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Substantial evidence indicates that medical mistrust, resulting from experiences with discrimination and marginalisation, is a determinant of health disparities in minority populations. However, this research is largely limited to the US and other industrialised countries. To broaden our understanding of the role of medical mistrust on health-care decision making, we conducted a study on healthcare experiences and perceptions in a rural, underserved indigenous community in northwest Namibia (n = 86). Mixing semi-structured interview questions with the medical mistrust index (MMI), we aim to determine the relevance of the MMI in a non-industrialised population and compare index scores with reports of healthcare experiences. We find that medical mistrust is a salient concept in this community, mapping onto negative healthcare experiences and perceptions of discrimination. Reported healthcare experiences indicate that perceived incompetence, maltreatment and discrimination drive mistrust of medical personnel. However, reporting of recent healthcare experiences are generally positive. Our results indicate that the concept of medical mistrust can be usefully applied to communities in the Global South. These populations, like minority communities in the US, translate experiences of discrimination and marginalisation into medical mistrust. Understanding these processes can help address health disparities and aid in effective public health outreach in underserved populations.

To investigate the relationship of predisposing, enabling, need, and immigration-related factors to tele-mental health services utilization among California adults, we conducted a secondary analysis of two waves of the California Health Interview Survey (CHIS) collected between 2015 and 2018 (N = 78,345). A series of logistic regression models were conducted to examine correlates and predictors to tele-mental health services use. Approximately 1.3% reported the use of tele-mental health services. Overall, health insurance status, severe psychological distress, perceived need for mental health services, and identifying as Asian, remained strong predictors for tele-mental health service use. When accounting for all factors, we found that being a non-citizen was associated with lower odds of tele-mental health service use (AOR = 0.47, CI = 0.26, 0.87, p

Infectious diseases exploit niches that are often spatially defined as urban and/or rural. Yet spatial research on infectious diseases often fails to define "urban" and "rural" and how these contexts might influence their epidemiology. We use dengue fever, thought to be mostly an urban disease with rural foci, as a device to explore local definitions of urban and rural spaces and the impact of these spaces on dengue risk in the provinfine urban and rural locales. Interviews conducted from 2019 to 2021 with 71 residents and 23 health personce of Esmeraldas, Ecuador. Ecuador, like many countries, only uses population size and administrative function to denel found that they identified the availability of basic services, extent of their control over their environment, and presence of underbrush and weeds (known in Ecuador as monte and maleza and conceptualized in this paper as natural disorder) as important links to their conceptions of space and dengue risk. This broader conceptualization of space articulated by local residents and professionals reflects a more sophisticated approach to characterizing dengue risk than using categories of urban and rural employed by the national census and government. Rather than this dichotomous category of space, dengue fever can be better framed for health interventions in terms of specific environmental features and assemblages of high-risk spaces. An understanding of how community members perceive risk enhances our ability to collaborate with them to develop optimal mitigation strategies.

Reducing racial and socioeconomic inequities in smoking has been declared a priority for tobacco control in the USA for several decades. Yet despite the rhetoric, these inequities persist and some have actually worsened over time. Although tobacco companies have targeted racially and ethnically diverse and lower-income tobacco users, which substantially contributes to these disparities, less attention has been given to the role of individuals and organisations within the tobacco control movement who have allowed progress in eliminating disparities to stagnate. We examine the failure of tobacco control professionals to ensure the widespread adoption of equity-focused tobacco control strategies. Review of major US tobacco control reports found that the focus on equity often stops after describing inequities in tobacco use. We suggest ways to advance equity in tobacco control in the USA. These recommendations fall across five categories: surveillance, interventions, funding, accountability and addressing root causes. Policy interventions that will have a pro-equity impact on smoking and related disease should be prioritised. Funding should be designated to tobacco control activities focused on eliminating racial and socioeconomic inequities in smoking, and tobacco control programmes should be held accountable for meeting equity-related goals.

IntroductionDrug use behaviors are closely associated with increased risk for HIV and other STIs among men who have sex with men (MSM) globally. Less is known about the drug use characteristics and their association with HIV/STI risk among MSM in Mexico, who have 13 times higher risk of acquiring HIV than the general population. We characterized distinct classes of drug use behaviors among a nationwide sample of MSM in Mexico and tested their associations with HIV risk behaviors.MethodsWe used latent class analysis (LCA) to analyze injection/non-injection drug use data collected by the online Encuesta de Sexo Entre Hombres self-administered survey among 15,875 MSM living in Mexico between May-June 2017. MSM were recruited on general social media sites (e.g. Facebook and Twitter), popular LGBT + focused web pages (e.g. Soy Homosensual and Desastre), and dating apps (e.g. Grindr and Hornet). We used robust Poisson regression to examine associations between drug use classes and recent sexual risk behaviors while adjusting for sociodemographic characteristics.ResultsMost participants were under 30 years of age (65.5%), received a Bachelor's degree or higher (65.2%), gay-identified (82.5%), HIV negative (58.1%), and lived in the Mexico City/State of Mexico region (34.5%). We identified five distinct drug use classes: Limited Drug Use (75.4%), Marijuana Only (15.1%), Sex Event Popper + Marijuana (4.3%), Club Drug + Marijuana (4.2%), and Elevated Polydrug Use (1.0%). Compared to the Limited Drug Use class, participants in all other drug use classes were significantly more likely to engage in condomless anal intercourse (aPR = 1.14-1.39; p

This study explores public preferences for algorithmic and human decision-makers (DMs) in high-stakes contexts, how these preferences are shaped by performance metrics, and whether public evaluations of performance differ depending on the type of DM. Leveraging a conjoint experimental design, approximately 9,000 respondents chose between pairs of DM profiles in two high-stakes scenarios: pretrial release decisions and bank loan approvals. The profiles varied by type (human vs. algorithm) and three metrics-defendant crime rate/loan default rate, false positive rate (FPR) among white defendants/applicants, and FPR among minority defendants/applicants-as well as an implicit fairness metric defined by the absolute difference between the two FPRs. The results show that efficiency was the most important performance metric in the respondents' evaluation of DMs, while fairness was the least prioritized. This finding is robust across both scenarios, key subgroups of respondents (e.g. by race and political party), and across the DM type under evaluation. Additionally, even when controlling for performance, we find an average preference for human DMs over algorithmic ones, though this preference varied significantly across respondents. Overall, these findings show that while respondents differ in their preferences over DM type, they are generally consistent in the performance metrics they desire.

ObjectivesThis study aims to assess if an integrated simulation-based training on respectful maternity care (RMC) and management of obstetric and neonatal emergencies could improve the quality of antenatal care (ANC).MethodsThe data are from two cross-sectional surveys administered in the East Mamprusi District of Northern Ghana in 2017 to evaluate the impact of integrated simulation-based training for healthcare providers. Surveys were administered to two groups of women aged 15-49 who delivered in a health facility before (baseline; n = 266) and 6 months after (end-line; n = 320) the intervention began. We assessed the quality of antenatal care pre- and post-training across two dimensions: service provision and experience of care. Analyses included linear and logistic regression.ResultsWomen in the end-line group reported higher quality of antenatal care than those in the baseline group. The average ANC experience of care score increased by 10 points at the end-line (Coeff = 10.3, 95%CI: 9.0,11.6), whereas the mean ANC service provision score increased by three points (Coeff = 2.6, 95% CI: 2.2, 3.1). End-line participants were more likely to have an ultrasound (OR: 24.1, 95%CI: 11.5, 50.3). Parity, tribe, education, employment, partner occupation, six or more antenatal visits, ANC facility, and provider type were also associated with ANC quality.ConclusionsIntegrated simulation-based training for health providers has the potential to improve the quality of ANC. Incorporating such training into continuing professional development courses will aid global efforts to increase the quality of care throughout the maternity continuum of care.

Abstract: The COVID-19 pandemic has severely impacted employment, housing, and food security for low-income public benefits recipients. The present study seeks to understand public recipients’ self-reported critical and ongoing needs at the outset of the COVID-19 pandemic. This study uses logistic regression to analyze survey data gathered on 10,089 public benefits recipients in the early stage of the pandemic to better understand their self-reported critical and ongoing needs. We also explored variations in need among different racial/ethnic groups and public benefits receipt status. Our research found that respondents from most racial/ethnic minority groups indicated a significant need for food, housing, and back-rent, with variation among different racial/ethnic groups in expressing specific needs for finding employment and help with applying for public benefits. Our findings also identify SNAP/CalFresh recipients as a particularly vulnerable group, and they were more likely to need help with food insecurity, finding employment, applying for public benefits, and paying backrent. While numerous federal, state, and local programs and initiatives were created to address widespread need, this study identifies potential gaps in these efforts and increases understanding of how to target aid for low-income populations in times of crisis.

Abstract: Purpose: Preference-based summary scores are used to quantify values, differences, and changes in health-related quality of life (HRQoL) that can be used for cost-effectiveness analyses. The PROMIS-Preference (PROPr) measure is a preference-based summary score comprised of 7 PROMIS domains. The PROMIS-16 is a new PROMIS profile instrument. We evaluated the measurement properties of PROPr generated from the widely used PROMIS-29 + 2 compared with the PROMIS-16. Methods: We performed a secondary analysis of data from an online survey of the general US population, with a longitudinal subsample who reported back pain. The survey included both the PROMIS-16 and the PROMIS-29 + 2 profiles. PROPr scores were calculated from each profile and compared by the distribution of scores, overall mean scores, product-moment correlations with pain measure scores (Oswestry Disability Index, Roland-Morris Disability Questionnaire, Pain Intensity, Interference with Enjoyment of Life, Interference with General Activity Scale, and Graded Chronic Pain Scale), and difference in mean scores in subgroups with 13 chronic health conditions (Cohen’s d). Results: Of the 4,115 participants in the baseline survey, 1,533 with any reported back pain were invited for the 6-month follow-up survey and 1,256 completed it. At baseline, the overall mean (SD) PROPr score was 0.532 (0.240) from PROMIS-16 and 0.535 (0.250) from PROMIS 29 + 2. At both time points, the correlations of PROPr scores with physical and mental health summary scores from the PROMIS-29 and 4 pain scales were within 0.01 between profiles. Using subgroups with chronic health conditions and comparing between profiles, Cohen’s d estimates of the difference in effect size were small (

Language is a fundamental aspect of human culture that influences cognitive and perceptual processes. Prior evidence demonstrates personality self-report can vary across multilingual persons' language contexts. We assessed how cultural identification, language dominance, or both dynamically influence bilingual respondents' self-conception, via self-reported personality, across English and Spanish contexts. During separate English and Spanish conditions, 133 Hispanic/Latino bilingual participants (70 female) completed the Big Five Inventory of personality. We used language use and acculturation surveys completed in both languages to calculate participants' relative language dominance and identification with U.S.-American and Hispanic culture. Participants reported higher levels of agreeableness, conscientiousness, and neuroticism in English relative to Spanish. Language dominance predicted cross-language differences in personality report, with higher extraversion reported in participants' dominant language. Within each language, greater endorsement of U.S.-American identity was associated with higher extraversion and conscientiousness and lower reported neuroticism. Agreeableness report in both languages was positively predicted by Hispanic identification. Our results clarify existing literature related to language and cultural effects on personality report among U.S. Hispanics/Latinos. These findings could inform assessments of self-relevant cognitions across languages among bilingual populations and hold relevance for health outcomes affected by cultural processes.

Large ancient DNA (aDNA) studies offer the chance to examine genomic changes over time, providing direct insights into human evolution. While recent studies have used time-stratified aDNA for selection scans, most focus on single-locus methods. We conducted a multi-locus genotype scan on 708 samples spanning 7000 years of European history. We show that the G12 statistic, originally designed for unphased diploid data, can effectively detect selection in aDNA processed to create 'pseudo-haplotypes'. In simulations and at known positive control loci (e.g., lactase persistence), G12 outperforms the allele frequency-based selection statistic, SweepFinder2, previously used on aDNA. Applying our approach, we identified 14 candidate regions of selection across four time periods, with half the signals detectable only in the earliest period. Our findings suggest that selective events in European prehistory, including from the onset of animal domestication, have been obscured by neutral processes like genetic drift and demographic shifts such as admixture.

Social capital is frequently invoked as a reason for engaging in collaborative environmental governance. Yet we have a limited understanding of how collaborative environmental governance mobilizes different types of social capital and how the advantages and costs of social capital accrue for different groups of people. Explicit measures of social capital, such as through social network methods, will help build an understanding of how social capital facilitates collective processes and for whom. We reviewed highly cited articles in Web of Science and Scopus using ‘social capital’ as the search term to identify foundational and emergent social capital concepts. In the context of collaborative environmental governance, we operationalized these social capital concepts with network measures drawn from our expertise and highlighted existing empirical relationships between such network measures and collaborative outcomes. We identified two different perspectives on social capital—one based on social relations that could be readily operationalized with social network measures and the other based on actor characteristics that can further contextualize network data. Relational social capital concepts included social relations among actors; the collective social setting in which relations are embedded; and the advantages and costs that social capital confers to individuals and the collective. Social capital concepts based on actor characteristics included socio-cognitions (e.g. trust, norms, identification with a group, shared meanings) and community engagement (e.g. group membership, civic participation, volunteerism). Empirical evidence using social network approaches to measure social capital reveals patterns in relationship building that influence collaborative and other sustainability outcomes. Social network approaches described here may help define and quantify the social capital mobilized by collaborative governance. Additional research is necessary to track the social capital of collaboratives over time, link it to outcomes, and better understand the social justice implications of collaborative governance.

Despite established efficacy for oral pre-exposure prophylaxis (PrEP) in reducing HIV incidence, multi-level barriers within the health system, clinics, and the processes that shape practice have hindered service delivery and subsequent population-level effects. We applied the Consolidated Framework for Implementation Research (CFIR) to assess the context of PrEP delivery for adolescent girls and young women (AGYW) in rural South Africa and identify the factors supporting and impeding PrEP implementation to develop strategies to improve PrEP delivery. Between 2021 and 2022, we conducted in-depth interviews with five young women with PrEP use experience and 11 healthcare providers as well as four key informant stakeholder interviews. Tailored interviews organized around the CFIR domains provided multiple perspectives on the inter-connected processes, gaps, and opportunities between health systems, clinics, communities, and PrEP services. Shifts in PrEP policies, funding pressures, and inconsistent communications from the National Department of Health spurred fragmented planning, engagement, execution, and monitoring of PrEP delivery processes within clinics already struggling to address multiple population health needs. Resulting challenges included: conflicting priorities within clinics and across NGO partners, unclear goals and targets, staffing and space constraints, and insufficient community engagement. Individual clinics' implementation climate and readiness to deliver PrEP varied in terms of operational plans and delivery models. Interviewees reported complexity of initiation procedures and support for PrEP maintenance, with opportunities to improve systems communications and processes to facilitate integrated services and more user-friendly experiences. Applying CFIR identified opportunities to strengthen PrEP delivery across levels within this complex service delivery setting.

Community engagement is a key pathway for incorporating social considerations into the development of utility-scale renewable energy facilities. Prior literature recommends meaningful, early community engagement to both improve siting outcomes and empower the public to participate in decision-making, but there is no recent nor comprehensive understanding of industry experiences with engagement. This study provides a critical contribution by revealing the practices and perspectives of project developers. We draw upon a survey of 123 professionals employed at 62 unique companies across the United States. We demonstrate that developers are highly concerned about the impact of community opposition on project deployment, and that they already use a variety of engagement strategies and adjust project designs in response to community feedback. However, the public is generally not made aware of project proposals until after land for the project is secured, and industry expenditures on engagement activities pale in comparison to other project development costs. We draw upon Arnstein's ladder of citizen participation to operationalize the engagement preferences of developers, and find that the majority of developers prefer that members of the public provide input but not recommend or make decisions. We characterize this preference as ‘halfway up the ladder’, compared to the idealized vision of full citizen empowerment envisioned in narratives of just transition. These findings contribute to discussion of the role and potential for community engagement to attend to justice in the energy transition.

Recognizing that centuries of mistreatment of low-income and minority communities by governments and corporations have resulted in widespread exposure to environmental harms, academics and policymakers are seeking ways to improve environmental justice. While it is commonly assumed that improved procedural justice (meaningful participation in decision making) should improve distributive justice (equitable distribution of environmental harms and benefits), empirical evidence of this link is nascent. This paper evaluates whether differing approaches to procedural justice shape recognition of distributive injustices by policymakers, focusing on implementation of the National Environmental Policy Act (NEPA) in Puerto Rico. NEPA requires federal agencies to evaluate the potential environmental impacts of projects they implement, fund, or permit; this review commonly includes an assessment of the project's impacts on distributive justice. Drawing on document analysis and interviews with project developers, regulators, and community organizations, we explore how and why four NEPA reviews consider distributional impacts. In all four cases, the community mobilized to voice concerns about the proposed projects' impacts, but the lead agencies and project developers did not always create the space for those voices to collaboratively shape the review. This demonstrates the role of the project developer in how distributive justice considerations are treated, as project leads have discretion on whether and when to provide space for community groups to participate in the process. This research makes two primary contributions. First, by linking features of the decision-making process with environmental justice-related outputs, this research provides practical understanding of ways to support distributive justice and expands knowledge about how participatory governance works within the context of US environmental policy. Second, by studying NEPA's implementation in Puerto Rico, we assess challenges associated with implementing Environmental Impact Assessment in a territorial setting, where the demographics and intensity of environmental problems are distinct from the 'traditional' American context the policies were designed to protect.

Starting in the 1970s, individuals, businesses and the public have increasingly benefited from policies prohibiting smoking indoors, saving thousands of lives and billions of dollars in healthcare expenditures. Smokefree policies to protect against secondhand smoke exposure, however, do not fully protect the public from the persistent and toxic chemical residues from tobacco smoke (also known as thirdhand smoke) that linger in indoor environments for years after smoking stops. Nor do these policies address the economic costs that individuals, businesses and the public bear in their attempts to remediate this toxic residue. We discuss policy-relevant differences between secondhand smoke and thirdhand smoke exposure: persistent pollutant reservoirs, pollutant transport, routes of exposure, the time gap between initial cause and effect, and remediation and disposal. We examine four policy considerations to better protect the public from involuntary exposure to tobacco smoke pollutants from all sources. We call for (a) redefining smokefree as free of tobacco smoke pollutants from secondhand and thirdhand smoke; (b) eliminating exemptions to comprehensive smoking bans; (c) identifying indoor environments with significant thirdhand smoke reservoirs; and (d) remediating thirdhand smoke. We use the case of California as an example of how secondhand smoke-protective laws may be strengthened to encompass thirdhand smoke protections. The health risks and economic costs of thirdhand smoke require that smokefree policies, environmental protections, real estate and rental disclosure policies, tenant protections, and consumer protection laws be strengthened to ensure that the public is fully protected from and informed about the risks of thirdhand smoke exposure.

BackgroundAdolescents and young adults with asthma face increased risks during the health care transition (HCT) from pediatric to adult care. Despite guidelines advocating for more HCT preparedness, this does not consistently occur in clinical practice. The rates of exposure to transition preparation in adolescents with asthma are unknown.ObjectivesOur goal was to understand the rates of HCT exposure among adolescents with asthma in the United States, along with predictive characteristics associated with receiving HCT exposure, as determined by using data from a nationally representative survey.MethodsWe studied adolescents aged 12 to 17 years with asthma in the 2020-2021 National Survey of Children's Health data set. We explored associations between sociodemographic, health-related, and provider practice-related variables and HCT exposure through univariate analysis and multivariable logistic regression.ResultsOnly 19% of adolescents with asthma from this cohort met criteria indicating that they had received HCT exposure. In our multivariable analysis, being older, being female, having a provider actively work with the child to make positive choices about health, having a written care plan addressing transition, having routine preventive care visits, and having a caregiver who has someone with whom to discuss health insurance into adulthood were associated with higher odds of HCT exposure. Hispanic ethnicity, lack of insurance, and residence in a metropolitan area were associated with lower odds of receiving preparation for transitional care but were not significant in the multivariable model.ConclusionsOur findings underscore the need to improve transitional care preparation for adolescents with asthma, with attention needed to address disparities based on sociodemographic factors, including health care access.

In the wake of recent interventions to better connect the subfields of international migration and race and ethnicity through a sociology of racialized immigration, we push this further by arguing for the necessity of a global Blackness perspective on global migration. Such a focus does not just reflect the role of race in the dynamics of migration, and vice versa, but more importantly shifts assumptions about this relationship. So, it is not enough to say that race matters in migration but rather that blackness and Black lives matter in how migration unfolds. Using global blackness as a starting point in our analyses of migration reveals a clearer and closer entanglement of race, racism, colonialism, and migration. We argue that global Blackness structures notions of who migrates and under what conditions, as well as our ideas regarding migrants and their descendants and use the examples of New York City, Paris, and France as paradigmatic sites for understanding this relationship.

Abstract: Sexual and gender minority (SGM) migrants’ disclosure of their identity or “coming out” has significant stakes. It can facilitate access to resources (institutional disclosure), cultivate intimacy and belonging (social disclosure), or support claims for legal protections (legal disclosure). This article analyzes SGM unaccompanied minors’ disclosures as shaped by the evolution of their legal consciousness in pursuing legal relief and incorporation in the United States. Ethnographic observations and in-depth interviews from 2014–2019 with 11 SGM unaccompanied minors reveal a striking pattern in their disclosure practices. During apprehension and detention, minors engaged in social, institutional, and legal disclosure of their SGM status. However, their interactions with agents from the Departments of Homeland Security and Health and Human Services led them to believe that SGM rights, support, and acceptance were contingent on legal status. Later, upon release from state custody, minors withheld legal disclosure from their deportation proceedings and immigration cases, even against the advisement of their attorneys. They also became more strategic in their social and institutional disclosure across other contexts. Post-legalization, however, minors broadened their disclosure practices and embarked on claims related to their SGM status. This study raises implications for research and policy. By analyzing shifts in legal consciousness over time, how certain experiences become reference points for how immigrants understand the law with respect to their identity and related behaviors are illustrated. It also extends the discussion of the far-reaching implications of SGM punishment and the disadvantages of immigration detention for children and youth.

BackgroundSince the 2022 Dobbs v. Jackson Women's Health Organization Supreme Court decision revoked federal protection for abortion rights, many states have restricted abortion. Although news media covers this shifting landscape through reporting, this article documents how entertainment content is responding to this new reality in its storytelling.MethodsThe sample is from a public database of abortion plotlines on American television (abortiononscreen.org). I separated the sample of 150 plotlines into two groups: plotlines that filmed and/or aired pre-Dobbs (January 2020-August 2022) and those that aired post-Dobbs (September 2022-December 2023). Coding occurred in Microsoft Excel.ResultsPost-Dobbs, there was an increase in procedural abortion depictions compared with pre-Dobbs, but no change in the consistently low number of depictions of medication abortion. The post-Dobbs sample included a 10% increase in teen characters compared with pre-Dobbs. Pre-Dobbs, the vast majority of plotlines (77%) did not portray any barriers to abortion care. Post-Dobbs, 33% depicted barriers. The most common reason for abortion seeking in both samples was age (11%). Pre-Dobbs, the next most common was a mis-timed pregnancy (10%). Post-Dobbs, the next most common was health concerns (11%).ConclusionsSince Dobbs, more television plotlines are portraying obstacles to abortion care, yet they continue to tell stories of white, non-parenting teenagers who make up a small percentage of real abortion patients. Plotlines overrepresent procedural abortion over the more common medication abortion. Depictions of health-related reasons for abortion seeking obscure more commonly provided reasons for abortions, such as mistimed pregnancies, caregiving responsibilities, and financial concerns. Considering the low levels of abortion knowledge nationwide, understanding what (mis)information audiences encounter onscreen is increasingly important.

PurposeWe aimed to estimate health state utility values (HSUVs) for the key health states found in opioid use disorder (OUD) cost-effectiveness models in the published literature.MethodsData obtained from six trials representing 1,777 individuals with OUD. We implemented mapping algorithms to harmonize data from different measures of quality of life (the SF-12 Versions 1 and 2 and the EQ-5D-3 L). We performed a regression analysis to quantify the relationship between HSUVs and the following variables: days of extra-medical opioid use in the past 30 days, injecting behaviors, treatment with medications for OUD, HIV status, and age. A secondary analysis explored the impact of opioid withdrawal symptoms.ResultsThere were statistically significant reductions in HSUVs associated with extra-medical opioid use (-0.002 (95% CI [-0.003,-0.0001]) to -0.003 (95% CI [-0.005,-0.002]) per additional day of heroin or other opiate use, respectively), drug injecting compared to not injecting (-0.043 (95% CI [-0.079,-0.006])), HIV-positive diagnosis compared to no diagnosis (-0.074 (95% CI [-0.143,-0.005])), and age (-0.001 per year (95% CI [-0.003,-0.0002])). Parameters associated with medications for OUD treatment were not statistically significant after controlling for extra-medical opioid use (0.0131 (95% CI [-0.0479,0.0769])), in line with prior studies. The secondary analysis revealed that withdrawal symptoms are a fundamental driver of HSUVs, with predictions of 0.817 (95% CI [0.768, 0.858]), 0.705 (95% CI [0.607, 0.786]), and 0.367 (95% CI [0.180, 0.575]) for moderate, severe, and worst level of symptoms, respectively.ConclusionWe observed HSUVs for OUD that were higher than those from previous studies that had been conducted without input from people living with the condition.

In the United States, immigrant Latino men who have sex with men (ILMSM) are, compared to white MSM, disproportionately burdened by HIV and lack access to highly effective HIV prevention strategies, such as pre-exposure prophylaxis (PrEP). Qualitative research centered on exploring barriers that ILMSM experience in accessing PrEP and other sexual services is extremely limited, despite a high prevalence of HIV in this population. In this study, a purposive sample of ILMSM (n = 25) was recruited to participate in a semi-structured in-depth interview to identify the distinct barriers and facilitators ILMSM experience in accessing sexual health services given their complex intersectional identities of being an immigrant, Latino, and a sexual minority man. Using a thematic analysis approach, nine themes were generated from the data representing barriers and facilitators. Barriers included: (1) cost and a lack of health insurance, (2) complexity of PrEP assistance programs; (3) challenges related to the immigrant experience; (4) impact of gay stigma; and (5) communication challenges. Facilitators included: (1) improving affordability and accessibility of PrEP services; (2) receiving services from LGBT- or Latine LGBT-centered clinics; (3) receiving services from medical providers who are gay and/or Latino; and (4) providing targeted community outreach, education, and promotion of PrEP to ILMSM. While many of the barriers illuminated in the study were structural (e.g., cost and lack of health insurance), and not easy to overcome, the findings highlight a range of facilitators that can support access to PrEP and other sexual health services for ILMSM. Considering these findings, we suggest strategies that may enhance access to needed sexual health services among ILMSM.

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.

Abstract: Latinx children now live in a wider array of U.S. geographic areas than in the past, including both established and new areas of Latinx settlement. This geographic heterogeneity could be consequential for Latinx children’s health care access, with prior research suggesting increased health access barriers for Latinx children in new versus established areas of settlement. Merging public-use county-level data with restricted individual-level health data from the National Health Interview Survey (2010–2014), we quantitatively examine how three health access indicators—health insurance coverage, delayed care, and usual place of care—differ among children (ages 4–17) in Latinx immigrant, Latinx U.S.-born, White U.S.-born, and Black U.S.-born families (n = 89,994) across established, fast-growing hub, new, and minor Latinx destination counties. We also examine the potential roles of local immigrant hostilities and health care resources in contributing to health access differences across destinations. In fully adjusted models, children in new destinations are less likely to have health insurance than peers in established destinations, and this disparity is even wider for Latinx children of immigrants. Adjusted model results also show that children in new destinations are more likely to have delayed care than those in established destinations, and children in these four groups in new destinations, fast-growing hubs, and minor destinations are more likely to have no usual place of care than peers in established destinations. Our results are consistent with prior work suggesting that more health care access barriers exist for children, particularly Latinx children of immigrants, in new versus established Latinx destinations.

Despite the substantial number of studies on the relationships between crime patterns and built environments, the impacts of street-level built environments on crime patterns have not been definitively determined due to the limitations of obtaining detailed streetscape data and conventional analysis models. To fill these gaps, this study focuses on the non-linear relationships and threshold effects between built environments and local crime patterns at the level of a street segment in the City of Santa Ana, California. Using Google Street View (GSV) and semantic segmentation techniques, we quantify the features of the built environment in GSV images. Then, we examine the non-linear relationships and threshold effects between built environment factors and crime by applying interpretable machine learning (IML) methods. While the machine learning models, especially Deep Neural Network (DNN), outperformed negative binomial regression in predicting future crime events, particularly advantageous was that they allowed us to obtain a deeper understanding of the complex relationship between crime patterns and environmental factors. The results of interpreting the DNN model through IML indicate that most streetscape elements showed non-linear relationships and threshold effects with crime patterns that cannot be easily captured by conventional regression model specifications. The non-linearities and threshold effects revealed in this study can shed light on the factors associated with crime patterns and contribute to policy development for public safety from crime.

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.

ImportanceHousing deposits and tenancy supports have become new Medicaid benefits in multiple states; however, evidence on impacts from these specific housing interventions is limited.ObjectiveTo evaluate the association of rental housing deposits and health care use among Medicaid beneficiaries receiving social needs case management as part of a Whole-Person Care (Medicaid 1115 waiver) pilot program in California.Design, setting, and participantsThis cohort study compared changes in health care use among a group of adults who received a housing deposit between October 2018 and December 2021 along with case management vs a matched comparison group who received case management only in Contra Costa County, California, a large county in the San Francisco Bay Area. All participants were enrolled in health and social needs case management based on elevated risk of acute care use. Data analysis took place from March 2023 to June 2024.ExposureRental housing deposit funds that covered 1-time moving transition costs. Funds averaged $1750 per recipient.Main outcomes and measuresChanges in hospitalizations, emergency department visits, primary care visits, specialty care visits, behavioral health visits, psychiatric emergency services, or detention intakes during the 6 months before vs 6 months after deposit receipt. Changes 12 months before and after deposit receipt were examined as a sensitivity analysis.ResultsOf 1690 case management participants, 845 received a housing deposit (362 [42.8%]

Abstract: Undocumented status impedes immigrants’ workplace claims to legal rights and better treatment. But what happens when they obtain lawful permanent residency – does the reluctance to make claims in the workplace change? If so, how? Drawing on timeline interviews, I examine changes in the relational legal consciousness and reported workplace claims-making of 98 formerly undocumented Latino immigrants. Most respondents reported increased willingness to engage in, and follow through with, workplace claims. However, gendered differences emerged. Men’s claims largely revolved around wage negotiations, moving to a better paying position, and enforcement of legal rights with an attached monetary value. They were also more likely to frame claims as legal rights. In contrast, women’s claims largely revolved around better work treatment, access to job benefits, and workplace accommodations. They were also more likely to frame claims as moral rights. I explain these outcomes as a function of three relational mechanisms: lawful status being understood relative to experiences being undocumented; gendering in the legalization process; and social ties promoting gendered expectations of lawful permanent residency. My findings highlight the importance of gendered differences in relational legal consciousness and how lived reference points (e.g., prior undocumented experience) inform how legal consciousness changes over time.

ImportanceThere is an increasing number of cancer 'survivors' and increasing research into supportive care. However, it is unknown how patterns of attention and citation differ between supportive and non-supportive cancer care research. We sought to estimate the engagement of high-impact studies of supportive compared to non-supportive cancer care papers.MethodsIn a cross-sectional review of top oncology journals (2016-2023), we reviewed studies examining supportive care strategies and a frequency-matched random sampling of studies on non-supportive interventions. We compared data on social engagement metrics, as represented by Altmetric scores and citations and funding status, by supportive care or non-supportive care articles.ResultsWe found overall Altmetric scores were no different between articles that did not test supportive care and those that did, with a numerically higher score for supportive care articles (86.0 vs 102; p=0.416). Other bibliometric statistics (such as the number of blogs, number of X users, and the number of X posts) obtained from Altmetric did not differ significantly between the two groups. Non-supportive cancer care papers had a significantly higher number of citations than supportive cancer care papers (45.6 in supportive care vs 141 in non-supportive care papers; p

Abstract: Beginning in 2007, the Chinese state used liberalising policy and funding to encourage the expansion of large‐scale grain farming. Despite this support, many of the new farms have struggled financially and folded. Drawing on Foucauldian biopolitics and resource security literature, I argue that, with modernised agriculture, the state primarily sought to create not commercial farms, but the redundant farming infrastructure needed to buffer its growing reliance on food imports, abide by global trade regulations, and sustain its urban export manufacturing economy. These balancing efforts harmed commercial farmers: land commodification and policy funding incentivised urban government officials to intervene in rural land‐use planning, but low global market aligned grain prices disincentivised them from considering the place‐particular viability of their plans for producers. This article contributes to critical agrarian change literature by highlighting how modernist states become beholden to rational scientific techniques and sacrifice rural areas for increasingly vulnerable urban areas.

Restrictive immigration policies harm the mental health of undocumented immigrants and their U.S. citizen family members. As a sociopolitical stressor, threat to family due to immigration policy can heighten anxiety, yet it is unclear whether political engagement helps immigrant-origin students to cope. We used a cross-sectional survey of college students from immigrant families (N = 2,511) to investigate whether anxiety symptomatology was associated with perceived threat to family and if political engagement moderated this relationship. We stratified analyses by self/parental immigration statuses-undocumented students, U.S. citizens with undocumented parents, and U.S. citizens with lawfully present parents-to examine family members' legal vulnerability. Family threat was significantly associated with anxiety; higher levels of political engagement reduced the strength of this relationship. However, this moderation effect was significant only for U.S. citizens with lawfully present parents. These findings emphasize the importance of the family immigration context in shaping individuals' mental health outcomes.

We discuss how epidemiology has been and can continue to be used to advance understanding of the links between urban areas and health informed by an existing urban-health conceptual framework. This framework considers urban areas as contexts for health, determinants of health and modifiers of health pathways, and part of a complex system that affects health. We highlight opportunities for descriptive epidemiology to inform the context of urban health, for example, by characterizing the social and physical environments that give rise to health and the actions that change those conditions. We then describe inferential tools for evaluating the impact of group-level actions (e.g., interventions, policies) on urban health, providing some examples, and describing assumptions and challenges. Finally, we discuss opportunities and challenges of applying systems thinking and methods to advance urban health. While different conceptual frames lead to different insights, each perspective demonstrates that urban health is a major and growing challenge. The effectiveness of urban health knowledge, action, and policy as the world continues to urbanize can be informed by applying and expanding upon research and surveillance methods described here.

BACKGROUND AND AIM[|]Traffic-Related Air Pollution (TrAP) adversely impacts human health, disproportionately harming disadvantaged communities. New technologies and infrastructure offer opportunities to reduce TrAP, but the health outcomes of individuals are not fully understood due to a lack of high-resolution models that grasp the complexities of transportation systems and their health implications amid evolving policies and technologies.[¤]METHOD[|]We introduce BEAM CORE (beam.lbl.gov), a high-resolution, agent-based transportation framework that simulates detailed passenger and freight activities. It captures interactions between transportation, land use, demographic and vehicle ownership changes at various scales. Validating crucial factors of emission modeling, including link-level VMT, speed and regional fleet in the San Francisco Bay Area’s nine counties, demonstrates its potential to be extended for assessing health outcomes from changes in TrAP.[¤]RESULTS[|]All major outputs from the BEAM CORE 2018 baseline have been calibrated and validated. Mode split and demographics align closely with census and survey data. Passenger and freight activities were validated against public and private data, with CO2 emissions corresponding to 3.67Mt/yr for medium/heavy-duty (MHD) and 22.79Mt/yr for all vehicles, demonstrating the model’s alignment with empirical data. The NOx, PM2.5 and PM10 from MHD exhaust, PM brake and tire wear are 14.8kt/yr, 424t/yr and 606.9t/yr under the 2018 baseline with high fractions of conventional vehicles, while the wide adoption of clean truck technologies under 2050 resulted in 87\%, 75\% and 56\% reductions respectively. BEAM CORE generates detailed fleet and activity data at high spatiotemporal resolution, enabling the integration with air quality models, including InMAP/AERMOD, to explore the causal pathway of health impacts from transport policy changes.[¤]CONCLUSIONS[|]We developed a sophisticated multi-dimensional transportation model for integration with advanced air quality, and health assessment models. It enables a thorough analysis of health impacts of transportation policies and technologies across diverse communities. It supports similar analyses in any area using local data.[¤]

Policies relevant to many key sociological processes are often subnational, enacted at the regional, state/provincial, and/or local levels. This applies notably in the politics of the environmental state, where public and private subnational environmental policies (SNEPs) have major consequences for managing climate change, addressing environmental injustices, regulating land uses, greening energy markets, limiting pollution, and much more. While sociologists focus more on national policies, diverse sociological contributions emphasize the importance of SNEPs and their origins, diffusion, implementation, and sources of backlash. We begin by providing a typology of SNEPs. Next, we highlight not only environmental sociology (with its particular attention to climate change and energy) but also the sociologies of social movements, politics, the economy, science, risk, and organizations, which have each offered unique perspectives. Finally, we outline an agenda for how sociologists can further elaborate a distinctive perspective that highlights inequality, valuation, diffusion, scale shifts, and venue-shopping up to national and global policy systems.

What does feminist theory have to offer sociology? Defining feminist theory as work that problematizes the gender binary and the relations of domination that constitute and emerge from it, we explore four key aspects of feminist scholarship. We begin with work that explores gender as a structuring trope. We then turn to how gender is coconstituted with other structures of power and domination. Next, we survey how feminists have theorized the relationship between nature and the social through the body. Finally, we examine feminist epistemological claims. We conclude by demonstrating the inextricability of feminist conceptual work and feminist politics. As we move across these bodies of work, we show how they are linked with one another and suggest some of the ways in which thinking like a feminist would help sociologists better grasp the dynamics of the social worlds we study.

Over the last two decades, the sociology of entrepreneurship has exploded as an area of academic inquiry. Most of this research has been focused on understanding the environmental conditions that promote entrepreneurship and processes related to the initial formation of an organization. Despite this surge in activity, many important questions remain open. Only more recently have scholars begun to turn their attention to what happens to organizations, and the people connected to them, as they mature and move through the life cycle of entrepreneurship. These open questions, moreover, connect to many classic themes in the literature on careers, organizational sociology, stratification, and work and occupations. Using a framework that focuses on three phases of the entrepreneurial life cycle—pre-entry, entry, and post-entry—we summarize sociological research on entrepreneurship and highlight opportunities for future research.

We examined three generations (grandparents, mothers, and grandchildren) to assess the association between grandparents' educational attainment and their grandchildren's epigenetic-based age acceleration and whether the association was mediated by parental educational attainment and mothers' life course health-related factors. Mothers were recruited to the NHLBI Growth and Health Study at 9-10 years and followed for 10 years (1987-1998). Mothers were then re-contacted three decades later (ages 37-42) to participate in the National Growth and Health Study (NGHS), and health information from their youngest child (i.e., grandchildren; N = 241, ages 2-17) was collected, including their saliva samples to calculate epigenetic age. Five epigenetic-based age acceleration measures were included in this analysis, including four epigenetic clock age accelerations (Horvath, Hannum, GrimAge, and PhenoAge) and DunedinPACE. Grandparents reported their highest education during the initial enrollment interviews. Parental educational attainment and mothers' life course health-related factors (childhood BMI trajectories, adult cardiovascular health behavioral risk score, and adult c-reactive protein) are included as mediators. Grandparents' education was significantly associated with Horvath age acceleration (b = -0.32, SE = 0.14, p = 0.021). Grandchildren with college-degree grandparents showed significantly slower Horvath age accelerations than those without college degrees. This association was partially mediated by parental education and mothers' health-related factors, especially adult cardiovascular health behavioral risk score and CRP, but not mothers' childhood BMI trajectory. This ability to conserve the speed of biological aging may have considerable consequences in shaping health trajectories across the lifespan.

Although widely acknowledged as an important social determinant of health, until recently researchers and policymakers have primarily approached housing insecurity as an urban issue, obscuring the visibility of its impacts in rural contexts, including the ways in which housing insecurity intersects with other health and structural inequities facing rural populations. Working to address this gap in the existing literature, this paper explores the experiences of housing insecurity in a rural context by reporting on an analysis of 210 in-depth interviews with 153 adults between the ages of 18-35, living in California's rural North State, a relatively overlooked far northern region of the state comprised of 12 north central and north eastern counties. Using in-depth qualitative interview data, we conducted an exploratory pattern-level analysis of participants' narratives structured by four dimensions of housing insecurity defined in the literature (housing affordability, housing stability, housing conditions, and neighborhood context). Drawing attention to the pervasiveness of rural housing insecurity within our sample, this analysis highlights the unique ways in which rurality creates distinct experiences not currently captured in the existing literature. Further research is needed across different types of rural communities to better understand the various ways that housing insecurity affects the everyday lives and health of rural residents. By grounding research within the experiences of rural residents, we are better able to respond to the crisis of rural housing insecurity and develop solutions that are tailored to rural residents' unique needs.

Developing and adopting strategies that preserve soil health from degradation due to drastic changes in climate is critical for securing sustainable viticulture. For example, healthy soils promote water infiltration, nutrient cycling, and retention functions that support grape production. However, little research has evaluated drivers of growers' decision-making processes and actions towards soil management practices that impact soil health in vineyards. The objective of this study was to assess wine grape growers' perceptions and attitudes of soil health to identify grower's most important soil health functions and definition, and to understand how these might influence behavior related to soil management practices. Therefore, we conducted semi-structured interviews with 16 wine grape growers understand current barriers, motivations, and opportunities for adopting and/or maintaining practices for building soil health in vineyards. Most growers described healthy vineyard soils as balanced, biodiverse, self-sustaining, and resilient systems that provide nutrient, and water cycling functions and support high-quality wine grape production. Three categories of growers emerged based on soil health attitudes including Early Adopter (n = 3), Early Majority (n = 4) and Late Majority (n = 9) groups. The main barriers for adoption and maintenance of soil health practices were high costs, potential economic risks, and lack of information on how these practices influence grape production especially for the Late Majority group. Most growers were willing to adopt more soil heath practices if additional specific, practical information could be provided on outcomes of soil health practices for wine grape production systems—especially economic benefits. The outcomes of this study guide future soil health research and outreach activities to better support growers in building and protecting vineyard soil health while achieving viticultural goals.

ObjectivesChimpanzees (Pan troglodytes) are patrilocal, with males remaining in their natal community and females dispersing when they reach sexual maturity. However, the details of female chimpanzee dispersal, such as their possible origin, are difficult to assess, even in habituated communities. This study investigates the utility of 87Sr/86Sr analysis for (1) assessing Sr baseline differences between chimpanzee territories and (2) identifying the status (immigrant or natal) of females of unknown origin within the territories of five neighboring communities in Taï National Park (Côte d'Ivoire).Materials and methodsTo create a local Sr isoscape for the Taï Chimpanzee Project (TCP) study area, we sampled environmental samples from TCP-established territories (n = 35). To assess dispersal patterns, 34 tooth enamel samples (one per individual) were selected from the Taï chimpanzee skeletal collection. 87Sr/86Sr analysis was performed on all 69 samples at the W.M. Keck Lab. The theoretical density and overlap of chimpanzee communities as well as generalized linear mixed models (GLMMs) were used to test each question.Results87Sr/86Sr ratios for natal male chimpanzees ranged from 0.71662 to 0.72187, which is well within the corresponding environmental baseline range of 0.70774-0.73460. The local Sr isoscapes fit was estimated with the root-mean-square error value, which was 0.0048 (22% of the whole 87Sr/86Sr data range). GLMMs identified significant differences in 87Sr/86Sr ratios between natal and unknown North community origin groups, suggesting that after 1980, females of unknown origin could be immigrants to North community (n = 7, z-ratio = -4.08, p = 0.0001, power = 0.94).DiscussionThis study indicates that 87Sr/86This study indicates that 87Sr/86Sr analysis can successfully identify immigrant females in skeletal collections obtained from wild chimpanzee communities, enabling the tracking of female dispersal patterns historically. There are, however, significant limitations within the scope of this study, such as (1) the absence of reliable maps for the TCP study area, (2) limited capacity for environmental sampling, (3) small sample sizes, and (4) tooth formation in wild chimpanzees.

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.

Sexual violence and sexual harassment (SVSH) are prevalent among college and university students; however, the experiences of ethnic minority students, especially Asians, are understudied. This study aimed to reduce this gap by exploring Asian students' perceptions of SVSH on three public university campuses in Southern California. We examined their perceptions about the campus environment related to SVSH, attitudes, and behaviors toward help seeking, and utilization of on-campus resources. A total of 23 in-depth interviews were conducted with Asian students enrolled at the three University of California campuses. Thematic coding was conducted to generate main themes and subthemes. Five main themes emerged: (a) SVSH is considered a "taboo" topic in Asian culture and family systems, and Asian student survivors are often reluctant to disclose incidents or seek support services. (b) Students did not feel their campus environments were tailored to understand or meet the sociocultural realities and needs of Asian student survivors. (c) Campus SVSH services and reporting processes were seen as non-transparent. (d) Peers were the major source of support and SVSH information, as opposed to official campus-based resources and training. (e) Survivors often conduct an internal cost-benefit analysis evaluating their decision about whether to report. This study highlights the lack of conversation surrounding SVSH in Asian families, and how the cultural stigma of sex and sexual violence prevented Asian students from receiving knowledge and resources about these topics in their families. Instead of relying on formal campus resources (e.g., Title IX and confidential advocacy services, mental health services), many students turn to their peers for support. Thus, facilitating peer support groups, training university students to support each other through SVSH incidents, and tailoring campus services to the diverse cultural backgrounds of students are key considerations to foster a safe campus environment and prevent SVSH.