term experiments.

PurposeIn an effort to address persistent inequities in maternal and infant health, policymakers and advocates have pushed to expand access to doula care. Several states, including California, now cover doula services through Medicaid. As coverage expands, research on the impact of doula care will likely increase. To develop best practices for research, it is critical to engage community doulas, clients, and other key stakeholders.DescriptionOur overarching goal was to build capacity for future doula- and client-centered research on community doula care. First, we established a Steering Committee with members from seven relevant stakeholder groups: community doulas, former or potential doula clients, clinicians, payers, advocates, researchers, and public health professionals. Second, we conducted a needs assessment to identify and understand stakeholders' needs and values for research on community doula care. Findings from the needs assessment informed our third step, conducting a research prioritization to develop a shared research agenda related to community doula care with the Steering Committee. We adapted the Research Prioritization by Affected Communities protocol to guide this process, which resulted in a final list of 21 priority research questions. Lastly, we offered a training to increase capacity among community doulas to engage in research on community doula care.AssessmentOur findings provide direction for those interested in conducting research on doula care, as well as policymakers and funders.ConclusionThe findings of our stakeholder-engaged process provide a roadmap that will lead to equity-oriented research centering clients, doulas, and their communities.

A wide range of digital innovations has changed property relations globally over the past fifteen years. What are we to make of these digital experiments with landed property? I argue we should not mistake their technological novelty for a break with the geographic and historical specificities of property relations. The yoking of property to modernity and civilization makes technological progress a fundamental part of how relationships to land are constituted and reconstituted, and in whose interests, throughout global capitalism. In this article, I situate 21st century housing market technologies within sedimented relations of landed property in the United States, showing the history of property innovation in the United States is also one of racialized wealth accumulation and dispossession. I interpret current anxieties about ‘robot landlords’ as anxieties about how the shifting landscape of property ownership appears to threaten the economic benefits associated with racial dominance.

This rejoinder engages with the commentaries on my article on ‘Digital experiments with landed property’ from Julien Migozzi and Sara Safransky. In my response, I share my reflections on the valuable provocations and interrelated themes offered in these generous commentaries. First, I argue that an especially distinctive aspect of digital experiments with landed property is the volumetric property relations they are generating. Second, I attend to subjectivities cultivated within and against digitised property relations, and how they relate to structures of power. Third, I extend my thinking on the glitchiness and fallibility associated with processes of experimentation.

Abstract: Great effort has been invested in increasing STEM achievement among students, but feelings of low status among underrepresented or otherwise vulnerable students may be creating additional challenges. The present study assessed how perceptions of social status within the classroom—termed subjective social status—aligned with objective course performance and differed by sex, first-generation status, work status, and race/ethnicity among 713 students enrolled across three introductory statistics classes. Findings indicated that final exam score was moderately related to ratings of subjective social status, suggesting that factors besides objective course performance may influence classroom subjective social status. When asked to explain how they evaluated their standing in the course, students reported five main themes, including both academic achievement with respect to exam scores and their understanding of course content. When examining differences by status-based identities in subjective social status, we found that female and first-generation students had lower subjective social status compared to their male and continuing-generation peers, although results were less robust for first-generation status. Likewise, working students reported lower subjective social status relative to non-working students, despite showing no difference in final exam score. In contrast, although Asian/Asian American students outperformed Latine students, there were no differences in reports of subjective social status between Asian/Asian American, Latine, and white students. Taken together, results suggest that factors beyond course performance may relate to students’ subjective social status, and subjective social status may contribute to disparities in academic performance, especially by sex and work status.

IntroductionAdverse childhood experiences (ACEs) are common and have been associated with poor developmental outcomes. We aimed to investigate the relationship between early ACE exposure, subsequent diagnosis of developmental delay, and receipt of developmental delay services by young children. In addition, we aimed to assess the impact of health-promoting behaviors such as breastfeeding and daily reading on these relationships.MethodsIn this cross-sectional analysis of nationally-representative data from the 2017-2018 National Survey of Children's Health, we examined the relationship between ACEs, prior breastfeeding, daily reading, and developmental delay diagnosis among 7837 children aged 3-5 years, using multivariate logistic regression to adjust for family, personal, and sociodemographic characteristics.ResultsWe found a dose-dependent relationship between ACEs and developmental delay diagnosis; compared to those without ACEs, developmental delay was more common among those with either one ACE (aOR = 2.03, 95% CI 1.17-3.52) or two or more ACEs (aOR = 2.34, 95% CI 1.25-4.37). Neither breastfeeding (exclusively breastfed for 6 months vs. never breastfed aOR = 0.70, 95% CI 0.33-1.46) nor daily reading (no reading versus daily reading aOR = 1.15, CI 0.57-2.33) were associated with incidence of developmental delay among study participants. There was no significant difference in receipt of services intended to meet developmental needs between children with and without ACEs.DiscussionChildren with very early ACE exposure are at increased risk for diagnosis of developmental delay. Early screening for ACEs and developmental delay may mitigate the early developmental manifestations of ACE exposure in vulnerable children.

Indigeneity, Autonomy, Indigenous Peoples, Latin America

Training district-level health officers and other mid-level health system managers revealed multiple contextual factors across political, administrative, and social axes affecting tuberculosis (TB) and TB control in Uganda. Individual relationships between local health, political, and media leaders affect efforts to inform the public and provide services, yet greater administrative coordination between national-level logistics, implementing partner funding, and local needs is required. Social challenges to TB control include high population mobility, local industries, poverty with high-density living and social venues, and misinformation about TB. Capitalizing on implementation knowledge and sharing data can overcome social geographic challenges to TB-prevention planning through strategic healthcare capacity-building at the district level.

California Proposition 56 increased the state tobacco tax by $2 per cigarette pack effective April 1, 2017. Between 2015-2020 San Francisco (SF) and some cities in Alameda County enacted local flavored tobacco sales restrictions. SF also increased its Cigarette Litter Abatement Fee, from $0.20/pack in 2015 to $1.00 in 2020. Compare the change in tobacco prices before (2015) and after (2019/20) the implementation of a $2 increase in tobacco excise tax and local flavored tobacco policies in SF and Alameda Counties. Descriptive study of the pre-to-post policy analysis design. We drew a proportional random sample of retailers (N=463) in SF and Alameda Counties, by city. Using multivariable, single- and multiple-level linear regressions, we compared inflation-adjusted average tobacco prices in 2015 vs. 2019/20 by county and by flavor policy, accounting for socio-demographics. Change in inflation-adjusted average tobacco prices in 2015 vs. 2019/20 by county and flavor policy, accounting for socio-demographics. Between 2015-2019/20, the increase in cigarette prices was higher than the $2 tax increase, and higher in SF than Alameda County (+$4.6 vs +$2.5). SF retailers stopped selling Newport menthol cigarettes and Blu brand menthol e-cigarettes in 2019/20. Adjusted average cigarette prices increased significantly more in SF and Alameda County cities with comprehensive or partial flavor policies versus cities without flavor policies (by $3.23 and $2.11). Local flavor policies affected menthol product availability and may have had positive spillover effects and indirectly increased pack prices.

In qualitative research, photographs and other visual data have been used with oral narratives in ethnography, interviews, and focus groups to convey and understand the perceptions, attitudes, and lived experiences of participants. Visual methodologies that incorporate photographic data include photo elicitation, which has varied approaches with the inclusion of photographs generated by researchers or participants, and Photovoice, which is a form of photo elicitation focused on participatory action research. Current literature provides insufficient guidance on a systematic coding process of visual data elements that could maximize capturing of visual data for qualitative analysis. We describe our rationale and process for developing a two-step systematic process for coding visual data, specifically photographs. The two-step systematic process for coding photographs involves coding the foreground (focal point) and then the background of the photograph, using separate codebooks. Application of this two-step coding approach resulted in surfacing additional rich data on the health-related contexts and environments in which participants lived. Incorporation of this methodology could enhance understanding of the context of health and generate ideas and new directions of inquiry.

IntroductionThe Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is among the largest U.S. social safety net programs. Although strong evidence exists regarding the benefits of WIC, take-up (i.e., participation among eligible individuals) has steadily declined in the past decade. This study addresses gaps in our knowledge regarding predictors of WIC take-up during this time.MethodsData were drawn from the 1998-2017 waves of the National Health Interview Study (NHIS), a serial cross-sectional study of the U.S.PopulationThe analytic sample included 23,645 children and 10,297 women eligible for WIC based on self-reported demographic characteristics. To investigate predictors of WIC take-up, we regressed self-reported WIC receipt on a range of individual-level predictors (e.g., age, nativity, income) and state- level predictors (e.g., unemployment rate, governor's political affiliation) using multivariable logistic regression. In secondary analyses, results were additionally stratified by race/ethnicity, time period, and age (for children).ResultsFor both women and children, older maternal age and higher educational attainment were associated with decreased take-up of WIC. Associations differed by race/ethnicity, time period, and state characteristics including caseload of other social programs (e.g., Medicaid).DiscussionOur study identifies groups that are less likely to take up WIC benefits for which they are eligible, thereby contributing important evidence to inform programs and policies to increase WIC participation among groups with lower take-up. As WIC evolves past the COVID-19 pandemic, special attention will be needed to ensure that resources to encourage and support the participation of racially and economically marginalized individuals are equitably distributed.

PurposeInvestigating transgender people's experiences sharing health information in clinical encounters may yield insights for family medicine clinicians.MethodsThis was a qualitative study using a community-based participatory research approach and interpretive description methodology. Seven qualitative focus groups were conducted with 30 transgender adults living in North America. We used purposive sampling to ensure diversity. The focus groups were transcribed verbatim, and 2 investigators independently reviewed and coded each transcript, then they mutually reviewed the transcripts, reconciled their coding, and summarized the codes into themes. Themes were reviewed with community members, participants, and uninvolved clinically oriented investigators for member checking and peer debriefing.ResultsFour themes were noted: (1) transgender people often perceive clinicians' questions as voyeuristic, stigmatizing, or self-protective; (2) patients describe being pathologized, denied or given substandard care, or harmed when clinicians learned they are transgender; (3) transgender people frequently choose between risking stigma when sharing information and risking ineffective clinical problem solving if clinicians do not have all the information about their medical histories; (4) improving the safety of transgender people is difficult in the context of contemporary medical systems.ConclusionsTransgender people often must choose between stigma and potentially suboptimal care. Improvements in medical culture, policies, procedures, and data collection tools are necessary to improve the quality and safety of clinical care for transgender people. Institutional and systems changes may be required to safely and effectively implement sexual orientation and gender identity (SOGI) data collection in clinical settings.

Given the potential for retraumatization among survivors of sexual violence engaged in research, we aimed to provide pertinent knowledge and exemplification of the integration of trauma-informed practice to research with survivors. Grounded in trauma-informed care, we discuss the need for trauma-informed research, drawing upon experiences and data from a longitudinal case-control study on sexual violence. Through trauma-informed research settings, we can improve research experiences for survivors of sexual violence, as demonstrated by positive experiences of participants in The THRIVE Study. By meeting the needs of survivors, researchers can increase participation while maximizing the research quality and advancement of research.

BackgroundPublic health experts have urged governments around the world to regulate newly legalized cannabis as they do alcohol to effectively and efficiently protect health. However, research evaluating the alignment of alcohol and cannabis policies is sparse. We assessed similarities and differences in local alcohol and cannabis control policies across California, and characterized localities adopting distinct policy approaches.MethodsUsing standard legal epidemiologic techniques, we collected and coded local alcohol and cannabis control policies relevant to public health for 12 California counties and all incorporated cities within them (N=241). We assessed whether localities were equally stringent on alcohol and cannabis policies by comparing overall restrictiveness (summed policy scores) and 9 specific provisions that applied to both substances. We captured distinct local alcohol-cannabis policy approaches using latent class analysis, and examined this classification in relation to local demographic, socioeconomic, political, and retail market characteristics.ResultsAll 241 localities permitted alcohol sales, while 71% banned cannabis sales. Among those that did not ban cannabis sales, more stringent alcohol policy scores were associated with more stringent cannabis policy scores (linear regression coefficient: 0.16 [95% CI: 0.07, 0.25]). Local governments rarely adopted the same provisions for alcohol and cannabis (e.g., limits on hours of sale, advertising restrictions), and only two regulated the co-location of cannabis and alcohol outlets. Localities that were restrictive on alcohol yet permissive on cannabis (12%) were more urban, politically progressive, and had more low-income and racial/ethnic minority residents. Localities that were more permissive on alcohol and restrictive on cannabis (51%) were more socioeconomically advantaged.ConclusionWe found few similarities between local alcohol and cannabis control policies. California's experience suggests that, as governments around the world legalize cannabis, lessons learned from regulating alcohol are not routinely applied to cannabis, particularly in communities distinguished by high social and economic advantages.

BackgroundThe cannabis industry has been described using the commercial determinants of health framework because it seeks to increase sales and profits through efforts to change the political environment. To increase understanding of these cannabis industry's efforts, this study describes cannabis industry campaign contributions in Colorado through an analysis of public records.MethodsWe reviewed datasets posted online at the Colorado Secretary of State's Transparent in Contribution and Expenditure Reporting (TRACER) Campaign Finance System. We generated descriptive data on cannabis industry contributions to elections and conducted regressions to identify predictors of contributions, and associations between lagged contributions and a legislator's cannabis industry score (how closely aligned lawmaker's legislative history is with the cannabis industry from -1 to 1).ResultsBetween 2005-2021, 429 cannabis-affiliated contributors gave $4,658,385 (2021 inflation-adjusted) to 512 electoral committees. Contributions came primarily from non-profits (45%), businesses (27%), and individuals (25%). After recreational legalization in 2012, contributions from non-profit donors with industry ties gave way to contributions from cannabis businesses, business owners, and lobbyists. Cannabis industry contributions to local and state-wide ballot initiative campaigns historically made up the majority of the industry spending, but contributions to candidate committees more than tripled between the 2009-2010 legislative cycle and the 2019-2020 cycle. From 2017-2020, every $10,000 in lagged campaign donations from cannabis industry affiliated contributors was associated with a 0.245-point increase in a legislator's cannabis industry score (p=0.04).ConclusionCannabis-affiliated interests made substantial campaign contributions in Colorado. Public health advocates should monitor industry connections to lawmakers and industry tactics used to mask the source of political contributions. Continued surveillance of the cannabis industry is essential to exposing conflicts of interest and preventing undue industry influence.

Adding manure to croplands restores carbon and nutrients in depleted soils, while addressing a waste disposal need. This practice depends on the abundance and activity of microbial communities to break down manure inputs, which provide carbon for microbial growth and release nutrients for plant and microbial uptake. In a 2-year field study, we measured changes to soil physicochemical properties and microbial community composition in a conventional rotation of summer sileage corn and winter wheat. Three ratios of manure to mineral N fertilizer were used: all manure (100% of plant N from manure), mixed (50% plant N from by manure and 50% from mineral fertilizer), and all mineral (100% plant N from mineral fertilizer). Yields of corn and wheat were similar across treatments. Soil microbial community dissimilarity increased with higher ratios of application, suggesting a dose-dependent relationship between manure application and microbial community composition. Both microbial biomass and dissolved organic carbon showed the greatest response immediately following manure application, then decreased until the next application. The Shannon index increased shortly after manure application, with the largest increase observed in soils receiving manure input. Many of the taxa that increased in relative abundance following manure application were specifically taxa known to be present in manure and not common or present in soil before manure application. Microbial community changes following manure application were transitory, indicating that without continual inputs of resources, these alterations are not maintained. This was in contrast to microbial biomass which slowly increased in size over the 2-year study period. Better understanding of how manure interacts with microbial communities will help in developing better nutrient management practices and help reduce our reliance on mineral fertilizers.

Rurality has served as a key concept in popular and scientific understandings of the US overdose crisis, with White, rural, and low-income areas thought to be most heavily affected. However, we observe that overdose trends have risen nearly uniformly across the urban-rural designations employed in most research, implying that their importance has likely been overstated or incorrectly conceptualized. Nevertheless, urbanicity/rurality does serve as a key axis to understand inequalities in overdose mortality when assessed with more nuanced modalities-employing a more granular analysis of geography at the sub-county level, and intersecting rurality sociodemographic indices such as race/ethnicity. Using national overdose data from 1999-2021, we illustrate the intersectional importance of rurality for overdose surveillance. Finally, we offer recommendations for integrating these insights into drug overdose surveillance moving forward.

IntroductionWidowed women make up 18-40% of the 12 million women living with HIV in eastern and southern Africa. Widowhood has also been associated with greater HIV morbidity and mortality. We compared the effectiveness of a multisectoral climate adaptive agricultural livelihood intervention (called Shamba Maisha) on food insecurity, and HIV related health outcomes among widowed and married women living with HIV in western Kenya.MethodsWe implemented Shamba Maisha (NCT02815579) using a cluster-randomized control trial design. The intervention arm received an US$175 in-kind loan to purchase a micro-irrigation pump, seeds, and fertilizer, and received eight training sessions on sustainable agriculture and financial management. Study outcomes were measured every 6 months over a 24-month follow-up period and trends in outcomes assessed using multilevel mixed-effects models.ResultsThe trial enrolled 232 (61.5%) married and 145 (38.5%) widowed women. Widowed women (mean age 42.8 ± 8.4 years) were older than married women (35.8 ± 9.0 years) (p

Previous literature has demonstrated that peer support is instrumental for the promotion of adaptive academic and mental health outcomes; however, limited research has examined prospective directional associations between peer support and adjustment within college settings. The purpose of this study was to investigate the longitudinal associations between peer support, academic competence, and anxiety among U.S. college students. U.S. students from a diverse 4-year university (N = 251, 75% women, 24% men, and

Shifting cultural norms transform the uses and meanings of medical practices, and, in turn, medical practices have the capacity to alter social relations. In this article, I use hysterectomy as a case for understanding how reproductive health practices are constrained by and contribute to notions of gender, race, and stratified reproduction. Hysterectomy is regularly performed yet understudied and has been transformed by both technological advances and shifting norms in gender and reproduction. I draw on 100 in-depth interviews with individuals who had, want, or are considering hysterectomy to treat chronic reproductive health conditions or as gender-affirming care for trans and gender-nonbinary (TGNB) individuals. These comparative groups shed insight across three gender groups (cis women, trans men, nonbinary) as well as across race. Findings show divergent patient–provider interactions ranging from physician support to provider coercion to gatekeeping. Similarly, the data reveal that hysterectomy evokes a wide range of reactions—from delight to neutrality to grief. These distinct reactions and interactions map on to gender, race, and ethnicity, revealing persistent reproductive stratification by social positionality. Bringing together feminist science and technology studies with intersectional theories of the body and reproductive justice, I show how stratified reproduction operates when gender identities vary and introduce the concept of opting into infertility.

BackgroundIn North America, overdose rates have steeply risen over the past five years, largely due to the ubiquity of illicitly manufactured fentanyls in the drug supply. Drug checking services (DCS) represent a promising harm reduction strategy and characterizing experiences of use and interest among people who inject drugs (PWID) is a priority.MethodsBetween February-October 2022, PWID participating in a cohort study in San Diego, CA and Tijuana, Mexico completed structured surveys including questions about DCS, socio-demographics and substance use behaviors. We used Poisson regression to assess factors associated with lifetime DCS use and characterized experiences with DCS and interest in free access to DCS.ResultsOf 426 PWID, 72% were male, 59% Latinx, 79% were experiencing homelessness and 56% ever experienced a nonfatal overdose. One third had heard of DCS, of whom 57% had ever used them. Among the latter, most (98%) reported using fentanyl test strips (FTS) the last time they used DCS; 66% did so less than once per month. In the last six months, respondents used FTS to check methamphetamine (48%), heroin (30%) or fentanyl (29%). Relative to White/non-Latinx PWID, those who were non-White/Latinx were significantly less likely to have used DCS [adjusted risk ratio (aRR): 0.22; 95% CI: 0.10, 0.47), as were PWID experiencing homelessness (aRR:0.45; 95% CI: 0.28, 0.72). However, a significant interaction indicated that non-White/Latinx syringe service program (SSP) clients were more likely to have used DCS than non-SSP clients (aRR: 2.79; CI: 1.09, 7.2). Among all PWID, 44% expressed interest in free access to FTS, while 84% (of 196 PWID) expressed interest in advanced spectrometry DCS to identify and quantify multiple substances.ConclusionsOur findings highlight low rates of DCS awareness and utilization, inequities by race/ethnicity and housing situation, high interest in advanced spectrometry DCS versus FTS, and the potential role of SSPs in improving access to DCS, especially among racial/ethnic minorities.

Environmental impact assessment (EIA) is a decision support tool that analyzes the environmental and social impacts of infrastructure projects. This paper focuses on the California Environmental Quality Act (CEQA), a law requiring EIA use in California, to examine where new infrastructure is proposed and whether EIA can shape infrastructure distribution and environmental justice through the review process. We analyze the temporal and spatial distribution of more than 7000 infrastructure projects and their environmental impacts as proposed under CEQA from 2011 to 2020. Using fixed-effects negative binomial regression to model the association between the number of initiated projects and existing socioeconomic and environmental conditions by census tract, and multinomial logistic regression to investigate determinants of a project's level of environmental review, we find an unequal distribution of infrastructure. We find that socio-economically vulnerable communities and those with greater burden of environmental pollution are less likely to be the site of newly proposed infrastructure, but that proposed projects tend to be beneficial, less-polluting infrastructure like parks or schools that could help redress past injustices. Moreover, projects proposed in vulnerable communities are less likely to receive the most stringent reviews or have their impacts mitigated. These findings suggest that CEQA interacts with distributive justice in contradictory ways. They also highlight the need to separately consider environmental amenities versus harms such that EIA processes do not stand as a barrier to constructing beneficial infrastructure in environmental justice communities.

No-till is often referred to as a climate change mitigation option, possibly with a stronger conviction, than as a practice to manage soil organic C (SOC) content. We conducted a global meta-analysis to evaluate the effect of no-till (NT) on SOC concentration (SOCc, g C kg−1 soil) and stock (SOCs, Mg C ha−1 land) across climate, soil texture, cropping systems, and no-till duration to appraise the priority-setting. Compared to conventional tillage, NT favoured a significant rise (ΔSOCc) of 38% in the 0–5 cm soil layer and a much lesser 6% increase in the 5–10 cm layer and no change beyond 10 cm. The temperate climate had nearly twice ΔSOCc in the 0–5 cm layer compared to other climates, while the tropical climate favoured sub-surface accumulation. Coarse- and medium-textured soils and the inclusion of legumes in crop rotation facilitated larger positive ΔSOCs under NT. The microbial biomass C was the most abundant C pool, with 61% and 23% increases under NT in 0–5 and 5–10 cm layers. A large ΔSOCc in aggregates also characterized the top 0–5 cm layer. The difference in SOCs was realized to a maximum 30 cm depth (5.4 Mg ha−1 or 14%) in favour of NT, although varying with the duration of its adoption. The contribution of NT in mitigating global anthropogenic greenhouse gas emissions is meagre, although it can substantially offset emissions from agriculture (17–58%). The benefit of NT in improving SOC is primarily restricted to the surface layer, which is potentially exposed, and therefore an increase could be short-lived. Nevertheless, a short-term gain in SOC is likely to enhance soil quality and crop productivity. Thus, NT may be promoted as a sustainable agricultural management practice rather than emphasizing its role as a potential climate change mitigation option.

PurposeThe complexities of modern civilization, coupled with challenges including systemic racism and climate change-related impacts, compel public health professionals to break down silos and collaborate towards the shared goals of protecting the wellbeing of current and future generations. This article highlights the growing collaboration between the Maternal and Child Health (MCH) and the Environment (ENV) Sections of the American Public Health Association (APHA) as members bring their collective focus to the protection of children's and pregnant people's environmental health.DescriptionThe MCH Section and the Children's Environmental Health (CEH) Committee of the ENV Section are collaborating on efforts to: inform key stakeholders?including public health and health care professionals, child care professionals, families, and youth?about environmental hazards and climate change impacts to children's and pregnant people's health and wellbeing; and provide tools and guidance about how to best protect these groups and how to advocate for climate action. The CEH Committee embraces a health equity paradigm and intentionally centers environmental, racial, and social justice as integral to effective children's health and climate change initiatives.AssessmentProjects to date include multiple joint sessions about children's environmental health and climate change at APHA's annual meetings, publications and various children's environmental health tools and resources, including a toolkit and lesson plan that equips public health professionals to provide guest lectures at their local high schools on climate change and health, and educational materials for caregivers on extreme heat, wildfires, and ticks and mosquitos.ConclusionThis collaboration could serve as a replicable model that can be applied to other interdisciplinary efforts seeking strategic partnerships to address complex health issues.

My grandfather was a prominent Jewish physician in Nazi Germany who escaped the Holocaust with his family but nevertheless came to a tragic end. As I, an American family physician, learned more about him, I was surprised by how much I identified with him. I was struck by how his success in his career had not been matched in other areas of his life, leaving him little to fall back on when his professional status was taken away. My grandfather's story has given me insights about him, my family, and myself and has taught me important lessons about the balance between professional and personal life.

IntroductionPregnancy is a time of increased vulnerability to mental health disorders. Additionally, the COVID-19 pandemic has increased the incidence of depression and anxiety. Thus, we aimed to assess mental health and associated healthy behaviors of pregnant people in California during the pandemic in order to contextualize prenatal well-being during the first pandemic of the twenty-first century.MethodsWe conducted an online cross-sectional study of 433 pregnant people from June 6 through July 29, 2020. We explored 3 hypotheses: (1) mental health would be worse during the pandemic than in general pregnant samples to date; (2) first-time pregnant people would have worse mental health; and (3) healthy behaviors would be positively related to mental health.ResultsMany of our participants (22%) reported clinically significant depressive symptoms and 31% reported clinically significant anxiety symptoms. Multiparous pregnant people were more likely to express worries about their own health and wellbeing and the process of childbirth than were primiparous pregnant people. Additionally, as pregnancy advanced, sleep and nutrition worsened, while physical activity increased. Lastly, anxious-depressive symptomology was significantly predictive of participant sleep behaviors, nutrition, and physical activity during the past week.DiscussionPregnant people had worse mental health during the pandemic, and this was associated with worse health-promoting behaviors. Given that the COVID-19 pandemic and associated risks are likely to persist due to low vaccination rates and the emergence of variants with high infection rates, care that promotes mental and physical well-being for the pregnant population should be a public health priority.

IntroductionWe sought to identify latent profiles of polysubstance use patterns among people who inject drugs in three distinct North American settings, and then determine whether profile membership was associated with providing injection initiation assistance to injection-naïve persons.MethodsCross-sectional data from three linked cohorts in Vancouver, Canada; Tijuana, Mexico; and San Diego, USA were used to conduct separate latent profile analyses based on recent (i.e., past 6 months) injection and non-injection drug use frequency. We then assessed the association between polysubstance use patterns and recent injection initiation assistance provision using logistic regression analyses.ResultsA 6-class model for Vancouver participants, a 4-class model for Tijuana participants and a 4-class model for San Diego participants were selected based on statistical indices of fit and interpretability. In all settings, at least one profile included high-frequency polysubstance use of crystal methamphetamine and heroin. In Vancouver, several profiles were associated with a greater likelihood of providing recent injection initiation assistance compared to the referent profile (low-frequency use of all drugs) in unadjusted and adjusted analyses, however, the inclusion of latent profile membership in the multivariable model did not significantly improve model fit.Discussion and conclusionsWe identified commonalities and differences in polysubstance use patterns among people who inject drugs in three settings disproportionately impacted by injection drug use. Our results also suggest that other factors may be of greater priority when tailoring interventions to reduce the incidence of injection initiation. These findings can aid in efforts to identify and support specific higher-risk subpopulations of people who inject drugs.

Abstract Despite increasingly programmatic politics and competitive elections, political clientelism remains an enduring feature of African politics. More so, while politicians rarely deliver on political promises, citizens continue to demand and participate in patron–client relations. While moral economy and instrumentalist accounts offer insight into the puzzling persistence of political clientelism, we offer an additional framework based on demands for social recognition. Beyond expectations of materialist exchange or the performance of cultural norms, citizens expect their political leaders to recognize them as dignified human beings and members of an identity group. Drawing on evidence from three diverse African contexts—urban Ghana, rural Senegal, and coastal Kenya—we argue that citizens engage in political clientelism as a vehicle for demanding three dimensions of social recognition: (i) To be seen and heard by leaders, (ii) to be respected as agents in the political process, and (iii) to be politically included and protected from harm. By providing new insights into the enduring logics of clientelism, citizen strategies amidst unequal power relationships, and the role of emotions in democratic politics, we aim to reconcile existing approaches and bring them into a more unified framework.

ObjectiveThe goal of this study was to examine if mental health and psychosocial well-being differed between middle-aged (MA; 40-59 years), younger-old (YO; 60-79 years), and older-old (OO; 80+ years) adults with respect to their trends, heterogeneity, and correlates.MethodsEighteen mental health and psychosocial well-being instruments were administered to 590 adults over age 40. Cross-sectional data also included self-report-based measures of sociodemographics, cognitive functioning, physical health and activity, and body mass index.ResultsAge trends across instruments varied in magnitude and shape, but generally supported an inverted U-shaped trend in mental health and psychosocial well-being, with small increases from MA to YO age (d = 0.29) and smaller declines from YO to OO age (d = -0.17). A U-shaped association between age and mental health heterogeneity was also observed. The strongest correlates of mental health and psychosocial well-being differed by age (MA: perceived stress; YO: successful aging; OO: compassion toward others), as did the associations of a flourishing versus languishing mental health and well-being profile.ConclusionsOur findings support the "paradox of aging," whereby declines in physical and cognitive health co-occur with relatively preserved mental health and well-being. Our findings indicate that variance in mental and psychosocial health does not increase linearly with age and support careful consideration of heterogeneity in mental health and aging research. Our findings also suggest that mental health and psychosocial well-being decouple from stress-related dimensions in MA and become increasingly associated with positive, other-oriented emotions in OO, broadly supporting socioemotional theories of aging.

BackgroundMaternal mortality is a public health crisis in the U.S., with no improvement in decades and worsening disparities during COVID-19. Social determinants of health (SDoH) shape risk for morbidity and mortality but maternal structural and SDoH are under-researched using population health data. To expand knowledge of those at risk for or who have experienced maternal morbidity and inform clinical, policy, and legislative action, creative use of and leveraging existing population health datasets is logical and needed.MethodsWe review a sample of population health datasets and highlight recommended changes to the datasets or data collection to better inform existing gaps in maternal health research.ResultsAcross each of the datasets we found insufficient representation of pregnant and postpartum individuals and provide recommendations to enhance these datasets to inform maternal health research.ConclusionsPregnant and postpartum individuals should be oversampled in population health data to facilitate rapid policy and program evaluation. Postpartum individuals should no longer be hidden within population health datasets. Individuals with pregnancies resulting in outcomes other than livebirth (e.g., abortion, stillbirth, miscarriage) should be included, or asked about these experiences.

Linking science with action affords a prime opportunity to leverage greater societal impact from research and increase the use of evidence in decision-making. Success in these areas depends critically upon processes of producing and mobilizing knowledge, as well as supporting and making decisions. For decades, scholars have idealized and described these social processes in different ways, resulting in numerous assumptions that now variously guide engagements at the interface of science and society. We systematically catalog these assumptions based on prior research on the science-policy interface, and further distill them into a set of 26 claims. We then elicit expert perspectives (n = 16) about these claims to assess the extent to which they are accurate or merit further examination. Out of this process, we construct a research agenda to motivate future scientific research on actionable knowledge, prioritizing areas that experts identified as critical gaps in understanding of the science-society interface. The resulting agenda focuses on how to define success, support intermediaries, build trust, and evaluate the importance of consensus and its alternatives – all in the diverse contexts of science-society-decision-making interactions. We further raise questions about the centrality of knowledge in these interactions, discussing how a governance lens might be generative of efforts to support more equitable processes and outcomes. We offer these suggestions with hopes of furthering the science of actionable knowledge as a transdisciplinary area of inquiry.

ObjectivesQuality of life (QoL) is an important consideration for people living with HIV (PWH). We investigated the relationship between stress, psychological resources, and proactive behaviors, on QoL (conceptualized as life satisfaction, successful aging, and depressive symptoms) by testing the hypotheses: (1) greater life stress (stress and functional impairment) is associated with poorer QoL; (2) resources (mastery, resilience, and social support) are associated with better QoL, beyond the influence of stress; and (3) proactive behaviors (medication management and leisure activities) mediate the relationship between resources and QoL.MethodsSecondary analyses were performed (N = 128 PWH). Participants' mean age was 52.3, 83.6% were male, and 53.9 identified as white. Multivariate regressions were performed within the context of path analyses.ResultsIn series 1, greater stress was associated with poorer life satisfaction (p