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The high prevalence and costs of urinary incontinence and related pelvic floor disorders in adults highlights the need for competent nurses and advanced practice nurses who can provide high-quality continence and pelvic health care. However, challenges exist in recognizing this as a nursing specialty, preparing new and experienced nurses with specialty knowledge and skills, increasing the number and diversity of the workforce, and promoting individual achievement and professional recognition as a continence and pelvic health nursing specialist. This White Paper provides recommendations based on evidence and expert opinion to support the Society of Urologic Nurses and Associate's efforts in advancing the roles of registered nurses and advanced practice registered nurses in the expanded specialty area of continence and pelvic health nursing. [ABSTRACT FROM AUTHOR]

In this paper, we apply the reproductive justice framework to discuss how gendered racism disadvantages pregnant and parenting young Black women aging out of foster care. Specifically, we highlight the reversal of Roe v Wade as reflective of the United States' long legacy of efforts to control Black women's reproduction. We then discuss the structural factors contributing to the reproductive injustices of young Black women aging out of care, including a lack of access to sexual and reproductive health education, barriers to educational attainment, and foster care-based relational and placement deficits. We conclude with research, practice, and policy enhancements. [ABSTRACT FROM AUTHOR]

Purpose: Using a minority stress paradigm, this paper examines the relationship between anti-transgender discrimination, harassment, and violence among transgender adults. Methods: Data from the 2015 U.S. National Transgender Survey were used to examine twenty types of anti-transgender experiences/problems (e.g., harassment at work, problems with police officials, verbal and physical assaults) in a sample of 27,715 transgender Americans aged 18 or older. Binge drinking during the previous month was the dependent variable, and eight control measures were examined in the multivariate analysis. Results: Experiencing any of the twenty types of anti-transgender discrimination, harassment, or violence increased the odds of binge drinking by 48%. Experiencing many such problems increased the odds of binge drinking by 104%. Multivariate analysis showed that anti-transgender discrimination, harassment, and violence remains a predictor of binge drinking even when other key measures are taken into account. Younger people, racial minority group members, and persons who were not married or "involved" were at particularly great risk. Conclusions: Consistent with the minority stress paradigm, the more different types of anti-transgender experiences people had, the more likely they were to engage in binge drinking. Targeted intervention needs to help transgender persons to avoid anti-transgender discrimination, harassment, and violence to the greatest extent possible, and to develop resiliency skills whenever they are victimized. This is particularly true for transgender persons who are younger, minority, and not "involved" in a relationship. [ABSTRACT FROM AUTHOR]

This paper aimed to explore BDSM involvement and its effects on mental health. The study had four objectives: (1) quantify frequencies of BDSM self-labels, (2) describe patterns of BDSM involvement subtypes (i.e. fantasy, behaviour, and identity), (3) compare BDSM-related involvement among two samples: members of the National Coalition for Sexual Freedom (NCSF) and a non-NCSF sample of adults interested in or practicing BDSM, and (4) understand whether BDSM identity specialty interest group membership is associated with enhanced health (i.e. coping). Data were drawn from archival survey data on sexuality and health. Participants (N = 1036) completed BDSM identity and behaviour measures. The most common BDSM identities were 'dominant' and 'submissive'. NCSF members adopted BDSM identity labels more frequently compared to general adult BDSM practitioners. Dominant and submissive fantasy and behaviour varied by gender, sexual orientation, and relationship status. For example, cisgender men reported elevated patterns of dominant and lowered submissive BDSM involvement. Compared to non-NCSF members, NCSF members reported higher dominant and submissive fantasies and behaviours, and better mental health and emotion regulation. Finally, submissive fantasy involvement displayed statistically significant, but weak, positive associations with psychological health. Potential implications for public health practice, theory development, and future research are discussed. [ABSTRACT FROM AUTHOR]

INTRODUCTION The majority of decisions on electronic nicotine delivery system (ENDS) premarket tobacco product applications (PMTAs) were made from October 2020 to February 2023; 99% (>25 million) had determinations by March 2023 and just twenty-three received marketing granted orders. We examined the unique devices and liquids used among US adults frequently using ENDS before, during, and after a majority of PMTA decisions were made. METHODS Data are from waves 1-5 (W1: May-Oct 2020, n=1179; W5: Feb-Apr 2023, n=1290) of a longitudinal survey of US adults (≥21 years) using ENDS ≥5 days/week. User-submitted photos of participants' most used devices and liquids were coded. Descriptive analyses and Wilcoxon signed-rank tests were used to understand the number and types of unique devices and liquids used in W1-W5, and the top brands in each wave. RESULTS From W1-W5, the number of unique ENDS device models and liquid products used by participants increased from 279 to 357 (p<0.001) and 546 to 695 (p<0.001), respectively. More unique devices in W5 versus W1 were disposable (W1: 16.5%; W5: 36.1%); fewer were disposable pod (W1: 6.5%; W5: 3.1%) or tank (W1: 53.8%; W5: 30.8%) devices. Liquids were primarily sweetflavored (W1: 81.1%; W5: 82.0%). The median liquid nicotine concentration increased from 12 to 50 mg/mL. In W5, few participants used FDA-approved devices (n=17; 1.3%) or liquids (n=6; 0.5%), and Elf Bar was the most commonly used device and liquid brand. Results for all waves are reported. CONCLUSIONS Despite PMTA decisions, an increase in the number of unique device models and liquid products used among adults who frequently use ENDS was observed from 2020 to 2023. Few participants in 2023 were using FDA-approved devices or liquids. Further research and monitoring are needed to inform how FDA prioritizes enforcement actions and what types of enforcement actions are effective. [ABSTRACT FROM AUTHOR]

Objective: This one-year pilot study investigated the effectiveness of a multimedia campaign, Heart Healthy U (HHU), to increase awareness about the link between unhealthy behaviors and risk for heart disease among emerging adults on a college campus. This paper describes the implementation of HHU. Participants: The HHU campaign was implemented from the Fall of 2019 through Spring 2020 and during this time there were approximately 15,043 enrolled students at the south eastern U.S. college campus. Methods: The HHU campaign employed print (e.g., banners, posters, and yard signs) and electronic formats (e.g., email, Instagram). We designed the methods across three phases: (1) relationship building and formative research, (2) campaign development, and (3) the Heart Healthy U campaign launch. Results: The HHU encountered challenges when the novel coronavirus (COVID-19 or SARS-co-V2) interrupted campus life, however we relied on the electronic formats to reach students during the state-wide lockdown/quarantine mandates. In addition, there were two changes to the HHU health messages. First, we updated the health messages to illustrate that eating healthy and engaging in physical activity supports immune function. Next, we developed new health messages to address effects of physical isolation and anxiety by promoting psychological well-being during this historic public health crisis. Conclusions: We asked whether a multimedia campaign on a college campus could encourage emerging adults to consume fruits and vegetables and engage in physical activity according to the federally-recommended guidelines. It is essential that interventions intended to reach today's emerging adults be presented in formats that they use (e.g., social media platforms), supported by campus administrators, and endorsed by peer influencers. In conclusion, more intervention studies are needed to counter the unhealthy social norm behaviors common to college campus life that increase heart disease risk, particularly among marginalized populations. [ABSTRACT FROM AUTHOR]

This study enriches the literature on social networks and social capital by investigating how parental status potentially impacts social network diversity in adulthood. Using the 2018 iteration of the General Social Survey (GSS, n = 2348), a high quality nationally representative survey of the United States, we utilize latent class and regression analyses, finding that parental status, especially medium and cross-status occupational connections contribute to social capital in the form of network diversity. Yet, personal socio-economic factors, notably income and race, largely offset parental effects. This underscores the complexity of network composition, emphasizing the influential role of individual resources, attributes, and mobility in shaping social networks and forming bridging social capital. [ABSTRACT FROM AUTHOR]

Several measures have been developed to assess loneliness in the general population. Here, we examined if, and how accurately, widely-used measures capture the experience of loneliness in autistic adults. A total of 203 autistic participants from the UK completed an online survey, which included two widely-used loneliness questionnaires: the University of California, Los Angeles (UCLA) Loneliness Scale Version 3 and the Social and Emotional Loneliness Scale for Adults (SELSA). Participants completed the measures and provided their views on how well they captured their experiences of loneliness. A direct measure, asking participants how often they felt lonely, was also completed. Results demonstrated that scores on the UCLA and SELSA questionnaires positively correlated with the direct measure of loneliness, suggesting that these tools accurately index autistic experiences of loneliness. However, qualitative responses suggested that participants found both scales difficult to complete. Using reflexive thematic analysis, we identified three themes that encapsulated participants' views: (1) failing to distinguish between the characteristics/experiences of loneliness and being autistic, (2) loneliness is not a static trait and (3) inappropriate wording. Given that our sample of autistic participants tended to prefer the UCLA scale to the SELSA, we provide initial recommendations around how the UCLA scale could be adapted for autistic adults. There has been increasing interest in research on loneliness in autistic adults. Much of this research has involved giving autistic adults widely-used questionnaires that are thought to measure how lonely people are. However, these questionnaires have been developed for the general public. We do not know whether these questionnaires accurately measure how lonely autistic adults are. We asked 203 autistic adults to complete an online survey that included two widely-used loneliness questionnaires: (1) the University of California, Los Angeles (UCLA) Loneliness Scale Version 3 and (2) the Social and Emotional Loneliness Scale for Adults (SELSA). We also asked participants to rate how lonely they were from 1 (often/always) to 5 (never). Participants were then asked to give their views on the questionnaires (e.g. what they thought was good, and what they thought was not so good about them). We found that the scores on the UCLA scale and the SELSA aligned with participants' ratings of how lonely they were, which suggests that these two questionnaires accurately measure loneliness in autistic people. However, our participants also identified several ways to improve the questionnaires. This included (1) better distinguishing the characteristics/experiences of loneliness from those of being autistic; (2) better reflecting how loneliness may change at different times and in different contexts and (3) making the phrasing of the questions clearer. Overall, our autistic participants tended to prefer the UCLA scale to the SELSA. Therefore, we present some recommendations about how the UCLA scale could be changed to be more suitable for autistic people. [ABSTRACT FROM AUTHOR]

Quarantine guidelines that arose with the COVID-19 pandemic limited opportunities for social interaction, raising concerns about increases in intimate partner violence and cyberabuse while simultaneously restricting access to help. The current study assessed increases in cyberabuse, sexual aggression, and intimate partner violence victimization and perpetration during the first year of the COVID-19 pandemic in a U.S. nationally representative sample of young adults ages 18 to 35, recruited from a probability-based household panel. Data were collected between November 2020 and May 2021. Descriptive analyses were conducted to assess the prevalence of any self-reported increase in cyberabuse, sexual aggression, or intimate partner victimization or perpetration during the COVID-19 pandemic. Logistic regression models were run for each outcome measuring any increase compared to no increase. Approximately one in ten U.S. young adults ages 18 to 35 reported experiencing an increase in cyberabuse victimization (12.6%) and cyberabuse perpetration (8.9%) during the pandemic. Similar proportions were observed for increased sexual aggression victimization (11.8%) and perpetration (9.0%). More than one in five respondents (21.4%) reported that their intimate partner was more physically, sexually, or emotionally aggressive toward them during the pandemic. Conversely, 16.2% of respondents reported that they were more physically, sexually, or emotionally aggressive themselves toward an intimate partner, compared to their behavior before the onset of the pandemic. Having an intimate partner and staying at home more than usual during the pandemic were protective factors for both cyberabuse and sexual aggression victimization. Respondent age, education, and race and ethnicity were not associated with increased victimization or perpetration of cyberabuse or sexual aggression. However, women reported lower odds of increased sexual aggression perpetration than men. These findings improve understanding of changes to interpersonal abuse and associated risk factors during a period of social disruption. [ABSTRACT FROM AUTHOR]

Background: Gender-diverse youth experience twice the risk for homelessness as their same-age cisgender peers and report experiencing discrimination in homeless shelters and supported housing. Method: Eighteen participants (9 gender-diverse residents and 9 staff members) were interviewed individually to understand their experience of and needs in these settings. Results: The major findings included: (a) Gender-diverse service recipients felt unsafe and vulnerable in these facilities. Sharing space in which to carry out occupations of vulnerability often triggered anxiety and PTSD. (b) Gender-diverse service recipients felt that staff members did not understand how cumulative trauma adversely affected participation in programmatic activities. (c) Staff members reported that their facilities did not provide formal training needed to understand and address the unique needs of gender-diverse residents. (d) Gender-diverse service recipients commonly sustained trauma throughout their lives that compromised their ability to attain desired daily life skills and adult occupational roles. Such ruptures in their knowledge base likely served to maintain their homelessness despite repeated shelter admissions and housing placements. Conclusion: Occupational therapists could provide essential intervention to a gender-diverse youth population, including assisting with the attainment of skills needed for apartment management, employment seeking, maintenance, and health management. [ABSTRACT FROM AUTHOR]

This study used latent profile analysis with data from 481 U.S. men to examine patterns of men's attitudes toward gender equity and their engagement in gender-equitable (GE) behaviors. Five resulting profiles included groups with (a) high endorsement of both GE attitudes and behaviors, (b) low endorsement of both, (c) mid-range endorsement of both, (d) strong endorsement of GE attitudes, but low engagement in action, and (e) low endorsement of GE attitudes but high participation in GE behavior. Worryingly, this last group reported higher rates of violence perpetration than other groups, while simultaneously reporting higher rates of participation in gender-based violence prevention actions. [ABSTRACT FROM AUTHOR]

Long COVID is associated with many symptoms, including fatigue. As some with long COVID report remission of symptoms over time, previous long COVID has become increasingly prevalent. This cross-sectional study assessed differences in fatigue and somatic symptom burden among individuals with current, previous, and no history of long COVID symptoms. An online survey was conducted with United States adults (N = 2,872), with 2,310 reporting never experiencing long COVID, 183 reporting previously experiencing long COVID, and 379 reporting currently experiencing long COVID. Multivariable linear regression analyses were used to assess the association of long COVID status with fatigue and somatic symptom burden. Participants were an average age of 41.3, with the majority identifying as female (51.7%), White (87.6%), and non-Hispanic or Latino/e (87.6%). Both fatigue and somatic symptoms were significantly higher among those with both current (ps < 0.001; d = 1.24, 1.38 respectively) and previous long COVID (ps < 0.001; d = 0.42, 0.82 respectively) compared to those reporting never having long COVID. These differences remained after accounting for health behaviors (alcohol use, tobacco use, physical activity, sleep). Long COVID, regardless of current presence, may be associated with fatigue and somatic symptom burden. [ABSTRACT FROM AUTHOR]

Experiencing parental deportation during childhood is associated with higher rates of mental health and behavioral health challenges. This adversity may be exacerbated by the uncertainty of what is happening to their deported parent and to their family system following a deportation experience. Effective clinical intervention can reduce the likelihood and/or severity of physical health, mental health and behavioral health difficulty caused by the trauma of parental deportation; however, clinicians have insufficient resources and guidance on effectively engaging with children and their families following parental deportation. Semi-structured qualitative interviews were conducted with English-speaking Latino individuals from the United States who experienced parental deportation between the ages of 6 and 17 (n = 10). Using interpretive phenomenology analytic procedures, three major themes emerged related to participants' experiences of their family after their parent's deportation: (a) I wish I knew what was happening, (b) I wish people had checked in on my emotions, and (c) I wish people had been supportive and included us in the conversation. These findings are examined from an ambiguous loss framework to provide clinical implications of children's needs after parental deportation. Suggestions are offered from the adults who lost their parent to deportation as a child about what they needed following their loss. By understanding what children need in these moments of crisis, practitioners, providers, and others are better prepared to address this form of complex childhood adversity. [ABSTRACT FROM AUTHOR]

Purpose: Intimate partner violence (IPV) interventions for young people involved with the child welfare and legal systems are critical. However, researchers have yet to systematically assess this knowledge area. Methods: We conducted a systematic review to identify IPV interventions targeting young people involved with the legal and/or child welfare system. Six electronic databases were searched for quantitative and qualitative peer-reviewed articles that focused on IPV victimization and/or perpetration; included child welfare and/or legal system-involved young people aged 10 to 24 years; delivered an intervention; and reported outcome(s). Three researchers independently screened captured article abstracts; two researchers conducted full-text eligibility assessments. Data were extracted and findings were narratively summarized and compared. Results: We identified seven eligible studies: two child welfare and five legal system studies. Three studies focused on IPV perpetration only; two on IPV victimization and perpetration; two on IPV victimization only. Only two studies mentioned IPV types. One intervention was culturally-tailored. Two studies assessed IPV as an outcome, with the one focused on educating about power dynamics in romantic relationships and improving communication skill deficits reporting significant IPV reductions. Other improved outcomes were present across studies (e.g., IPV knowledge, trauma symptoms, condom use). Conclusion: Few IPV interventions focus on young people involved with the child welfare and/or legal system. We call for more research on this topic that is trauma-informed, culturally relevant, and includes all genders. It should also include components related to gender and power and healthy communication and target multiple types of IPV victimization and perpetration. [ABSTRACT FROM AUTHOR]

Introduction: Although psychoeducational group interventions are increasingly used for adults diagnosed with attention-deficit/hyperactivity disorder (ADHD), a comprehensive review focused on the feasibility and acceptability indicators of these interventions remains lacking. Furthermore, although previous research has explored various aspects of psychoeducation for ADHD, such as its definition and approaches, limited research has focused on the synthesis for outcome measures and patients' experiences related to these interventions. Therefore, this scoping review aims to map the existing evidence reported on psychoeducational group interventions for adults diagnosed with ADHD. The objective is to provide a comprehensive overview of feasibility indicators, acceptability, and outcome measures used in psychoeducational group interventions. Method: A comprehensive structured literature search on the topic was performed in seven bibliographic databases, and the resulting records were independently screened, and their data extracted by two reviewers. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-S) to ensure the transparency and rigor of this scoping review. Results: The searches yielded 7510 records. Eight studies met the inclusion criteria. These included studies were conducted in European countries and the United States. Among these, six studies used a randomized control design, one an open feasibility trial, and one a pre-post intervention design. All the studies reported some feasibility and acceptability indicators. While all the studies reported on the severity of symptoms of ADHD as an outcome measure, some also reported on outcomes related to psychological or mental-health problems, quality of life, changes in knowledge regarding ADHD, or the level of self-esteem, functioning, and impairment. Conclusion: This scoping review revealed that psychoeducational group interventions are generally acceptable for patients in terms of patient satisfaction with the group intervention. All included studies reported some feasibility indicators, with some reporting good attendance and relatively low dropout rates. Most studies reported positive effects on ADHD and mental health symptoms, suggesting that these interventions are beneficial for adults with ADHD. However, several gaps exist regarding the reporting on the feasibility indicators, acceptability, and outcome measures employed across studies. [ABSTRACT FROM AUTHOR]

Context Previous studies have demonstrated associations of endogenous thyroid hormones with diabetes; less is known about stages of diabetes development at which they are operative, mechanisms of associations, and the role of the hypothalamic-pituitary-thyroid axis. Objective This study examined associations of thyroid hormones with incident prediabetes and diabetes and with changes in glycemic traits in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), the largest cohort of Hispanic/Latino adults with diverse backgrounds in the United States. Methods The study includes 592 postmenopausal euthyroid women and 868 euthyroid men aged 45 to 74 years without diabetes at baseline participating in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Baseline hormones included thyrotropin (TSH), free thyroxine (FT4), total triiodothyronine (T3), and indices calculated from thyroid hormones evaluating pituitary sensitivity to thyroid hormone. Transitions to diabetes and prediabetes, and changes in glycemic traits determined at the 6-year follow-up visit, were examined using multivariable Poisson and linear regressions. Results Among women, T3 (incident rate ratio [IRR] = 1.65; 95% CI, 1.22-2.24; P =.001) and TSH (IRR = 2.09; 95% CI, 1.01-4.33; P =.047) were positively, while FT4 (IRR = 0.59; 95% CI, 0.39-0.88; P =.011) was inversely, associated with transition from prediabetes to diabetes. Among men, the T3/FT4 ratio was positively associated with transition from normoglycemia to prediabetes but not from prediabetes to diabetes. Indices measuring sensitivity of the pituitary to thyroid hormone suggested increased sensitivity in men who transitioned from prediabetes to diabetes. Conclusion Positive associations in women of T3 and TSH and inverse associations of FT4, as well as inverse associations of thyroid indices in men with transition from prediabetes to diabetes, but not from normoglycemia to diabetes, suggest decreased pituitary sensitivity to thyroid hormones in women and increased sensitivity in men later in the development of diabetes. [ABSTRACT FROM AUTHOR]

Background: Health disparity and under-utilization of health services is prevalent among Asian refugees and migrants in Western countries and can profoundly impact health outcomes. Cambodians who survived extreme physical and emotional trauma during the genocides enacted by the Khmer Rouge regime in the 1970's are particularly vulnerable to poor mental health outcomes decades later. Understanding the experiences of help-seeking and service use by displaced Cambodians in Western countries may help to design more effective and culturally safe healthcare services. Aims: To identify characteristics or factors associated with help seeking behaviours and service utilization of displaced Cambodians with mental health issues living in Western countries. Methods: This review followed the Arksey & O'Malley methodological framework for scoping reviews. Articles for review were identified through searches of nine electronic databases and manual searches. Relevant articles were selected, and data was extracted and synthesized into key themes. Results: This review included 15 articles. Most of the studies were conducted in the USA (n = 13) with one each conducted in Canada and New Zealand. Seven studies used qualitative interviews, five used a cross-sectional survey approach, two used a mixed-methods approach and one was a narrative review and case series. Key findings highlighted the impact of Cambodian cultural beliefs about mental health (guilt, shame and help-seeking stigma) on service utilization and the disconnect between Western models of service provision and preferred Cambodian ways of receiving support. Conclusion: Mental health services in Western countries are likely to be under-utilized by Cambodians due to a mismatch between health beliefs and Western models of care. Further investigation of the association between health beliefs and barriers to service utilization among adult Cambodian refugees is warranted. [ABSTRACT FROM AUTHOR]

Sleep duration changes across the life course and differs by education in the United States. However, little research has examined whether educational differences in sleep duration change over age—or whether sleep duration trajectories over age differ by education. This study uses a life course approach to analyze American Time Use Survey data (N = 60,908), examining how educational differences in weekday sleep duration change from middle to older adulthood (ages 40–79). For men only, differences in total sleep time between individuals with less than a high school degree and those with more education converge in older adulthood. Results suggest that this leveling is explained by decreasing educational stratification in work hours as men enter older adulthood. Findings highlight the importance of employment for shaping gendered socioeconomic differences in sleep and demonstrate differences by education in how sleep duration changes over age, with possible implications for health disparities. [ABSTRACT FROM AUTHOR]

The purpose of this cross-sectional study was to investigate the relationship between Body Mass Index (BMI), cholesterol, and cancer in United States (US) adults. Data were collected from the 2020 Medical Expenditure Panel Survey (MEPS). Eligible participants were US adults (≥18 years) with data on BMI, cholesterol, and cancer status, who were alive at the end of the data collection period. An adjusted logistic regression model assessed associations between eight possible combinations of BMI and cholesterol status (independent variable) with cancer diagnosis (dependent variable). Among 27,805 individuals in the 2020 MEPS data, 20,818 met the eligibility criteria (weighted N = 252,340,615). Of these 2668 (weighted N = 29,770,359) had cancer and 18,150 (weighted N = 222,570,256) did not have cancer. In the adjusted logistic regression model, underweight and normal weight individuals with high cholesterol were associated with higher odds of cancer (odds ratio, OR = 2.002, and 95% confidence interval, CI = 1.032–3.885, and OR = 1.326 and 95% CI = 1.047–1.681, respectively), while obese individuals with normal cholesterol were associated with lower odds of cancer (OR = 0.681; 95% CI = 0.543–0.853) compared to normal weight individuals with normal cholesterol. This study offers insights into specific groups of individuals who may be prioritized for cancer prevention. Further research is required to investigate these findings in additional subpopulations. [ABSTRACT FROM AUTHOR]

Background: Nocturia, the most common lower urinary tract symptom (LUTS), significantly impacts socioeconomic factors and individuals' quality of life and is closely related to many diseases. This study utilized data from NHANES 2005–2010 to explore the relationship between family income to poverty ratio (PIR) and the presence of nocturia symptoms in adults aged 20 or older in the United States. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) in 2005–2010, including 6,662 adults aged 20 or older, were utilized for this cross-sectional study. The baseline data was used to display the distribution of each characteristic visually. Multiple linear regression and smooth curve fitting were used to study the linear and non-linear correlations between PIR and nocturia. Subgroup analysis and interaction tests were conducted to examine the stability of intergroup relationships. Results: Out of the 6,662 adult participants aged 20 or older, 1,300 households were categorized as living in poverty, 3,671 households had a moderate income, and 1,691 households were classified as affluent. Among these participants, 3,139 individuals experienced nocturia, representing 47.12% of the total, while 3,523 individuals were nocturia-free, constituting 52.88% of the total population. After adjusting for all other covariates, it was found that PIR was significantly negatively correlated with nocturia (OR: 0.875, 95%CI: 0.836–0.916 P<0.0001). This trend persisted when PIR was divided into three groups (PIR <1, PIR 1–4, PIR > 4) or quartiles. There was a non-linear negative correlation between PIR and nocturia. Conclusion: Our findings indicated that lower PlR was associated with a higher risk of nocturia in adults aged 20 or older in the United States. These findings highlight the importance of considering socioeconomic factors in preventing and managing nocturia. Nonetheless, further exploration of the causal nexus between these factors was precluded due to the constraints of a cross-sectional design. [ABSTRACT FROM AUTHOR]

Importance: Hepatitis B is a serious problem in the United States (US), with up to 2.4 million Americans living with a chronic infection. Only 26–32% of people living with hepatitis B in the US are diagnosed. Additionally, just 30% of all adults are vaccinated against the virus. In 2022, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC) updated adult hepatitis B vaccination recommendations to include all adults aged 19–59 years and those 60 years and older with risk factors for hepatitis B. Subsequently, in 2023, the CDC recommended that all adults be screened at least one time in their lives. Observations: Electronic health record (EHR) tools (prompts, order sets, etc.) have proven to be an effective method of increasing hepatitis B screening and vaccination, but longstanding challenges and questions around hepatitis B vaccines and tests could prevent effectual EHR implementation. As the new recommendations directly impact providers who may have limited familiarity with hepatitis B, guidance on how to identify eligible patients and triggers, order sets to facilitate vaccine/test selection, and proper documentation and patient follow-up is necessary. Conclusions and Relevance: This communication offers a practical framework for health systems to build an effective EHR strategy for the updated adult hepatitis B recommendations. We also provide comprehensive responses to clinicians' questions that are frequently asked prior to screening or vaccinating for hepatitis B. [ABSTRACT FROM AUTHOR]

Nonmedical prescription stimulant use (NPSU) is an ongoing public health crisis in the United States. There exists, however, a dearth of research investigating specific childhood risk factors that may contribute to this illicit use. Adverse childhood experiences (ACEs) may be a significant risk factor to address in the prevention and treatment of NPSU, as research has provided evidence for increased substance use, potentially including prescription stimulant misuse, among individuals who have experienced trauma. A systematic review of the literature was conducted to gather and synthesize research articles specifically examining the relationship between nonmedical prescription stimulant use in adults and the experience of adverse childhood experiences (ACEs). Four studies met all inclusion criteria and were included in the review. The results demonstrated that the nonmedical use of prescription stimulants in adults is significantly associated with ACEs, with a higher numerical count of ACEs associated with a greater likelihood of nonmedical prescription stimulant use. Gaps in the literature were identified, specifically noting a lack of information available regarding the relationship between ACEs and NPSU within gender- and racially diverse populations. The findings have implications for informing interventions related to ACEs and the misuse of prescription stimulant medication in adults. [ABSTRACT FROM AUTHOR]

The concept of vulnerability to sex trafficking has been the subject of intense academic debate. It is well documented in the literature that child sex trafficking is facilitated by the abuse of a position of vulnerability, though limited research has focused on children's order of birth as an element of vulnerability to sex trafficking. The objective of this article, based on a sample of 112 Central American women smuggled to the United States for the sex trade before they had attained the age of eighteen years, is to examine whether the order of birth constitutes an element of vulnerability to sex trafficking. Trafficked minors had vulnerabilities linked to structural-level and individual-level factors. We conclude that sisters occupying the first place in the order of birth are the most susceptible to being recruited by an international network that smuggles women for prostitution. On the contrary, the youngest and middle sisters are less at risk due to the protection and guidance of the other sisters. [ABSTRACT FROM AUTHOR]

Diabetic retinopathy (DR) is a microvascular complication of type 2 diabetes and the leading cause of blindness globally. Although diabetes-related eye exams are widely recognized as an effective method for early detection of DR, which can help to prevent eventual vision loss, adherence to screening exams in the United States is suboptimal. This article describes a quality improvement project to increase DR screening rates and increase knowledge and awareness of DR in adults with type 2 diabetes in a primary care setting using mobile DR screening units. This project addressed gaps of care and demonstrated that primary care settings can increase access to DR screening through a patient-centered process and thereby help to prevent irreversible outcomes of DR and improve quality of life. [ABSTRACT FROM AUTHOR]

Background: The cost of spine-related pain in the United States is estimated at $134.5 billion. Spinal pain patients have multiple options when choosing healthcare providers, resulting in variable costs. Escalation of costs occurs when downstream costs are added to episode costs of care. The purpose of this review was to compare costs of chiropractic and medical management of patients with spine-related pain. Methods: A Medline search was conducted from inception through October 31, 2022, for cost data on U.S. adults treated for spine-related pain. The search included economic studies, randomized controlled trials and observational studies. All studies were independently evaluated for quality and risk of bias by 3 investigators and data extraction was performed by 3 investigators. Results: The literature search found 2256 citations, of which 93 full-text articles were screened for eligibility. Forty-four studies were included in the review, including 26 cohort studies, 17 cost studies and 1 randomized controlled trial. All included studies were rated as high or acceptable quality. Spinal pain patients who consulted chiropractors as first providers needed fewer opioid prescriptions, surgeries, hospitalizations, emergency department visits, specialist referrals and injection procedures. Conclusion: Patients with spine-related musculoskeletal pain who consulted a chiropractor as their initial provider incurred substantially decreased downstream healthcare services and associated costs, resulting in lower overall healthcare costs compared with medical management. The included studies were limited to mostly retrospective cohorts of large databases. Given the consistency of outcomes reported, further investigation with higher-level designs is warranted. [ABSTRACT FROM AUTHOR]

Purpose: Family--professional partnerships are important for youth learning to use aided augmentative and alternative communication (AAC). This study examined the family-oriented beliefs and practices of speech-language pathologists (SLPs) working with preschool and school-aged children learning to use aided AAC (aged 3--21 years), specifically during the COVID-19 pandemic. Method: Participants were 25 SLPs who participated in an individual semistructured interview. Qualitative analysis was used to identify and describe groups of SLPs based on commonalities and differences in their beliefs and practices working with families. The characteristics of SLPs in each group was also explored descriptively (e.g., race/ethnicity, work setting, caseload). Results: SLPs clustered into three groups based on their beliefs and practices: (a) professionally centered, (b) family-allied, and (c) family-focused. SLPs varied across these groups in how they planned services, offered training/coaching, communicated, shared resources, offered emotional support, and adapted to and with different families. Conclusions: Findings indicate the need to support greater family-centeredness in AAC services by building on the strengths of SLPs in the field. Promoting strong family--professional partnerships could in turn improve outcomes for students who use AAC. [ABSTRACT FROM AUTHOR]

Objectives: The association between religiosity and secular mental health utilization is unclear. Evidence suggests that religious and spiritual leaders (R/S leaders) may be more trusted than secular mental health therapists (SMHTs) and are often the first point of contact for individuals with mental health problems who identify as religious. Methods: Generalized equation estimate (GEE) analyses were used to examine the association between religiosity and mental health seeking behaviours in 2,107 participants using t Midlife in the United States Study (MIDUS) data collected between 1995 and 2014. Results: The final model indicated that after adjusting for covariates, higher levels of baseline religious identification and baseline spirituality (assessed in 1995) predicted an increase in visits to R/S leaders from 1995 to 2014 by a factor of 1.08 (95% CI=1.01–1.16) and 1.89 (95% CI=1.56–2.28), respectively. Higher levels of baseline religious identification reduced SMHTs visits by a factor of 0.94 (95% CI=0.90–0.98), whereas higher levels of baseline spirituality increased SMHTs visits by a factor of 1.13 (95% CI=1.00–1.27) during the same timeframe. Conclusion: Higher levels of spirituality and religious identification increased the frequency over time of seeking mental health support from R/S leaders relative to SMHTs. Individuals with mental illness may seek support from religious resources, mental health professionals, or both, underscoring the importance of collaboration between R/S leaders and SMHTs. Mental health training for R/S leaders and collaboration with SMHTs may help alleviate mental health burden, especially among those who highly value their religious and spiritual beliefs. [ABSTRACT FROM AUTHOR]

Disasters share a common potential for significant ecological and psychosocial disruption at the individual, community, and societal levels, and are especially harmful to members of social groups in vulnerable situations, including youth in foster care and those recently emancipated from care. These young people are susceptible to mental health challenges and understanding their resiliency is key to mitigating pandemic-related harms. This qualitative study aims to (1) understand how the COVID-19 pandemic affected the mental health of older youth between the ages of 18 and 23 (M = 20.5 years, S.D. = 1.7 years), currently in or aged out of foster care (M = 5.9 years in care, S.D. = 4.4 years), and experiencing mental health challenges, and (2) gain insight into the resiliency that supports young people in dealing with these challenges. Twenty-six young people (77% female-identifying, 38% White, 27% Hispanic) in the USA participated in in-depth interviews. Salient themes include: 1) supportive relationships, 2) adaptive coping skills and mindsets, and 3) environmental, institutional, and social supports. Results amplify the voices of these young people concerning the impact of COVID-19 on their mental health and foreground the dynamic strategies they are using to alleviate their distress. [ABSTRACT FROM AUTHOR]

Introduction: Current implementation efforts have failed to achieve equitable HIV pre‐exposure prophylaxis (PrEP) provision for transgender and gender‐diverse (trans) populations. We conducted a choice‐based conjoint analysis to measure preferences for key attributes of hypothetical PrEP delivery programmes among a diverse online sample predominantly comprised of transmasculine and nonbinary individuals in the United States. Methods: Between April 2022 and June 2022, a national online survey with an embedded conjoint analysis experiment was conducted among 304 trans individuals aged ≥18 years in the United States to assess five PrEP programme attributes: out‐of‐pocket cost; dispensing venue; frequency of visits for PrEP‐related care; travel time to PrEP provider; and ability to bundle PrEP‐related care with gender‐affirming hormone therapy services. Participants responded to five questions, each of which presented two PrEP programme scenarios and one opt‐out option per question and selected their preferred programme in each question. We used hierarchical Bayes estimation and multinomial logistic regression to measure part‐worth utility scores for the total sample and by respondents' PrEP status. Results: The median age was 24 years (range 18–56); 75% were assigned female sex at birth; 54% identified as transmasculine; 32% as nonbinary; 14% as transfeminine. Out‐of‐pocket cost had the highest attribute importance score (44.3%), followed by the ability to bundle with gender‐affirming hormone therapy services (18.7%). Minimal cost‐sharing ($0 out‐of‐pocket cost) most positively influenced the attribute importance of cost (average conjoint part‐worth utility coefficient of 2.5 [95% CI 2.4−2.6]). PrEP‐experienced respondents preferred PrEP delivery in primary care settings (relative utility score 4.7); however, PrEP‐naïve respondents preferred pharmacies (relative utility score 5.1). Conclusions: Participants preferred programmes that offered PrEP services without cost‐sharing and bundled with gender‐affirming hormone therapy services. Bolstering federal regulations to cover PrEP services and prioritizing programmes to expand low‐barrier PrEP provision are critical to achieving equitable PrEP provision. Community‐engaged implementation research conducted by and in close collaboration with trans community stakeholders and researchers are needed to streamline the design of patient‐centred PrEP programmes and develop implementation strategies that are salient to the diverse sexual health needs of trans patients. [ABSTRACT FROM AUTHOR]

Disparities in socio-economic status (SES) predict many immune system-related diseases, and previous research documents relationships between SES and the immune cell transcriptome. Drawing on a bioinformatically-informed network approach, we situate these findings in a broader molecular framework by examining the upstream regulators of SES-associated transcriptional alterations. Data come from the National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative sample of 4543 adults in the United States. Results reveal a network—of differentially expressed genes, transcription factors, and protein neighbors of transcription factors—that shows widespread SES-related dysregulation of the immune system. Mediational models suggest that body mass index (BMI) plays a key role in accounting for many of these associations. Overall, the results reveal the central role of upstream regulators in socioeconomic differences in the molecular basis of immunity, which propagate to increase risk of chronic health conditions in later-life. [ABSTRACT FROM AUTHOR]

To examine variables associated with engagement in (1) integrative health and medicine (IHM) and (2) nonpharmacologic modalities rather than opioids among United States adults with chronic pain.Methods: Using the 2019 National Health Interview Survey, we examined sociodemographic, pain, and mental health predictors of (1) the sum of IHM modalities (ie, chiropractic care, yoga/Tai Chi, massage, or meditation/guided imagery) used to manage pain and (2) exclusive engagement in nonpharmacologic pain management modalities (ie, IHM, a chronic pain self-management program, support groups, or physical, rehabilitative, occupational, or talk therapy) or opioids in the past 3 months.Results: Metropolitan residency, higher family income, higher education levels, increased number of pain locations, and increased frequency of pain limiting life/work activities were associated with increased odds of IHM engagement. Older age, male sex, non-Hispanic Black/African American race/ethnicity, and daily opioid use were associated with decreased odds of IHM engagement. Older age, male sex, and increased depressive symptoms were associated with decreases in the count of IHM modalities used to manage pain. Metropolitan residency, higher family income, and higher education levels were associated with increased odds of exclusive nonpharmacologic modality engagement. Older age and increasing frequency of pain limiting life/work activities were associated with decreased odds of exclusive nonpharmacologic modality engagement.Conclusions: We identified several contrasts between factors prevalent among individuals with chronic pain and factors associated with engagement in nonpharmacologic and IHM modalities. These results support efforts to address barriers to accessing these modalities among subpopulations of adults with chronic pain (eg, older adults, individuals identifying as Black/African American, rural residents, and those with lower levels of education and income).Plain Language Summary: This study examined factors influencing the use of integrative health and non-drug treatments for chronic pain in the United States. Results revealed that metropolitan residence, higher income, and education were associated with increased use of these treatments, while older age, male sex, daily opioid use, and non-Hispanic Black/African American ethnicity were associated with decreased use. The findings emphasize the importance of addressing barriers to these forms of care, especially among older adults, Black/African American individuals, and those with higher depressive symptoms and lower education and income levels, who are more likely to have chronic pain. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic had a profound social and economic impact across the United States due to the lockdowns and consequent changes to everyday activities in social spaces. Methods: The COVID-19's Unequal Racial Burden (CURB) survey was a nationally representative, online survey of 5,500 American Indian/Alaska Native, Asian, Black/African American, Latino (English- and Spanish-speaking), Native Hawaiian/Pacific Islander, White, and multiracial adults living in the U.S. For this analysis, we used data from the 1,931 participants who responded to the 6-month follow-up survey conducted between 8/16/2021-9/9/2021. As part of the follow-up survey, participants were asked "What was the worst thing about the pandemic that you experienced?" and "Was there anything positive in your life that resulted from the pandemic?" Verbatim responses were coded independently by two coders using open and axial coding techniques to identify salient themes, definitions of themes, and illustrative quotes, with reconciliation across coders. Chi-square tests were used to estimate the association between sociodemographics and salient themes. Results: Commonly reported negative themes among participants reflected disrupted lifestyle/routine (27.4%), not seeing family and friends (9.8%), and negative economic impacts (10.0%). Positive themes included improved relationships (16.9%), improved financial situation (10.1%), and positive employment changes (9.8%). Differences in themes were seen across race-ethnicity, gender, and age; for example, adults ≥ 65 years old, compared to adults 18–64, were more likely to report disrupted routine/lifestyle (37.6% vs. 24.2%, p < 0.001) as a negative aspect of the pandemic, and Spanish-speaking Latino adults were much more likely to report improved relationships compared to other racial-ethnic groups (31.1% vs. 14.8–18.6%, p = 0.03). Discussion: Positive and negative experiences during the COVID-19 pandemic varied widely and differed across race-ethnicity, gender, and age. Future public health interventions should work to mitigate negative social and economic impacts and facilitate posttraumatic growth associated with pandemics. [ABSTRACT FROM AUTHOR]